Publication of the Verita Executive Summary and Recommendations
Spire Healthcare welcomes the report it has received from Verita of the governance arrangements at Spire Parkway and Little Aston hospitals in the light of concerns raised about the surgical practice of Mr Ian Paterson, a consultant surgeon employed by the Heart of England NHS Foundation Trust, who also operated in Spire’s Parkway and Little Aston hospitals.
The Report was commissioned in April 2013 and, following a scoping exercise, work began in July 2013.
The Spire Healthcare Board, including its Clinical Governance and Risk sub-committee, has read the Report and noted its contents. It has already discussed in great detail with Spire’s management team their rigorous plans to improve Spire’s processes, and confirms that the Recommendations set out in the Report will be implemented in full. In addition it was discussed at the Medical Advisory Chair’s Committee meeting held on 28 February.
Spire has today published on its website the Executive Summary and Recommendations from the Report, and a summary of its planned actions in response.
Reason for commissioning the Review
Spire commissioned the Report in order to understand fully the circumstances that enabled Mr Paterson to practise as he did. We are committed to making sure all possible lessons are learned from this event and our goal is to provide assurance that the actions that have already been taken, and will be taken in response to the Recommendations in this Report, will together ensure that this situation can never happen again.
Verita is an independent consultancy that has advised on a number of high profile cases, within the NHS and other public sector organisations, and has a wealth of experience assisting with governance reviews and public enquiries. For more information please visit www.verita.net
Scope of the Report
Verita was asked to:
- Produce and comment on a detailed timeline setting out what the two Spire hospitals (Parkway and Little Aston) knew about Mr Paterson’s clinical practice, when they knew it and the action they took by way of response
- Set out the relevant governance arrangements in place at the hospitals from 2007 onwards (previous to this the Spire group had been part of Bupa) and to report on the extent to which they were complied with
- Comment on any changes already made to Spire’s governance arrangements after matters concerning Mr Paterson coming to light
- Report on any other relevant matters that arose in the course of the review
- Engage with patients who wished to contribute to the independent review
- Provide a written report containing clear Recommendations aimed at learning lessons from these events.
Contributors to the Report
In order to make the Report both as comprehensive as possible, and a powerful tool for learning in what has been an unprecedented clinical review process for both Spire and the wider UK healthcare sector:
- Spire wrote to over 700 patients, who had been treated by Mr Paterson and subsequently recalled by Spire, inviting them to participate within the terms of reference
- Verita itself:
- invited patients to participate via its website
- contacted two law firms representing approximately 250 patients to ask if any of their clients wanted to contribute
- spoke with Solihull Breast Friends, which then publicised the review in a newsletter and on Facebook.
Mr Paterson himself was requested to take part but declined to do so.
Verita analysed over 5,500 pages of documentation, and conducted 47 interviews, including with patients, senior Spire managers, current and previous Spire CEOs, the Spire group medical director, the medical director of the HEFT, fellow consultants of Mr Paterson, and General Practitioners who had referred patients to Mr Paterson.
Findings and Recommendations
There were a number of findings identified by Verita, which included the following:
- Between December 2007 and August 2011, there were a number of key events and missed opportunities at Spire Parkway and Spire Little Aston to have monitored Mr Paterson’s practice and behaviour and taken action
- Mr Paterson continually breached Spire’s practising privileges policy and these breaches should have been a warning that Mr Paterson had shown himself unwilling to comply with Spire’s policies and procedures
- During this period there was poor communication between the Heart of England NHS Foundation Trust (HEFT) and Spire about HEFT’s investigation into Mr Paterson
- Our systems and processes for the monitoring of consultant practising privileges at the two Spire hospitals (including the work of the medical advisory committees, process for consultants appraisals, review of clinical outcomes, and handling of complaints and concerns) are in need of review
- Criticisms were made of our patient recall process and the expediency of our review.
