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RCS calls for the government and health bodies to accelerate improvements in private hospitals

04 Feb 2020

The Paterson Inquiry is due to publish its report on Tuesday 4 February 2020. Ahead of this imminent report, the Royal College of Surgeons England [“RCS”]:

  • sets out the background to this Inquiry
  • ·outlines the recommendations RCS has put forward to the Inquiry, and our work with other stakeholders to improve oversight and standards of care in the independent sector


In December 2017, the government launched an independent national Inquiry following the malpractice of jailed surgeon, Ian Paterson. Despite concerns raised about his professional competence and conduct, Paterson was allowed to continue working for over a decade across the NHS and independent sector. His trial established that this rogue surgeon had undertaken numerous unnecessary breast operations over many years, causing appalling harm and distress to dozens of patients. This raised a series of questions about how surgery in the independent sector is regulated and assured, and about the oversight and governance of doctors who work across the NHS and independent sector.

Key recommendations and ongoing work by the RCS and other bodies to assure standards in the independent sector

The President of the RCS, Professor Derek Alderson, gave oral evidence to the Inquiry in September 2018.  He called for equivalent and consistently high standards of care to be enforced in both the NHS and the independent sector, to improve patient safety.

RCS has been working with government, regulators and providers to take forward action in several areas, including:

  1. Independent sector participation in clinical audits: The independent sector does not actively contribute to the majority of national clinical audits that collect data on care outcomes, including cancer audits, despite the fact that many independent providers regularly offer cancer treatment. The RCS has been working with the Healthcare Quality Improvement Partnership to address barriers to independent sector participation in clinical audits. Pilots are underway now to include breast cancer and cataract surgery undertaken in the independent sector in national audits.


  2. Improved data collection and publication: The RCS is aware that patients often turn to the independent sector to access new surgical procedures or treatments that are not routinely available in the NHS. However, many such innovations are introduced without being registered, and there is no long-term follow-up data. The RCS has been calling for all new surgical procedures and devices used in either the independent or NHS sectors to be registered, with related data collected in the appropriate national audits, before they are offered to patients.


  3. Greater oversight of clinicians working in the independent sector: RCS is part of an expert advisory group that recently developed a new Medical Practitioners Assurance Framework. This aims to improve clinical governance in the independent sector, and was launched by the Independent Healthcare Providers Network of the NHS Confederation.  


  4. Improving patient safety investigations: The government is planning to establish the Health Service Safety Investigations Body [“HSSIB”] through a Bill to be re-introduced in this parliament. As currently construed, the new body will not have authority to investigate patient safety incidents in the independent sector, unless they are funded by the NHS. The RCS is pushing for an amendment to the Bill to make sure the HSSIB has the power to investigate all patient safety incidents that occur in the independent sector.


  5. Improved surgical training: RCS has recommended that, in order to improve surgical training opportunities in the NHS-funded independent sector, a national framework for training should be established. This would have the added benefit of ensuring consistent standards of training, streamlined funding and indemnity arrangements are in place. The RCS has been leading work on this.

Commenting ahead of publication of the Inquiry’s report, Professor Derek Alderson, President of the Royal College of Surgeons England, said:

“While this Inquiry cannot undo the terrible consequences of Paterson’s criminal actions, its findings will be extremely important for patient care across the NHS and independent sector.  The vast majority of doctors perform their work to a high standard with the utmost care for their patients. However, we must do everything possible to ensure that a rogue individual cannot do so much harm to so many, ever again.

“We hope the Inquiry has taken our evidence-based recommendations on board and will continue to work with organisations responsible for regulating surgery and monitoring clinical practice. It is the responsibility of us all to ensure robust protections are in place across the independent sector.”

Notes to editors

  1. The report will be presented in the House of Commons on Tuesday 4 February and will be available on
  2. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.
  3. For more information, please contact the RCS press office: telephone: 020 7869 6047; email:; out-of-hours media enquiries: 07966 486832.

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