Independent Inquiry into the Issues raised by Paterson

We recommend that there should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data, for example, how many times a consultant has performed a particular procedure and how recently. This should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and independent sector.

The Paterson Inquiry recommended creating a single, publicly accessible repository of consultants' whole practice across England. In July 2026, Baroness Merron of the Department of Health and Social Care stated that the National Consultant Information Programme covers National Health Service (NHS) practice and NHS-funded independent care, but does not record independent sector practising privileges (Baroness Merron, Jul 2026). The Minister added that patients cannot currently access this data, and incorporating independent sector care to achieve a single repository remains an ambition over time (Baroness Merron, Jul 2026). In a review dated April 2025 and published in February 2026, the Thirlwall Inquiry legal team found that creating a single repository presented challenges requiring further work across the system (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that it should be standard practice that consultants in both the NHS and the independent sector should write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient's GP, rather than writing to the GP and sending a copy to the patient.

In July 2026, Baroness Merron, Parliamentary Under-Secretary at the Department of Health and Social Care, stated that the NHS Standard Contract requires outpatient letters to follow Professional Record Standards Body guidance to write directly to patients, and that private providers must send letters detailing costs and procedures under a Competition and Markets Authority order (Baroness Merron, Jul 2026). In February 2026, the Thirlwall Inquiry legal team noted that guidance was published in 2018 and 2021, and recorded that exploring how to monitor progress and make the process easier for professionals remained to be done (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that the differences between how the care of patients in the independent sector is organised and the care of patients in the NHS is organised, is explained clearly to patients who choose to be treated privately, or whose treatment is provided in the independent sector but funded by the NHS. This should include clarification of how consultants are engaged at the private hospital, including the use of practising privileges and indemnity, and the arrangements for emergency provision and intensive care.

The Inquiry recommended explaining differences between National Health Service (NHS) and private healthcare. In July 2026, Baroness Merron of the Department of Health and Social Care stated that it had published patient experience minimum standards for NHS-funded elective care waiting lists, promising an update in due course (Baroness Merron, Jul 2026). The Thirlwall Inquiry legal team found in February 2026 that the government had accepted the recommendation (The Thirlwall Inquiry legal team, Feb 2026). In commentary of September 2024, published in February 2026, the department and NHS England stated that drafting patient information had halted before the July 2024 general election, leaving ministerial agreement on how to proceed outstanding (DHSC and NHS England, Feb 2026).

We recommend that there should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. The GMC should monitor this as part of Good Medical Practice.

In July 2026, Baroness Merron for the Department of Health and Social Care stated that NHS England has integrated decision support tools to facilitate two-stage decision-making that introduces a period of reflection before consent, alongside independent healthcare standards advising specific reflection time (Baroness Merron, Jul 2026). The Minister had affirmed in April 2026 that doctors are expected to follow General Medical Council guidance requiring that patients receive the time and support needed to make informed treatment decisions (Baroness Merron, Apr 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that while guidance from the council and other bodies indicated patients should have sufficient time to consider options, no defined period was required (The Thirlwall Inquiry legal team, May 2024).

We recommend that CQC, as a matter of urgency, should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings, including in breast cancer care, and that patients are not at risk of harm due to non-compliance in this area.

In April 2026, Baroness Merron of the Department of Health and Social Care stated that the Care Quality Commission assesses multidisciplinary team working under its quality statement on how staff, teams, and services work together, and is consulting on sector-specific hospital frameworks where this would be assessed in future (Baroness Merron, Apr 2026). The department and NHS England previously noted in an update published in February 2026 that the commission will reflect specific cancer team prompts in service-specific guidance (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team found that the commission had added prompts on multidisciplinary teamworking to its diagnostic imaging inspection framework (The Thirlwall Inquiry legal team, May 2024).

We recommend that information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector.

The Inquiry recommended more effective communication on escalating healthcare complaints to independent bodies. In commentary of September 2024, published in February 2026, the Department of Health and Social Care and NHS England stated that the Parliamentary and Health Service Ombudsman had rolled out standards requiring complaint escalation routes to be communicated across NHS services, while the Independent Sector Complaints Adjudication Service incorporated these standards for private providers (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team found that the Care Quality Commission had strengthened guidance expecting patients to have access to independent resolution (The Thirlwall Inquiry legal team, May 2024).

We recommend that all private patients should have the right to mandatory independent resolution of their complaint.

In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England reported that complaint standards had been rolled out and that independent resolution for private providers operated through the Independent Sector Complaints Adjudication Service's voluntary scheme (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team found that the recommendation was accepted in principle, noting that 94% of recorded private patient episodes were with providers subscribing to the service (The Thirlwall Inquiry legal team, May 2024). The department had previously decided in December 2022 that amending legislation to mandate independent complaint resolution was disproportionate after finding that 98% of patient episodes already had access to resolution (Department of Health and Social Care, Dec 2022).

We recommend that the University Hospitals Birmingham NHS Foundation Trust board should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen.

In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England reported that University Hospitals Birmingham NHS Foundation Trust had contacted all known living patients of Ian Paterson by August 2020 and reviewed their care by June 2021 (DHSC and NHS England, Feb 2026). They noted that the trust continues to support relatives of deceased patients who make contact, offering detailed reviews and meetings to discuss findings (DHSC and NHS England, Feb 2026). In its February 2026 review, the Thirlwall Inquiry legal team found that the recommendation had been accepted in full and that the trust had carried out the patient contacts and care reviews (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that Spire should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen, and that they should check that they have been given an ongoing treatment plan in the same way that has been provided for patients in the NHS.

