HUNDREDS of rheumatology patients have stopped receiving drugs they did not need or had their diagnosis changed after a damning review of the service found the standard of care was “well below” what would be considered acceptable.
Jersey’s Health and Community services department has said it will be contacting some of the affected patients “over the coming weeks” and would also be seeking legal advice on “an appropriate approach to compensation”.
The independent review by the Royal College of Physicians also noted there was “no evidence” of standard operating procedures for most aspects of routine rheumatological care and, in some cases, “no evidence of clinical examinations”.
It also found that there had been incorrect diagnosis and wrongly prescribed drugs, describing the standard of care as “well below what the review team would consider acceptable” for a contemporary rheumatological service.
The review was commissioned by HCS medical director Patrick Armstrong, following concerns raised by a junior doctor in January 2022.
It sparked an audit of 341 patients on biologic drugs to ensure their diagnosis was correct.
Biologics are powerful drugs derived from natural sources such as human, animal, fungal or microbial cells. They work by suppressing the immune system and disrupting the inflammation process that leads to joint pain.
However, they can make patients more susceptible to life-threatening infections.
The audit found that, 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.
Following this discovery, HCS carried out a wider review which included over a thousand patients on Disease-Modifying Antirheumatic Drugs. Of those patients, over 45% had their diagnoses changed as a result while nearly a third stopped receiving the drugs.
Chris Bown, the 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.”
He continued: “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.”
He added that HCS was making process on the development of “more robust clinical governance”, including the appointment of a new specialist rheumatologist to lead Jersey’s rheumatology service.
Mr Bown said: “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.”
