Judges ban jail restraints after child deaths

• John Carvel, social affairs editor
• The Guardian,
• Tuesday July 29 2008

Use of painful physical restraint to maintain discipline in privately-run child jails was outlawed by the court of appeal yesterday as an infringement of young people's fundamental human rights.

The court quashed regulations introduced by the government 12 months ago allowing staff to use violent methods to keep order in secure training centres in England and Wales.

Methods include pulling back thumbs and karate-style blows to the ribs and nose. Use of a controversial "nose distraction technique" involving the deliberate infliction of pain had already been suspended after ministers received medical advice that it could be dangerous.

The regulations were introduced last year after inquests into the deaths in custody of Gareth Myatt, 15, and Adam Rickwood, 14.

Myatt was asphyxiated while being restrained by three members of staff at Rainsbrook secure training centre, Northamptonshire. Rickwood, the youngest child to die in custody in Britain, hanged himself after being restrained at the Hassockfield centre, Co Durham.

A Ministry of Justice spokeswoman said: "We are examining the court's judgement with great care and we are considering an appeal."

NHS manager preyed on clinic's patients, inquiry finds

• Rachel Williams
• The Guardian,
• Thursday July 17 2008

Poor management and a string of missed opportunities allowed the manager of an NHS eating disorders clinic to manipulate more than 20 young female patients into sexual relationships, an independent investigation concluded yesterday.

For two decades David Britten, now 54, described by the investigation's chair as a "manipulative predator who represents a clear danger to women", targeted the most vulnerable women - the very young or the most unwell, the report found. He "groomed" them to render them emotionally dependent on him, isolating them from their families and leading each to believe they were in an exclusive relationship. In reality, he was often involved with several other women at the same time; in 1998 he was involved with eight patients. Some women became pregnant by him.

Britten, who worked as a nurse in the eating disorders service at the Gordon hospital in London from 1980, and became the manager of the specialist Peter Dally Clinic, in Westminster, when it opened in 1996, would make patients feel special by telling them he could only give psychotherapy to a small number - even though he was not qualified to do so.

Witnesses told how women became desperate to see him, with queues forming outside his door. When patients believed they were in love with him, and that he felt the same, he would manipulate them by withholding personal time. Sexual encounters took place in his office, with the door locked, and in the women's bedrooms at the clinic.

Britten's sexual relationships with patients, the youngest of whom was 17, only came to light when women came forward after he was sacked in 2002 for gross misconduct: for meeting patients individually, showing favouritism, meeting them behind closed doors, holding the keys to their flats and blocking complaints against him.

An earlier inquiry into claims of inappropriate touching made by two patients, led by the now defunct Riverside Mental Health Trust in 1998, was "seriously flawed" and was a missed chance to detect his abusive practices, the inquiry found.

The authors of the report, commissioned by North West London Strategic Health Authority, now NHS London, said Britten had had unprofessional contact with at least 23 women. Lawyer Sarah Harman, who represents some victims, said she believed from talking to her clients that up to 40 could be affected.

The Peter Dally Clinic closed in 2001 when the Central and North West London Mental Health Trust took over. It is now taking legal advice on whether action should be taken against other staff, two of whom are believed to be still in the NHS.

The inquiry criticised the Nursing and Midwifery Council for failing to strike Britten off the nursing register until 2004, despite claims of abuse two years earlier.

The Crown Prosecution Service has said there is too little evidence at present to prosecute Britten, who may be living in northern France.

Harman said her clients, who were responsible for securing the inquiry, still wished to see Britten prosecuted and were furious that he would be entitled to draw an NHS pension. They found it hard to accept that Britten's managers had not apologised to them, she added.

NHS blamed for nurse's abuse of patients

• Sara Gaines and agencies
• Society Guardian,
• Wednesday July 16 2008

Inadequate NHS management allowed a predatory male nurse to manipulate 23 vulnerable patients into sexual relationships, an inquiry said today.

David Britten, 54, preyed on patients battling eating disorders at the Peter Dally Clinic, central London, for 20 years before allegations of sexual misconduct emerged when he was sacked for unrelated matters.

Today an investigation, commissioned by NHS London concluded poor management, missed opportunities and the reluctance of his vulnerable victims to speak out allowed the abuse to carry on.

The report said Britten, the clinic's former manager, was a "manipulative predator who represented a clear danger to women".

No criminal charges have been brought, as the Criminal Prosecution Service said there was insufficient evidence.

The chairwoman of the investigation, Alison McKenna said: "The effect of David Britten's abuse of these vulnerable women cannot be overestimated.

"Britten was a specialist in eating disorders and would have known that affected individuals can be very compliant and eager to please. He deliberately targeted vulnerable patients, grooming them for his own sexual gratification."

NHS London's chief nurse, Trish Morris-Thompson, apologised on behalf of the health service.

"As a nurse and a midwife, I am appalled by David Britten's actions and that they went unchecked for so long. He abused not just these women but also his position of professional trust," she said.

"This report has lessons for NHS organisations around the country and it is my job to ensure that the lessons are widely disseminated. They will be."

The Peter Dally Clinic closed in 2001 when the Central and North West London mental health trust took over and Britten's activities were uncovered.

Britten was employed as a mental health nurse in the eating disorders service in Westminster from 1980 to 2002 and was manager from 1996.

The report says there were two significant factors that allowed his abuse to remain undetected for so long. The first was poor management of the eating disorders service. The second was the understandable reluctance of vulnerable women to speak out against someone upon whom they were dependent for their care.

