Rogue surgeon report does not pretend there are easy answers | Society

The key question after every medical care scandal is how to stop it happening again. Robert Francis QC’s 2013 report into the neglect and...

The key question after every medical care scandal is how to stop it happening again. Robert Francis QC’s 2013 report into the neglect and mistreatment of patients at Stafford NHS hospital sought to prevent any repeat by recommending that healthcare staff, hospital trusts, medical regulators and government ministers made no fewer than 290 changes to policy and practice.

Seven years on patient safety incidents occur in most hospitals daily and more patients than ever end up stuck on trolleys on corridors waiting for a bed, which involves a known risk of harm and death. History shows that legal and regulatory changes do not make healthcare risk-free.

In his 232-page report into the needless butchery breast surgeon Ian Paterson inflicted on at least 1,000 and probably many more patients, the Rt Rev Graham James does not pretend there is an easy way of ensuring that no rogue doctor, nurse or midwife can ever damage someone again.

As he explains: “There is not a single change to regulations or procedures which would prevent another Paterson.” However, he has nevertheless made 15 recommendations, over a modest five pages, with that objective.

Some are sensible proposals to make it easier for patients to get the right care from the right surgeon. They include a website outlining surgeons’ expertise and experience; plain English letters from surgeons to patients outlining what they plan to do and why; and adequate time for patients to ponder the procedure proposed and consent or not.

The “bewildering” eight-year delay before Patterson was suspended, even though complaints and reviews should have meant that occurred earlier, lies behind James’s suggestion that health professionals should be removed from duty much sooner after concerns are raised about them.

However, professional bodies representing staff are likely to fear that such a change would make NHS staff even more fearful of making blunders, most of which are accidental. Paterson’s serial recklessness is untypical of how patients come to harm.

This inquiry is different to previous similar reports in that some of its recommendations are aimed at private healthcare providers and the state’s regulation of treatment they provide. James has rightly identified “gaps in responsibility and liability between the NHS and independent sector” and urged ministers to close them.

Decoded, he wants the government to end an anomaly whereby anyone injured by the NHS sues the hospital involved whereas those who come to harm during the receipt of private care have to sue the doctor or other professional involved, not the hospital.

Victims whom Paterson injured while working at two Spire Healthcare hospitals were left in legal limbo, unable to sue them and also unable to sue him because his insurers, the Medical Defence Union, decided the consequences of his actions were not their responsibility because they constituted crimes rather than clinical errors. However, James’s exhortation to ministers to sort this does not suggest specifics.

Linda Miliband, a lawyer at Thompsons, which represents 650 of Paterson’s victims, is not alone in believing that James did not go nearly far enough in improving the regulation of private providers like Spire, which runs 39 hospitals across the UK.

Action Against Medical Accidents, the patient safety charity, also wanted more robust measures. “Private hospitals must no longer be able to evade liability when things go wrong by saying that they don’t employ the consultants who work there. Insurance cover in private medicine has to be as good as, and as effective, as that available to patients injured by the NHS but the reality is, right now, it’s nowhere near equivalent,” Miliband points out.

“There must be multidisciplinary teams working in all private hospitals – it’s standard in the NHS but almost non-existent in the private sector. And the Care Quality Commission must be provided with the same performance data, in the same format from the private sector as it demands of the NHS in order to create a clear and consistent picture of patient safety across the board,” she adds.

So ideas for upping private healthcare’s liability for medical negligence to the same standard as that which already exist in the NHS do exist, but are not detailed in the Paterson inquiry report.

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Newsrust: Rogue surgeon report does not pretend there are easy answers | Society
Rogue surgeon report does not pretend there are easy answers | Society
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