Ian Paterson, a former surgeon, has been jailed for 15 years for performing unnecessary operations on patients who trusted him. He was convicted of 20 counts in total, but it’s possible many more people suffered needlessly at his hands. This can be avoided in the future.
Jeremy Hunt, the Secretary of State for Health, has said there will be a ‘comprehensive and focused inquiry to ensure that any lessons are learnt…’ Quite how Mr Hunt proposes to be both comprehensive and focused remains to be seen. Perhaps the inquiry should also be both top-down and bottom-up, the better he may straddle the issue. Nevertheless, learning lessons from such a dreadful series of events is a good thing, and I welcome the peering-through of whatever magnifying glass or telescope he proposes.
However, lessons have already been identified, and examined, and revisited, and relearned, presumably by experts and very important senior people. And yet for all this, it was a patient – one of Paterson’s victims, John Ingram, who identified and clearly articulated what needs to be done.
‘We need a robust method of peer review of the actions of these surgeons…’ he said.
Clearly, people had plenty to say about Paterson. The review by Sir Ian Kennedy into the affair mentions a few. According to Kennedy, Paterson was ‘autocratic,’ ‘well-known as being difficult,’ ‘not a team-player,’ ‘high-handed to the point of being dismissive of colleagues,’ and ‘challenging.’ Several staff described him as arrogant and a bully.
A surgeon struts around the hospital doing his best impression of Kim Jong-un, and his actions don’t quite breach the threshold for taking action. If that’s the case, the threshold is wrong. John Ingram has given us the solution, now we need to implement it.
‘A robust method of peer review’ must include all colleagues who work with an individual. Junior doctors, nurses, healthcare assistants, physios, porters. Everyone’s opinion is worth hearing, and ignoring what people say out of hand because of their position is irresponsible.
What constitutes a ‘peer’ here is important. It’s not a matter of seniority or clinical experience. I’ve heard of more cretaceous consultants not considering junior doctors as ‘colleagues’ (and certainly not peers). This cannot stand; in fact hearing a dinosaur express such a view should at the very least raise an eyebrow. A cleaner might not know if an appropriate amount of tissue was excised in an operation. They do know about the hospital, and some of the people in it, and if they see someone making their junior doctors cry. Their opinions must be sought.
Behaving autocratically and in a bullying manner is incompatible with being an effective and safe clinician. Bullying behaviour comes from many sources, but it does not originate in the confident calm brain of a capable scientist, well-used to questioning themselves and critically appraising their work. Being ‘technically brilliant’ is no excuse, and in fact is usually an illusion the dictator creates and promotes, better to hide their inadequacies. Any glossing-over of this type of behaviour by senior clinicians or managers or policymakers should be seen for what it is – collusion.
Sadly, this collusion permeates the NHS at all levels. Dr Chris Day’s ongoing battle to protect the rights of junior doctors to raise concerns shows that a lot of effort is still being expended to ensure people in the NHS keep their mouths shut.
While those gags to raising concerns remain firmly tied on, doctors like Paterson will continue to be exposed now and again. It is disappointing that Kennedy’s report makes only passing reference to this, and directs most of its recommendations at the Board of the Trust, rather than detailing cultural changes that could defend us against these people.
Such changes would not even be expensive to implement, and would save money. Allowing people to raise concerns with genuine protection (and genuine safeguards against vexatious claims) may cause some wobbles as dodgy doctors are named and shamed. But this would just be the drainage of unwanted pus. Prioritising the elimination of Paterson’s type of behaviour will give his sort nowhere to hide. There will be fewer patients injured needlessly, and fewer settlement payouts from the NHS. Insurance premiums will go down. More money will be available for patient care. Staff will be bullied less. They will be happier and more productive. They will feel their opinions matter more. They will suggest new ideas. Some will be worth implementing. Patients get even better care. It’s a complete no-brainer.
This is why I welcome Jeremy Hunt’s oxymoronic plan for an inquiry, despite a sad suspicion nothing will change as a result. Certainly, we know enough already to make useful changes, without using the ‘wait for the report’ excuse to avoid actually doing anything.
A proper inquiry will find that transparency and honesty about how our colleagues behave is our best preventative medicine against the ugly festering boil of bullying. It will acknowledge that the people on the ground see quite a lot of stuff that is concerning, and yet don’t currently operate in a system which allows them – really allows them – to raise those concerns and have those concerns taken seriously. And it will highlight that bullying behaviour is not just something that juniors have to deal with, but that it’s a reliable way of identifying an ineffective clinician who is a risk to patients.
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