The health service must do more to spot warning signs that staff are using their position in order to abuse patients, a new report into sexual and physical assaults committed by rogue medical personnel has found. The problem is particularly acute for doctors who achieve “superhero” status, it warns.

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The analysis of how healthcare professionals were able to get away with their misbehaviour for years has concluded the NHS needs to overhaul its procedures to prevent a repeat of such scandals. Examples included breast surgeon Ian Paterson, who was jailed in May for 15 years for carrying out unnecessary cancer operations, and specialist Myles Bradbury, who was jailed for 22 years (reduced to 16 on appeal) in 2014 for abusing young cancer patients.

The probe, by experienced NHS investigators Verita, has been shared with the Observer. It has identified three key types of devious and deceitful tactics used by NHS personnel to create opportunities to exploit vulnerable patients.

The firm has previously examined the NHS’s handling of scandals including Jimmy Savile’s abuse and rape of patients. This time it has identified patterns of behaviour that bosses, management teams and its 1.4 million staff need to be warned about and told to report if they become suspicious.

Its findings are based on an in-depth inquiry into the misdemeanours of Paterson and Bradbury as well as George Rowland, a consultant urogynaecologist who performed unnecessary or botched operations on hundreds of women with incontinence, and David Britten, a senior nurse who groomed and had sexual relationships with young women undergoing treatment for eating disorders.

“The NHS ought to have been on to these cases faster than they were,” said Ed Marsden, the firm’s managing director. “Our analysis showed there were common traits which, if identified and challenged earlier, could help stop or prevent safeguarding issues. NHS organisations must be much more alert to these patterns of behaviour to identify and stop abuse by staff. The NHS must learn lessons from these cases.”

Verita says that NHS bosses should be wary of health professionals who acquire what it calls the “superhero status” of the three doctors and one nurse studied in the review. Their seniority and expertise in their field meant that their unusual behaviour was not challenged by colleagues or patients.

“Myles Bradbury cultivated unusually close relationships with patients and families for a doctor. He made them feel special and dependent on him. For example, he gave them his mobile phone number and he ran clinics out of hours. That’s unusual behaviour. They thought he was going above and beyond to help them. But those kinds of oddities should give long pause for thought,” said Marsden. Bradbury was jailed for abusing 18 children with cancer at Addenbrooke’s hospital in Cambridge between 2009 and 2013.

“This ‘superhero status’ also allowed Ian Paterson to make false diagnoses and carry out unnecessary or dangerous breast surgery while receiving plaudits from many unsuspecting patients,” added Marsden. “It took nine years before concerns raised about him finally led to his suspension by the General Medical Council. Britten convinced his victims they were receiving special treatment to resolve their eating disorders and then betrayed their trust. He, Paterson and Rowland were all treating vulnerable people who were very seriously unwell. ‘I can bring about a cure, I can fix it’ – that’s what they cultivated and got patients to think. Patients want to trust that they’re getting the very best care and a health professional with bad intent can exploit that.”

Alarm bells should also ring when any member of staff starts acting like a “lone wolf” – creating space and opportunities within the working environment to carry out abuse. “For example, Rowland practised in a separate location where he was subject to less stringent assessment and away from the eyes of colleagues who may have challenged his approach, while Britten relocated to a specialist eating disorders unit physically separate from the main hospital,” said Marsden.

NHS bosses also needed to be much quicker at picking up signals that someone who was not abiding by the usual rules might have a sinister agenda, he added. Bradbury and Paterson both resisted being monitored, while Bradbury was reluctant to be shadowed by students and trainee doctors, which is a long-established way of consultants helping young recruits learn medicine.

Verita has also found that hospitals need to be clearer and more consistent with both staff and the public about what will happen in an appointment, especially if it involves an intimate physical examination, and offer a chaperone if requested to help patients know what to expect and make them less deferential.

“We must do all we can to prevent these crimes. This work by Verita offers useful insights and information on particular behaviours that, combined with other concerns, may well indicate that abuse is taking place,” said Saffron Cordery, the director of policy and strategy at NHS Providers, which represents NHS trusts in England. “Ultimately, every member of staff and every patient must feel safe to raise the alarm.”