Eljamel Independent Clinical Review: online public engagement event - 7 February 2025

The purpose of this event was to discuss the draft terms of reference for the Independent Clinical Review (ICR) and to explain how the review will function.

It also provided an opportunity for former patients to get clarification regarding the ICR process. 

Introduction

My name is Professor Stephen Wigmore, and I am the Chair of The Independent Clinical Review (ICR) of former patients treated by Muftah Salem Eljamel also known as Sam Eljamel.

May I begin by thanking everyone that has joined this meeting today and to welcome you all. The purpose of today’s meeting is to present the draft terms of reference for the ICR into patients treated by Eljamel and to explain how I intend the ICR will work and how it will deliver the roles required of it.

There will be an opportunity to ask questions regarding the operation of the ICR later. I would remind patients that this is a public meeting and so if you are asking a question that relates to your own case, please do not disclose any personal details or any matters which you consider private or sensitive in this forum.

I am conscious that the former patients of Eljamel have been campaigning for a very long time for these ICR's to take place. I thank you for your patience and apologise that the creation of the infrastructure required to support the ICR has taken longer than I had imagined. The complexity of the arrangements and the interactions between stakeholders, the requirement of the ICR to maintain independence from Scottish Government and NHS Tayside and the need for the terms of reference of the ICR and the Public Inquiry (Eljamel Inquiry) led by Lord Weir to align have all been very necessary considerations which have contributed to the delay. Now that the work of the ICR is almost ready to begin I am hopeful that we will be able to make rapid progress.

Status and leadership – refers to terms of reference 1-3

The ICR of individual cases of former patients of Mr Eljamel will be independent of Scottish Government and NHS Tayside. It will be person-centred, and trauma informed. I will come back to the issue of the independence of the ICR later. With respect to the nature of the reviews it is important that they are person-centred in that they focus on the needs and concerns of the individual patient. The reviews will be trauma informed and by this I mean that the team conducting the reviews will have an understanding and recognition of trauma and we hope that the process of review responds to the needs of patients avoiding causing re-traumatisation, avoiding biases and building trust. 

The reviews will be of medical records and the Applicant statements provided by former patients or their representatives. They will include patients treated by Mr Eljamel in NHS Tayside and also patients treated privately.

I would like to take this opportunity to introduce myself to you more fully. I accepted the appointment of Chair of the ICR of Former Patients of Eljamel on the 28th February 2024 from the Cabinet Secretary for NHS Recovery, Health and Social Care. I am a graduate of King’s College, University of London and the University of Edinburgh and have practised as a doctor in Scotland for most of the past thirty four years. I have worked as a consultant surgeon since 2002 and have been a Professor of Surgery since 2005. I was appointed as Head of Department of Surgery at the University of Edinburgh in 2018 and to the Regius Chair of Clinical Surgery in 2019.

My area of subspecialty interest is in liver and pancreas cancer and liver transplantation. Having a different subspecialty interest from the subject of these reviews allows me to maintain complete objectivity and oversight of the work of the neurosurgeons who will undertake the reviews under my supervision. I have chaired a number of complex inquiries and reviews in the past involving allegations of medical misconduct and patient harm.

I am supported by an independent administrative team who are experienced in providing administration for public inquiries. The administrative team will provide liaison with the patient group, obtain consent from patients who wish to participate and will assist the collection of Applicant statements from patients by the Inquiry team. In addition, the administrative team will coordinate the provision of documents for review to the neurosurgeons and will coordinate the distribution of reports to individual patients or their representatives as requested. They will also provide reports to the Public Inquiry where patients have consented to this.

In addition, the ICR will be a supported by a group of expert neurosurgeons. I would like to reassure patients that I have gone to considerable lengths to establish a process which will ensure that these neurosurgeons have sufficient expertise and have no conflict of interest with either Eljamel or with NHS Tayside and are able to provide truly independent reviews. I am being supported in this process by the leadership of the Society of British Neurological Surgeons which represents the majority of consultant Neurosurgeons working in the United Kingdom.

Purpose relates to: terms of reference 4-8

TOR 4 describes the purpose of the ICR and I will read this in full. The purpose of the ICR is to review the care and treatment with each former patient to provide clarity to the patient or their family as to what happened in the case of the patient.

In addition, the ICR will also provide information to the Public Inquiry in the form of individual reports which may be used by the Public Inquiry in the fulfilment of its terms of reference.

The ICR is not a legal entity and does not have the authority to determine any questions of civil or criminal liability. Having said that if the reviewing neurosurgeons find evidence of substandard practice this will be included in the report which will form part of the clinical evidence for the Public Inquiry.

Each of the individual ICR's will result in a personalised report which will be provided to the former patient or their relative.

TOR 7. Each of the ICR’s will ascertain the timing of events relating to neurosurgical care and treatment including the actions taken by Mr Eljamel and where appropriate by medical colleagues who were under the supervision of Mr Eljamel and who played a part in such treatment. Whether concerns or complaints were raised about the care or treatment received by or on behalf of the former patient. Whether the care and treatment provided by Mr Eljamel and where appropriate colleagues under the supervision of Mr Eljamel playing a part in such care or treatment were reasonable based on clinical guidelines and practice at the time which they were provided and where possible what physical damage was caused to the patient and whether that physical damage resulted from the treatment (or lack of treatment) by Mr Eljamel or medical colleagues under his supervision on the balance of probabilities.

