Hospital managers at Jersey’s General Hospital are accused of pressuring frontline staff to follow “unsafe practices” – and then ignoring their concerns when alarms were raised.

An independent review of the island’s neurology department – the latest in a series of critical health reports in recent years – revealed that some staff felt compelled to comply with practices they believed carried risk, driven by managers who, because of their limited experience in a hospital environment, “did not fully grasp the potential consequences”.

When staff attempted to challenge those practices, they reported their warnings were “often ignored”.

The invited assessment carried out by the Royal College of Physicians into Jersey’s neurology service also described the department as “overstretched” and “unmanageable at times”.

Of the 12 clinical cases examined, seven demonstrated “good practice” and the remaining five were marked as having “room for improvement” – but the review’s wider findings paint a picture of systemic strain, outdated procedures and governance gaps.

“Overstretched” neurology staff

Twenty recommendations were issued following the four-day inspection, conducted in January and February last year.

Among the concerns raised were reports of incorrect prescriptions reaching pharmacy teams, the absence of a neurology prescriptions database at the time of inspection, and a risk register that contained no documented risks.

Staff “reported feeling overstretched and working beyond their job plans to maintain a high quality of service for patients requiring neurology care”, the report stated.

But medical director Simon West rejected the suggestion that unsafe practices were being followed under managerial pressure.

“I was sorry to see this view within the review; however, I would disagree with it,” he told Express.

“The medicine care group, which look after departments such as neurology, is managed by experienced clinicians, who have patient safety at the heart of what they do.”

He stressed that nothing in the report concluded that unsafe practices were actually being carried out, describing the remarks as a “personal opinion” and noting that managers were also described elsewhere in the review as supportive.

“Challenging and unmanageable” workload

The Royal College of Physicians review team warned that the workload facing the small neurology team was “challenging and unmanageable at times” as the department grappled with the departure of its only substantive consultant – which Mr West likened to losing “the captain of the ship”.

The review referred to “instances where incorrect prescriptions were received by the pharmacy team” and noted that there appeared to be “no database in existence at the time of the review for monitoring neurology prescriptions”.

The same ‘Blueteq’ system used in rheumatology is expected to be rolled out for neurology, but at the time of inspection it had not yet been embedded.

The reviewers also highlighted poor job planning and the absence of a “demand-and-capacity-mapping exercise” within the department.

The report encouraged the recruitment of a dedicated neurology clinical pharmacist to oversee the prescription of “high-cost, disease modifying drugs”, and concluded that a single neurology consultant would not be sufficient to meet future demand.

“Quite a significant departure”

Recruitment difficulties were acknowledged, though the review team observed that “opportunities for strategic planning” had been missed ahead of the loss of the department’s only substantive practitioner – which Mr West described as “quite sudden”.

“He was quite a significant departure, which was quite sudden – we then had a period where we’ve struggled to recruit substantively,” he said.

The medical director insisted that replacing the substantive neurologist was not a matter of cost.

“[There] is no budgetary concern at all,” he stated, “we have financed one substantive neurologist [and] we have an agreement that we would finance two substantive neurologists.”

A range of recommendations was put forward, from introducing a remote tele-neurology service to formalising links with a UK neuroscience centre.

Mr West said: “The review was conducted to review the service. If we are honest, it says that in some cases there’s been poor or just adequate care, [but] it’s not all that.”

One recommendation proposed a “standardised clinic for general neurology clinics,” allocating 30 minutes to new patients and 15 minutes for follow-up appointments.

A key governance issue concerned the neurology risk register, which the review team found contained no documented risks.

Mr West accepted that “populating the risk register is the responsibility of the care specialism and the care group”.

“We’ve lost the captain of the ship”

Perhaps the only notable deviation from uncomplicated agreement with the recommendations set out in the review is Mr West’s attitude to the recruitment of a dedicated neurology pharmacist.

“There isn’t a dedicated neurology pharmacist, but there is a dedicated neurologist for high-cost drugs and biologic agents, both of which are the areas where the college was drawing concern with respect to a neurologist.

“Jersey is not big, and, equally, we have our issues within pharmacy in terms of recruitment, but we do have a lovely gentleman called Seb McNeilly, who is a high-cost drugs pharmacist who’s responsible for biologics as well.”

He continued: “We’ve done two things: we’ve got a high-cost, biologic agent pharmacist and we’ve also got Blueteq software, but it needs to be embedded and rolled out.”

While Mr West couldn’t be specific on when exactly the Blueteq system would be up and running, he confirmed that it would be later this year.

Finally, he noted the task ahead of them to find a new substantive consultant to hopefully preside over the department for the next “20 or 30 years”.

“Now, if you like, we’ve lost the captain of the ship, and we need a new captain.”

“Work continues to enhance the service”

Following the publication of the review, Health Minister Tom Binet said: “Health and Care Jersey invited the Royal College of Physicians to independently review the neurology department as part of its commitment to delivering safe, high-quality care for islanders.

“I was pleased to see that the review highlighted a strong commitment across the neurology team, senior management as well as the ministerial team to improve services and that it also found that there were solid foundations in place to support patient outcomes.

“Following the recommendations outlined in the review, an action plan has been drawn up and two of the actions have already been completed.

“Work continues to enhance the service, and I’d like to thank the team who work in this complex specialty for their continued dedication and commitment to patients.”

The full report can be found from page 294 of the latest Health Advisory Board papers.

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