A REVIEW of Jersey’s neurology department has called for the recruitment of a second consultant neurologist after finding staff “overstretched” and their workload “challenging and unmanageable”.
Conducted by the Royal College of Physicians early last year and released yesterday, a review team identified “workload pressure” as a “dominant theme”, noting limited budgets and an endemic culture of staff working “beyond their job plans”.
The wide-reaching report also questioned the “robustness” of governance in place for prescribing high-cost drugs, despite the much-vaunted introduction of Blueteq software in other departments at the General Hospital.
It also raised concerns that succession planning opportunities had been missed ahead of the retirement of the Island’s only consultant neurologist.
Four specialist reviewers nominated by the Association of British Neurologists and a lay reviewer reviewed 12 clinical records between 16 and 17 January last year.
They returned several weeks later in February to conduct interviews with those working in the neurology service.
The interviews conducted by the RCP revealed instances of incorrect prescriptions, poor job planning, confusion over basic service requirements and even unsafe practise.
Of the 12 cases analysed, seven were classified as ‘good practice’, with the remaining five marked as “room for improvement”.
Twenty recommendations were then identified to “help inform the development of a contemporary model for the service”.
Eighteen of the recommendations are “short-term”, with an expected implementation timeline of between zero-to-six months.
Ideas suggested by the review team include a tele-neurology service to reach patients in their houses and the recruitment of a specialised clinical pharmacist for neurology.
Ahead of the review, the JEP spoke to several people living on the Island about their experience with the neurology department.
“Pretty hopeless”
One man – who asked not to be named – was diagnosed with temporal lobe epilepsy in the summer of 2020.
He says he was prescribed a drug for his condition that had “worse-and-worse” side effects, but was told by the consultant neurologist it was the “only drug available”.
Unhappy with his treatment after finding out that other drugs were available several years after the initial prescription, the patient decided to seek out another consultant.
Unfortunately, he was told there was “only one” on the Island.
Describing the situation as “pretty hopeless”, he said his GP later informed him that he had been given the “wrong drugs” at the “wrong dosage”.
But he said things got worse when he rang up the department in 2023 to find there were “no medical records” to his name and no accompanying care plan.
It was only after he began with a specialist neurologist at Queen’s Square in London he felt things began to fall into place.
He found out that he had required a “stronger MRI” and a more specialist neurologist than Jersey was able to offer.
“I wrote to Jersey to make a formal complaint”, he explained. “I said, ‘Look, you didn’t have any records, I was on the wrong drugs, you gave the wrong MRI and I didn’t have a care plan,’ and they wrote back to me and basically said, ‘yeah, that’s the right story’.”
An attempt to bring a legal claim against the department ran into difficulties, but he maintains that the “non-care” he experienced led to three-and-a-half years wasted.
He told the JEP that he hoped the review could lead to improved relations between the neurology service and experts abroad.
“I think it’s all too easy in Jersey, as we’re an island, to effectively act as an island, and where progress is made, for us not to be aware of it.
“There ought to be a message so it doesn’t happen that people with properly life-changing challenges don’t get appropriate care, and if somebody isn’t equipped to help them, there ought to be within the whole Island, in healthcare, a way to make sure they are not left high and dry”, he said.
Speaking to the JEP on Wednesday, medical director Simon West agreed that the Island needed two consultants to cope with the “ever increasing volume of workload”.
He added that the Hospital has “finances to resource one substantive neurologist”, as well as an “agreement that we would finance two substantive neurologists.”
Interviews for a substantive neurologist are expected to place on 10 March this year, he confirmed.
“Appointments have been cancelled last-minute”
For one Islander, however, who also volunteered her story under a condition of anonymity, key appointments in the department can’t come soon enough.
She told the JEP that “support and intervention” for her partner – who has several ongoing neurological issues – has been “sporadic, especially over the last year”.
She said: “When we initially saw neurology [a few years ago] there seemed to be better care and more consistent treatment and management.
“However, more recently, appointments have been cancelled last-minute, and treatments recommended, but then nothing happens.
“There are clearly issues with staffing right now and when we have met staff they have tried their best and have been kind.
“However, we currently have no appointments booked and no idea when or if the recommended treatment will start. We are constantly in limbo.”
Echoing parts of the report, she continued: “There appears to be little or no teamwork around the patients, and no onward referral locally or to the UK.
“I know the neurology team will be under enormous pressure and this criticism is not directed to any one person in any way.
“Money needs to be redirected urgently to support robust locum cover, until positions are permanently filled, onward referrals to the UK and the creation of a multidisciplinary team to address the neurological needs of the island population.
“I am not even sure if there is currently a qualified neurology consultant in post.
“This lack of assessment, treatment and MDT management from neurology is extremely frustrating, disappointing and worrying.”
Wrongly treated for Parkinson’s
Frustration, disappointment and worry are concepts all-too-familiar for another Islander, who says she was misdiagnosed with Parkinson’s in 2022 by the department’s then-consultant neurologist.
