Learning lessons from the Paterson case #3

In our first post in this series, we outlined the case of Ian Paterson, the jailed breast surgeon, whose actions have prompted a new government inquiry – currently underway.

At inQuisit we have experience that’s relevant. And have identified five issues we think are paramount. First, we touched on the critical issue of the patient perspective – something sometimes lost sight of in the wake of Paterson.

In our second post, we explored two other critical issues: informed consent; and communication and confidentiality.

Today, we finish by looking at two other vital areas where we can learn key lessons from this case.

Governance and new procedures

Above and beyond all else, all healthcare services, whether NHS or independent, need scrupulous governance – where, again, the Kennedy Review highlights ‘a significant lapse in good governance’. Anyone with responsibility in hospital management needs to ensure that everyone working on site adheres to approved policies and practice.

But how does the independent sector make sure that those who are granted practising privileges are up to the job? What ongoing scrutiny is there to ensure they continue to be so? How often are privileges withdrawn from surgeons about whom concerns are raised?

There need to be frameworks in place for introducing new techniques, in the same way they exist for introducing new medicines or devices. Otherwise, individual surgeons are allowed to develop their own approaches without scrutiny, which – as shown by the Paterson case – isn’t safe.

At inQuisit, we think the medical advisory committees should take the lead on ensuring there are rigorous processes for introducing new surgical techniques; and the hospital board needs to provide oversight here too. Plus, again, of course, patient consent to any procedure needs to be real, and informed – including the patient being told if a novel technique is being used; what is known about the associated risks and benefits; and how this compares with a more established procedure.


And finally, related to all that’s come before, of course, is how patient complaints are handled.

‘Concerns were raised about Paterson as far back as 2003’, explains The Guardian, ‘but, despite several internal and external investigations and complaints from patients, GPs and other surgeons, the General Medical Council did not suspend him until 2011.’ That’s eight long years of missed opportunities.

For any hospital manager, making sure complaints are handled thoroughly, attentively and responsively can alert them early to major problems. At inQuisit we advise that complaints are a goldmine for learning: the insights they provide can prove invaluable. Using complaints to trigger alerts about a service means identifying recurring themes and actions to address shortcomings; and making sure this information is shared within the organisation.

Again, crucially, hospital boards need to be involved. The board needs to provide oversight of the themes that have been identified, and to scrutinise actions. Close the loop here, and you may avoid further, future catastrophes.

The Kennedy Review, quite rightly, described the Ian Paterson case as ‘a tragic story’. But it also said, to move forward and take positive steps, ‘the focus must be on the systems in place which brought about what happened’.

How we can help

We think that’s right. And that, at inQuisit, we can help inform the debate.

We also offer specific services geared to any healthcare provider looking to improve their performance around complaints:

  • You may wish: to conduct a thematic review of complaints; or get help with individual cases. These are both services we offer at inQuisit Adjudication
  • At inQuisit Training we work with organisations to develop bespoke online training programmes for health staff into how to prevent and handle complaints

We’ll also be watching this space carefully, and getting involved where we can. And we’ll report back in this blog on the government inquiry into the Paterson case when it publishes its findings next summer.

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