The NHS took appropriate action in dismissing him but the Nursing and Midwifery Council did not take action to suspend or strike him off the nursing register until 2004, despite having received a string of allegations over the previous two years.

A new eating disorders service opened in central London in 2002 and the report said: "We believe that the policies, procedures and change in ethos at the [new] clinic provide a significantly improved and safer service."

Thomas O'Neill removed from GSCC register

O'Neill failed to reveal past misconduct in job applications

A social worker who conducted “inappropriate and exploitative sexual relations” with two vulnerable service users has been removed from the register.

Thomas O’Neill repeatedly “pestered” the women by telephone over a 13-month period while at Westminster Council and asked to see them outside work, an independent committee at the General Social Care Council found.

He also acted dishonestly in failing to tell prospective employers and the GSCC of his past misconduct, the committee said.

O’Neill, of south London, joined Westminster Council in January 1998 and began working with the female service users as part of a multi-agency team assigned to a supported housing unit.

He was sacked in February 1999 for gross misconduct when the inappropriate relationships came to light.

Job applications

O'Neill omitted his employment at Westminster and subsequent dismissal on application forms for two other jobs - at a social care and housing agency and Brent Social Services - and for registration with the GSCC.

The committee concluded that O’Neill’s failure to supply complete work histories amounted to misconduct. The GSCC code of practice requires all social workers to be “honest and trustworthy”.

A statement from the GSCC said: “Due to the seriousness and breadth of the misconduct, the committee felt that it had no choice but to remove O’Neill from the register.”

O’Neill became the 19^th social worker to be struck off in England for breaching the code of practice since the organisation began investigating allegations of misconduct in April 2006.

In January this year, the council called for the development of codes of practice on sexual boundaries for social care staff.

• Martin Wainwright
• The Guardian,
• Saturday June 21 2008

It was the scale of his dishonesty which did for Dr Raj Persaud, the celebrity psychiatrist who was reprimanded and suspended from practice for three months by the General Medical Council last night.

The best-known "mind doctor" in Britain could be either an outstanding practitioner or a matchless media performer for the profession, the GMC decided. But he did not have time to do both. Laden with columns, book commissions and broadcasting jobs, Persaud harvested eight degrees and diplomas, a hospital consultancy, two research medals and a professorial chair by the age of 43.

"I was under stress. I should have been much more careful," he told a four-day fitness-to-practice hearing in Manchester. But the stress was of his own making and drove him to make plagiarism a habit.

He was told by Dr Anthony Morgan, chairman of the panel of four experts, two men and two women: "The public is entitled to expect that doctors will be honest and trustworthy at all times, and that they adhere to the highest standard of probity. Your conduct has fallen below the standards of behaviour that the public is entitled to expect from doctors and undermines the public's confidence in the profession."

Persaud, who appeared regularly on TV's This Morning programme, admitted nine cases of plagiarism but denied that he had been deliberately dishonest. The panel heard evidence that he wrongly had blamed sub-editors for missing out attributions and quotation marks, and dismissed his defence.

Morgan said that all four members were "in no doubt that your dishonest conduct and plagiarising other people's work on multiple occasions represents a serious breach of the principles that are central to good medical practice".

Imposing the suspension, Morgan told Persaud that the panel's lightest option, of a warning and imposing conditions on his practice, was "insufficient as they would not adequately reflect the gravity of your misconduct, or protect the public interest by maintaining public confidence in the medical profession".

The short suspension was influenced by the fact that Persaud had "cut down on [his] media and journalistic projects" and "was more cautious about taking on extra work".

The action was triggered by a complaint from the Scientology movement, which has crossed swords with Persaud over modern psychiatry, but widened to include a growing number of allegations.

The Citizens Commission on Human Rights, founded by the Scientologists, complained to the GMC that a hostile article by Persaud in the Independent in 2005 plagiarised several passages from another professor.

Persaud, a keen poker player and risk-taker, was embedded in the medical establishment in a way which partly explains the GMC decision to go for suspension rather than a warning. He lectured to the National Institute for Clinical Excellence, examined students, and was even a referee for articles submitted to the Journal of Medical Ethics.

Persaud claimed his dual skills made him an ideal "talking head" for psychiatry, compared to what he called "unqualified media pundits who normally dominate the media debate". Personable and fluent, he seemed well-qualified to advise other people on how to run their lives. His undoubted talents made lasting friendships, and several media figures, including Richard Madeley and Judy Finnigan, and the broadcaster Martin Bashir, said last night that they wanted to work with him again.

Bashir said in a statement read to the hearing by Robert Francis QC, Persaud's defence counsel, that he had "a personal relationship [with the doctor] for which I'm deeply grateful" and found him "invariably generous in recommending the work of others".

The former foreign secretary, Dr David Owen, submitted a statement praising Persaud's work in helping the public's understanding of mental health; and Transworld, which has published a series of books by the doctor, said they were "important work, and we hope to continue working with him".

Persaud grew up in a high-achieving family and was sent to Haberdasher's Aske's public school before taking his first degree at University College, London. He is married to an eye surgeon at Moorfields hospital, London, and has a son and a daughter. He quipped in one of his media profiles that his children were "the ultimate test of his sanity".

Even his victims acknowledge his innovatory flair, which won him the Royal College of Psychiatrists' research medal, the Osler medal, and the Denis Hill Prize from his own hospital, the Maudsley.

Prof Richard Bentall, whose work was used without attribution in Persaud's 2003 collection of case studies, From the Edge of the Couch, told the GMC panel he was baffled that such a clever colleague could be so stupid.

