Paterson inquiry: HR processes ‘stood in way of patient safety’

Disgraced surgeon Ian Paterson. Photo: Shutterstock

The confidential nature of HR processes in the NHS “stood in the way of patient safety”, according to the independent inquiry into the issues raised by the disgraced breast surgeon Ian Paterson.

The Bishop of Norwich the Rt Revd Graham James, who chaired the inquiry into how Paterson continued to perform botched and unnecessary surgery on hundreds of women, recommended that investigations into healthcare professional’s behaviour – including HR procedures – should result in suspension if there is “any perceived risk to patient safety”.

Many who gave evidence to the inquiry commented that HEFT investigated Paterson using HR processes, and this meant that he was guaranteed a duty of confidentiality which stood in the way of patient safety” – the Inquiry report

Furthermore, if the healthcare professional also works at another provider, whether in the NHS or in the private sector, any concerns about them should be communicated to that provider.

Paterson, who is serving a 20-year prison sentence, worked with cancer patients at Solihull Hospital, part of the Heart of England NHS Foundation Trust (HEFT) from 1998. He also practised as a surgeon in the independent sector such as Bupa Little Aston Hospital from 1993 and at the Bupa Parkway Hospital from 1998, which later became part of Spire Healthcare,

Paterson increasingly treated his private patients at Spire Parkway Hospital. There were concerns about Paterson’s clinical practice over many years, particularly his unapproved “cleavage-sparing” mastectomies, in which some breast tissue was left behind. This procedure meant cancer returned in many of his patients, while other women had unnecessary surgery.

Clinical colleagues first raised serious questions about his surgical procedures in 2003, but he was not suspended by HEFT or Spire until 2011.

In 2017, Paterson was convicted of 17 counts of wounding with intent and three counts of unlawful wounding relating to nine women and one man, whom he had treated as private patients between 1997 and 2011.

In his report, Bishop James said: “The suffering described; the callousness; the wickedness; the failures on the part of individuals and institutions as well as Paterson himself – these are vividly described in what patients told us.

“The scale of what happened, the length of time this malpractice went on; the terrible legacy for so many families; it is difficult to exaggerate the damage done, including to trust in medical organisations.”

The inquiry report said that “many who gave evidence to the inquiry commented that HEFT investigated Paterson using HR processes, and this meant that he was guaranteed a duty of confidentiality which stood in the way of patient safety, so patients being treated by Paterson were unaware that there were concerns about the safety of his operations.

“We believe this approach to have been a mistake, given that patient safety should have been the paramount consideration. We understand that, where concerns about a doctor’s practice arise, they can be managed by placing restrictions on what that doctor can or cannot do, or excluding them from practising altogether, pending the outcome of any investigation or HR process.

“In that way, ‘transparency’ with patients would not be an issue since the option of treatment – or a particular treatment – by the doctor in question would not arise.”

The report also had recommendation around corporate responsibility in the provate healthcare sector. “We heard that many patients treated at HEFT, and many treated at Spire, did not feel that the hospitals took responsibility for what had happened,” reads the report.

“In the NHS, consultants are employees and the NHS hospital is responsible for their management, and accepts liability when things go wrong. The situation is very different in the independent sector where most consultants are self-employed.

“Their engagement through practising privileges is an arrangement recognised by [Care Quality Commission]. However, this recognition does not appear to have resolved questions of hospitals’ or providers’ legal liability for the actions of consultants. We recommend that the government addresses, as a matter of urgency, this gap in responsibility and liability.”

David Hare, chief executive of the Independent Healthcare Providers Network said it would study the inquiry’s report carefully, and work with the wider healthcare sector to act on its recommendations.

“The independent sector has already taken important steps to help improve the way that healthcare settings communicate concerns about clinicians that work across multiple sites, and will consider the recommendations in the report to assess what more can be done.

“All parts of the healthcare system, including clinicians, providers and regulators across both the NHS and independent sector, must now work together to ensure that patient safety is prioritised in all healthcare settings – building on the progress made in recent years, so that patients can have full confidence in the behaviour of those that treat them.”

Niall Dickson, chief executive of the NHS Confederation, said: “We can see that both the NHS and independent sector are committed to work together and to share intelligence to make sure that patients are not let down by individual clinicians in this way again…

“This is a pivotal moment for patient safety and we all need to recognise the need for greater consistency in how information is shared so that everyone has a comprehensive understanding of the quality of clinical care that is being delivered.”

He added: “We also need to send the right signals at national and local level which help to create safe cultures throughout our healthcare system – this is still a work in progress and part of it is making sure that staff at all levels feel able to speak up and raise concerns. This is what patients expect and deserve.”

Health minister Nadine Norris apologised on behalf of the government and the NHS, for what happened, not least that Paterson was able to practise unchecked for so long.

“I would also like to pay tribute to the bravery of all those former patients who came forward to tell their stories to the inquiry and whose anonymised accounts have been recorded in the report. I know this will make for difficult reading, as it highlights the human cost of our failure to detect and put a stop to Ian Paterson’s malpractice.”

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