In addition, each of the ICR's will analyse the adequacy of follow up care and signpost patients to further care if possible.

Participation: terms of reference 9-10

All former patients of Mr Eljamel during his employment with NHS Tayside or in private practice or their representative/relative are able to participate in the ICR.

This process will be an opt-in process whereby former patients or their representative/relative are required to self-identify. I will explain this process later. 

All former patients or their representative/relative will be asked to provide written consent so that the ICR can access their medical records. In addition, consent will also be sought to share relevant extracts of medical records, a copy of each of the ICR reports and contact details with the Public Inquiry to assist the Public Inquiry and to enable the Public Inquiry to further investigate a specific case should it wish to do so.

Methodology: terms of reference 11-15

Each of the ICRs will review medical records including the NHS Tayside records, primary care records and relevant private care facility records). We are aware that some patients records may have been destroyed and the ICRs will report on the adequacy of patient records to the Public Inquiry. 

I am conscious that patients are anxious that this review is different from previous desktop reviews and patients will be invited to contribute a statement which we are calling an “Applicant statement” detailing their experiences and concerns which will form part of the evidence relied on by the expert neurosurgeons when undertaking their review and making their report. This Applicant statement will include a list of questions which are important to the terms of reference of the ICR but also to the needs of the Public Inquiry. The Public Inquiry will provide reasonable support to the ICR for this part of the methodology.

The neurosurgeons will review documents provided to them including secondary and primary care records where appropriate and Applicant statements provided in response to a questionnaire. They will undertake their reviews based on their own clinical expertise, the standards of practice at the time and also based on the concerns raised by patients in their statements. The neurosurgeons will also be required to address a prepared list of questions which have been chosen to align with the clinical evidence required by the ICR and the Public Inquiry. 

As part of this work the ICR will develop and publish systems to ensure patient confidentiality. In this regard we have undertaken a data protection impact assessment, I have been appointed as a Data Controller for the purposes of the ICR and I have appointed a data protection officer who is an expert in Information governance. The ICR is advised by experts in data protection and information governance. 

In addition to the individual reports the ICR will produce an overarching report which will investigate and report on the former patients of Eljamel as a group, seeking to identify patterns and behaviours which may not be evident from individual cases. This report will be provided to the Public Inquiry and will be made available to the public and Scottish ministers. 

The role of the ICR in the work of the public inquiry: terms of reference 16-18

The Public Inquiry. The ICR is a process which is independent from the Public Inquiry led by Lord Weir, in the sense that the assessments and opinions which it will produce are based on the clinical independence of the experts within it. The Public Inquiry has statutory powers under the Inquiries Act 2005 and is investigating a broad range of matters. The ICR will, with patient’s consent, share personal reports with the Public Inquiry as well as other reports as requested on overarching themes arising from the individual reviews. In this sense the ICR will provide clinical evidence on behalf of patients to the Public Inquiry. This does not affect the ability of former patients of Eljamel from giving evidence to the Inquiry, should the Inquiry request it. It may be that the Public Inquiry wishes to investigate individual cases further. Where patients have given consent for this to happen their details will be shared with the Public Inquiry who will then contact them directly for any further evidence it may require. Subject to appropriate measures being taken to protect inappropriate disclosure or publication of sensitive material (details of which will be published by the Inquiry in due course), the Inquiry’s current intention is that the Applicant statements and patient records as well as the ICR’s individual and overarching reports will form part of the evidence available to its work.

A Memorandum of Understanding giving more detail about how the two processes will work together has also been agreed and will be published in early course in the interests of clarity and transparency.

The remaining terms of reference 19-20 relate to interpretation and define and describe the key individuals or stakeholders that the ICR refers to. 

I would like to now consider some specific issues

The role of NHS Tayside. The ICR is being undertaken independently of NHS Tayside and neither the board nor the senior management team have access to the ICR. The ICR is using the Patient Liaison Response Team and records departments from NHS Tayside to assist the ICR to facilitate contact between the ICR and individual patients and secondly to provide secondary care notes for transfer to the neurosurgeons. I am aware that concerns have been raised by former patients regarding transparency and honesty in providing these records. NHS Tayside will take no part in the reviews other than providing patients clinical notes to the ICR for review.

The role of Scottish Government. The ICR is being undertaken independently of Scottish Government. In the interests of full disclosure, I will tell you that the ICR was commissioned by the Cabinet Secretary for NHS Recovery, Health and Social Care and has a duty to report to Scottish Ministers as well as to individual patients, the Public Inquiry and the public as a whole. The ICR has been supported by Scottish Government tendering processes which was a requirement for its establishment. The ICR will use a ring-fenced area of the electronic Records and Document Management (eRDM) system to which Scottish Government employees do not have access. The eRDM is the usual platform used by Public Inquiries and other independent investigations.