Bentall, who had appeared with Persaud on the Radio 4 programme All in the Mind, said he was "flabbergasted" and added, all but scratching his head: "I find it hard to believe that somebody with the reputation of Persaud would deliberately set out to do something so obviously wrong." But he had.

Analysis of his own psychological issues had already started well before the hearing's verdict, and it will naturally draw on Persaud's voluminous work.

In one of countless newspaper articles, on top of more than 100 academic papers in his name, he wrote: "Psychologically embedded in the relationships of the powerful are the seeds of their eventual destruction ... people with elevated power become disposed to elevated levels of risk-taking. They are more mentally oriented to potential rewards and oblivious to pitfalls."

A psychiatrist who regularly appeared as an expert on the BBC has been struck off the medical register after he lied about his academic qualifications and performed unethical drugs tests on mentally ill patients.

Tonmoy Sharma, who was a senior lecturer at the Institute of Psychiatry in London, has been exposed as a fraud who repeatedly referred to himself as a "professor" when records show that he had never completed a PhD thesis.

	Tonmoy Sharma was found guilty of serious professional misconduct

Despite this, Sharma, who was registered at the Clinical Neuroscience Research Centre in Dartford, Kent, regularly used the letters PhD after his name and managed to deceive the NHS and some of the world's largest pharmaceutical companies.

He also appeared on the BBC2 series Mind of a Murderer in 2000 and was often used as an expert commentator on BBC News Online stories.

A General Medical Council panel yesterday found Sharma guilty of "serious failings of personal integrity" after hearing that he recruited mentally ill patients to test drugs without seeking proper approval.

Andrew Popat, chairman of the panel, told Sharma: "Your persistent and wide-ranging dishonesty and untruthfulness, spanning a number of years, together with your lack of insight, is so serious that it is fundamentally incompatible with your continuing to be a registered medical practitioner."

Mr Popat said Sharma, the author of several books on mental illness, had "contributed significantly towards the advancement of medical science" and was highly regarded by his colleagues.

However, after a 10-month hearing, the GMC Fitness to Practise panel found Sharma guilty of serious professional misconduct and struck him off the medical register.

The 42-year-old, who trained in India, was found to have acted unprofessionally in relation to five major studies between 1997 and 2003, involving four leading pharmaceutical companies including Eli Lilly and the Janssen Research Foundation.

He also misled the companies when he chose to use identical patients in different studies, subjecting them to MRI scans and tests that had not been approved by an ethics committee. In 2003, he recruited mental health patients in unsolicited telephone calls and without consent from their doctors. He then failed to give them proper information about the trials - one schizophrenic was simply handed a leaflet.

His misconduct was first uncovered by the drugs company Sanofi, and a complaint resulting in his temporary suspension was made to the Institute of Psychiatry in 2001, prompting an investigation.

Sharma, who represented himself at the hearing, denied the claims and insisted that he "believed in ethics in medicine".

Probe into mental health trust

A MAJOR investigation into the quality of care provided to self-harmers by a local health trust is being launched today.

The Healthcare Commission, a watchdog which checks on standards, has started the investigation after allegations were made about the West london Mental Health NHS Trust.

Investigators will look at the period from April 2005 to the present day to see how the trust responded to safety incidents over that period, particularly focussed on self-harmers and the systems in place to stop them hurting themselves again.

The investigation comes after impromptu visits to some of the 32 sites run by the trust across Ealing, Hounslow and Hammersmith and Fulham, by officers on February 13.

Particular focus is being put on how many incidents have occurred, how they were dealt with and how these "near misses" were investigated.

Nigel Ellis, the commission's head of investigations, said: "Clearly, there are particularly challenging safety issues that have to be managed at mental health trusts.

"We are not saying the services provided by the trust are unsafe. If we believed they were unsafe we would take immediate action. But we have a duty to patients to be certain that all necessary systems are in place to manage risks.

"We are pleased to have the full co-operation of the trust in our work and will report back fully and publicly in due course, making recommendations to improve services if necessary."

Service users, their families and staff members will all be interviewed as part of the investigation and people who think they might be able to contribute to the investigation can telephone 0845 601 3012.

Mental Health Nurse Convicted Of Fraud Is Struck Off

• David Batty and agencies
• guardian.co.uk,
• Monday March 3 2008

Colin Norris outside Newcastle crown court. Photograph: Owen Humphreys/PA

A nurse was today convicted of murdering four elderly patients with lethal doses of the diabetes drug insulin.

Colin Norris, 32, who worked at two hospitals in Leeds, was also found guilty of the attempted murder of another elderly woman.

The trial at Newcastle crown court heard that suspicions were raised when Norris, of Elgin Terrace, Glasgow, predicted the death of a patient. The patient, Ethel Hall, slipped into a fatal coma later on his shift.

Hall, 86, from Calverley, Leeds, was recovering after hip surgery at Leeds General Infirmary at the time of her death. Tests found around 12 times the normal level of insulin in her blood.

West Yorkshire police looked into earlier deaths while Hall was working at the infirmary and the city's St James's hospital. They found three other women, none of whom were diabetics, had died from insulin overdoses.

The staff nurse was found guilty of the murders of Doris Ludlum, 80, of Pudsey, Bridget Bourke, 88, of Holbeck, at the infirmary between June and December 2002, and the murder of Irene Crooks, 79, of Leeds, at St James's in October 2002.

The jury also found him guilty of the attempted murder of Vera Wilby, 90, of Rawdon, at the infirmary. She recovered from an unexpected hypoglycaemic attack in 2002 but died a year later.

