Findings from the Verita report

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 were taken in response to the Recommendations in this Report, will ensure that any future criminal activity is picked up much more quickly and acted upon, than it was in the Paterson case.

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 inquiries. For more information please visit www.verita.net 

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.

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 Heart of England NHS Foundation Trust (HEFT), fellow consultants of Mr Paterson and General Practitioners who had referred patients to Mr Paterson.

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) were 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 including the following:

• 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
• 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
• 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
• 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

Read the executive summary and recommendations document

Spire takes its responsibilities towards its patients very seriously. In this regard, Spire fully accepted the Report and its Recommendations.

Spire published its response to the Recommendations in 2014.

Although the Verita Review was limited to Spire Little Aston and Parkway Hospitals, Spire decided that these steps should be adopted across the entire group, to reinforce its governance processes.

In addition to the Verita Recommendations, Spire 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 roll out of a corporate practising privileges database to enable relevant up-to-date information (including on individual adverse events) to be stored for individual consultants
• 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 shared 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.