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Sir Ian Kennedy Review – Heart of England NHS Foundation Trust

By Senior Associate, Clinical Negligence

It has been over two months since the Heart of England NHS Foundation Trust announced that it had asked Sir Ian Kennedy, an eminent academic lawyer and the man responsible for the Bristol Report in . Sir Ian Kennedy is chairing the independent review into the management of concerns regarding breast care services at Solihull Hospital, arising from incomplete mastectomy procedures and other questionable treatment such as unnecessary lumpectomies and lymph node removals .

Sir Ian Kennedy

Sir Ian Kennedy has a strong background in dealing with such issues as those caused by Mr Paterson’s practices and indeed he is no stranger to controversy. Sir Ian has been a member of numerous committees and inquiries. For nine years, he was a member of the General Medical Council. In 1978, he founded the Centre of Medical Laws and Ethics, of which he later became president.

Most notably, he chaired the public inquiry into children's heart surgery at the Bristol Royal Infirmary (1998–2001), which concluded that paediatric cardiac surgery services at Bristol were "simply not up to the task", because of shortages of key surgeons and nurses, and a lack of leadership, accountability, and teamwork. This resulted in his becoming chair of the Healthcare Commission, from its creation (in shadow form) in 2003, until it was merged with other regulatory bodies to form the Care Quality Commission in 2009. In October 2009, Kennedy became chair of the King's Fund’s inquiry into the quality of general practice in England, replacing Niall Dickson.

It will therefore be comforting to patients of Mr Paterson that someone with such a reputation for upsetting the medical hierarchy is at the helm of this investigation. Indeed, Sir Ian Kennedy invited breast cancer patients who were treated by surgeon, Mr Ian Paterson, at Solihull Hospital to a meeting on Wednesday 13th March at the St John’s Hotel in Warwick Road, Solihull.

The Meeting

The meeting was said to be for the purpose of providing past patients “with the opportunity to share their experiences of how the hospital managed their concerns and issues relating to incomplete mastectomies. Those attending will also discuss whether the actions taken in response were appropriate, and carried out in a timely manner. This will form part of Sir Ian Kennedy’s evidence gathering.” More information about the remit of the investigation can be found on the dedicated website set up by the Trust in relation to this review.

There were 49 people who attended the meeting including the writer. The attendees were patients of Ian Paterson and their friends and family. Sir Ian emphasised that he wanted everyone to share their experiences not only with the rest of the attendees but more importantly, to get in touch with him to arrange a meeting or to send him a detailed description of their experience. He promised to read every single complaint or letter received and to consider absolutely everything he could.

Quite rightly there were questions asked as to whether he could be sure that he had access to all relevant documents held by the Trust which might be relevant to his investigation. Sir Ian assured the room that he was “confident” of full cooperation from the Chairman of the Trust. Several attendees raised the question of the 2003 and 2007 reviews into Mr Paterson’s practices undertaken by the Trust. We know that these were undertaken from Data Protection Act requests which have been made on this subject but as yet, we have been unable to obtain a copy of the review or any associated documentation which took place in 2007. Whilst Sir Ian was again “confident” that he would have everything he needed he couldn’t directly answer the question about whether or not he had seen or had access to those particular documents.

One of the most striking things about the meeting was the wealth of experiences that Mr Paterson’s patients brought to the table. Everyone had a different story, each one more distressing than the other. It is not just a case of Mr Paterson undertaking untested new surgical procedures such as the Cleavage Sparing Mastectomy (CSM) or of him performing unneeded and unwarranted surgeries (lumpectomies/ lymph node removal) but the way he did so to women who are at one of the most vulnerable points in their lives. They trusted him and he broke that trust. They are angry but what makes them more angry is the fact that there were a wealth of other medical practitioners with whom they came into contact throughout their treatment path and not one of those (until the brave whistle blowers got involved) did anything to assist these women. What was very clear was that these women are very angry, not just for themselves but importantly for those women who are no longer here to be angry for themselves as a result of Mr Paterson’s treatment of them.

Whilst the meeting may have been a useful voice for many women who feel that, even through the recall process, they have not been listened to or properly communicated with, it remains to be seen whether the views expressed to Sir Ian will ever see the light of day. We have to hope that he will employ the same tenor he has previously employed when dealing with such investigations. It is clear that this type of situation must never happen again. In the meantime though, the Heart of England NHS Foundation Trust has huge bridges to build with these women and their families and with the community as a whole.
If you have been treated by Mr Ian Paterson at Solihull or Good Hope Hospitals or the private hospitals, Spire Parkway or Spire Little Aston, and you would like your views to be heard, or you would like to investigate making a claim for compensation

Please get in touch with Emma Doughty, Nisha Sharma or Rebecca Brown.