The Report of the Ayling Inquiry was published on 9th September 2004 as a White Paper. Clifford Ayling’s daughter Joan wrote to the Department of Health on 27th September 2004 indicating that she would be responding to the Inquiry Report. She wrote again on 31st December 2004 and received a reply dated 3rd February 2005 (with a copy of a reply dated October 2004 which had got lost in the post) indicating that any representations would be forwarded to the appropriate official at the Department of Health.
The letters from the Department of Health indicated that the inquiry “no longer exists” and implied that only representations about the Report’s recommendations, not the evidence those recommendations were based on, are of any concern. That cannot be right.
This website is to be a regularly updated response to the Inquiry Report and is in the public domain. It will take time to produce but when it is in a sufficiently finalised form it will be printed out and sent to the Department of Health.
Former patients will be referred to anonymously. The letters used in the Inquiry Report will remain for the same patients and others will be referred to in alphabetical order as they are referred to whilst the response is being produced. As updates will be inserted this means letters referring to patients will not necessarily run on in alphabetical order when the response has been finalised.
Clifford Ayling began his career as an electronics engineer in the 1950s and decided to study Obstetrics and Gynaecology after the birth of his first child. He qualified in Medicine in 1963 and went on to specialise in Obstetrics and Gynaecology, obtaining the D.R.C.O.G. in 1965 and the M.R.C.O.G. in 1970. He became a Fellow of the Royal College of Obstetricians and Gynaecologists in 1985. He worked in a number of hospitals in the London area and then in Kent from the mid-1970s onwards. He worked on research projects on electronic fetal monitoring and helped to set up the ultrasound service at Canterbury and Margate. He went into General Practice in Folkestone as a junior partner in 1980 and full-time in 1984. He continued as a Clinical Assistant in hospitals, specialising in colposcopy and working at the William Harvey in Ashford until 1994. An active member of a number of committees, Clifford Ayling spoke out against Health Authority decisions that were not in the best interests of patients. In early 1998, he featured in a local newspaper under the heading “Doctor launches blistering attack on health authority plan”.
On 11th November 1998 Clifford Ayling was arrested as four women had made allegations of indecent assault. It turned out that the Health Authority had actively trawled former patients of Clifford Ayling and encouraged them to make statements to the police. This trawling exercise continued and Clifford Ayling was eventually convicted in December 2000 and given a four year sentence. Less than three months after the convictions Clifford Ayling’s assets were frozen as civil proceedings to claim for damages were instigated by the former patient who had made the first “complaint” to the Health Authority early in 1998. More women joined the group action and were represented by the firm of solicitors that had participated in the trawling exercise prior to the criminal trial. They were awarded a total of £256,000 damages in April 2002. It had been indicated that more former patients would be claiming damages from Clifford Ayling, but when it became clear his assets were not as substantial as first thought, the group action geared itself to claiming damages from the Health Authority and an attempt was also made in 2004 to sue Clifford Ayling’s former colleagues at the Practice in Folkestone.
The solicitor who represented the former patients that had claimed damages from Clifford Ayling and some who had already begun proceedings against the Health Authority, represented those same former patients and others at the Inquiry that was set up in 2002 to look into the handling of complaints about Clifford Ayling. On the day the Inquiry Report was published in September 2004, a group of 31 women obtained an out of court settlement from the Health Authority worth £350,000. Amongst the women presented as “victims” at a press conference on the same day were a woman who had made allegations that were not pursued by the Crown Prosecution Service and another woman whose allegations led to an acquittal by the jury at the criminal trial in 2000.
Prior to Clifford Ayling’s criminal trial, over 800 people signed a petition (set up by two patients) to “wholeheartedly support Dr C.R. Ayling against the scurrilous accusations that have been made against him”. Over 120 patients wrote testimonials, amongst them healthcare practitioners. 79 of the patient testimonials were written by women who specifically stated they had had intimate examinations by Clifford Ayling. Yet these were barely referred to at Clifford Ayling’s trial and no witnesses for the defence were called. These testimonials outweigh the 77 ‘former patients’ who participated in the Inquiry, many of whom only came forward after the convictions when compensation was already on the cards. At least one woman who made allegations after Clifford Ayling’s conviction appears to never have been a patient of his at all. None of the patients who wrote testimonials in support of Clifford Ayling were expecting financial reward of any kind. Extracts from their testimonials show clearly that they were happy with Clifford Ayling’s treatment and wished to be able to continue as his patients. Extracts from correspondence spanning Clifford Ayling’s medical career or from statements made during the run-up to the criminal trial also show that the portrayal of him in the media and the Inquiry Report has been misleading, exaggerated and at times wantonly malicious.
