Reflecting on medical scandals and their impact on women

Earlier this month, CHPI held a screening at the Royal Society of Medicine of the recent ITV documentary “Bodies of Evidence” – a film which looked at the activities of the convicted breast surgeon Ian Paterson.

We were joined by an audience of over 100 patients, professionals, regulators, medical doctors, and campaigners to watch the documentary and to discuss it afterwards.

We did this because despite several inquiries dating back to the Rodney Ledward scandal in 2000, coroners’ inquests, health committee reports and promises of change there are outstanding gaps in the regulations designed to protect patients from harm, particularly in private hospitals. Getting the right people in the room to discuss the film was a good way of keeping the issue on the agenda and in the minds of those who may be able to bring about change.

The documentary, an uncomfortable watch to say the least, looked in detail at the conviction of Ian Paterson and the lengths patients and whistleblowers went to in order to bring him to justice.

It explains to the viewer how he performed hundreds of unnecessary operations mainly on women, side-stepping justice, gaslighting patients and other medics who raised concerns and using all the complexities of the healthcare system to cover up what he did. Despite many red flags, such as patients making complaints, colleagues raising concerns about the nature and volume of his caseload, and various internal investigations, Paterson continued to operate for years before being stopped.

But what we discussed in the Q&A after the screening reminded the audience that the Paterson cases are not the only examples of patient safety scandals affecting women. The recent medical devices review by Baroness Julia Cumberledge investigated the dangerous and detrimental use of vaginal mesh as well as interventions used in pregnancy like Sodium Valproate and hormone pregnancy tests like Primodos, despite warning signs and patients saying there was something wrong.

There are themes which run through all of these scandals: even with the current regulatory safeguards in place there is still the possibility of significant malpractice and it is more challenging to raise concerns in the private sector due to the lack of an effective complaints system. In addition, a significant majority of the patients affected in these cases are women.

Here are a few takeaways for CHPI and the rest of the audience after an informed and interesting discussion:

• If there is no systemic way to capture and triangulate the experience of patients who raise complaints or concerns about treatment, medical negligence is much less likely to be prevented. It’s what happened both for Paterson’s patients, and also for patients who were prescribed medical devices that were at best completely ineffective, and at worst maimed women and ruined lives.

• The volume of complaints and concerns about Paterson, vaginal mesh and other similar devices only reached a tipping point which led to action by the authorities after far exceeding the number one would reasonably expect to prompt an intervention. Almost regardless of the nature of the complaints, it is astounding how many patients can raise concerns and yet be written off as individual examples of poor practice or unfortunate accidental circumstances. Many felt that the bar needs to be set lower so that investigations are triggered earlier.

• There are some major data gaps, particularly in private hospitals and also in the monitoring of the side-effects of drugs and devices. Some of these gaps are elementary, for instance, basic information about the number of surgeries undertaken by private hospitals is not fully published, but neither is more complicated data about diagnosis and treatment decisions. The audience and panel also discussed the gaps in the MHRA systematically recording negative side effects reported by patients.

• It’s unclear where accountability ultimately lies when a doctor is providing services within a private non-NHS setting. It could be the General Medical Council – the regulator of the medical profession; - the NHS (if it commissioned a service from a private hospital) the Care Quality Commission, the Health and Safety Executive… or it could be none of these. Falling between the gaps is a real thing for patients when things go wrong. Some might argue – uncharitably - that each of these organisations know that they can pass the buck if questioned about their own responsibility but pretty much every inquiry into a patient safety scandal has highlighted how complex and fragmented healthcare regulation is in the UK.

• Although getting data and information from public sector organisations under the Freedom of Information Act is often difficult – as journalists and the team at CHPI have experienced – this lever does not exist in relation to private sector organisations even when they are providing services to the NHS. The team that made the documentary, which was directed by Ali Millar who has extensive experience of investigative work, encountered considerable resistance from private healthcare providers when requesting information but were unable to rely on the FOIA to assist. This leads to wider questions about the accountability and transparency of private companies particularly as more and more NHS services are contracted out to the private sector.

• Some of the legal professionals and doctors who attended our event claimed that there are “hundreds” of cases where patients receiving care in private hospitals have received unnecessary and harmful treatment which haven’t yet come to light – it is extremely worrying to think that the potential for another Paterson type scandal to occur still remains.

CHPI is continuing to work on patient safety issues – it’s been one of our core programmes of work for several years - because we know that without effective and reliable regulation trust in healthcare is undermined and patients will be avoidably harmed. We will also continue to focus on accountability since unless those providing health and social care are transparent and open in how they operate, public money is likely to be wasted and patients will remain unable to seek redress when things go wrong.