Norris was arrested on December 11 2002, but released on bail pending further inquiries. His employers, the Leeds Teaching Hospitals NHS Trust, suspended him the next day.

He was eventually charged with the four murders and one attempted murder on October 12 2005.

Norris will be sentenced tomorrow morning.

Speaking outside the court after the verdict, detective chief superintendent Chris Gregg said the nurse faced a lengthy prison sentence.

He described Norris as an "extremely arrogant individual" who was "looking for opportunities to kill".

"While others around him were duly caring for patients, he was looking for opportunities to kill by poisoning them with insulin," said Gregg.

"Within a six month period Norris murdered four women and attempted to murder another. His confidence was growing to such an extent he clearly felt he could kill with impunity."

The families, in a statement issued through West Yorkshire police, welcomed the guilty verdict.

They said: "We are pleased with today's verdict, which brings to an end a lengthy investigation which has been like a black cloud hanging over us for five long years.

"Our relatives, Ethel Hall, Vera Wilby, Doris Ludlam, Bridget Bourke and Irene Crookes, went into hospital to receive treatment and recover.

"However due to the actions of this man, a person from whom they should have received care and been able to trust, they passed away. He cut short their lives and their precious time with their children, grandchildren and in some cases great-grandchildren."

Leeds Teaching Hospitals NHS Trust apologised to the victims' families for their relatives' premature deaths.

Its medical director, Dr Hugo Mascie-Taylor, said the trust had since increased the use of CCTV and had a permanent police presence on site.

David Scutt, the Crown Prosecution Service reviewing lawyer, said: "Colin Norris preyed on his patients at a time when they were at their most trusting and most vulnerable. Each was elderly and had undergone major surgery for hip fracture repair; each also had other serious underlying medical problems.

"His choice of insulin or anti-diabetic agents to poison them showed a degree of careful planning.

"Our thoughts and sincere condolences go out to the victims and their families at this time."

• Gaby Hinsliff
• The Observer,
• Sunday January 28 2007

To the television scriptwriters, it must have seemed just another torrid soap opera romance. And the tale of handsome young doctor Matt Parker's fling with his beautiful but unstable patient certainly kept Holby City viewers glued to the screen.

But when Kathy Haq, a nurse from Sunderland, saw it she was moved to fury. What horrified her was the dismayed reaction of some fans on the BBC drama's website when Parker ended the affair: 'They were saying, "Oh, he shouldn't have had to finish with her". The public have got to know that this is just not allowed.'

The story did not just offend Haq's professional sensibilities - a doctor can be struck off for sleeping with a patient because of the risk of exploitation. It also revived painful memories. She was a 19-year-old trainee nurse when, suffering from depression, she was referred to a psychiatrist called William Kerr.

In the privacy of the consulting room, she says, the doctor exposed himself to her, saying that 'this is what you need'. What is shocking about the abuse that she went on decades later to describe in court is that it was preventable.

A subsequent public inquiry into how Kerr and his colleague Michael Haslam got away for decades with indecently assaulting and seducing vulnerable patients established that the first complaint against Kerr was in 1965 - by a woman patient who reported being told that sex would cure her. By the Eighties, there had been nearly 30 separate complaints or concerns raised about Kerr's behaviour, but none was taken sufficiently seriously to prompt a full investigation. When a senior nurse at the Clifton Hospital raised the alarm after learning a patient had had an affair with Kerr, she was demoted.

'People used to say to me: "How do you keep going year after year?" and I'd say, "sheer anger",' says Haq, who now runs the Kerr/Haslam survivors' group. She says the effect on the victims' marriages, jobs and health was devastating. One girl whose father approached the group was sent to Kerr aged 16 after being sexually abused by an uncle, but claimed she was subsequently abused by Kerr. Another woman 'still thinks he is coming for her to take her children away, 25 years down the line. Those kids are grown up and married, and she still has dreams about this'.

The medical establishment insists that, in the nine years since Kerr was charged, medical regulation has been transformed rendering such a scandal far less likely now. But with rising numbers of ordinary Britons now seeing therapists and plans for a massive government-backed expansion of 'talking therapies', campaigners fear a whole new class of vulnerable patients is emerging.

While NHS psychiatrists like Kerr and Haslam were at least regulated by the General Medical Council, the growing army of counsellors, therapists, healers and alternative medicine practitioners are not. There is no register they can be struck off, no professional code to break, no way for the GMC to rule on their competence or ethics. Yet they have intimate access to vulnerable, distressed and damaged people. Campaigners says this gives rise to a grey area which serves neither patients nor reputable practioners. The case reported in The Observer today of alternative practitioner the Barefoot Doctor, who has been forced to defend himself on his website against allegations of inappropriate relationships, illustrates this.

The Department of Health will shortly unveil plans for a massive overhaul of medical regulation, including the long-term creation of a 'level playing field' for alternative practitioners. The move follows concerns that some psychiatrists subject to GMC investigation simply reinvent themselves as unregulated therapists, while patient groups argue that any unqualified individual can currently call themselves a counsellor.

Nearly half the complaints received by Witness, which represents patients alleging sexual abuse, involve unregulated practitioners. Director Jonathan Coe estimates there are 100,000 people offering so-called 'talking therapies' nationwide: 'Anyone can put a plaque on the door and start seeing vulnerable people. That has to change.'

Yet the recent history even of regulated professions suggests too often patients were betrayed. The public inquiry report into Kerr and Haslam is one of four sitting on the desk of Health Minister Andy Burnham, beside those into serial killer and GP Harold Shipman; the gynaecologist Clifford Ayling, who sexually assaulted patients for decades in Kent, and the surgeon Richard Neale, struck off in Canada following a patient's death but allowed to practise in his native Britain.

