Malpractice should be investigated proactively and holistically to identify underlying causesBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2510 (Published 23 May 2017) Cite this as: BMJ 2017;357:j2510
I question what a public enquiry into the Paterson case will achieve.1 The facts are already in the public domain, and the theme of institutional failure to act effectively is familiar to us all. Much more useful, in my view, would be a review of how healthcare is regulated and how concerns might better be handled in future.
Malpractice does not occur in isolation, yet no organisation, as far as I know, has the remit to investigate a concern in the context of the underlying failures of governance and systems—except perhaps the hospitals themselves. But time and again we see that hospital management are too concerned with limiting reputational damage—an inherent conflict of interest that will always exist.
The regulatory framework is fragmented. The General Medical Council’s purpose is to ensure that doctors on the register are fit to practise. The Care Quality Commission has a defined remit based on prescribed standards and does not investigate doctors at all. The Medicines and Healthcare Products Regulatory Agency looks at drugs and devices. Civil courts are concerned with compensation, and the criminal justice system requires proof beyond reasonable doubt that a law has been broken. None of these bodies identifies the underlying causes or deals with the problem holistically.
Although I cannot immediately suggest a definitive solution, the important question for the future is not what happened in this case but how all serious allegations should be handled and by whom. The answer might be as simple as having an investigation process or regulatory body that is independent of the management of the hospital in which the problems occurred and that is able to work proactively and across the boundaries of different regulators and interests.
Competing interests: I am an insurance medical officer who has raised concerns about doctors in the course of my work. These views, however, are my own and written in the capacity of a private individual.
Full response at: http://www.bmj.com/content/357/bmj.j2138/rr-3.