Review finds 'inappropriate prescribing' of medicine in Jersey's rheumatology service

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‘SYSTEMIC governance problems’ are likely to be present in areas of the Health Department, the government has admitted after results from an audit of patients were announced.

Health Minister Karen Wilson said that initial feedback from a review of the rheumatology service indicated that her department had fallen behind ‘best practice’ in a number of areas.

Issues uncovered have included medicines being prescribed inappropriately.

The review, which was initiated last month following concerns that some patients were not receiving the best treatment, is the latest indication of the extent of problems facing the Island’s healthcare service, and follows a damning report into governance published last year.

The latest report, released this week, indicated the need for a more integrated relationship between GPs and hospital clinicians, closer links with other rheumatology services and a reduced reliance on pharmaceutical companies for drug information and training.

The feedback notes a number of service weaknesses at that time including poorly written patient notes, some inappropriate prescribing of biologic agents (naturally occurring substances used to treat rheumatic conditions), and prescriptions that did not include the clinical condition being treated.

Medical director Patrick Armstrong said that around 340 patients whose treatment included biologic agents had been the subject of a review.

Deputy Wilson said that while the review carried out by the Royal College of Physicians had been focused specifically on rheumatology, the initial ‘feedback highlights some systemic governance problems… that are likely to be present in other parts of Health’.

She added: ‘The Royal College has said it was reassured to hear that steps were being taken to develop an open and transparent culture and to implement a governance framework that allows scrutiny of all aspects of healthcare, but nobody should be in any doubt about the seriousness of this review and these initial findings.’

The way the healthcare system operates has been in the spotlight since the publication of a review by Professor Hugo Mascie-Taylor into clinical governance arrangements in secondary care last August. In January of this year it was confirmed that a turnaround team would be set up to help senior leaders within the Health Department tackle the challenges faced, while in April Deputy Wilson announced plans to set up an Interim Health Board.

The Health Minister added: ‘It is clear that over a period of time [the department] had fallen behind “best practice” in a number of areas and now needs to catch up.

‘Work is proceeding on improvements recommended last year in the [Mascie-Taylor] review and this initial Royal College feedback underlines the need for a relentless focus on strengthening governance through the establishment of the proposed HCS Board.’

A States Assembly debate into Deputy Wilson’s plans for the interim board was due to take place next week, but has now been pushed back to mid-June. The Health Minister said the delay had been initiated by ministers so that ‘revision and refinement’ could be carried out into some of the details.

Rheumatology patients with concerns are being asked to email the Patient Advice and Liaison Service using or call 443515.

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