The four cases are very different, but what they have in common is the devastation visited on patients and families, the profound deafness of medical professionals to complaints about colleagues and the repression of NHS whistleblowers. What shines through is the ease with which the deep trust placed in doctors was breached.

For solicitor Sarah Harman, the sheer avoidability of the suffering is the worst thing. After nearly 30 years of complaints against Ayling, none of which were seriously pursued, the final indignity was the General Medical Council's decision to let him continue practising while under investigation for sexual misconduct. Seven women reported being assaulted during that time. 'I acted for women who had been abused many years ago. They felt angry that their complaints were not heeded. They couldn't believe so many women were making the same complaints,' Harman, the sister of Harriet Harman, the Constitutional Affairs Minister, says.

Perhaps the most startling failure to act, according to the independent inquiry into the Ayling case, came in 1980 when a nursing sister, Penny Moore, allegedly caught the gynaecologist masturbating over a patient. Moore banned him from the antenatal clinic at Thanet Hospital, Kent, and told the woman's consultant, who promised Ayling would be referred to a psychiatrist.

But the police were not involved and there is no evidence that anything was done. When, some time later, Moore discovered Ayling was to be allowed back on the ward and protested, she was told by a consultant 'not to question a fellow of the Royal College of Obstetricians and Gynaecologists'.

Yet the evidence kept piling up. The same year a patient's husband complained of 'sadistic' treatment, saying Ayling appeared to enjoy giving the woman a rough internal examination. Hospital staff refused to be treated by him for their own pregnancies. There were repeated complaints of uncomfortable deliveries, lingering too long over intimate examinations, inappropriate sexual remarks and offering to sew patients up 'nice and tight' after episiotomies. He was eventually sacked in 1987 for injuring a baby during a Caesarean but got a job in Thanet's colposcopy clinic, which performs invasive tests on the vagina and uterus, instead.

A year later a woman escorting her teenage daughter to his clinic reported Ayling for rubbing himself up against the girl. His contract was not renewed, but no connection was made with the fact that Ayling had also worked as a GP since 1981. He continued to do so, triggering further complaints of unnecessary vaginal and breast examinations. Patients who queried him were told they could die of cancer if they did not submit and Harman argues he often treated women who had little other choice.

'He dealt with army wives who didn't know the area. He took on women who were not seen by other practices because they were drug users. He over-examined them and frightened them by saying that they needed tests every three months, which they didn't.'

A neighbouring GP, to whom some of Ayling's patients defected, was worried enough to raise the allegations with Ayling, who denied any wrongdoing. After similar complaints emerged at another hospital employing him, an inquiry began in 1993 but Ayling continued to do locum work. Finally in 1998 the health authority received a complaint of indecent assault and involved the GMC: he was arrested shortly afterwards.

Two decades after Penny Moore's challenge, Ayling was sentenced to four years for indecent assault. He was out of jail before the inquiry's findings were published, protesting his innocence. Nonetheless around 30 of Harman's clients successfully sued for compensation.

Meanwhile Moore, the unsung heroine of the inquiry, is said to remain distressed that she could not do more to help. It is a feeling Lin Bigwood would recognise. The former deputy sister at Clifton Hospital now lives quietly in the West Country, her career never having recovered from confronting Kerr.

In 1983 a psychiatric patient told Bigwood she had had an affair with Kerr, and that he had sex with others too. The nurse spent five years fighting for an inquiry into his behaviour. For her pains, she was demoted, while Kerr retired in 1988 with a glowing letter of thanks. The professionals had again closed ranks.

Haq says that, while attitudes now have changed dramatically from the 'old school tie' days of doctors arrogantly defending colleagues they trained with, the culture has not entirely disappeared. 'At the time a lot of them were public schoolboys, now we have got comprehensive school lads coming through. But there's still a tendency to protect your colleagues.'

She was one of 15 women who eventually went to court in 2000 - although Kerr, suffering from a degenerative brain disease, did not undergo a standard trial. He was found guilty on one of 19 counts of indecent assault, with the rest either ruled not proven or allowed to lie in record when the jury could not decide. Kerr was placed on the sex offenders' register and subsequently died. Haslam, charged after this trial ended, was sentenced to three years.

The subsequent inquiry found what it called an 'unhealthy' culture of professionals reluctant to act against each other, with patients routinely disbelieved. It recommended more collation of 'soft' evidence - concerns falling short of official complaints - and research into sexualised doctor-patient relationships. The Ayling report recommended offering chaperones for intimate examinations, and better co-ordination of separate complaints.

Both were investigating offences dating back to an era of old-fashioned deference to doctors. Yet the Kerr/Haslam inquiry concluded that, even by 2005, too little had changed: 'Substantial risks remain that patients or staff who raise concerns will not be heard... we are not persuaded that their concerns will even now be speedily and appropriately addressed.' Could it happen still?

Jonathan Coe argues it is. His organisation, Witness, receives around 100 direct reports of abuse annually, a caseload dominated by obstetricians and gynaecologists - whose consultations are uniquely intimate - and psychiatrists, whose power to section patients gives them an unusual hold over potential victims. 'I have met women who came forward and were encouraged not to say anything,' he says. 'They were told, "It won't be good for your mental health if you raise this".'

And even when patients persevere, it is usually their word against a doctor's. Which is why Witness has campaigned for a civil standard of proof in GMC cases - on the balance of probabilities - not the tougher criminal standard of beyond reasonable doubt. The change was backed by Dame Janet Smith's inquiry into Shipman, and by the government's Chief Medical Officer, Professor Sir Liam Donaldson.

