HR processes that prioritised employee confidentiality allowed convicted breast surgeon Ian Paterson to “hide in plain sight”, while colleagues were “genuinely fearful” about raising concerns, an independent inquiry has found.
The Paterson inquiry, which looked into how the surgeon was able to subject hundreds of women to life-changing and unnecessary surgery in NHS and private hospitals for more than two decades, found concerns regarding Paterson were dealt with “under HR processes and not as a patient safety issue” and did not receive “significant attention” from the hospital board.
The inquiry stated that because the organisation treated the complaints as an HR issue, Paterson was guaranteed a duty of confidentiality that “stood in the way of patient safety” because patients and their families were unaware of safety concerns.
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It concluded that this approach was a mistake, and that patient safety “should have been the paramount consideration”.
Paterson was convicted of 17 counts of wounding with intent and three counts of unlawful wounding of patients between 1997 and 2011.
The inquiry revealed that serious concerns were first raised about Paterson’s procedures in 2003. However, he was not suspended until 2011, and those providing evidence to the inquiry felt “genuinely fearful of the consequences” of speaking out.
It heard medical staff at Solihull Hospital, part of the Heart of England NHS Foundation Trust (HEFT), were subjected to bullying and aggression after raising concerns, and detailed a growing sense of fear among surgeons who did not want to risk scrutiny.
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Four doctors who raised concerns to the chief executive in 2007 were later subjected to investigation by the General Medical Council (GMC). While the report noted this was not as a direct result of them speaking up, there was a belief that this increased the likelihood of them being subjected to investigation, it stated.
A healthcare professional who worked alongside Paterson told the inquiry that the GMC found them “unfit to practice” after bringing evidence forward, but “consultants who never reported anything were clearly fine to continue practising.”
The inquiry also heard new managers were not made aware of past concerns raised about Paterson’s practice. Four managers – including former HEFT chief executive Mark Newbold, who suspended Paterson – provided statements claiming they were not told about concerns raised against him in 2007. Newbold, who started in 2010, said he was not made aware it was a “current issue”, while another stated it had been “wiped from corporate memory”.
An anonymous whistleblower claimed former chief executive Mark Goldman said he couldn’t suspend Paterson without evidence and that Paterson could take them to an employment tribunal and sue for loss of earnings.
Paul Holcroft, associate director at Croner, said there was no simple answer when it came to employee suspensions. “Employers in the medical industry should not take this case as carte blanche to immediately suspend any employee accused of gross misconduct,” he said. “The reality is that every case of suspension will differ on its facts, but the sensitive nature of the medical industry is likely to be an important factor.”
Holcroft added that suspending employees could be difficult as employment tribunals often disapprove of staff being removed from the workplace. But employers faced with similar situations needed to consider what measures were necessary to remove the risks posed by an employee who was being investigated, he said.
“This may mean requiring the employee to stay at home, but less severe measures such as extra supervision or a reallocation of certain duties, so that some normality for the employee can be maintained, may also be sufficient,” he said.
The inquiry recommended that any perceived risk to patient safety should result in suspension.
Niall Dickson, chief executive of the NHS Confederation, said: “Our thoughts are with the many victims who suffered needlessly at the hands of Ian Paterson and I hope that the strength of the recommendations in this report provides some reassurance that lessons are being and will be learned.
“We also need to send the right signals at national and local level that help to create safe cultures throughout our healthcare system – this is still a work in progress and part of it is making sure that staff at all levels feel able to speak up and raise concerns. This is what patients expect and deserve.”