Terms of Reference

Ian Paterson, a consultant who was employed by the Heart of England NHS Foundation Trust and practised in the independent sector at Spire Parkway and Spire Little Aston, was convicted of 17 counts of wounding with intent and 3 counts of unlawful wounding.  He was imprisoned in 2017.

In consequence, the Government committed to ensuring lessons are learned in the interests of enhancing patient protection and safety, both in the independent sector and in the NHS.

In December 2017, Philip Dunne MP, Minister of State for Health, established an independent, non-statutory Inquiry, under the Chairmanship of The Right Reverend Graham James, Lord Bishop of Norwich.

On his appointment, the Chair made a public commitment that the Inquiry would be informed by the concerns of former patients of Ian Paterson.  These terms of reference have been informed by a period of engagement during February-March 2018; the Inquiry Team met more than 150 patients and their families face to face, and received written observations from many more and from other interested parties.

Terms of Reference

  1. A central objective of the Inquiry is to afford former patients of Ian Paterson and their families an opportunity to tell of their experiences and to be heard.  The Inquiry will be informed by their concerns and it will examine and seek to learn from what happened to them, both in the independent sector and in the NHS.
  2. The Inquiry will consider issues raised in previous relevant reports about Ian Paterson, but does not intend to revisit the evidence that led to his conviction.
  3. The Inquiry will review the circumstances and practices surrounding Ian Paterson as a case study, and consider other past and current practices, so as to draw conclusions in relation to the safety and quality of care provided nationally to all patients.  The issues it will consider include:
    1. a comparison of the accountability and responsibility for the safety and quality of care received between the independent sector and in the NHS; including the roles of hospital providers and others in appraising, reporting, considering concerns and monitoring as regards healthcare professionals’ activity levels, conduct and performance;
    2. how and when information is shared between the NHS, independent sector, and others, including concerns raised about performance and patient safety;
    3. the arrangements for assuring that healthcare professionals maintain appropriate professional standards and competence, including appraisal, revalidation, scope of practice, and the role of hospital providers, professional and quality regulators, and other oversight bodies;
    4. multi-disciplinary working, including a comparison of practice in the NHS and the independent sector;
    5. the role of independent sector insurers, medical indemnifiers and medical defence organisations (including sharing of data);
    6. the arrangements for medical indemnity cover for healthcare professionals in relation to all patients receiving care in the independent sector, whether such patients are medically insured or their treatment is NHS-funded or self-funded;
    7. the means by which patients are referred from the NHS to the independent sector by individual healthcare professionals, including the role of NHS waiting times in relation to that practice;
    8. the adequacy of the response to patients following adverse incidents, including clinical recall, in both the independent sector and the NHS; and
    9. any other significant matters that may arise during the course of the Inquiry.
  4. The Inquiry will be restricted to matters concerning the treatment of patients in the independent sector and the NHS in England.
  5. The Inquiry will:-
    1. produce a report which will provide an overview of the information it has reviewed, and which will set out any findings of fact it has made and its recommendations;
    2. compile an annex to the report detailing the experiences of patients and their families; and
    3. if information is obtained in the course of the Inquiry, report any instances of apparent collusion or other conduct of concern (including conduct that indicates the potential commission of criminal or disciplinary offences) to the relevant employer(s), professional or quality regulator(s), and/or the police for their consideration.  The Inquiry does not have the power to impose disciplinary sanctions or make findings as to criminal or civil liability.
  6. The Inquiry will aim to report its conclusions and recommendations in summer 2019. The Inquiry will publish its report and the Secretary of State for Health will make arrangements for its presentation to Parliament.