Given a course of treatment to help deal with low dopamine – an essential factor for anyone with Parkinson’s – she began to develop “really, really bad anxiety”.
“I couldn’t sleep”, she explained. “I didn’t sleep at all because I already have enough dopamine.”
The misdiagnosis triggered what she felt to be a “catalogue of errors” during which stronger drugs were prescribed to counteract the side effects of another.
More than two years later, in 2024, a ‘DAT scan’ in Southampton showed a perfectly normal amount of dopamine – and no Parkinson’s.
“Basically, I was just treated for three years with various medications, until they discovered that I don’t actually have Parkinson’s”, she said.
In the meantime, she decided to leave her well-paying managerial job because she “couldn’t function properly” and didn’t want to let her staff down.
“At one point, I spoke to my kids about Dignitas, about going to Switzerland to end my life should it get the best of me, and that was quite traumatic”, she said.
Despite receiving an apology from the department on several occasions, she feels as if her mistreatment has been brushed under the carpet.
“I want them to acknowledge how it changed my life.
“I was struggling for money – I [didn’t] know what I was going to do, what was going to happen to me? Am I going to get kicked out? Am I going to lose my apartment?
“I was in a dark place.”
“Like we’re second-class citizens”
Sophie Reid – founder of the Sophie Reid Neurological Association – said that no one from the Neurology Department came to see her after a seizure in September 2024.
Her husband, she said, tried and failed “for four or five weeks” to get through to an expert, to no avail.
In her view, many of the issues in the department boil down to a lack of funding. She added that it felt like there was almost a prejudice against neurological patients.
“For example, if you have a brain injury, you’re not going to get better, [and] I feel sometimes they think it’s a waste of time putting funding into neurology because they just see it like we’re second-class citizens in terms of health.”
Without having seen the review, Ms Reid urged the department to take on board recommendations she expected to be made.
“They need to follow their advice, really, otherwise people are getting sicker and sicker.”
“I’m happy holding people to account”
Mr West, speaking from his office at the General Hospital, seemed to agree with elements of Ms Reid’s assessment.
“I think running a service on a fixed term appointment with locums is haphazard: it doesn’t allow for good continuity of care, and it doesn’t allow us to protect our patients”, he conceded.
But elsewhere the medical director spoke positively about the department and its potential for growth.
One avenue outlined in the review and heartily endorsed by Mr West concerned the “upskilling” of the department’s nursing and allied health professionals.
He stated: “We need to take our medical workforce and our nursing workforce on the same journey, upskill them to the top of their licences and have them work together in concert.”
On Mr West’s account, the review pointed to a need for his workforce to “keep pace” with an ever-growing number of referrals on the island.
Blueteq, a web-based system used to manage the prescribing of high-cost drugs, will be an essential part of the hospital’s toolkit going forward, he noted.
The technology will aid with ensuring prescriptions are correct for biologics and other neurological drugs, and smooth the way for better planning and time management.
The review, he told, was welcome– and supplied the department with a helpful rubric for how to improve in the immediate future.
“It’s broken down nicely for us”, he said.
“If you look at the recommendations – I think there’s 20 recommendations in all – you [can see] that they’re broken down into nice little chunks where they say, ‘Try and get this done.’
“Does that mean that we will have the best neurology department in the world? Well, the most important thing for any department is the people, and it’s why the workforce is so important.”
He advised patients with unfavourable experiences of the department to go through Patient Advice and Liaison Service (PALS).
“The important thing is that we have a system and a mechanism in place by which patients can be heard”, he explained.
“As medical director, you know, ultimately, if people are genuinely unhappy, and they do this, they can utilise me.
“I’m happy holding people to account if needed, I have held people to account as required, and I’ll continue to make sure that where necessary I hold people to account if that’s appropriate.”
[ITALICS] The Patient Advice and Liaison Service can be reached Monday to Friday, 8am to 4pm, via telephone on 01534 443515 or by emailing PALS@health.gov.je.
A hard few years for Health
THE neurology review is the latest in a series of critical assessments of the Island’s health services in recent years.
A Royal College review of the rheumatology service prompted by a whistleblower found that hundreds of patients were given strong drugs when they needn’t have been, which may have caused harm.
The deaths of 182 patients were reviewed and it was later deemed “likely” some died due to the treatment they received.
Then a review of radiology published in 2024 revealed that the Hospital had to recall 20 women for breast cancer screening and review more than 2,700 scans over fears that a radiologist misdiagnosed patients.
That year, the Royal College was also invited to review Orthopaedic Surgery and Theatres and the independent board responsible for overseeing Health’s operations also requested a review of General Surgical Acute on-call services. Neither has had its results made public.
Earlier, in 2022, an £85,000 independent review involving more than 70 interviews with 53 staff led senior clinical lecturer Hugo Mascie-Taylor to conclude that that bullying, a “bias against standardisation” and “vested interests” are dominant in the health service. He noted that this was described by several interviewees as ‘The Jersey Way’ and warned that such attitudes were putting patient safety at risk.
