22 January 2024
Health and Community Services (HCS) have today published the Royal College of Physicians' (RCP) independent review of the Rheumatology Service. The review was commissioned by Mr Patrick Armstrong, Medical Director for HCS, following concerns raised in January 2022 by a junior doctor.
The RCP review team “found the standard of care to be well below what the review team would consider acceptable for a contemporary rheumatological service." The team also noted that in some cases there was “no evidence of clinical examination" and there was “on occasions, an incorrect diagnosis." The RCP review says “in many cases prescribing [of biologic drugs] was out with both UK and European guidance."
In addition to these findings about clinical practice the RCP review team found no evidence of agreed pathways or standard operating procedures for most aspects of routine rheumatological care, noted that both public and private patients were being seen in the same clinics and there was no meaningful explanation of how this overlap of private and public patients was managed and planned. The review team was also concerned to hear there was a lack of built-in challenge to prescribing, particularly biologics, by the pharmacy team.
The findings were of sufficient concern that the RCP recommended that HCS undertake an audit of patients on biologic drugs to ensure their diagnosis was correct. This audit has been completed and in over half the records reviewed, clinicians were not able to identify sufficient evidence to support the patient's diagnosis. Approximately one in four of the patients reviewed had their biologic drugs discontinued because these drugs were not felt to be necessary.
The findings of this audit prompted HCS to widen its review to approximately 2,400 patients, including rheumatology patients on Disease Modifying Anti-Rheumatic Drugs (DMARDS) and non-rheumatology patients seen in recent years by the doctors leading the rheumatology service prior to January 2022. This wider review resulted in the diagnosis of more patients being changed and a number of patients also had their DMARDS stopped.
Chris Bown, Chief Officer for Health and Community Services said: “What has emerged from the RCP review and our own additional work, is a picture of a rheumatology service that none of us at HCS could be proud of. The people of Jersey deserve better, and we are deeply sorry that we did not provide a service that staff, patients and our community could be satisfied with.
“A number of patients have had changes to diagnoses or medications as a result of the work we have undertaken and it is inevitable that some of these patients will have been harmed clinically, emotionally and/or economically by their earlier diagnosis or treatment. We expect that in most cases the level of harm will be minor or negligible but, of course, any level of harm is completely unacceptable and over the coming weeks we will be contacting any patient where we think harm may have been caused and we will be discussing with lawyers an appropriate approach to compensation.
“We are making progress on the development of more robust clinical governance processes across HCS, including the appointment of a new, specialist rheumatologist to lead Jersey's rheumatology service, stronger governance frameworks such as monthly Care Group Governance meetings, and we have made it clear that clinicians must now follow certain additional, key clinical guidelines such as the National Institute for Health and Care Excellence guidelines.
“Our task now is to make the improvements recommended by the RCP and to ensure that HCS becomes a beacon of good governance, not just in rheumatology but across the full spectrum of our health and care services.
“Finally I want to commend the junior doctor who originally raised concerns and our medical director Patrick Armstong, who commissioned the RCP review. It's very important that healthcare staff feel free to speak up when they see something they think is not right. And when a junior doctor or anyone within HCS raises concerns about the practice of another colleague – even perhaps a senior and well-respected doctor – it is vitally important these concerns are taken seriously, fully considered and thoroughly investigated. That is what we have tried to do in this case."
The full report can be found here.
gov.je