The Inquiry asked Spire Healthcare to recall Ian Paterson's patients and provide treatment plans. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England reported that the provider had finished reviewing all known living patients (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team found in February 2026 that the provider had contacted all known living patients by December 2020 and reviewed nearly all affected patients by its 12-month update (The Thirlwall Inquiry legal team, Feb 2026). In the same commentary of September 2024, published in February 2026, the department and NHS England noted that the helpline remains open, reviews of deceased patients continue, and legacy computer systems are still being checked to contact any omitted patients (DHSC and NHS England, Feb 2026).

We recommend that a national framework or protocol, with guidance, is developed about how recall of patients should be managed and communicated. This framework or protocol should specify that the process is centred around the patient’s needs, provide advice on how recall decisions are made, and advise what resource is required and how this might be provided. This should apply to both the independent sector and the NHS.

The Inquiry recommended creating a national framework to guide NHS and independent sector patient recalls. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England stated that the National Quality Board (NQB) published the framework in 2022 to guide patient-centred recall and that the Care Quality Commission (CQC) incorporated it into assessments (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team noted that the framework had been published in June 2022 following the government's acceptance of the recommendation in full (The Thirlwall Inquiry legal team, May 2024).

We recommend that the Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals in light of the serious shortcomings identified by this Inquiry and introduce a nationwide safety net to ensure patients are not disadvantaged.

In June 2026, Baroness Merron stated for the Department of Health and Social Care that a sector-led voluntary Code of Practice introduced in January 2025 was undergoing an independent implementation evaluation, to be followed by an impact evaluation to determine whether further interventions are required (Baroness Merron, Jun 2026). Earlier, the Thirlwall Inquiry legal team found in May 2024 that reform of clinical negligence cover remained a challenging issue, with three options due to be explored through ongoing work (The Thirlwall Inquiry legal team, May 2024).

We recommend that the government should ensure that the current system of regulation and the collaboration of the regulators serves patient safety as the top priority, given the ineffectiveness of the system identified in this Inquiry.

The Inquiry recommended that the government ensure healthcare regulation and regulator collaboration prioritise patient safety. In June 2026, Baroness Merron of the Department of Health and Social Care stated that the government was consulting on draft legislation for the General Medical Council to deliver greater collaboration, with those provisions intended to roll out to other professional regulators later (Baroness Merron, Jun 2026). In a review dated April 2025 and published in February 2026, the Thirlwall Inquiry legal team noted that statutory instruments to modernise regulation and establish a duty to co-operate remained outstanding (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that if, when a hospital investigates a healthcare professional's behaviour, including the use of an HR process, any perceived risk to patient safety should result in the suspension of that healthcare professional.

In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England maintained that the recommendation was not accepted, stating that its underlying goals could be met through clear guidance and robust investigations (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team recorded in its February 2026 review that the recommendation had not been accepted by the government (The Thirlwall Inquiry legal team, Feb 2026). In their September 2024 update, the bodies noted that policy frameworks for raising concerns were being developed, alongside national people policy frameworks for providers to adopt locally, which will include a resolution framework (DHSC and NHS England, Feb 2026).

If the healthcare professional also works at another provider, any concerns about them should be communicated to that provider.

The Inquiry recommended sharing concerns about healthcare professionals with any other providers they work for. In commentary of September 2024, published in February 2026, the Department of Health and Social Care and NHS England reported that NHS Resolution guidance requires exclusion decisions to be communicated to other providers, while broader reforms to strengthen information sharing remained under consideration (DHSC and NHS England, Feb 2026). The department stated that the timing of legislative changes to the Medical Profession (Responsible Officers) Regulations 2010 was subject to the priorities of the new government (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team noted in February 2026 that further consideration within that regulatory review was awaited (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that the government addresses, as a matter of urgency, this gap in responsibility and liability.

In June 2026, Baroness Merron, Parliamentary Under-Secretary at the Department of Health and Social Care, stated that the Care Quality Commission expects independent sector providers to meet fundamental standards of care and can take enforcement action if they do not, with principles from the Medical Practitioners Assurance Framework now incorporated into inspections (Baroness Merron, Jun 2026). In February 2026, the Thirlwall Inquiry legal team found that the framework had been refreshed to clarify provider responsibility and that NHS Resolution had issued resources on excluding professionals, noting that issues relating to liability were addressed under another recommendation (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that when things go wrong, boards should apologise at the earliest stage of investigation and not hold back from doing so for fear of the consequences in relation to their liability.

In September 2024 commentary published in February 2026, the Department of Health and Social Care and NHS England described implementation as ongoing, noting that Care Quality Commission guidance clarifies that an apology does not amount to an admission of liability (DHSC and NHS England, Feb 2026). The department also highlighted that it had issued a call for evidence in May 2024 as part of a review of the statutory duty of candour (DHSC and NHS England, Feb 2026). In its review published in February 2026, the Thirlwall Inquiry legal team found that the recommendation was accepted in full and that compliance with the candour duty is assessed during regulatory inspections (The Thirlwall Inquiry legal team, Feb 2026).

We recommend that, if the Government accepts any of the recommendations concerned, it should make arrangements to ensure that these are to be applicable across the whole of the independent sector's workload (i.e. private, insured and NHS-funded) if independent sector providers are to be able to qualify for NHS-contracted work.

In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England confirmed that the recommendation was not accepted, explaining that differences in operational and governance models between the sectors require different approaches (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team noted in May 2024 that the recommendation was not accepted by the government and was due to be reviewed further (The Thirlwall Inquiry legal team, May 2024). The department had stated in February 2024 that "no further action has been taken in relation to this recommendation" (The Department of Health and Social Care, May 2024).