22 July 2024
Health and Community Services (HCS) have published an update on the review of the
past care and treatment from the Rheumatology Service ahead of the July Health Advisory
Board meeting.
Concerns about the HCS Rheumatology Service emerged in January 2022, when a junior
doctor raised some issues. As a result, HCS commissioned an independent review of the
Rheumatology Service from the Royal College of Physicians (RCP), which was published
earlier this year.
In addition to commissioning the independent review and following a recommendation
from the RCP, HCS decided to undertake five detailed clinical audits of patients seen by
the two doctors working in rheumatology over the three-year period prior to January 2022.
These included reviews of patients receiving biologic medication, patients on Disease-Modifying Anti-Rheumatic Drugs (DMARDs) plus other inpatients and outpatients seen by
the two doctors.
The clinical audits found significant concerns. In the review of biologic medication in over
half the records reviewed, there was not sufficient evidence in the patient records to
support the diagnosis. Following face-to-face clinic review appointments, 38% of patients
reviewed had their biologics and/or DMARDs stopped.
HCS is also conducting a review of patients who were treated by the Rheumatology
Service in the three-year period up to January 2022 – and who have subsequently died.
Any case in which concerns about care and treatment are raised is subject to an
independent Mortality Learning Review (MLR), conducted by an independent clinician.
To date the total number of patients in this review is 190 and it is likely that over the course
of the review this number may change. It is important that the review of each deceased
patient is conducted thoroughly, carefully and sensitively. It expected that the review of
deceased patients will continue throughout this year and beyond. Updates on progress will
be provided regularly to the Health Advisory Board and full information will be published
when the review is complete.
Under Jersey law, HCS is required to notify a death where there is reason to believe that a
deceased person has died under such circumstances that may require investigation.
Officers from HCS have been working within the parameters of the law during the review
of deceased patients from the Rheumatology Service.
At present, just over 120 of the 190 cases have been reviewed, with approximately one in
three of these requiring an MLR. 23 MLRs have been completed to date and 20 cases
have been referred to the Viscount.
Mr Patrick Armstrong, HCS Medical Director, said: “Our initial focus was to review the care
and treatment for living patients and I can confirm that all patients whose cases were
reviewed as part of these clinical audits are now having their care assessed by
independent specialist Consultants. To date, these assessments have concluded that the
diagnosis, treatment, and care of 33 patients was below expected standards and may
have resulted in possible medical harm. These patients are being sent ‘Duty of Candour’
letters offering each of them a sincere apology and confirming what they have already
been told verbally.
“Some of these patients may wish to seek legal redress and HCS is developing an
approach to legal matters that is patient-friendly, not overly protracted or complicated and
which respects a patient’s right to seek independent legal advice if they so wish. HCS
hopes to be able to make any settlement offers, where appropriate, later this year either on
a case-by-case basis or by way of a general compensation scheme.
“The work to review patients from the service who have subsequently died is ongoing and
we will be contacting the relatives of these patients should concerns about the care their
loved ones received be raised.
“I would like to reassure patients of the Rheumatology Service that the recommendations
made by the Royal College for improvements to the services are progressing well. Of the
26 recommendations made, 16 have been fully implemented, and the remaining 10 are
well on the way to being implemented.
“Specifically, a new Biologics Pharmacist has begun work and is reviewing HCS
prescribing practice and implementing improved governance; we have improved access to
physiotherapy and podiatry for rheumatology patients; and progress is being made to enrol
Jersey into national audits.”
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