Case records of patients who received rheumatology care (FOI)

​​Original Request

With reference to this report:

Report of the invited service review to Health and Community Services.pdf (gov.je)

Structured judgement review of 18 case records of patients who received rheumatology care between January 2019 and December 2021 (for further information see section 5.2. continues to Section 7.

Section 7

To undertake a clinical review of 18 case records*** of patients who received rheumatology care between January 2019 and December 2021, to include:

• index cases where specific concerns have been raised
• 6 cases selected at random (every nth case from the time period chosen)
• 6 cases selected by the consultant in general medicine.

Further detail is required around the sample 18 patients.

A

Index cases where specific concerns have been raised : Please provide further insight into how these six patients was selected. Is this a repetition of six cases selected by the consultant? 

B

Six cases selected at random (every nth case from the time period chosen). Please provide the algorithm / set of rules for a 'random' selection.

C

Six cases selected by the consultant in general medicine. Was this Dr Y?

Original Response

Cases were chosen from the Rheumatology Outpatients cohort who were treated by Dr Y or Dr Z and prescribed biologics in the stipulated time period. As noted in Section 5.3 of the Royal College of Physician’s (RCP’s) report referenced above:

‘‘The RCP was provided with clinical records for 18 patients, the original terms of reference stipulated a mix of selected and random cases, however all 18 cases provided were randomly selected from patients diagnosed with a rheumatological condition and who were treated with biologics.’

Internal Review Request

The Freedom of Information (FOI) request seeking detail of the case selection methodology for the Invited Review of Rheumatology services was received by Health and Community Services (HCS) on 4 July 2024. A response was issued by HCS on 20 August 2024, and provided to the applicant by the Central FOI Unit on 21 August 2024.

Following receipt of the FOI response, the applicant requested an Internal Review, querying the level of detail provided in the response.

The applicant contacted the Central FOI Unit to request an Internal Review, as follows:

“Sorry, that does not answer my question at all. 

Also it shows that the Terms were not followed. 

I asked for the algorithm, the set of rules that was applied in making it a random selection process. 

It has been 25 days late and a poor response. 

I am raising this as a compliant.”

Internal Review Response

The Government of Jersey Assistant Chief Executive Officer and the HCS Information Governance Manager were asked to undertake the Internal Review. Neither party had been involved in composing the original response. 

The Internal Review was coordinated and administered by the HCS FOI Officer, and took place at the Government of Jersey Headquarters on 10 September 2024. The in-scope FOI response and the Internal Review Procedure were shared with both reviewers on this day. 

Both the Assistant Chief Executive Officer and the HCS Information Governance Manager were asked to consider whether:

• the Freedom of Information request had been handled appropriately
• it is possible to provide you with any further information. 

Was the request handled appropriately?

On receipt of the original FOI request, information was sought from relevant persons involved in the Medical Care Group and the ongoing service review for Rheumatology. 

Responses were collated and information assured, and an excerpt from the Royal College of Physicians report which noted that a revised selection criteria was employed for the review was included in the original FOI response.

The response was sent for review and approval by the Executive leadership, after which it was issued by the Central FOI Unit.

All appropriate processes were followed throughout.

Is it possible to provide any further information?

Circumstances did not allow for cases to be selected in accordance with the original criteria. It was determined that selecting all cases at random would mitigate against any concerns that prejudice or bias could have influenced the case selection. 

The alternative case selection was communicated to the Royal College of Physicians and is clearly documented in their report, as per the excerpt included in the original FOI response.

Cases for selection included only those on biologics (both actively attending clinic, and per database held by Rheumatology of patients on biologic therapies). Patients were listed alphabetically in an Excel file, and a random selection made by the Locum Consultant in Rheumatology with the process supported by the Care Group. No algorithm was used. Records of those selected were then checked to ensure that the biologic medication was commenced by Dr Y or Dr Z.

The Royal College of Physicians’ report of the Rheumatology service review was published in January 2024:

Royal College of Physicians - Jersey Rheumatology Report (gov.je)

An update was published in July 2024, communicating the outcome of detailed clinical audits for patients seen by the two doctors working in Rheumatology over the three-year period prior to January 2022:

HCS Advisory Board Rheumatology Service Update.pdf (gov.je)

This reported that, following face-to-face clinic review appointments, 38% of patients reviewed had their biologics and / or Disease-Modifying Anti-Rheumatic Drugs (DMARDs) stopped, and that Mortality Learning Reviews (MLRs) conducted by an independent clinician are underway and a number of cases have been referred to the Viscount for further investigation.

In respect of the complaint regarding time taken to respond

The Freedom of Information response was provided on Day 32, following 12 days approved extension to the initial 20 working day period of the request. Whilst the initial period prescribed is 20 working days, the Law allows 65 working days to respond to Freedom of Information requests, should such time be required to complete the identification and review of records, and ensure the response complies with all legislation.​