For most people the main problem with surgery is the wait to be seen rather than worrying about the quality of the treatment. This is a reasonable assumption to make, since most surgeons are performing operations and procedures to the high standards expected by their own professional association. But there are a concerning number of exceptions here in the North East and beyond that raise questions of an individual and systemic nature.
Two local cases
Two cases in this region are currently attracting unwelcome headlines. First, that of Dr Amir Bhattii, the surgical lead on breast cancer at County Durham & Darlington Foundation Trust (CDDFT), where hundreds – possibly thousands – of women, are pursuing claims of medical negligence. The allegations cover every point of the patient journey from missed diagnoses to unnecessary surgery and inconsistent review. The human tragedy arising from this has been captured by the BBC Look North health correspondent, Sharon Barbour, in a compelling documentary, Hidden Scars, which is available on BBC iPlayer.
The second case concerns consultant orthopaedic surgeon, Leslie Irwin, a hand and wrist specialist, who practised at Sunderland Royal Hospital and the private Spire Hospital in Washington. He is now under investigation for allegedly performing numerous unnecessary and harmful surgeries on multiple patients. At this stage the concerns only relate to surgery at the Spire Hospital but in the meantime – unlike Dr Bhatti – he has relinquished his registration to practise with the General Medical Council.
This is far from being a regional problem. National headlines have recently been generated by the treatment of children at Great Ormond Street Hospital by orthopaedic surgeon Yaser Jabbar. In this case dozens of children are thought to have been left with life-changing injuries over a five-year period of interventions by Jabbar, a lower limb reconstruction specialist. He no longer has a licence to practise medicine in the UK but continues to operate on children in Dubai.
Medical negligence claims
These incidents, and others like them, draw attention to a relatively unnoticed ethical and financial challenge facing the NHS – the scale of medical negligence claims. To some extent these are now seen as anticipated outcomes of an over-stretched service and can arise in a variety of ways: misdiagnosis or delayed diagnosis; birth injuries; failure to obtain informed consent; medication errors; and – as with the cases above – surgical errors.
The sums involved in settling claims are now a huge drain on NHS finances and are growing fast. A recent report from the House of Commons Public Accounts Committee reported that £3.6bn was spent on settling claims in 2024-5, and that the NHS’s total liabilities for medical negligence have hit an ‘astounding’ £60bn. The latter sum is so huge that it is the second-largest liability across the whole of government, with only nuclear decommissioning more costly.
The reasons behind this seemingly exponential rise are complex and include: more awareness on the part of patients; the growth of specialist medical negligence solicitors; the high-value settlements arising from lifetime care needs; and the systemic strain of under-funded services and workforce shortages. But what of the specific types of case arising from the stories of Bhatti, Irwin and Jabbar, outlined above? Here, two recurring strands give rise to concern: use of the private sector and problems of governance and culture.
The private sector
In the case of Bhatti there was an extraordinary contracting out of NHS breast cancer services to two private providers – Spire Healthcare Ltd and Durham Surgical Services – from 2012 onwards. Both clinics were led by Bhatti himself whilst he was also the surgical lead within CDDFT. To confound matters, CDDFT was paying Bhatti a fee per procedure, thereby providing an incentive to see as many patients as possible in as short a time as possible. He profited handsomely, with CDDFT handing over almost £6 million for the outsourced service. Irwin, about whom less is currently known, is also being investigated for treatments arising from his work at Spire Healthcare.
Right to Choose
The widespread use of private clinics and hospitals is built on the initiative known as Right to Choose, introduced by the last government but still in force. Under this arrangement, once a GP has determined that a referral is clinically appropriate, patients have the right to choose any provider – NHS or private. The local NHS then pays the bill irrespective of whether they have the funds or consider the case to be a priority.
There is surely a case for saying that the private sector should only be used when NHS bodies identify a clear need for additional provision, rather than allowing the market to dictate demand. In the case of CDDFT and Bhatti, it is far from clear why the relationship with the two private companies was allowed to run rampant with such disastrous patient outcomes, but it certainly benefited Bhatti financially. This sort of conflict of interest is widespread. A report by the Centre for Health and the Public Interest, for example, found over 600 medical consultants owning shares and equipment in private hospitals where they work and to which they refer their NHS patients.
NHS trusts also have questions to answer here. An extensive independent investigation of the breast cancer scandal at CDDFT found major failures in governance and culture – ignored warnings; ineffective audit trails; absence of corporate oversight; and a ‘toxic and fearful’ culture. Similar concerns are being expressed in the case of Great Ormond Street, where NHS England is launching an independent investigation into the management and culture of the hospital. It is in such circumstances that clinical negligence can flourish.
A review of the costs of clinical negligence by the National Audit Office suggests that improving the initial system response to harm can reduce the number and cost of claims, yet the Public Accounts Committee report (above) concluded that progress towards instilling a proper patient safety culture in the NHS has been too slow. Legal claims are often made largely out of frustration in the absence of a transparent investigation.
The public finances are under huge pressure from competing demands, not just within the NHS, but adult social care, children’s social care, Send provision, student debt, defence and more. The costs of clinical negligence should not be blithely added to these demands. And patients who have suffered unnecessarily deserve so much better.
