Paterson scandal: Is the NHS learning from mistakes?

Ian Paterson is serving a 20-year jail term for 17 counts of wounding with intent

Shipman, Mid Staffordshire, Morecambe Bay, and now Ian Paterson, the breast surgeon that performed botched and unnecessary operations on hundreds of women.

The list of NHS-related scandals has got longer. It's tempting to say the health service has not learned lessons even after a string of revelations and reviews. But is that fair?

The important point to make about Paterson, the rogue surgeon and the scandal which could have harmed more than 1,000 patients, is that it involved the private sector even more than the NHS.

The inquiry, chaired by Bishop Graham James, makes clear there were failings at every level of a dysfunctional health system when it came to patient safety.

• Surgeon wounded hundreds amid 'culture of denial'

• Paterson victims' families call for manslaughter charges

The public and private health systems did not compare notes about suspicious behaviour by a consultant.

Staff working with Paterson thought that his surgical methods were unusual but, perhaps cowed by being ignored after raising concerns, kept their heads down.

Add to that the power and status of a surgeon in the medical world and, in the words of the report, Paterson was "hiding in plain sight".

So could it happen again?

The bishop says it's clearly impossible to eliminate the activities of determined criminals in any profession.

He acknowledges that some improvements have been made on policing.

System-wide approach

But he says that a decade on from the Paterson scandal, he is not convinced that medical regulators, with a combined budget of half a billion pounds a year, are doing enough collectively or collaboratively to make the system safe for patients.

And that is the case, he believes, even after the former Health Secretary Jeremy Hunt pledged to prioritise patient safety in England and set up a specialist health investigations unit to probe major safety breaches.

The General Medical Council (GMC), which regulates doctors, offered an apology to patients who were let down and said a system-wide approach was needed to build on safeguards set up after the Paterson scandal.

There was an acknowledgment that more had to be done and regulators needed to work more closely together to protect patients.

The Care Quality Commission, the Nursing and Midwifery Council and the Professional Standards Authority for Health and Social Care are other watchdogs mentioned in the report.

The review chair notes tellingly that while regulators spoke of major improvements which should identify another Paterson, some doctors and nurses had told the inquiry that it was "entirely possible that something similar could happen now".

Question of trust

It's worth remembering that the NHS was ranked top in a comparison of 11 countries by the US think tank the Commonwealth Fund in 2017.

The report praised the UK health service for the safety of its care and systems to prevent ill health.

Nearly 17 million patients per year are admitted to hospitals in England for some sort of procedure or operation. Much of NHS care is first rate.

The fact that the NHS and the private sector are jointly held responsible for failings over Paterson is a reminder that the health service is not intrinsically less safe than independent providers. Far from it.

The review goes as far as to suggest that if private hospitals lag behind the NHS in implementing the report's recommendations there should be no more state funding of treatment in the independent sector.

This is ultimately a question of trust in health professionals wherever they work.