The recent Paterson Inquiry report was a milestone in a long fight by patients. The inquiry laid bare both the horrific extent of this rogue surgeon’s criminal behaviour, and the failings in systems of regulation and oversight that enabled his abuse to continue, over an unforgivably long period.
Paterson’s criminal trial in 2017 found him guilty of 17 charges of wounding with intent, but the Inquiry believes that many more patients—more than 1,000—are likely to have undergone unnecessary procedures. Despite clinical colleagues raising serious questions about his practice back in 2003, Paterson continued working until 2011 across the NHS and the independent sector.
His patients’ testimony makes harrowing reading, and must now provoke the government and regulatory bodies to take action. At the Royal College of Surgeons of England (RCS) we have repeatedly called for common standards, monitoring and redress, across both the NHS and private healthcare sector. In particular, a “single repository” of data—bringing together information on every surgeon’s work across both sectors—is critical if monitoring is to be meaningful. Work in the independent sector is a legitimate endeavour, but it cannot and must not be a hiding place for bad practice. Surgeons who carry out hip surgery in the NHS should not suggest to patients that they have expertise in shoulder surgery in the independent sector, nor should the occasional procedure performed in the NHS form the basis for private practice.
To achieve common standards there need to be formal, contractual agreements between consultants and independent service providers, stipulating clear lines of accountability for patient safety. We want to see common processes for consultant appraisals, with information shared across sectors and between institutions. Those who fly in the face of clinical or ethical standards should not be able to hide in plain sight by switching between the NHS and the independent sector.
The Paterson Inquiry additionally highlights a gap in the rights of some patients treated in the independent sector, who do not have access to independent adjudication of complaints. Many patients have no idea this is the case until things go wrong, at which point answers and actions seem hard to secure. The government has an opportunity to address this now, by ensuring the Health Services Safety Investigations Bill going through parliament covers the independent sector too. The investigative body that the Bill will enshrine in law, does not encroach on the GMC or the courts’ roles in establishing civil or criminal liability for mistakes or negligence. It will investigate and identify systemic risks to patient safety. Private healthcare institutions must come under the spotlight of these investigations on the same basis as NHS hospitals.
The legislation also presents an opportunity to address the longstanding absence of regulation of Surgical Care Practitioners (SCPs). Those undertaking these roles find themselves in a regulatory Bermuda Triangle, overseen by neither the General Medical Council nor the Nursing and Midwifery Council. This has perverse effects in two directions, diminishing accountability to patients on the one hand, and undermining surgical training on the other. Without clear regulation for the SCP, surgeons may be reluctant to delegate responsibility. Trainees in particular, find themselves drawn away from training opportunities to perform tasks that could be delegated to SCPs. If SCPs were regulated, some could take on greater roles, ensuring trainee surgeons can put the hours in to learn their core skill of undertaking surgical procedures.
The main focus of attention has rightly been on Paterson’s victims and their families. The government and the whole healthcare system owe it to those patients to act quickly in the interest of patient safety, promptly reviewing and implementing the recommendations of the report. The vast majority of doctors perform their work to a high standard with the utmost care for their patients, but, the Paterson case is a vivid reminder of the need for further action to ensure a rogue individual cannot do so much harm to so many people ever again.
Derek Alderson, President of the Royal College of surgeons.
Competing interests: None declared