ABS Response to the Conviction of Ian Paterson

The Association of Breast Surgery would like to express its sympathy to the patients who have suffered as a result of Mr Paterson’s actions.

Although Mr Paterson has never been a member of the Association of Breast Surgery, the organisation views this incident very seriously. Work is ongoing to review the events that have occurred and identify lessons that can be learnt, both general and those specific to breast surgery. These will be disseminated to our members and those involved in breast care.

We would like to reassure patients that this incident reflects the actions of a single individual surgeon working outside acceptable standards of care and does not represent the current standard of breast care in the UK. The first priority of our members is always the health, wellbeing and safety of patients.

The Association of Breast Surgery constantly endeavours to raise the already high standards of breast surgery by providing members with ongoing education and training with support for research and national audits. These collectively aim to ensure the delivery of a high standard of breast surgery care throughout the UK.

Mark Sibbering (President)
on behalf of the Trustees of the Association of Breast Surgery
31st May 2017 

Summary of Key Recommendations (to date)

For Surgeons

The Association of Breast Surgery Trustees would like to remind all surgeons of their professional responsibilities and duties as highlighted in:

• GMC 2013 guidance, ‘Good Medical Practice’ 
• Royal College of Surgeons 2014 guidance, ‘Good Surgical Practice’ 

Safety and Quality of Care

Members of staff must be able, and feel able to express concerns about the safety and quality of care provided to patients and be listened to. When staff feel that their concerns are not being addressed appropriately within their organisation, they have a duty to raise them with the relevant professional regulatory body.

Multidisciplinary Team (MDT) Working

It is now widely accepted that breast care should be provided by breast specialists in each discipline and that multidisciplinary teams form the basis for best practice.

The principles of MDT meeting discussion are as follows and should be followed in both the NHS and in private practice:

• The discussion should occur before the final result is communicated to the patient.
• The meeting should be quorate with all required disciplines present. The diagnostic MDT meeting should include a pathologist, radiologist or consultant radiographer in breast imaging, surgeon or breast clinician and breast care nurse.
• The outcome of the MDT discussion should be accurately recorded.

Private Practice

• It is recommended that surgeons should always practise within the area of their specialty training, and that their scope of practice carried out in the private sector should be similar to that carried out in the NHS.
• All private practice workload should be included in annual appraisal discussions.
• All patients who undergo needle biopsy during assessment and all newly diagnosed breast cancer patients should be discussed at an appropriate multidisciplinary team (MDT) meeting.

Benign (non-cancer surgery)

Diagnostic Surgery

With appropriate use of the triple assessment process the number of patients requiring open diagnostic surgery should be minimal. All such cases should be discussed at a MDT meeting prior to the decision for such surgery.

Risk Reducing Breast Surgery

The Association of Breast Surgery has developed / adopted guidance relating to risk reducing surgery in women at increased risk due to a family history of breast cancer and contralateral mastectomy. 

The Association of Breast Surgery will look to develop clear guidance relating to risk reducing surgery for histological risk factors that increase breast cancer risk in collaboration with both patients and commissioners.

Consent

It is important to ensure genuine patient consent to treatment with full information, both in the NHS and with the same rigour in private practice.

For Patients

• Patients should not hesitate to ask questions of their surgeons.
• Breast care is delivered by specialist multidisciplinary teams. Individual care should be discussed by that multidisciplinary team and regardless of whether treated in the NHS or privately patients can ask to see documentation of the team discussions relating to their care when an operation or treatment is being recommended.
• Patients should not feel uncomfortable asking for a second opinion.
• If patients have any concerns about their treatment or are unsure how to proceed with a particular treatment, they should not hesitate to ask for a second opinion, and can contact the Patient Advice and Liaison Service (PALS) at their local hospital, who will be able to give guidance on this process.

To read the full list of recommendations please click here.