AN investigation into whether Jersey’s rheumatology department had a formal arrangement with a UK professor – who reportedly provided “quality assurance” and “a second opinion” for difficult cases – is needed, according to the chief officer for Health and Community Services.
Chris Bown spoke after a review of the service by the Royal College of Physicians found the standard of care in the unit was “well below” what would be considered acceptable.
The review, which examined rheumatology case records between January 2019 and December 2021, also prompted HCS to carry out its own audits – which found that hundreds of patients were given drugs they did not need.
The RCP report also raised concerns about staffing within the department, which was being run by two doctors who were not on the specialist register for rheumatology.
It noted that there had previously been a link with a rheumatologist from another centre in the UK, but that once they retired, “no replacement was secured”.
It stated that one of the doctors in the department had mentioned “the previous reassurance of input from an external professor of rheumatology”, who was described as having provided “quality assurance and a second opinion for challenging cases” as well as “an opportunity to discuss the latest research”.
“The professor had retired five years prior, and the resource had not been replaced,” the report continued.
Responding to the comments, Mr Bown said that: “Further investigation will be needed to understand if there was ever a formal arrangement in place with the professor and what decisions were made following his retirement.”
He continued: “Providing comprehensive health services for a relatively small island is always challenging. You cannot have specialists in every single area of complex clinical practice. But you should have good clinical governance, a system through which individual clinicians and health organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.
“This involves building an environment in which clinical excellence can flourish and it involves quality assurance and risk management.”
He added: “In addition, it is the duty of any doctor to ensure they are practising within their level of competency and to seek advice from appropriate sources, including senior clinicians elsewhere. This is a fundamental aspect of clinical governance. Both the doctor and the employer have responsibilities in this context.”
The RCP report levelled criticism over a lack of governance, not just in rheumatology, “but across the healthcare organisation”.
Mr Bown said: “Over a number of years HCS has fallen behind on clinical governance but we are now in the process of improving it.
“In this context the RCP report is consistent with the findings of the review of governance and quality of clinical care in Jersey that was completed in the summer of 2022. That review made over 60 recommendations, and we are now making progress on actioning these.”
