Ministers accused of ‘knowingly exposing’ patients to risk after partial response to Paterson scandal

Ministers have been accused of “knowingly exposing” NHS and private patients to safety risks after delaying again a full response to the inquiry into the Ian Paterson scandal.

Victims of rogue surgeon Ian Paterson, who was jailed in 2017 for carrying out unnecessary surgery on patients, told The Independent there was a “clear and present danger” of similar crimes being committed without urgent action being taken.

On Tuesday, the government released a partial response to an independent inquiry, led by Reverend Graham James, which reported in February last year. It revealed Paterson was able to carry out unnecessary surgery on more than 1,000 patients over a 14 year period due to a “dysfunctional” health system and the wilful blindness of managers.

The government response addressed only three recommendations directly with ministers promising a full response later this year.

David Rowland, director at the Centre for Health and the Public Interest criticised the lack of action as the NHS sends more patients to private hospitals in the wake of the coronavirus pandemic.

As many as 3 million NHS patients may have been treated privately, a figure which could grow as the NHS tackles huge backlogs in coming months.

Mr Rowland said: “There's nothing in the government's response which even give an indication that they are taking seriously the risks associated with provision of services within private hospitals.”

He said ministers had been warned repeatedly about safety risks, adding: “It can only be seen to be a political choice not to intervene to take action in order to protect patients, because clearly the systemic risks are there and comes on the back of the government expanding the role of the private hospital sector in the delivery of NHS services.

“By not taking action now to intervene to make private hospitals safer they are knowingly exposing more NHS patients to the same risks identified by the inquiry.”

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Last week it emerged Spire Healthcare had set aside £22m, after a recall of 5,500 of Paterson’s patients identified new victims who had been given surgery and procedures they did not need.

Deborah Douglas, a victim of Ian Paterson, told The Independent: “There is still a clear and present danger of another Paterson happening. They haven’t actually tackled anything that’s complex and the longer this goes on the more chance it will happen again.”

She said: “The recommendations they've responded to are all the soft ones that should have already been done anyway. In all this time, to not address some of the key issues or at least give us a plan, I just think it's appalling. I don't buy the fact that they couldn't have produced a plan, with the timescale for those 15 recommendations, by now.”

The ministerial statement did not address key issues such as the inquiry’s suggestion of a single mandatory database of consultants in England recording all their performance data, where they work, and the procedures they carry out.

It also did not respond to the issue of practising privileges, where private doctors like Paterson are able to effectively rent space in hospitals to treat patients. They are not considered employees and in the event of a safety concern or clinical negligence claim companies can try to avoid any liability for what happened in their hospitals.

This is what happened in the case of Ian Paterson when his insurer walked away prompting a major court battle that was settled out of court with the NHS, Spire Healthcare and insurers paying £37m to around 750 patients.

Kashmir Uppal, a partner at law firm Shoosmiths, and who represented patients bringing claims against Paterson and Spire Healthcare told The Independent: “They need to go further and they need to deal with the disparity between the NHS and the private sector when it comes to liability and indemnity. Because otherwise, patient safety in the private sector is always going to remain an issue, because it's not going to have the control mechanisms that exist in the NHS, to ensure that doctors given practising privileges are acting appropriately and in the best interest of patients.

“If hospitals were directly liable for doctors, then there would be far more control. If this issue of practicing privileges and the liability and indemnity provisions that arise from that is not addressed then this is an open playing field for this to happen again.

“The law remains that a private hospital who gives a doctor practicing privileges is not responsible for the acts or omissions of that private doctor.”

In a written statement to parliament, patient safety minister Nadine Dorries, blamed the Covid-19 pandemic for forcing what she called a “a pragmatic response” to the inquiry.

She said the Paterson inquiry report was “difficult reading and describes the terrible harms that can occur when the malpractice of an individual, rogue surgeon goes unchecked. We will continue to consider all the recommendations and produce a full response to the inquiry’s 15 recommendations during 2021.”

Of the 15 recommendations the government responded to only three. One involved clearer communication with patients in letters from doctors, which Ms Dorries said would be added to the standard NHS contract – but this would not apply to private patients, which the inquiry specifically referenced.

The General Medical Council will be asked to work with doctors to embed better approaches to consent by patients and the Care Quality Commission will check hospital teams are properly meeting and discussing patient care.

David Hare, chief executive of the Independent Healthcare Providers Network, said: “As the government has recognised, the independent sector has already taken a number of important steps to further improve quality and safety in the sector including through strengthening the oversight of clinicians working across both independent and NHS providers.

“This is reflected in the Care Quality Commission’s independent assessment of the sector which currently shows that 84 per cent of all independent sector hospitals are currently rated as either good or outstanding, which compares favourably to the wider healthcare system in England.”