Some try to claim that patients and colleagues who supported Clifford Ayling before his conviction may no longer support him now. That is not true. Many people in Folkestone and Cheriton do not believe the allegations that were made against him. One or two courageous journalists have occasionally voiced doubts about the case, but television reporters appear to have lost all sense of impartiality and they have either totally ignored the other side of the story when it has been provided or appear to have bowed to invisible lobbies who believe that proper investigation of the case may be damaging to their aims.
Women who claimed for compensation say they did so to “protect” patients from “another Clifford Ayling”. What their allegations have done instead is to trigger off a whole spate of scaremongering about intimate examinations that are a vital part of women’s health. The result can only be more embarrassment for the women who will have chaperones imposed against their wishes and less thorough checks by doctors who can no longer fully trust their patients.
The Ayling case has been described as “groundbreaking” in that former patients were allowed to sue a doctor personally. This has led to a number of similar cases with convicted doctors who are today in prison. Not unexpectedly, the majority of doctors targeted in this way are not far off retirement, have unencumbered assets, and worked under a Health Authority that can be held vicariously liable.
Anna Pauffley, chairman of the Ayling Inquiry, previously represented more than 100 care workers and social workers at an Inquiry set up in 1996 which led to the Waterhouse Report on the alleged sexual abuse of children in care in Clwyd and Gwynedd in North Wales. In the closing days of that Inquiry Tribunal she made a full-scale attack on its procedures, suggesting that a policy of “trial by ambush” had operated.
“…then I come on to my fourth submission: has the approach of the treasury team been impartial and balanced? We say that it should have been if it was genuine in its desire to conduct an inquisitorial, as against an adversarial process. It has been evident from the first day of the proceedings, we say, that the treasury team had a case that they were to pursue…Accordingly, we submit that from the first day of the Tribunal’s sitting the die has been cast, witnesses were taken through their evidence-in-chief and complaints were made about abuse they maintained they had suffered. It mattered not that there may have been material that showed probable inconsistency, the complaint was sympathetically led. It mattered not if that witness also had good things to say about care staff…That evidence was not led in-chief very largely. There has been an almost morbid pre-occupation with anything that might have been wrong with the system and criticisms of individuals. Seemingly the Treasury team was not interested in eliciting the positives, the good examples of child care, they were intent on finding out about the bad practice, the mistakes that were made. There has been no balance.”(1)
The contents of this website will set out to show that the same criticisms made by Anna Pauffley of the Inquiry Tribunal that led to the Waterhouse Report can be levelled at her own team throughout the Inquiry process into the handling of complaints about Clifford Ayling.
FORMAL WRITTEN SUBMISSIONS SEPTEMBER 2006
To be made to the Secretary of State for Health
IN RESPONSE TO THE REPORT OF THE COMMITTEE OF INQUIRY INDEPENDENT INVESTIGATION INTO HOW THE NHS HANDLED ALLEGATIONS ABOUT THE CONDUCT OF CLIFFORD AYLING, SUBMITTED TO THE SECRETARY OF STATE FOR HEALTH ON 15TH JULY 2004 BY THE HONOURABLE MRS JUSTICE PAUFFLEY
Submissions founded on documentary evidence and research.
Click on the index for direct access
A. General Submissions
B. Role of the Ayling Inquiry
C. Complaints Procedure and Handling
E. NHS Policy
F. Defining Sexualised Behaviour
H. Hospital Midwives
I. Medical career structure
J. Evidence to the Inquiry
K. Lay witnesses
L. 'Incidents' allegedly witnessed by hospital staff in 1980 and 1988
M. Compensation Claims
N. Former Patients
O. Media Coverage
A. General Submissions
1. It is submitted that many of the assertions contained in the Ayling Inquiry Report are misleading, incomplete or wrong. It is further submitted that the Ayling Inquiry Report presents a misinformed and disinformed knowledge of the Ayling case because the Committee of Inquiry overlooked vital evidence and ignored or rebuffed key witnesses.
i) It is submitted that all written statements submitted to the Ayling Inquiry and the transcript of the Inquiry's oral hearings should not be destroyed and should be made public. It is further submitted that the far-reaching effects of the Ayling Inquiry Report for all members of the British public, particularly female patients, are such that it is in the public interest to know on what evidence the Ayling Inquiry based its recommendations.
2. It is submitted that the recommendations contained in the Ayling Inquiry Report are founded on largely uncorroborated oral evidence and that their widespread application in the United Kingdom will present a risk to women's health and further discourage doctors from specialising in Obstetrics and Gynaecology.
i) Emerging health trust guidelines drafted as a response to the recommendations in the Ayling Inquiry Report show that those recommendations are difficult to interpret in a precise manner within the context of the provision of health services to women, particularly in the primary care setting or in the provision of emergency treatment.
ii) The lack of proper analysis in the Ayling Inquiry Report of clinical procedures, standard practice, signs and symptoms (including pain on examination) and commonly confronted patient reaction within the highly sensitive realm of Obstetrics and Gynaecology and Women's Health will lead too many misinformed women to misinterpret situations in which they come into contact with health professionals.
