Breast surgeon Ian Paterson was jailed in August 2017 for ‘17 counts of wounding patients with intent’, says this piece in The Guardian. In fact, he had been abusing the trust of his patients and employers for years. The case sent shockwaves, rightly so, across the NHS and the private healthcare sector. It wasn’t only that it was allowed to happen at all, but just how long it took to be addressed.
In January, the Government launched its independent national inquiry into the Paterson case – which is due to report its findings in the summer of 2019. The inquiry’s Chair, the Right Rev Graham James, the Bishop of Norwich, is quoted: ‘The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry.’
There is a positive opportunity here. How can everyone involved in healthcare management – whether NHS or private sector – focus their efforts to ensure nothing like this ever happens again?
Five key areas
There are specific issues, of course, around surgeons working across sites with ‘practising privileges’. There’s also an inherent power imbalance between these surgeons and their patients – who rely on the expertise of the medics. But this just makes the abiding principles matter more, and clearer. And the need for proper checks and balances.
At inQuisit we’ve identified five key areas of concern. We’ll take these in turn over a series of three blog posts. We’ll outline the problems, and share thoughts about potential remedies.
First up, and always central, is the issue of patient perspective.
To understand some of what went wrong in the Paterson case, a useful starting place is the Kennedy Review, which explored the Heart of England NHS Foundation Trust’s role and responses. While acknowledging the scale of wrong doing, the review stresses – we think helpfully – ‘the focus must be on the systems in place which brought about what happened’.
Our focus, at inQuisit, is above all else on those systems. We’re well placed to make constructive suggestions. And will be doing so here, and more formally as and when we’re able.
First and foremost, then, the issue of patient perspective: it’s clear from the Kennedy Review this is something that was, at times, lost sight of. Kennedy says, for instance, ‘There was another perspective which could and should have been adopted: that of the patient.’
One criticism highlighted in the review, to take an example, seems to have been the mishandling of patient recall, which it describes as ‘hopelessly flawed’. (Only selected patients were recalled, at a point when all clearly should have been. A decision the review suggests was based on a fruitless, as it turned out, attempt at ‘containing’ the story…)
One practical suggestion coming out of our work at inQuisit might be the use of patient advocates. Mostly, in the UK, the focus has been on advocacy for especially vulnerable groups. But all patients are vulnerable to an extent: we think there’s an argument for wider adoption of advocacy across healthcare.
We would not want this ever to become ‘dangerously paternalistic’, as this article in the Journal of Medical Ethics, puts it – one big theme for us at inQuisit is that all healthcare should be properly collaborative, with patients and their doctors relating as equals and adults. But we do think there’s a role for someone – a patient advocate – to be involved in talking with clinicians specifically about the patient perspective, and how it’s being held in mind through all decision making.
Such patient advocates could help serve as an interface between patients and those providing services. And their specific remit would be to ensure that patients’ perspectives are incorporated into every aspect of a service.
Next time we’ll home in on two other key issues: informed consent; and communication.
And, then, in our final post on this, for now, we’ll explore: governance and new procedures and – absolutely pivotal for us here at inQuisit – complaints, and how they’re handled, and learned from.