There are 15 recommendations in the report and we will be implementing all of these. The recommendations include as follows:
- Discussions of the medical advisory committee and any sub-committees should be properly recorded in the minutes. Agreed actions should be confirmed as followed up and closed down and documented in subsequent meeting minutes
- The process for reviewing consultants’ practising privileges should be improved in a number of areas, including setting out the requirements for maintaining practising privileges, and the scenarios that may result in their suspension or withdrawal
- Spire’s Group Medical Director should continue to look at ways of improving data collection and analysis to make it easier to compare and benchmark consultant clinical outcome data across Spire hospitals (and ideally with surgeons in the NHS)
- Information on adverse events should be recorded in consultant practising privileges files, form part of the information hospitals make available to the NHS appraiser as part of whole practice appraisal, and reviewed by the medical advisory specialty representative before making their recommendation to the Hospital Director as part of the biennial review of practising privileges
- Job descriptions for Hospital Directors and Matrons should be reviewed to ensure they clearly reflect their responsibilities for granting, reviewing and withdrawing consultants’ rights to practice at a Spire hospital
- The Hospital Directors should ensure that consultant surgeons operate only on patients with breast cancer when there is evidence that they have undergone ‘triple assessment’ and been discussed at an appropriate multidisciplinary team meeting
- Arrangements should be put in place to ensure that senior members of staff and medical advisory committee members are informed if a consultant is under investigation by a NHS trust or by the hospital itself
- Spire should review its arrangements for reviewing and recalling Mr Paterson’s remaining patients in order to ensure that it has processes and resources in place to establish as quickly as possible which of Mr Paterson’s breast and non-breast patients have had inappropriate or unnecessary surgery.
The Executive Summary and Recommendations can be found in the attached document.
Spire response to the Report and Further Actions
Spire takes its responsibilities towards its patients very seriously. In this regard, Spire fully accepts the Report and all the Recommendations set out therein. A number of the Recommendations made by Verita have already been addressed by Spire and the rest are being implemented as a priority.
Spire’s non-executive directors will take an active role in implementing the Recommendations, and Spire will itself publish progress on implementing the Recommendations and further actions (see below) after 12 months.
Although the Verita Review was limited to Spire Little Aston and Parkway Hospitals, Spire has decided that these steps, to reinforce its governance processes, shall in any case be adopted across the entire group.
In addition to the Verita Recommendations, Spire has itself decided to take the following further actions to improve its processes:
- Strengthening our whistleblowing policy to include the raising of concerns by non-employed healthcare professionals, including other doctors
- Appointment of a Head of Regulatory Assurance to assess and provide regular assurance of business compliance with healthcare-related regulatory and statutory requirements
- Addition to Spire’s national annual audit programme of (i) an audit of practising privileges documentation and (ii) a biennial review of consultants across all hospitals
- Development and rollout of a corporate practising privileges database to enable relevant up-to-date information (including on individual adverse events) to be stored for individual consultants
- Engagement with the Association of Independent Hospitals Organisation (AIHO, of which Spire is a founding member), the General Medical Council and the England Revalidation Board on developing a more robust means of monitoring a consultant’s scope of NHS practice
- Development of a standard service level agreement for hospitals to use with local NHS Trusts to formalise arrangements for discussion of cancer patients at a peer reviewed multi-disciplinary team (MDT) meeting
- Roll out of an electronic MDT platform to create an electronic record for Spire cancer patients, and to facilitate MDT discussions either in-house or by NHS Trust MDTs
- Taking advice on the drawing up of a ‘recall protocol’ which will detail how any future patient recall processes will be implemented, managed and reported.
Spire also intends to share its learnings from the Report with other hospital groups in the private healthcare sector in order to disseminate and drive best practice in the sector.
Continuation of the recall
Although the Report has been issued, Spire’s team leading the review and recall of patients will look for and enact opportunities to expedite the assessment of Mr Paterson’s remaining patients as soon as possible. We continue to encourage any patient with concerns to contact us, on 0800 044 3134 where they can arrange to speak with our professional medical staff.
Comment from Spire Healthcare’s Chief Executive
Rob Roger, Chief Executive of Spire Healthcare, said: “We give a full and unreserved apology to all of the patients and their families for any distress they have suffered as a result of their treatment by Mr Paterson while he was a surgeon at the Spire Parkway and Little Aston hospitals. I would also like to apologise to the professionals who raised concerns at the time Mr Paterson was practising.
“Verita’s independent Report makes for difficult reading and we intend to learn from this incident. The commissioning of the Report, our commitment to implementing all of its Recommendations and our decision to take further actions beyond the Report’s Recommendations, are all designed to try to ensure that this will not happen again in any Spire hospital.
“This has been a challenging situation for everyone involved, and we will continue to ensure our patients affected by this are cared for. I know there are some patients who feel our recall process should be improved and I wish to emphasise that we are looking at our process now to further improve this.”
Dr Jean-Jacques de Gorter, Spire’s Group Medical Director, said: “We are committed to the full implementation of Verita’s Recommendations and to share our learning with colleagues across all independent hospitals.”
Helpline and enquiries
If any patient has immediate concerns they should call our dedicated phone line, 0800 044 3134, where they can arrange to speak with our professional medical staff.