But it is fiercely opposed by the British Medical Association, which argues it has compelling reasons for objecting: when Maria Marchese claimed the psychiatrist who treated her partner had raped her, she seemed to have cast-iron proof - traces of the doctor's DNA on her underwear. Dr Jan Falkowski was suspended and told he faced prosecution. He lost private patients and friends, while his relationship with his fiancee foundered under the strain of constant menacing text messages from his so-called victim.

But all was not as it seemed. Marchese was recently jailed for nine years after a court heard she bombarded the couple with death threats - including threatening to kill guests at their wedding. As for the supposed DNA evidence, she had fabricated it using a condom stolen from Falkowski's dustbin.

The case illustrates the risks for some doctors working with disturbed women. Although Coe argues that the false accusation rate is only about 2 per cent, undeniably some practitioners face malicious complaints threatening their livelihoods and liberty. The BMA argues that lowering the burden of proof would mean dangerous miscarriages of justice.

Caught in the middle of this passionate debate is Finlay Scott, the softly spoken chief executive of the GMC. He gave evidence to all four inquiries, and says quietly that their stories stayed with him: 'Talking to the victims of Kerr and Haslam was a profoundly moving and distressing experience. It is undeniable they were let down by the system - not narrowly by the GMC, but by the whole regulatory system.'

For, as Scott points out, in too many cases doctors and local health authorities did not bother contacting the GMC even as the complaints stacked up. It was repeatedly involved only at the eleventh hour, something Donaldson wants to change by putting GMC affiliates into local NHS organisations.

The vast majority of doctors, Scott argues, are competent and caring, but nonetheless he backs a shift in the burden of proof, although he thinks this should vary according to the gravity of the crime. 'If you are contemplating taking away a doctor's livelihood, then you have to be sure of your facts. On the other hand if you are proposing restrictions on a doctor's practice - that they will not undertake a particular kind of procedure - you can be more flexible.'

The GMC has already moved to defuse criticism by publishing proposals for reform, including appointing an equal number of lay and medical members to investigative panels and a tougher code of conduct. That appears to be enough to avert threats to abolish the GMC. But it still faces criticism over past failings especially in cases such as that of Richard Neale, a British doctor struck off in Canada in 1985 after a pregnant woman whose birth he had induced died. Neale returned to England and a consultant job in Northallerton, Yorkshire: although a subsequent inquiry found the GMC was informed of the Canadian conviction in 1985. In 1988 it was uncovered during routine checks after Neale applied to become a police surgeon, yet the GMC did nothing to stop him practising.

As Donaldson concluded in a review last July, Neale was shown an 'inexplicable degree of leniency'. He was only exposed when newspapers heard of the Canadian death.

Better patient protection in future, Scott argues, may lie in tying regulation to risk. If it knew where rogue doctors were most likely to emerge, the GMC could concentrate its efforts. The other priority is encouraging patients to stand up for themselves. Haq is helping the Committee for Health Regulatory Excellence to compile advice for patients on what constitutes doctors overstepping the mark. While she does not believe abuse could now happen on the scale it did in Yorkshire, she says it will always continue. 'There are rogue doctors and rogue nurses out there. Hopefully the work we are doing will make people aware that this is not acceptable.'

More sensitive handling of victims could also, Coe argues, encourage them to come forward. One woman Witness recently supported through a GMC case was left alone in a room during the hearing, where the accused doctor approached her to her terror. Harman, however, sounds a note of genuine optimism. Last year she represented a group of women sueing neurologist Dr Brian Phillips over claims he groped them during routine examinations. Although he was acquitted in court, the GMC struck him off for indecency.

The contrast between the cases of Ayling and Phillips convinced her that the GMC has genuinely changed, she says. 'They realised the way they dealt with Ayling was not approriate, and all credit to Ayling's former patients for that. I do feel positive.'

When ministers publish their conclusions shortly, women nationwide will see whether that hope is justified.

The accused men

William Kerr and Michael Haslam
A 2005 government inquiry found the two NHS consultants sexually assaulted at least 77 of their patients over a 20-year period. According to the inquiry, Kerr had raped or molested at least 67 women between 1965 and 1988. Thirty-eight of the women complained to nurses and 11 GPs but were dismissed as 'fantasists'.

Michael Haslam was jailed for three years in 2003, after being found guilty of four charges of indecent assault on three patients between 1981 and 1988. William Kerr was deemed unfit to stand trial for health reasons.

Clifford Ayling
The Kent GP molested dozens of victims over 30 years. Concerns were first raised in 1975, but he continued working until 2000. He was jailed for four years in 2000 after being convicted of 13 counts of indecent assault on patients between 1991 and 1998.

Richard Neale
Consultant gynaecologist Neale botched operations on women that left them in constant pain, incontinent or unable to bear children. He was struck off the medical register in Canada in 1985, following the deaths of two patients, but was allowed to work in the UK until 1999. He was struck off the UK medical register in 2000. He was arrested and then bailed in 2006, as part of an ongoing police inquiry.

Which doctors might turn rogue?

Some doctors present a far higher risk than others of turning rogue, according to the anecdotal evidence of the head of the General Medical Council's Fitness to Practise Panel.

Defendants are significantly more likely to be male than female. Although half of junior doctors and a majority of medical students are now female, chief executive Finlay Scott said the caseload is disproportionately male.

