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“Yes.” This was the dismaying response of consultant breast surgeon, Mr Hemant Ingle, when asked at a talk, hosted by the Centre for Health and the Public Interest (CHPI), whether he thought another scandal on the scale of that caused by Ian Paterson could unfold today. Disgraced breast surgeon Paterson is currently serving a 20-year sentence after unnecessarily operating on over 1,200 patients at NHS and private hospitals in the West Midlands area between 1997 and 2011. Three months into my first year of General Practice Specialty Training, I sat in that auditorium utterly stunned at Mr Ingle’s candour. Was it pessimism or devastating realism? Having watched the appalling events unfold in a screening of the ITV documentary ‘Bodies of Evidence: The Butcher Surgeon’, we were honoured to be joined by a panel of experts, including Debbie Douglas, one of the indescribably courageous patients who helped to expose Paterson. Over the next hour, the panel unpacked the factors deemed to have enabled Paterson’s actions, his potential motives and the consequences of the subsequent inquiry for society at large. It made for disturbing listening. Having trained entirely within the public sector, as all new medical graduates must do in the UK, I was completely ignorant to the circumstances within private hospitals which had catalysed Paterson’s reign of terror. I had no idea that private hospitals bore no responsibility for the patients treated within their walls, that doctors working in such hospitals often had no requirement to adhere to otherwise national guidance on healthcare provision, that private hospitals may have no facility to provide adequate emergency treatment to those suffering medical complications after procedures performed on their own premises. Before that evening, I had never before heard a patient state so heartbreakingly that they struggled to trust medical professionals. That disquieting symposium was not my first exposure to the sinister side of medicine. Seeking supplementary education in a field strikingly neglected in my own core undergraduate and postgraduate medical education, I had, just a few weeks before the CHPI event, joined a webinar hosted by the British Society of Sexual Medicine (BSSM). One of the presenters was a patient who had experienced first-hand the pernicious effects of vaginal mesh insertion. Whilst her story had a positive outcome, other vaginal mesh patients have not been so fortunate. Thousands of women continue to suffer from chronic pain, fatigue and urinary dysfunction, amongst countless other symptoms. Through subsequent investigations, it has emerged that vaginal mesh manufacturers had significant financial links to clinicians, researchers and Royal Colleges, and that side effects and complications were widely under-reported. Campaigns such as Sling The Mesh, founded by Kath Sansom, ensure that this landscape is changing, but it should not have come to this. I’m not sure how to feel any more. I’ve spent a lot of time with doctors over the last eleven years. At sixth form, I would send countless unsolicited emails to consultants at local hospitals, pleading for the chance to observe their surgeries, to shadow their ward rounds. Throughout university, I scribbled down every word of juniors, registrars, consultants, hoovering each crumb of knowledge that might make me the best doctor that I could be. Since I graduated in 2020, and started working as a Foundation Year Doctor in London, these professionals have become my peers, my colleagues, my 'bosses'. Whilst of course, some have been more personable, more welcoming, than others, I have thankfully never had the misfortune of encountering a character like Paterson. In Ipsos' 'Global Trustworthiness Index', most recently released in October 2021, doctors were ranked highest in 28 countries, with over 70% of UK respondents believing us to be the most reliable of all professionals. This was the mindset in which I trained; I felt comfortable and worthy of such an accolade. I want to be the person that patients can rely on at their most vulnerable, that relatives feel they can approach with any worry, large or small. To hear now that, for entirely good reason, the implicit confidence that the public had in their medical professionals is no longer a guarantee, made me feel rather unsteady. How do I feel about being part of a profession in which such deceit can go unchallenged? Do I want to be associated with 'experts' who fail to acknowledge the legitimate anxieties of their patients? I'm not going to leave medicine. Fortunately, the Patersons of the world are hugely outnumbered by respectable, conscientious, genuine, caring doctors – those that do earn the premier spot in an Ipsos poll. However, I do think that I have been naïve. Whilst Paterson’s actions are deplorable, a single ‘rogue’ surgeon can be dealt with. This is not to downplay the absolute devastation and anguish that he has caused his patients and their loved ones, and not to diminish the fact that his ousting took far too many attempts from those bold enough to question him, and not nearly enough support from those who should have held him accountable. It is the systemic failures which allowed Paterson to operate unmonitored, which enabled vaginal mesh surgeries to continue unchecked, which permitted side effects to go unrecorded, that I find so unsettlingly insidious. Whether these repeated failures in the healthcare system are underpinned only by financial motives, by greed, as seems the most obvious explanation, we may never know, and perhaps finding reason should not be our priority. As a doctor, my duty is to advocate. Fortuitously for themselves and those whom they are now able to advise and support, both Debbie Douglas and the patient featured in the BSSM webinar are intelligent, well-spoken, confident women. Others affected by the scandals mentioned here, and countless more that are not, may not be so well-equipped. Those who are perhaps older, less educated, who do not speak English as a first language, with other medical conditions rendering them less able to campaign, rely on others to do so on their behalf. This is only one piece of the jigsaw – in order for patients to request help, they must know who is able to help them, and must feel secure and empowered to ask for assistance. Similarly, doctors must feel emboldened in discussing issues with appropriate colleagues. This is not necessarily easy. A conversation after the CHPI panel discussion highlighted how GPs in particular, often mistakenly viewed as lesser doctors, may feel pressured to maintain respect for themselves within the medical profession and, thus, be reluctant to escalate patient concerns for fear of ridicule from secondary or tertiary care. It goes without saying that such anxiety should never alter the care we provide to patients. However, this perceived imbalance of medical aptitude, resulting in such a discrepancy in the level of esteem to which medical professionals are held, is just one example of a saddening toxic facet of the medical world. This is also reflected in the response to whistleblowers, both in the moment and through the lasting effect on a professional’s career, as exemplified by Mr Hemant Ingle speaking of the hospital that previously employed both himself and Paterson: “They don’t like me, of course they don’t”. Only by changing this mindset, and curating a more supportive, protective, transparent culture, where healthcare professionals of all levels and types can freely voice concerns, can we ever hope to avoid such disasters in the future. So, in real terms, what should I do as a training GP? Put simply, I must abide by the GMC’s ‘Duties of a Doctor’. Firstly, I must remain aware and knowledgeable of current biomedical and medicolegal affairs to ensure that I do not inadvertently, even if innocently, reassure or dismiss patient concerns through ignorance. Attending regular knowledge update courses and accessing appropriate journal articles are more formal avenues of learning, but I should supplement these by keeping abreast of health news in popular media, such that I may pre-empt problems with which patients may present. This is all with the understanding that I must never act beyond the limits of my competence and must never allow fear of criticism to prevent me from seeking advice, whether this is from more senior colleagues, supervisors or specialist doctors. For my patients, and indeed for colleagues who may come to me with their own queries, I should reciprocate by remaining approachable and sympathetic. My interactions with colleagues and patients alike should take place in a partnership model – while of course there are many times when hierarchy can be appropriate, I aspire to be the doctor who equips her patients to become experts in their own health and to advocate for themselves. I will strive to communicate with patients in formats appropriate to each individual. Once a patient has chosen to trust me, I must be mindful of the fact that trust can just as easily be lost as gained. I shall keep patient safety at the fore by following GMC guidance on raising and acting upon concerns, reporting any adverse effects of medication or treatment that are divulged to me, obeying my duty of candour if I believe a patient to have been placed at risk, not allowing any conflicts of interest to influence patient care, and acting with overarching honesty and integrity. Yes, another Paterson-level scandal could, and will almost certainly, unfold again. However, if I aspire to achieve each aim outlined above, I will indeed become the kind of doctor that sixteen-year-old me held in such high regard. Until we fix the system, all I can do is my best.

