Independent Inquiry into the Issues raised by Paterson

The Independent Inquiry into the Issues raised by Paterson, chaired by Bishop Graham James, examined the circumstances surrounding Ian Paterson, a surgeon convicted of wounding patients, and the wider patient safety, consent, complaints, indemnity, and regulatory issues exposed by his case across both the NHS and the independent sector. The final report, published on 4 February 2020, made 17 recommendations addressed principally to the Department of Health and Social Care, with others directed to the CQC, GMC, NHS England, University Hospitals Birmingham NHS Foundation Trust, and Spire Healthcare.

In its December 2021 response, the government accepted 9 recommendations, accepted 6 in principle, did not accept 1, and kept 1 under review. The single recommendation not accepted (12a) proposed automatic suspension of a healthcare professional where any perceived patient safety risk arose during investigation; the government stated that blanket automatic suspension could deter reporting and be disproportionate, and that suspension should be decided case-by-case. Recommendation 15, on extending standards across the independent sector's full workload as a condition of NHS contracted work, was not accepted but kept under review, with the government citing concerns about proportionality and unintended consequences.

The clearest published evidence of completed action concerns the patient recall recommendations. The government stated that University Hospitals Birmingham (Recommendation 7) and Spire Healthcare (Recommendation 8) had contacted all known living former patients, and that NHS England had published the National Quality Board Recall Framework (Recommendation 9) in June 2022. Recommendations on patient correspondence (2), consent reflection (4), complaint escalation signposting (6a), and board apologies under the duty of candour (14) are supported by published guidance, frameworks, and regulatory changes.

For several recommendations accepted in principle, the public record shows activity but no completed structural change. No single cross-sector consultant data repository (Recommendation 1), no published document explaining NHS and independent sector differences (Recommendation 3), no legislation for mandatory complaint resolution (6b), no mandatory indemnity regulation (10), no statutory cross-provider information-sharing requirement (12b), and no legislation closing the practising-privileges liability gap (13) have been identified to March 2026. On indemnity, the published response itself notes that the January 2025 Code of Practice is voluntary and does not constitute the mandatory safety net recommended.

The principal source for progress is DHSC and NHS England's own April 2025 update submitted to the Thirlwall Inquiry, which is a government account rather than an independent assessment. There is no GOV.UK implementation dashboard for this inquiry, and no independent verification of the government's stated progress has been identified.