Other agencies. The ICR has no role or responsibility to communicate with any other agency and no data will be shared with any other agency or organisation other than the Public Inquiry. 

Order of reviews. The order in which cases will be reviewed will be decided by the ICR and will consider specific requests for prioritisation of cases from the Public Inquiry.

Private patients. The ICR was established with the purpose of investigating patients who received care through NHS Tayside. I have been made aware that some patients may have received some consultations or treatment through the private sector. After reflection, such private patients will now be offered the opportunity for review by the ICR and where possible their private medical records will be retrieved. The ICR is being undertaken independently of private health care providers. For those patients who received private health care it will be necessary to contact the provider to request access to records. In the private health care system at the time that Mr Eljamel was working it was common for records to be held by both the private health care provider and/or the surgeon himself. We anticipate that it will not be possible to obtain copies of the surgeon’s own records, unless copies are also held by the provider.

Physical examination. The scope of the ICR as set out by the Cabinet Secretary does not include physical examination of patients and as such physical examination will not form part of the review process. I have made the exception that if the reviewing neurosurgeons feel that there is a compelling reason to undertake a clinical examination in a specific patient and that this examination is likely to provide important new information then physical examination may be considered.

Length of the ICR's. The ICR will be conducted as quickly as possible and reports, where consent is given, will be continuously fed into the Public Inquiry allowing both processes to run simultaneously. It is not possible to be confident of the length of time that the ICR will take as it is not yet clear how many patients will require review. 

I have given you a great deal of information and so in the interests of clarity I would like to recap using the slides that are being shown, the key points of how the ICR will operate from the perspective of an individual wishing to participate. 

Slide 1 – ICR title

Slide 2
The ICR is available for all former patients of Mr Eljamel, public and private, who hold concerns about their care. Involvement will require you or your representative to go to the website and complete a registration form which should be sent to the ICR at the address enquires@eljamelclinicalreview.scot

Slide 3
Our preferred method of communication is digitally via email however we are aware that it is not easy for everyone to communicate in this way. We are setting up a PO Box and a telephone helpline and we will do our best to assist you in registering for review. 

Slide 4
When your registration form is received by the ICR you will be sent a consent form and a privacy notice. The consent form is important to complete and must be sent back to us if we are to progress your review. The consent form asks your permission to obtain your medical records and share your information including your report with the Public Inquiry team. The privacy notice explains how your information will be handled, how long it will be stored, use of your data, your rights regarding this and how to make a complaint if you feel that your data has been handled improperly.

When your consent form is returned you will receive an “Applicant statement” form from the Public Inquiry team.

Slide 5
The Applicant statement form is an important document and is your opportunity to explain what happened to you or the former patient in as much detail as possible. There are a series of structured questions which we would like you to answer even if you think they may not relate to you directly. We would like to hear about all of the different aspects of your treatment including your clinical care, consent, diagnosis, treatment or lack of treatment, complications you may have experienced, harm, after care or additional treatment that you may have required. 

We are also keen to understand whether you believe you were involved in research, were affected in some way by private practice or through being operated on by surgeons under the supervision of Mr Eljamel. Similarly, we are keen to know whether you made a formal complaint or raised a concern and how this was dealt with and what was the outcome. Part of the reason for asking these questions relates to some of the wider systemic issues which will be investigated by the Public Inquiry.

You will have the opportunity to attach any evidence that you hold to your Applicant statement such as correspondence and the ICR will provide details on how to do this.

Finally, you will be asked to make a statement of truth and sign your statement.

Slide 6
When your Applicant statement is received it will be reviewed to ensure that it has been completed correctly. It is possible that you may be contacted if further details or clarification are required. 

Once this has been completed your Applicant statement and your medical records will go forward for review.

Expert neurosurgeons who have no conflict of interest with Mr Eljamel or NHS Tayside will review your case and write a report. 

Slide 7
When the review has been completed it will be checked by me and by the Inquiry team. If there are no further questions you will be sent a copy of your report and a copy will also be submitted as evidence to the Public Inquiry. If you decide you wish to participate in the ICR but not the Public Inquiry your report will be sent to you and no one else. 

Slide 8
Your report will contain details of your clinical care, details of concerns or complaints that may have been raised, an assessment of whether care and treatment provided were reasonable based on clinical guidelines and practice at the time, where possible what physical injury was caused and whether this injury resulted from treatment (or lack of treatment) on balance of probabilities.

The ICR will review the adequacy of your after care and where possible signpost patients to further care.

Slide 9
As I mentioned in relation to the terms of reference the ICR will also produce an interim and final report looking at patterns of behaviour, events and failures which may be evident from pooling information from cases together, but which may not be evident from looking at single cases in isolation. These reports will be made available to the Public Inquiry and the final report will be made public. 

Slide 10
I would urge former patients or their relatives/representatives to register to participate in the ICR if this is their wish as soon as possible as this will help us plan the delivery of reviews and reports. 

Please read the how to apply document on the website.

If you have any questions, please contact the ICR email address or our helpline number of which will be posted soon. 

If you need help to participate in the ICR we will do our best to help you.

Slide 11 – questions