Clive Flashman, Chief Digital Officer I have spoken a number of times in the last 12 months on the need to embed patient safety into the design of new digital health and care innovation. I mentor on a number of digital health accelerator programmes and try to convince all of my mentees that this should be a priority for them, normally with a large degree of success. I do worry however, that with less funding around for this type of innovation in the current economic climate, patient safety will be pushed down the list of priorities that innovators consider when designing and producing their new solutions. I also worry that innovators can’t easily access the patients they need, to test out their products/ services so that they have the evidence to know that they are safe and reliable for everyone who needs to use them. We need better ways to bring these two groups together, as it is in everyone’s interests that innovative new health and care solutions are properly tested by the patients who are likely to use them. Over the next 12 months, I foresee an increasing use of AI-based technologies, which have the potential to interact with patients and potentially deliver prescriptive analytical solutions, and basic elements of clinical judgements – or at least clinical recommendations. I’m also interested to see how digital twins might improve patient safety so that digital health technologies, surgical procedures and other patient facing interventions can be tested on the patient’s digital twin before being implemented with/ on the patient themselves. Stephanie O’Donohue, Content and Engagement Manager I returned from maternity leave six weeks ago and I was reminded immediately of the power and importance of collaboration in the realms of patient safety. But what do we actually mean by genuine collaboration? In my experience, the collaborations that have the greatest impact are inclusive, respectful and action-focused. Where people come together with shared goals and an understanding that different perspectives are essential. When I'm part of a diverse group of people, I feel grateful for their unique skills and experience, and energised to contribute my own. Bring people together. Really listen to their perspectives. Talk about your motivations so you can refine what you want to achieve. Set the scene for a respectful, safe space. And, importantly, work out what actions you are each going to take as part of your collaboration to get you closer to those goals. Because talking is great, but when it comes to patient safety, impact is even better. My hope for next year is to see more diverse collaborations on key patient safety issues. I'd particularly like to see patient and family insights proactively welcomed and given equal weighting. We've seen some incredibly successful patient-led campaigns, but too often their contributions are sidelined to the detriment of safety improvements. Helen Hughes, Chief Executive Healthcare is pressurised more than ever in a (nearly) post pandemic world. Across the globe, clinicians, leaders and politicians are grappling with demand for services in health systems with staff who are often exhausted and covering workforce capacity and skills gaps. This does not bode well for the delivery of safe care and planned reductions in avoidable harm. But despite this rather grim reflection, for me, this has been another year of hope. I’ve had the privilege of working with and supporting amazing clinicians, patient safety experts, patients and campaigners who are passionate in their commitment to safe and effective care. There are networks of people sharing good practice, leading the implementation of system improvements and challenging the healthcare system to be more accountable to patients and families. I feel privileged to contribute to this, through our work at Patient Safety Learning and in collaboration with our partners, and know that 2023 will be another year closer to our goal of reducing avoidable harm. Mark Hughes, Business and Policy Manager This year has seen the publication of two more major reports into serious patient safety failings in NHS maternity services. Both reports have highlighted the all too familiar themes of patients’ safety concerns being dismissed, poor quality investigations and the persistence of a culture in parts of the healthcare system that deters speaking up. The latter is particularly concerning to me; I felt a sense of déjà vu reading this year’s NHS Staff Survey results which illustrated the wider prevalence of this, with over 160,000 staff who responded not able to say that they would feel secure raising concerns about unsafe clinical practice. If we’re to break these patterns in inquiry after inquiry, we need our healthcare leaders to get to grips with the systemic issues and put patient safety at the core of their thinking. As noted in our report earlier in the year, 'Mind the implementation gap', a helpful starting point would be to introduce effective and transparent performance monitoring to ensure inquiry recommendations are translated into action and improvement. In 2023 we need to make real progress in implementing outstanding safety recommendations, which will not be easy in the context of the wider challenges we face, particularly staff shortages in both health and social care. My hope for the new year is that with a bit more political continuity in the Department of Health and Social Care, our healthcare leadership can begin to move towards to more system-focused approach to these challenges. This would help to ensure that we can maximise the benefits of new institutional developments, such as the establishment of Patient Safety Commissioners in England and Scotland and the transition to the new Health Services Safety Investigations Body and Maternity and Newborn Safety Investigations Special Health Authority, to improve patient safety. Samantha Warne, Lead Editor of the hub As Editor for the hub, I am privileged to work closely with patients, helping them share their stories and supporting them to get their voices heard. Often there is frustration felt that no one is listening and that their concerns are being dismissed. This is particularly true in women’s health. Sadly, many women are still facing barriers in getting the treatment they need and we are seeing doctors failing to take women’s concerns seriously. This year, we heard from hub member Sophie about the pain and gaslighting she experienced when having an IUD fitted, shared appalling accounts of how women who have been harmed by pelvic mesh surgery have been treated by their doctors and have seen women continuing to share with us their awful experiences of painful hysteroscopy. The damaging narratives around female pain cause harm to patients far beyond their initial experience. But we are seeing changes. In July, the Government published the first ever Women’s Health Strategy for England to tackle the gender health gap. In October the All Party Parliamentary Group on Menopause published their final report with their recommendations following a year-long inquiry to assess the impacts of menopause. As hub topic lead Saira Sundar wrote earlier this year, “there is a real change being forced by women themselves, with the public increasingly questioning and insisting on improvement and the right to be heard.” My hope for 2023 is that we will see continued positive action being taken in women’s health and that the hub can help bring to the forefront the patient safety issues women experience. Lotty Tizzard, Content and Engagement Manager The issue that has most troubled me this year is health inequality; we are still such a long way from closing the access gap. There are so many people who are unable to access the care and treatment they need, for complex and varied reasons, and evidence suggests that the Covid-19 pandemic and the resulting pressure on health services has widened the gap. It’s more important than ever that the Government and NHS invest in new approaches. In April 2022, I read the Diabetes UK report Recovering diabetes care: preventing the mounting crisis, which highlighted the stark inequalities in access to diabetes care between the most and least deprived areas of the country. What really saddened me was reading that this disparity is happening among children as well as adults, for example, in access to life-changing diabetes technology such as insulin pumps. However, there are many charities and organisations doing great work and research in this area, and it will be interesting to see the impact of NHS England Core20PLUS5 approach to tackling specific areas of the health system where inequalities have the biggest impact. My hope for next year is that we will see increasingly effective application of research insights so that services can reach those individuals who are missing out on care. How can organisations tailor their approach and make clinics and information more accessible and culturally competent? How can fellow patients help reach those with poor health literacy or limited access to online technology? There are some innovative ideas out there that can be amplified, and I hope we can use the hub to help share them. Do you have a story, reflection or resource to share? the hub is designed for frontline staff, patients, managers, and anyone else with an interest in patient safety, to come together and share their insights. You can sign up today for free for full access to our library of resources and all of the benefits on offer to our members.