Doctors who trained and qualified abroad also face proportionately more complaints, although it is not clear whether foreign doctors are less competent, or just less likely to be protected by any old boys' network. 'We do not have a complete answer,' said Scott.

Cases are disproportionately likely to involve doctors working in obstetrics and gynaecology, general practice and certain specialist branches of surgery.

The GMC, which handles about 150 cases a year, regulates on behalf of patients, maintains a register of trained doctors and is largely funded by their professional fees. Nurses and midwives have their own body, The Nursing and Midwifery Council (NMC)

Useful link

Witness: against abuse by health and care workers

• Rosie Cowan, crime correspondent
• The Guardian,
• Wednesday June 9 2004

A dangerous paedophile convicted yesterday of drugging, raping and filming girls got a job as a police doctor, despite previous accusations of sexually abusing children.

Robert Wells, 52, was jailed for 15 years after being found guilty of nine of the 11 charges he faced, including raping an 11-year-old girl twice and sexually assaulting her three times.

Wells, who denied all the offences, also filmed himself attacking another 11-year-old girl as she slept after giving the victim and her five-year-old sister Angel Delight dessert laced with tranquillisers.

The Winchester crown court jury of nine men and three women deliberated for seven and a half hours before clearing Wells of raping and indecently assaulting the five-year-old.

But in a shocking parallel to the case of the Soham murderer, Ian Huntley, it was revealed yesterday that a vetting loophole led to Wells getting a job as a police surgeon six years after being charged with assaulting two girls. Detectives fear he abused many more victims in his 27 years as a doctor.

In 1995, Wells was cleared of attacking an eight-year-old girl and a girl of 15 in Brighton when two separate trials at Lewes crown court collapsed following legal arguments. The General Medical Council decided to take no action.

However, in October 2001 he was sub-contracted through Primecare medical staffing agency to work for Hampshire police, examining victims of crime, despite being known to the neighbouring Sussex force.

Guidelines in place from 1993 to 2002 meant police were only obliged to carry out local checks. They now have to run checks everywhere the prospective employee lived for the previous five years.

Hampshire's assistant chief constable, Colin Smith, who is responsible for police doctors in the force, said vetting procedures had been tightened as a result of the Wells case. He would not have employed Wells had he known of any previous allegations, but he said that Primecare, Wells' main employer, had the major responsibility for carrying out checks.

Primecare said it completed all the required government checks at the time, and Hampshire police insisted they were satisfied Wells did not abuse any of the 20 girls under 16 he examined as part of 3,731 examinations he carried out for them from October 2001 until his arrest in February 2003.

Nevertheless, the case raises questions about how many more sex abusers might have slipped through the net and obtained jobs giving them access to children and vulnerable adults. Huntley, who murdered schoolgirls Holly Wells and Jessica Chapman, got a job as a school caretaker in Soham, Cambridgeshire, despite a catalogue of sexual accusations against him from women and girls in Humberside, where he had previously lived; these were wiped from police records because he had no convictions.

Passing sentence yesterday, Judge Keith Cutler said Wells was a dangerous sex offender who used his status and wealth to gain the trust of his victims' parents, and that his behaviour cast a shadow over the entire medical profession.

The offences took place in 2002 and 2003. But detectives believe Wells may have abused many more victims in his 27 years as a doctor and appealed for them to come forward.

Police officers, who described his deviousness and total refusal to cooperate with the investigation, are trying to decode encrypted computer files which could yield vital clues, although they admitted this could take years.

Detective Inspector Sara Glen, who headed the inquiry, said the computer file had a long list of girls' names on it and she was convinced more crimes would be uncovered.

• Sarah Bosley
• The Guardian,
• Monday April 29 2002

Looking back, it seems so obvious that Clifford Ayling's patients should have walked out of the surgery door and never come back. They should have refused to take off all their clothes, insisted on a chaperone and threatened to sue if he laid an abusive finger on them. But each thought she was alone, those who did complain were ignored and the GP regularly assaulted women in the name of obstetrics and gynaecology, probably for more than 20 years.

Ayling was convicted of 13 indecent assaults on 10 women patients and jailed for four years in December 2000, but his trial answered none of the most important and disturbing questions about the abuse he perpetrated - such as why he was not stopped years earlier. Nor did the successful civil case brought by 16 of the women for compensation. Their hopes now are pinned on a government inquiry, due to start soon. Although the women lost the battle to have it held in public, they won the right to be present throughout, listening to the questions and, it is hoped, the answers.

So far, 64 women have contacted Canterbury solicitor Sarah Harman with tales that sometimes echo each other spookily. They all, she says, tell a similar story - a story which the medical profession and managers time and again refused to believe in the face of Ayling's denials.

One of them was Steina Pluckrose, who arrived to sign on at the surgery in 1990 just after she moved to Folkestone, having separated from her husband. She was 27. Ayling called her into the consulting room immediately for a routine he repeated with numerous other women patients. He said that she must have her breasts checked.

"He got me stripped naked," she says. "I was a bit shell-shocked. His attitude was so brusque - it was so businesslike. You didn't like to argue with him. If you questioned him you were a stupid, hysterical woman.

"He did the breast check very slowly. I'd never had one before." She had to sit naked on the edge of the bed. "He stood between your legs. You are humiliated for a kick-off and you have only just met this man, who is about six inches from your face."

But it was hard for any of them to know where clinical necessity began and ended. Ayling did a smear test a couple of weeks later and the results showed a genuine problem. "He said there were pre-cancerous cells that he needed to keep an eye on. A few months later he gave me another test. After three to four smears, he booked me in for a colposcopy," she says.

