In December 2017, Philip Dunne MP, Minister of State for Health, announced an independent, non-statutory Inquiry, under the Chairmanship of The Lord Bishop of Norwich, into the practices of breast surgeon Ian Paterson, who was convicted in April 2017 of wounding with intent and unlawful wounding.
Today, 4 February 2020, the Inquiry published its report and Matt Hancock, the Secretary of State for Health and Social Care, presented its findings and recommendations to Parliament.
The remit of the Inquiry
The remit of the Inquiry was to seek to learn from what happened to former patients of Ian Paterson, both in the independent sector and in the NHS, and draw conclusions in relation to the safety and quality of care provided nationally to all patients.
The Inquiry looked at the local care and treatment for private patients in the Solihull area, and reviewed current and past practices to establish if safeguards for patients treated at independent healthcare providers fell short of the standards the public has a right to expect. Lessons learned here will be applicable to care provided by the independent healthcare sector across the country.
What the Inquiry means to the victims
Lesley Cuthbert comments:
“The Inquiry at least meant that many of Paterson’s victims had the chance for their voice to be heard. Indeed, the terms of reference of the Inquiry were widened extensively as a result of consultation with patients and interested parties. It’s pleasing to know that the victim’s contributions were clearly taken into account.
However, whatever the Inquiry concludes or recommends, many of those who, like me, were harmed by this man still feel anxious in the light of the latest revelations about further wrongdoings by two other surgeons at Spire Parkway and the notice from the Coroner’s Office concerning further investigation into some of the unnecessary deaths at the hands of Mr Paterson.”
An important turning point? What this means to both the NHS and the private medical sector
Kashmir Uppal commented:
“The Inquiry must make recommendations which protect patient safety in the NHS and private sector including proper protection of ‘whistle-blowers’. When management at the Trust failed to take effective steps to ‘control’ Mr Paterson, medical colleagues should have felt confident enough to report Ian Paterson’s practices outside the Trust to organisations such as the GMC, and had the GMC taken the requisite action at that time, i.e. in 2003, Mr Paterson could and should have been stopped.
It is also clear too that the patient recall process was flawed in both the private and NHS sectors. It’s essential that any recommendations for an improved process will ensure patients are informed of incidents that affect them much earlier. We hope that the Inquiry’s conclusions and recommendations will enhance future private and NHS healthcare patient protection so that an Ian Paterson can never happen again.”
Regulation and liability in the private healthcare sector
“The question of liability and accountability in private healthcare urgently needs to be addressed and that can only be achieved by making the private healthcare provider responsible for the actions of a doctor practising at a private hospital in the same way that the NHS is. It is estimated that more than 1,000 women and men could have suffered at the hands of Paterson. Those he treated in the NHS received compensation relatively promptly. But victims who underwent surgery carried out at private Spire Healthcare hospitals, often after referral from the NHS or being lied to about ‘lengthy waiting lists’ for procedures and the need for speedy surgery, had to wait and fight hard for any compensation or admission of liability at all.”
Spire Healthcare at first said it was not liable for paying compensation because Paterson was technically not their employee – they merely gave him ‘practising privileges’. Paterson’s professional indemnity insurer, the Medical Defence Union, said his cover was ‘discretionary’ – meaning the cover could be pulled at any time – and because Paterson’s operations were illegal, they were not covered by the policy.
Making a private healthcare provider liable will be the most effective way of making them stand up and change practices to ensure that patient safety is the priority.
"Vulnerable patients like me were taken advantage of by a supposedly highly respected senior consultant who was given a high level of responsibility and autonomy in the private sector. We need better monitoring of surgeons operating in the private healthcare sector including independent and rigorous appraisals together with proper investigation of any concerns raised about a surgeon by his colleagues and patients. Ideally, there ought to be a duty on medical professionals to report issues to the GMC promptly”.
How this affects the country’s trust in healthcare services
The Inquiry concedes that, although Paterson was a rogue individual, some of the failings that allowed him to escape justice for so long were clearly managerial and systemic. Overall, the public’s faith in our healthcare services remains strong, as it should. The vast majority of healthcare professionals in the NHS are dedicated, competent people working with care and integrity. However public faith in private healthcare provision has undoubtedly been eroded. Kashmir concludes:
“Many victims of Paterson’s private practice found themselves embroiled in a needlessly lengthy and stressful legal process. Legislation is needed to protect private healthcare patients to ensure that private providers take responsibility for the actions of their surgeons and also to assure that they are monitoring them correctly. There ought to be equally consistent consequences for failing to adhere to standards of patient care and safety in both the public and private healthcare sectors.”