Watching Dispatches on Channel 4 about the failings of surgeon Ian Paterson, we have to ask again why more people didn’t speak up about something that plainly was going wrong. There must have been many people involved in his operations and their aftermath. Clearly, intimidation is an issue and fear of reprisals. Also, there is the way in which a man with such authority, power and self-confidence can make others doubt their own judgement. We’ve proposed on this site that the web app Care Comments could help. Through Care Comments people submit their observations in a low-risk way to service commissioners. In the Paterson case we might suppose that observations would have been submitted from .. fellow surgeons, theatre colleagues, ward staff, referring GPs, Macmillan nurses etc. With such a volume of data that cross references and triangulates to confirm a problem, the imperative to take action is strong. It’s not the only solution, but it is worth consideration.