Oral Medicine Care In Focus

The Health Minister, Michael McGimpsey, made the following statement to the Northern Ireland Assembly.

"I welcome this opportunity to provide an update on an issue which has emerged in relation to the regional oral medicine service.

"In November 2009 the Belfast Trust became aware that six people who had been referred for surgery following a diagnosis of oral cancer could potentially have been referred at an earlier stage of their illness.

"Patients will attend oral medicine clinics if they suffer the following symptoms: Persistent mouth ulcers; Unusual changes to gum, roof of mouth etc; White patches or lesions/abnormalities in the mouth; Teeth grinding; Facial pain or Complications of radiotherapy to head and neck.

"A small number of people attending the service may have cancer. Each year in Northern Ireland there are about 160 cases of oral cancer.

"The course of disease in oral cancer cannot be predicted and suspicious abnormalities or ulcers in the mouth may be totally innocent or harmless while others may progress to cancer.

"In December 2009 the Belfast Trust took action to review and 'look back' exercise into this issue.

"This was an extremely time-consuming looking at some 3,000 clinical charts, lab reports and radiological investigations of every patient who had attended the service during 2009.

"However, during the time that this intensive work was being completed, it became clear that there were problems in relation to the management of a number of patients. This raised major concerns which the clinical experts determined needed to be addressed as a matter of urgency.

"The key issue which emerged was that 18 people were identified where concern existed regarding the quality of care. All of these 18 people were being actively managed by specialists in the health service at the time concerns were identified.

"Following further investigations it is now known that there is a total of 22 people for whom there are serious concerns , 15 cancer patients have been identified and four cancer patients have since died - three from oral cancer and one from other causes.

"Mr Speaker, I would like to take this opportunity to express my deepest sympathies to all the families of these patients following the loss of their loved ones.

"I have already said we now know that 15 patients who were diagnosed with oral cancer may have had some delay in their diagnoses.

"In relation to the six people identified initially, I have been informed that they have all had the opportunity to discuss their condition with their clinician and they are aware of the potential delays in treatment.

"At this stage, I understand that not every patient will have been told there was a potential delay in their diagnosis. This is partly to do with the fact that some are complex cases and many of the patients had a range of other conditions which were being treated.

I want to assure patients and this House that the Belfast Trust will inform individuals of any potential delays.

"I want to take this opportunity to apologise to all patients who may have had delays in their diagnosis. The public must have confidence that their treatment will be responsive, rapid and of the highest quality.

"Oral cancer covers a number of cancers and different types of tumour, all with different clinical features some of which will progress at different rates.

"Mr Speaker, clinicians have also advised me that the review has focused on patients seen in 2009. Those see in the clinic in 2007 or 2008 should not have cause for concern. However, if they have any questions they can contact the helpline or speak to their dentist or GP.

"As most members will be aware and following an announcement by the Belfast Trust on Friday, there were intermediate concerns about a number of further individuals. As a result, 117 people are now being invited to attend a review clinic. Letters have now been issued so all patients affected should have received them at this stage.

"For those 117 individuals, while most will not have conditions that require action it is important that they are seen. Also many of the 117 people will be under the care of their own dentist who is trained and skilled at identifying the signs of oral cancer.

"Mr Speaker, I want to apologise to all those patients who have suffered any anxiety and concern as a result of this recall. The steps being taken are a precautionary measure but necessary because of our commitment to patient safety and to provide them with the assurance they need about their health.

"The Belfast Trust has set up a number of clinics which start today with around two sessions on most days – morning and afternoon. These clinics are for the 117 patients who have been recalled. As of yesterday, around 50 appointments have been made for clinics in the coming days.

"Further clinics will follow in the days and weeks ahead. I am hopeful, that the vast majority of patients who need to be reviewed will be seen during this week.

"Belfast Trust also set up a helpline on Friday – freephone number 0800 980 1100. As of yesterday they had received around 60 calls.

"Mr Speaker, in relation to the dentist at the centre of this matter, I know that Belfast Trust took the decision in December 2009 to supervise this individual's work. The trust considered this a proportionate way to ensure patient safety whilst the investigation was ongoing.

"Restrictions were in place by January 2010 and as part of that process the individual was referred to NCAS in December 2009. NCAS is the National Clinical Assessment Service and is a national service which advises trusts on the handling of concerns about the practice of doctors, dentists and pharmacists.

"During December 2009 and early January 2010, the Trust also referred this individual to the General Medical and General Dental councils.

"General dental practitioners across Northern Ireland have been advised of concerns regarding this individual’s work. In December 2010, this dentist was removed from clinical practice by the Belfast Trust.

"My first priority is to ensure that all patients who have been recalled are dealt with appropriately and quickly.Once this process has been completed I will expect an urgent update on the outcome of these clinics. I understand, that this issue will cause considerable public anxiety, not least for those people who have been directly affected.

"I have to say that I share the shock and concern that the public will rightly feel about this matter. I am very unhappy about the distress caused to patients and the handling of this matter.

"I was first made aware that concerns had been expressed about the timeliness of referral for the treatment of six cases in December 2009. I was assured at that time that all six patients were being appropriately managed and receiving the treatment they required.

"However, I am deeply concerned that I only received further detail on 31 January 2011 with full briefing, at my request, provided to me on 1 February. When I was made aware, I immediately decided that I must make a statement to the House.

"Unfortunately, the issue was leaked to the media last Friday which left the Trust with no other option but to release a statement. This meant the Trust was not in a position to ensure all patients had received their letters inviting them to clinics before it was made public.

"I expect this inquiry will be rigorous and independent. It will examine the quality of care to patients, the circumstances surrounding this issue and the subsequent handling. I will advise members of further details about this inquiry as soon as possible.

"I will then decide what further action needs to be taken to ensure that lessons are learned and measures put in place to avoid any similar incidents," the Minister concluded.

See: Inquiry Ordered As MLAs Debate Dentist

(BMcC/GK)