Perioperative practitioners have worked tirelessly to rise to the challenges presented in recent years, and now continue to face the challenge of managing record-breaking waiting lists. Theatre work is challenging. You’re on your feet all day, mentally engaged and, at times, emotionally charged. This study day gives you an opportunity to focus on your own health and wellbeing as well as the welfare of your patients. "If we look after ourselves, we can look after others!" Topics will include: Review of mental health wellbeing and how to optimise it Health diet and fluid intake The benefits of exercise Optional Tai Chi taster session The importance of sleep and rest Debriefing and feedback to prevent burnout and PTSD Menopause awareness Open debate: Achieving a work-life balance in a demanding perioperative role Book

The uncertainty and anxiety that come with the experience of complexity can be overwhelming. It can be hard to think clearly and act wisely, and our wellbeing can easily suffer. The COVID-19 pandemic has made these experiences an everyday occurrence for many people, and the need for us to work clearly, wisely and healthily has never been more pressing. These Organisational Development workshops from the King's Fund will lift the lid on complexity. Together, you’ll explore how encouraging ourselves and others to understand and acknowledge the loss of control when faced with complexity can help us, our teams and our wider organisational systems survive and even thrive in conditions of uncertainty. The workshops will help you: make sense of the messy reality of complexity, accurately categorise different aspects of that reality and be able to choose appropriate, measured, responses understand your own preferences and strengths in relation to the complexity around you and develop strategies to stretch beyond them help yourself and others be their best during uncertain times. Join one or two sessions, or the whole series. Buy tickets

The uncertainty and anxiety that come with the experience of complexity can be overwhelming. It can be hard to think clearly and act wisely, and our wellbeing can easily suffer. The COVID-19 pandemic has made these experiences an everyday occurrence for many people, and the need for us to work clearly, wisely and healthily has never been more pressing. These Organisational Development workshops from the King's Fund will lift the lid on complexity. Together, you’ll explore how encouraging ourselves and others to understand and acknowledge the loss of control when faced with complexity can help us, our teams and our wider organisational systems survive and even thrive in conditions of uncertainty. The workshops will help you: make sense of the messy reality of complexity, accurately categorise different aspects of that reality and be able to choose appropriate, measured, responses understand your own preferences and strengths in relation to the complexity around you and develop strategies to stretch beyond them help yourself and others be their best during uncertain times. Join one or two sessions, or the whole series. Buy tickets

The uncertainty and anxiety that come with the experience of complexity can be overwhelming. It can be hard to think clearly and act wisely, and our wellbeing can easily suffer. The COVID-19 pandemic has made these experiences an everyday occurrence for many people, and the need for us to work clearly, wisely and healthily has never been more pressing. These Organisational Development workshops from the King's Fund will lift the lid on complexity. Together, you’ll explore how encouraging ourselves and others to understand and acknowledge the loss of control when faced with complexity can help us, our teams and our wider organisational systems survive and even thrive in conditions of uncertainty. The workshops will help you: make sense of the messy reality of complexity, accurately categorise different aspects of that reality and be able to choose appropriate, measured, responses understand your own preferences and strengths in relation to the complexity around you and develop strategies to stretch beyond them help yourself and others be their best during uncertain times. Join one or two sessions, or the whole series. Buy tickets