February 4, 2020

Paterson report: disgraced breast surgeon hiding in plain sight

On 7 December 2017 the Government announced an independent enquiry into the circumstances and practices surrounding Ian Paterson. Ian Paterson was a Consultant breast surgeon who was employed by the Heart of England NHS Foundation Trust, and had practising privileges in the independent sector at Spire Parkway and Spire Little Aston. In April 2017 he was found guilty of 17 counts of wounding with intent and sentenced to jail for 20 years.

The Inquiry intended to publish its report before the end of 2019 but after a delay associated with the recent general election it was published today. A copy of the report can be found on the Government website at: https://www.gov.uk/government/publications/paterson-inquiry-report

The report found that the boards of the Heart of England NHS Foundation Trust and Spire were remote from front-line health and that there was a gap in information available to patients.  Concern was also raised about the differences in the treatment of patients in the private sector compared to the NHS.

The key recommendations for change can be summarised as follows:-

  • There should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data. This database should be accessible and understandable to the public and should be mandated for use by managers and healthcare professionals in both the NHS and independent sector;
  • It should be standard practice that consultants in both the NHS and the independent sector should write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient’s GP, rather than writing to the GP and sending a copy to the patient;
  • The differences between how the care of patients in the independent sector is organised and the care of patients in the NHS is organised, is explained clearly to patients who choose to be treated privately, or whose treatment is provided in the independent sector but funded by the NHS;
  • There should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options;
  • The CQC, as a matter of urgency, should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings;
  • Information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector. It is also recommended that all private patients should have the right to mandatory independent resolution of their complaint;
  • A national framework or protocol, with guidance, is developed about how recall of patients should be managed and communicated;
  • The Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals and introduce a nationwide safety net to ensure patients are not disadvantaged. This recommendation was made following a medical defence organisation withdrawing insurance cover for Ian Paterson given that his activity was criminal;
  • The Government must address, as a matter of urgency, the position that independent hospitals do not have any clear responsibility or legal liability for the actions of consultants; and
  • When things go wrong, boards should apologise at the earliest stage of investigation and not hold back from doing so for fear of the consequences in relation to their liability.

Whether the Government will be keen to extend the indemnity principle so as to act as a safety net remains to be seen. However they will be reporting on their recent consultation regarding the indemnity market generally and we can expect significant change in light of the report. The balance of the recommendations, which are of practical effect, are likely to be adopted wholesale. Irrespective of the official response to the report, healthcare providers can, and should, now move towards tightening up their own procedures by reviewing their own information leaflets, consent processes and ensuring that the complaints procedure is clear and well understood.