Rheumatology service (FOI)

Request

There is likely a longest ever waiting list for the appointments and procedures at Jersey Hospital (over twelve thousand patients waiting in July). The situation for some specialties is very worrying - for rheumatology the number of patients waiting increased from 74 in March 2002 to 258 as reported by gov.je in July 2022 - an increase of almost 250% in four months. The median waiting time for routine rheumatology patients increased from two weeks in March up to 23 weeks in July 2022.

The gov.je website (Arthritis (rheumatology service) lists only a single (locum) consultant for rheumatology - Dr Helmi Jazebi, no other doctors of any grade are listed.

A

What happened to the two consultant doctors who for many years were treating Jersey patients with arthritis and other rheumatology conditions?

In particular why does the website not list Dr Richardson who was suspended earlier this year in unclear circumstances after many years of service as described by local press?

Is Dr Bevan still employed by the hospital? if not - when did he stop working?

B

How many rheumatology patients have been waiting for more than 200 days and how many for more than 300 days for their initial appointment (on 1 September or other latest available date please)?

C

What is the plan of the hospital management to address the waiting list problem and how long will it take to achieve a previous level of 74 patients waiting?

D

Why are there no active job advertisements for a permanent consultant rheumatologist on gov.je website, BMJ nor NHS Jobs? What are the management plans in that respect?

E

Can a department like rheumatology be safely staffed with a single locum doctor? Are there any regulations/ hospital procedures in that respect?

F

When does Dr Jazebi's contract expire?

G

Are we saving money by recruiting locum doctors? What is an average annualised cost of agency locum consultant hired at present by the Jersey Hospital? How many locum consultants are currently employed at Jersey Hospital? Please provide the information by specialty with the corresponding duration of contract.

H

Is it correct that the fully entitled Jersey patients who in desperation are being forced to seea  rheumatology consultant privately are now being charged full prices for their specialist rheumatology treatments available only through our hospital pharmacy, not possible to be prescribed by GPs and costing hundreds of pounds, sometimes in excess of one thousand?

Response 

A

The Rheumatology Service previously operated with two Consultants with General Medical Council (GMC) specialist registration: one Consultant in Geriatrics / General Medicine and one Consultant in General Medicine.

The service is currently operating with one Locum Consultant with GMC specialist registration in Rheumatology and a further Locum Consultant scheduled to start in October 2022 who has GMC specialist registration in Rheumatology. 

Dr Richardson is employed with Health and Community Services (HCS) as a Consultant Physician. Dr Richardson is a general physician with interests in Internal Medicine, Care of the Elderly, Rheumatology and osteoporosis.

Dr Bevan resigned from his post, with his last date of employment as 17 April 2022.

B

As of 6 September 2022:

22 people have been waiting for more than 200 days for their initial Rheumatology appointment.

15 people have been waiting for more than 300 days for their initial Rheumatology appointment.

Source: Power BI

C

Health and Community Services (HCS) have advertised the vacant permanent post previously on two occasions without any applicants. An advertisement has been re-issued on 6 September 2022 on NHS Jobs. HCS is also working with a recruitment agency to substantively recruit to the post. A waiting list trajectory will be produced based on start date once an appointment is confirmed.

D

Please see response to Question C.

E

The department is currently operating with one Locum Consultant with General Medical Council specialist registration in Rheumatology and a further Locum Consultant scheduled to start in October 2022 who has General Medicine Council Specialist Registration in Rheumatology. There are also two Nurse Specialists in Rheumatology. There are no specific regulations or procedures in relation to single-handed Consultant specialities.

F

Dr Jazebi's current contract expires on 31 December 2022.

G

There is currently one Locum Consultant in post with Rheumatology. This does not save money but ensures the provision of service. Staffing figures for September 2022 record that 45 Locums are engaged across the hospital.

The following table details the number of Locums working by speciality as of September 2022 and the months in which their contracts end:

It would not be possible to provide an accurate average annual cost for a Locum Consultant which takes account of all variables, including number of on-call shifts that could be worked, which are paid at different rates. Additionally, the contract of services is commercially sensitive and as such, Health and Community Services considers that disclosure would likely prejudice the commercial interests of the department, or others. Therefore, Article 33 of the Freedom of Information (Jersey) Law 2011 has been applied.

H

There has been no change to the private charging arrangements for medication. Charges are applied in line with the March 2017 Policy on Private Patients, Jersey General Hospital.

Section 2.3.8 Provision of Medicines (private prescriptions)

Outpatient Treatments – Medicines on GP List:

The Hospital pharmacy will not dispense medicines on the GP list. All prescriptions should be issued as private prescriptions and dispensed and charged for by a community pharmacy.

Alternatively, a Consultant can write to the patient's GP with details of the medicines required and the GP will issue a prescription.

Outpatient Treatments – Medicines not on GP List:

Medicines not on the GP list will not be dispensed by the Hospital pharmacy.

Community Pharmacists will not be able to order medicines that can be procured via pharmaceutical manufacturers or wholesalers. The hospital would only look to supply medicines in urgent situations. Charges are passed onto the patient by the community pharmacy.

Some medicines, such as certain cancer treatments, can only be supplied by the hospital pharmacy and the charges passed onto the patient by HCS.

Article Applied

Article 33 - Commercial interests

Information is qualified exempt information if –

(a) it constitutes a trade secret; or

(b) its disclosure would, or would be likely to, prejudice the commercial interests of a person (including the scheduled public authority holding the information).

Prejudice test

Article 33 is a qualified exemption and as such, we have conducted a prejudice test as required by law. Disclosing information relating to contractual service arrangements is likely to prejudice the commercial interests of HCS and others. When considering the application of this exemption, HCS has determined that whilst it is in the public interest to disclose information, this is outweighed by the necessity to limit any impact on its commercial interests in contracting future Locum clinician services and as such, Article 33 has been applied.