Recommendations from the Paterson Inquiry cover medical indemnity, information to patients, consent, MDTs, complaints, patient recall, ongoing care, investigating health professionals, corporate accountability, and adoption of all these in the independent sector.
Information to patients
There should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data; for example, how many times a consultant has performed a particular procedure and how recently.
This should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and independent sector.
It should be standard practice that consultants in both the NHS and the independent sector to write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient’s GP, rather than writing to the GP and sending a copy to the patient.
Differences between how the care of patients in the independent sector is organised and the care of patients in the NHS is organised should be explained clearly to patients who choose to be treated privately or whose treatment is provided in the independent sector but funded by the NHS.
This should include clarification of how consultants are engaged at the private hospital, including the use of practising privileges and indemnity and the arrangements for emergency provision and intensive care.
There should be a short period introduced into the process of patients giving consent for surgical procedures to allow them time to reflect on their diagnosis and treatment options. The GMC should monitor this as part of Good Medical Practice.
Multidisciplinary team (MDT)
The Care Quality Commission (CQC), as a matter of urgency, should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings, including in breast cancer care, and that patients are not at risk of harm due to non-compliance in this area.
Information about the means to escalate a complaint to an independent body should be communicated more effectively in both the NHS and independent sector. All private patients should have the right to mandatory independent resolution of their complaint.
Patient recall and ongoing care
The University Hospitals Birmingham NHS Foundation Trust board should check that all patients of Paterson have been recalled and communicate with any who have not been seen.
Spire should check that all patients of Paterson have been recalled and to communicate with any who have not been seen, and that it should check that they have been given an ongoing treatment plan in the same way that has been provided for patients in the NHS.
Improving recall procedures
A national framework or protocol, with guidance, should be developed about how recall of patients should be managed and communicated.
This should specify that the process is centred around the patient’s needs, provide advice on how recall decisions are made and advise what resource is required and how this might be provided. This should apply to both the independent sector and the NHS.
The Medical Defence Union used its discretion to withdraw cover since Paterson’s activity was criminal, the report said, leaving patients without cover.
It recommended that the Government should urgently reform the current regulation of indemnity products for healthcare professionals ‘in light of the serious shortcomings identified by the Inquiry, and introduce a nationwide safety net to ensure patients are not disadvantaged’.
The Inquiry did not believe the creation of additional regulatory bodies provided an answer.
It said the Government should ensure the current system of regulation and the collaboration of the regulators served patient safety as the top priority ‘given the ineffectiveness of the system identified in this Inquiry’.
Investigating healthcare professionals’ practice and behaviour
If, when a hospital investigates a healthcare professional’s behaviour, including the use of a human resources process, any perceived risk to patient safety should result in the suspension of that healthcare professional.
If the healthcare professional also works at another provider, any concerns about them should be communicated to that provider.
Consultants’ private hospital engagement through practising privileges is recognised by the CQC, but this does not appear to have resolved questions of hospitals’ or providers’ legal liability for the actions of consultants, the Inquiry stated. It recommended the Government urgently addressed this gap in responsibility and liability.
When things go wrong, boards should apologise at the earliest stage of investigation and not hold back from doing so for fear of the consequences in relation to their liability.
Adoption of the Inquiry’s recommendations in the independent sector
If the Government accepts any of the recommendations, it should make arrangements to ensure these are applicable across the whole of the independent sector’s workload – i.e. private, insured and NHS-funded – if independent sector providers are to be able to qualify for NHS contracted work.