‘Bodies of evidence: the butcher surgeon’ shows us why a lack of oversight in private healthcare leaves patients open to dangerous practices
ITV’s Bodies of Evidence programme last week highlighted a massive betrayal of trust and one of the biggest ever medical scandals in the UK and makes it clear that the business model in the private hospital sector needs a radical overhaul to protect patients.
This disturbing documentary focused on the Birmingham surgeon Ian Paterson, currently serving a 20-year prison sentence for carrying out unnecessary operations on patients under his care. Much of the testimony came from women (with one man) who trusted Paterson implicitly and thought he had saved them from cancer, only to find out years later that both their immense anxiety and their surgery had been unnecessary.
Paterson worked as a breast surgeon for the NHS at Solihull hospital and at two private hospitals in Birmingham owned by Spire. He declined to provide any comments for the programme, but from archival film we see him throughout as arrogant, devoid of empathy, and failing to take any responsibility for his manifest betrayal of patients.
Having a lucrative private practice seems to lend an unwarranted aura of superior knowledge and skills, resulting in unmerited deference from both uncritical peers and managers. The question of why Paterson behaved as he did was hardly posed and remained unanswered, but it seems clear that the wealth gained from both operating on, and over investigating thousands of patients in the private sector allowed him to enjoy a lavish celebrity lifestyle as well as giving him kudos.
‘I am telling you that this operation is needed’
Patients interviewed were largely those who had private health insurance. Typically, they were referred because of a breast lump, being seen at a vulnerable time and falling under Paterson’s charismatic spell, describing him as a god-like figure who held their life in his hands. This perspective was reinforced by his breast cancer nurse colleague (seemingly besotted with him) and through the patient support group ‘Breast Friends’ of which he became patron as a way of further enhancing his image. He successfully promoted himself as ‘the finest breast surgeon in Birmingham’, driving an Aston Martin and living in an expensive Georgian house in upmarket Edgbaston.
Patients were often told that they needed radical surgery (breast removal with reconstructive surgery) while not being informed that laboratory examination of tissue had not actually shown malignancy and that in many cases no surgery was needed. For those with a postcode indicating an affluent area, NHS waiting times were exaggerated in the expectation they were then likely to opt for private care. One patient sadly summed up their experience as follows: ‘I was taken, lied to, drugged and body parts removed for no reason’. They spoke of profound loss of trust in the medical profession.
NHS managers slow to react
A newly appointed consultant colleague in Solihull raised concerns about Paterson in 2007 noticing that he railroaded management decisions about patients through the Multi-Disciplinary Team (MDT) meetings. He was asked by Paterson to undertake a breast removal in his stead, but insisted on seeing the results of investigations supporting the need for surgery.
In fact, the evidence pointed to a benign condition for which intervention was not necessary. Letters of concern were then sent to senior managers prompting an investigation. Although the subsequent findings confirmed inappropriate operations by Paterson and recommended that he worked for a time under supervision, the report was kept confidential, the whistle blower was moved to another hospital and Paterson allowed to work for another four years.
The light slowly dawns
A breast surgeon from Scotland who met Paterson described him as brusque, arrogant, rude and noted that he intimidated other colleagues. He felt that the Spire hospitals should have recognised that the very large numbers of patients being operated on raised significant concerns in itself. He also noted that Paterson had never trained to be a specialist breast surgeon and would not have had all the skills needed to manage this group of patients. The Spire MDT was either non-functioning or out of line with national guidance in not having a radiologist or pathologist contributing to assessment and decision making. In 2009 two General Practitioners complained to Spire about patients who were told they had cancer when this was untrue, and asked for an investigation. Rather than an independent audit, Spire gave the job to Paterson’s sycophantic breast nurse, by whom he was exonerated.
In 2009 Solihull hospital managers were moved to investigate Paterson’s practice once again, but allowed him to select the patients for review! The next year, a new chief executive began investigating in earnest. The fact that patients were being recalled was advertised in the press. Information gathered led to Paterson being suspended by the NHS in 2011, while Spire allowed him to continue to work for a further three months. When the whistleblowing consultant had presented Spire managers with evidence of Paterson omitting or disregarding investigation results, and carrying out unnecessary surgery and tests, they were persuaded by Paterson that this was a ruse to take his private work from him.
Justice of sorts
West Midlands police interviewed hundreds of patients and in 2017 the case against Paterson was heard in Nottingham Crown Court with ten of his private patients as witnesses. He was found guilty on 17 accounts of wounding with intent and sentenced to 20 years in prison. An inquiry was carried out by the Bishop of Norwich who talked to hundreds of patients and published a report in 2020. Over 11,000 patients had been under Paterson’s care, 6,500 at Spire hospitals. The Bishop told Spire to recall them all, but patients say little support was offered by the hospitals. Spire paid out £27m in compensation but did not attempt to identify all patients, and did not admit legal responsibility.
David Rowland from the Centre for Health and the Public Interest (CHPI) appeared in the programme and provided some further background information on the business model in the private hospital sector. CHPI published data on serious patient safety concerns in private hospitals following the Paterson inquiry, and exposed the proliferation of joint venture businesses between NHS medical consultants and healthcare companies. Rowland emphasised that the refusal by private hospital companies to accept full responsibility for what happens in their facilities (‘they are not our staff, they just use or facilities’) means that patients will always be at risk since there can be no guarantee of patient safety without full liability. Further, the regulatory regime which covers private hospitals does nothing to address this central weakness and has in most cases ignored or overlooked the extent to which patients have been put at risk. Spire’s main interest was pulling in consultants and maximising the number of operations with little or no management oversight. All this is even more concerning given the current government obsession with investing in the private health care sector rather than the NHS.
The Bishop misses the mark
The inquiry into Paterson led by Bishop Graham James failed to tackle the hugely problematic nature of the relationship between the private sector and the NHS. As pointed out by Rowland, investors in UK private hospitals must have breathed a huge sigh of relief on reading the bishop’s recommendations:
“At stake for the investors was the possibility that the Right Reverend Graham James would deem their business model so incompatible with the safety of patients that it would require fundamental reform. Yet rather than tackle the private hospital industry head-on, the bishop put forward a series of low-impact recommendations which will do nothing to prevent another Paterson, but instead leaves intact the archaic and dangerous form of medical practice that abetted him.”
Following on from Paterson, Spire was hit with another scandal when surgeon Michael Walsh working in Leeds was also found to have performed unnecessary surgery leaving many patients traumatised and with chronic pain. CHPI has made a number of important recommendations including that the surgeons and other consultants who work in privately run hospitals should be directly employed. In addition, the legislation governing private hospitals should be amended to make clear that all those who are registered with the CQC should be fully liable for all the services which are provided within them, including the actions of surgeons and other healthcare professionals. The government appears to have little interest in pursuing this. It is tempting to go even further and say that, given the current desperate crisis in the NHS with shortages of staff, beds and money, the best way for the independent sector to provide support would be for it to be taken into public ownership.
Dr John Puntis is Co-chair Keep Our NHS Public and a retired Consultant Paediatrician