The long awaited Paterson Inquiry report has come out today.

This report aims to address public concerns raised in part by the case of Ian Paterson, the breast surgeon who was convicted in 2017 of 13 counts of wounding with intent and three counts of unlawful wounding. Mr Paterson was jailed for 20 years.

Many independent sector providers have been working to improve practices in anticipation of this report, but it remains to be seen whether the Government considers that it has gone far enough and whether further regulation is needed.

In his opening statement, report author Bishop Graham James describes a “healthcare system which proved itself dysfunctional at almost every level”

The report criticises the large and uncoordinated group of regulatory bodies and the difficulties in navigating their areas of responsibility. 

The recommendations in the report (p.223) are:

1. A single database of consultants across England, setting out their practising privileges, critical performance data, including the number of times they have performed a procedure and how recently. This would be publicly accessible and mandatory;
2. Doctors in the NHS and independent sector to write to patients outlining their treatment in simple language and copy this letter to the GP rather than the other way round;
3. Differences between the organisation of NHS and independent sector care to be explained to patients in the independent sector (including those treated in the sector but funded by the NHS) to also encompass practicing privileges, indemnity and provision of emergency care;
4. All patients to be allowed a short period to reflect on diagnosis and treatment options before they consent to any treatment;
5. Each patient with breast cancer to have their case discussed at an MDT, whether in the independent sector or the NHS, with the CQC to have responsibility for ensuring compliance;
6. Information about complaints pathways to be communicated more effectively in the NHS and independent sector and private patients to have the right to mandatory independent resolution of their complaint;
7. A national framework or protocol with guidance to address recall communication and management;
8. Urgent Government reform of discretionary indemnity;
9. The system for collaboration of regulators to be reviewed with the Government to ensure that it serves patient safety. 
10. Hospital investigation of a healthcare professional’s behaviour to lead to suspension of the professional if any perceived risk to patient safety;
11. The Government to address the gap in responsibility and liability in the independent sector which remains unresolved;
12. Apologies from hospitals to be made immediately when things go wrong;
13. The Government to ensure that arrangements made in response to the recommendations are applicable across the whole of the independent sector (private, insured and NHS funded), as a qualifying condition for independent sector providers to do NHS work

The recommendations made in this report raise many questions about implementation and suggest that a statutory framework may be the solution to the problems raised. The likelihood of this intervention will be increased if the NHS and private sector fail to take adequate steps to implement these recommendations now.

There is no doubt that the independent healthcare sector has sought to pre-empt these conclusions in the Medical Practitioners' Assurance Framework. We will be looking to see over the next few months or perhaps years, whether the Framework provides sufficient reassurance to the Government. At the very least, we can assume that changes to the practice of discretionary indemnity are in the offing.

This insight is an introduction to the issues raised by the inquiry and its recommendations. We aim to explore both as they touch on the independent sector, insurers and the NHS in further publications and will be hosting a seminar over the coming weeks. For further information please contact Majid Hassan, Anna Walsh, Ian Cooper or Sarah Bryant.