In 2007, a review of breast surgery services provided through Solihull Hospital, identified that a surgical technique performed for some mastectomies by one of our consultants, Mr Ian Paterson, required closer scrutiny to establish whether it represented best practice, based upon current clinical knowledge.

The technique involved performing the mastectomy and leaving behind a small amount of residual breast tissue to assist in providing an improved cleavage for the patient.

The Trust understands that this procedure was being carried out in good faith, believing it to be appropriate for patients, to achieve removal of the carcinoma, but with a better cosmetic result than a traditional mastectomy. This procedure was not performed on all patients undergoing mastectomy.

The review highlighted that this was not a usual procedure and the appropriate guidelines had not been followed to introduce this new technique. This Trust’s position, after careful consideration, was that the technique was not an approach considered appropriate going forward, and the method was therefore stopped.

Action taken

Letters were sent to all patients we identified through our records as having had mastectomies performed under Mr Paterson’s care at Solihull Hospital since 1998 and at Good Hope Hospital between 1994-8, inviting them to attend a special recall clinic to ensure we have reviewed their current clinical condition. The Trust has  seen and reviewed all those patients who responded to the recall letters.

We have and continue to work hard to increase our understanding of the clinical issues and any potential consequences of this procedure, and in order to help patients with their treatment decisions. The Trust has undertaken work with the West Midlands Cancer Intelligence Unit (WMCIU) in order to monitor recurrence rates, and we regret that we are currently unable to advise definitively upon whether patients who underwent a CSM are at a statistically greater risk of recurrence than if they had undergone a full mastectomy, as there is no published data available.

Part of the reason for undertaking a full recall, in addition to making sure patients are identified and reviewed, is to be able to gather data on this procedure, to identify whether there is any potential additional risk, or whether recurrences fall within the statistical ‘norms’ of recurrence.

Actions taken update: 9-01-2013
Leading healthcare lawyer to chair review of breast care services at Solihull Hospital

Sir Ian Kennedy has been invited by Heart of England NHS Foundation Trust to chair an independent review into the management of concerns regarding breast care services at Solihull Hospital, arising from incomplete mastectomy procedures.

“It was very important to us to make sure, first of all, that all of the patients concerned were seen and had their care reviewed and this is what we have been focusing on over the past 12 months,” confirmed Dr Aresh Anwar, medical director, Solihull Hospital.  “Now that this is completed we have, as promised, asked an experienced independent chair to look at the actions this organisation took, to see if there are lessons to be learned about how to raise concerns into clinical practice and how to take appropriate action.”

The Review will commence on Wednesday, 9 January 2013 and will also examine the timeline of information as it evolved, the Trust’s response to concerns raised by staff, patients and the public relating to incomplete mastectomies, and also consider whether the actions taken in response were appropriate, and carried out in a timely manner.

On completion of the evidence-gathering process, Sir Ian Kennedy will make recommendations to the Trust’s Board in a report that will be made publicly available. The report is expected to be completed in summer 2013.

Trust chairman The Right Hon. Lord Philip Hunt, said: “The Board fully recognises the concerns expressed by patients about the length of time taken to complete the clinical investigation and to take action.  It therefore wants a fully open, independently conducted review to determine whether there are lessons to be learned about how the organisation responded to the situation as it evolved, and how it might improve its response to concerns if they are raised in the future. We hope that this review may also assist the wider NHS when facing concerns about individual practitioners.”

Sir Ian Kennedy is an eminent academic lawyer and an expert in the law and ethics of health. He chaired the Bristol Royal Infirmary Inquiry, and is currently chairman of the Independent Parliamentary Standards Authority (IPSA), which independently monitors and controls MPs’ expenses, pay and pensions.

Sir Ian Kennedy, said:  “I am delighted to take up this commission and I am keen to talk to patients and staff as part of the evidence-gathering process.  I urge anyone who would like to talk to me about their specific experience to come forward. We have set up a dedicated website to keep everyone informed throughout the review process.”

Please get in touch

If you are a patient who has had a mastectomy at any time under Mr Paterson’s care at our Trust and has not been recalled to clinic or are concerned about the procedure you may have had, then we would invite you to contact us on the number below. We will then arrange for you to come to a special clinic to see an alternative surgeon for a review of your treatment and care. This includes patients who may have been discharged.

The contact number, 0121 424 5473, which is our advice line for mastectomy patients, is available between the hours of 9am and 12 midday, Monday to Friday with the opportunity to leave a message at other times. If anyone is at all concerned we would encourage them to get in touch.

For more information on the Review, please visit  www.breastcarereview.co.uk