She went to the hospital for the internal examination which would remove suspect cells for analysis, expecting to see Rodney Ledward, the consultant gynaecologist who was himself later struck off the medical register for performing botched operations. But it was Ayling again. "My heart sank when I saw him in his little white coat," she says. "He got me in the stirrups and got as close as he could. He patted the inside of my thighs."

There was another colposcopy, carried out in the GP's surgery, before Pluckrose decided she had to get away and booked herself in with her mother's GP. Tests at the new surgery quickly showed that she was in need of urgent treatment - she underwent a very deep cone biopsy to remove cancerous cells.

What was Ayling's motivation? Did he despise women, lust after them or was he in obsessive pursuit of hidden disease?

These are unanswered questions. He underwent specialist training in obstetrics, but never made it to consultant status. From around 1980 to 1994, he worked as a clinical assistant in obstetrics and gynaecology in various Kent hospitals, holding clinics and delivering babies.

Long before Pluckrose went to sign on at his GP surgery there was cause for concern. At least seven complaints were made during the time he had worked in Kent hospitals. As early as 1980, he was sent for psychiatric assessment after what Harman describes as "a brutal delivery". The psychiatric report has been lost.

Ayling's hospital career continued. Two more women who complained in 1982 and 1986 were persuaded not to take it further by doctors who knew Ayling. In 1987, Ayling delivered Linda Shaw's son. She tells of feeling herself rip inside as he pulled with forceps at the baby's head while her husband and the nurses held the bed down. The baby's face was bruised and his head elongated. He suffered no long-term effects, but she did. Ayling neglected to give her antibiotics and her wound festered. Two repair operations were carried out by Ledward.

Shaw consulted a solicitor and asked Ledward to write a letter outlining the damage. "He said, 'Who delivered you again?' I said it was Dr Ayling and he said, 'Oh, Clifford.' That's when I knew it would be no good," she says. Ledward's letter says the delivery was fine.

Two more complaints in 1992 - one from a student midwife which led to Ayling receiving a warning letter, and one in 1993 - were investigated by a manager at the William Harvey Hospital. On November 5 1993, Ayling was interviewed by Peter Savege, then clinical director of Kent family health services authority, who told him patients said he had rubbed himself against their thighs and got an erection. Ayling claimed that it was not his penis but a large bunch of keys, which he then produced from his pocket.

The explanation was accepted, but the following year, Ayling's contract to work in South Kent hospitals was not renewed. When his lawyers protested, the hospital management insisted that there was no stain on his professional character. He got a reference signed by Rodney Ledward and another consultant to say he "gives an entirely satisfactory service".

This allowed him to continue to assault women at his medical practice for years to come, selecting, it now appears, the more vulnerable, like Sue Alsworth and Trish Howard who were both just 16 when they first saw him on their own. "I was 16 and naive and never had any previous doctor," says Alsworth, who is now 25. "I'd been brought up to trust my doctor." She had "numerous" breast examinations carried out by him and internal examinations, but there came a day, a couple of years on, when she felt confident enough to put a stop to it. "The last time I went to him he asked to examine my breasts again. I said, 'No - you have shown me how to examine my breasts.' He said yes - we have to do it. That was the first time I became very self-conscious. I thought, there is no breast cancer in my family and I'm young and fit and healthy. I let him go through with the routine. After that I left his surgery and never returned."

Howard, now 23, went to ask him for the morning-after pill. He said she could not have it unless she agreed to a breast examination. "I had to let him do it. I was crying. My mum was a patient and I thought if I didn't have this examination he would tell my mum," she says. In her medical notes, it is recorded that she also had an internal examination. Howard says she can't remember and now thinks she may have blocked out the memory. "I remember laying down looking out of the window really crying," she says.

Jacqui Godden was 23 and on tranquillisers because of family problems. She, too, was told to strip naked for a breast and internal examination when she went to register with the practice. "I was quite surprised because my husband and two children were in and out like yo-yos. But I thought he was being a very cautious, caring doctor."

Now she thinks of him as an abuser. She was dependent on tranquillisers. He refused to give her repeat prescriptions without intimate examinations. For three years, she had an internal examination every two weeks and a smear every month. Each time she had to strip naked. She wanted to come off the tablets, but he prescribed more and she started to take more. "The more he abused me, the more medication I took," she says. "I asked Ayling so many times if I could have counselling. He pulled his chair up close and said: 'I'm your doctor, I'm your midwife, I'm your counsellor.'"

Finally she found another GP and was off the drugs within a year. "My life was given back to me," she says.

Angela Hodges, 54, a businesswoman, was less vulnerable, but still found it hard to escape. He demanded that she bare her breasts so he could listen to her heart when she had a chest infection, and ran his fingers over her nipples. "I knew he had assaulted me," she says, "but I thought I was alone. He was very controlling."

She asked for a chaperone when he carried out an internal examination, but it turned out to be Ayling's sister-in-law - his wife was the practice receptionist. The chaperone made no difference to his behaviour. He told Hodges that her womb was tilting back - as it had for 30 years, since the birth of her first child - and tried to pull it forwards. "My entire body was lifted off the bed," she says. "I screamed out."

Harman is now suing the health authority for failing to stop Ayling. "All down the line, women weren't listened to," she says. "By the end of 1998, more than a dozen women were making very serious allegations and he was still permitted to practice."

The General Medical Council did not interfere because the police were involved, so Ayling was able to break his bail conditions, send the chaperone out of the room and assault another patient as late as September 2000, a month before his trial began. There are very many questions for the inquiry to answer.