The trail of destruction left by the surgeon Ian Paterson must lead to changes that go far beyond those introduced since his jailing in 2017. The scale of the malpractice set out in the report of an inquiry chaired by the former bishop of Norwich, Graham James, is all the more staggering when you consider that, of more than 11,000 patients treated by Paterson between 1997 and 2011, the 211 cases represented in the report are a tiny fraction. Paterson performed 4,077 surgeries in two private hospitals run by Spire Healthcare, and 1,207 mastectomies for the Heart of England NHS trust.
The testimony of patients, most of whom were women, about their experiences with Paterson makes for deeply uncomfortable reading. Again and again, the doctor is reported to have arranged tests and operations that went wrong or were later revealed to have been unnecessary. For years, he got away with carrying out an incomplete mastectomy he described as “cleavage-sparing” – often without patients’ consent. While it is beyond the scope of the inquiry to speculate as to the surgeon’s motives, the extent of the damage he inflicted on women’s lives and bodies via his attacks on their breasts speaks for itself.
Paterson is behind bars, his sentence having been increased by the court of appeal from 15 to 20 years. But the report does not treat his eventual conviction as the end of the story. Instead, it sounds the alarm, calling for far-reaching cultural and behaviour change to ensure that such abuses will never be repeated. Colleagues and managers in healthcare settings must in future be more curious. Institutions should cultivate a “broader sense of responsibility” and be much bolder when dealing with complaints and concerns raised by staff. The deference shown to consultants such as Paterson, who bewilderingly managed to cling on to his reputation as “one of the best” despite any number of mishaps, must be challenged.
Practical suggestions as to how such a culture shift might be achieved include the excellent suggestion that consultants’ letters should, in future, be sent to patients and copied to GPs, instead of the other way around. In some ways it is refreshing to see the problem tackled in this sociological way. The report points out that the Care Quality Commission, General Medical Council, Nursing and Midwifery Council and Professional Standards Authority for Health and Social Care already have an annual budget of £439m, and a staff of more than 5,000 people, between them. Adjusting processes and budgets will not make a difference unless people change too.
Such subtleties do not detract from the report’s exposure of gaping holes in the regulation of private healthcare. A mandatory independent complaints process, including access to advice, should be instituted immediately. Nor can the government continue to ignore the glaring anomaly whereby private hospitals are exempt from legal liability, which rests instead with individual consultants – leaving patients at the mercy of insurers. The criminal offence of providing false information to regulators must be extended to private companies straight away.
As in previous inquiries into health service failures, participants showed generosity of spirit by making clear their strong wish to prevent any repeat of their experiences. Ministers must now act swiftly to show the victims that their efforts have not been in vain.