3. It is submitted that the contents of the Ayling Inquiry Report are scaremongering and the sensationalist media activity that the report generated has been damaging to the excellent work done by charitable organisations that set up informative websites or produce comprehensive leaflets on the subject of women's health, promoting regular examination and check-ups as recommended in official government body literature.
i) Under the title Future Trends the 1997 publication Benign Gynaecological Disease (E.J. Thomas & J. Rock, Health Press Ltd.) stated that "Benign gynaecological diseases, particularly menstrual disorders, are the most common reasons for a woman to consult her family physician or her gynaecologist. The impact these conditions have on women's health and subsequent economic and social functioning will be increasingly recognized in the future".
ii) Refusal to review the Ayling Inquiry Report in the light of the grave concerns that have been repeatedly brought to the attention of the Department of Health suggest that Government interests have been placed higher than the health of the nation's women and the speciality of Obstetrics & Gynaecology, essential to women's good health, will suffer as a result.
4. It is submitted that the climate of mistrust and the 'blame' culture perpetuated by the contents of the Ayling Inquiry Report is damaging not only to the doctor-patient relationship but also to the relationship between health professionals who work together.
i) Despite the assurance from the Inquiry Chairman Anna Pauffley on 6th November 2002 that the Ayling Inquiry was not a witch-hunt, at least two hospital health professionals were referred to the General Medical Council and a number of General Practitioners were involved in civil litigation as a direct result of having given evidence to the Ayling Inquiry or having been a colleague of Clifford Ayling.
5. It is submitted that the Ayling Inquiry Report contains conclusions to assessments that were made on a subjective basis. It is further submitted that the Ayling Inquiry Report contains unquantifiable and pejorative terms that are indicative of bias and contains assessments that are designed to attribute blame.
Paragraph 3.72: "Mr Patterson concluded…by saying that, if Penny Moore was
correct, "then we are culpable
Paragraph 3.109: "We unhesitatingly prefer Mr Patterson's account…
Paragraph 3.165: "We found Mr Homeshaw to be a reticent witness…we found this
surprising and unhelpful
Paragraph 3.213: "…it seems to us that Dr Pickering's…assertion…was at worst to
verge on the culpable and at best to rely on a selective
interpretation of GMC guidance…
Paragraph 3.219: "…the litany of complaints…
Paragraph 3.236: "This seems to us to be yet another example of…
Paragraph 3.268: "In our view it is unfortunate that…
Paragraph 3.269: "We find it surprising that…
Paragraph 3.310: "The letter is remarkable for a number of reasons…
Paragraph 3.329: "We find it difficult to accept that…
Paragraph 4.91 : "The Inquiry found it difficult to believe that…
6. It is submitted that the Ayling Inquiry Report focused inequitably on male doctor activity in the presence of a female patient and presented a positive bias to the nursing profession and the evidence of female lay witnesses.
i) Family Planning Clinics are often run by female doctors or midwives and many Obstetrics and Gynaecology services are today being provided by female health professionals who are not doctors. For example, the Colposcopy/Gynae/Oncology service provided by the Kent & Medway NHS Trust and based in Ashford and Margate is now run by "two nurse colposcopists who manage their own caseloads, a gynaecology oncology clinical nurse specialist and a clinical trials nurse specialist for research".
ii) The right of a female patient to be seen by a female doctor or the Practise Nurse for gynaecological complaints or contraceptive services is not a guarantee that the patient will not be subjected to inappropriate sexualised comments or abusive behaviour.
iii) The Observer reported in June 2006 that the Nursing and Midwifery Council have been overwhelmed with complaints including allegations of giving the wrong medicines to patients, not providing basic care, incompetence, bullying, stealing from patients and verbal abuse.
7. It is submitted that the Ayling Inquiry put patients at the centre of the complaints system to such an extent that it failed to address the rights of health professionals to have complaints about patients who act inappropriately properly investigated or acted upon.
i) It is further submitted that this bias violates the principles of the Equality Bill and constitutes non compliance of a public body with its equality duties. This bias is also contrary to measures purported on 5th April 2005 by MP Patricia Hewitt to have been established "to ensure a society free from prejudice, discrimination and unfair treatment".
ii) The Ayling Inquiry Report states that "The fear that patients had, that their word would not be believed, was not unjustified…a witness commented: "The emphasis was very much on giving doctors the benefit of the doubt and protecting them against possible unwarranted accusations from their employers and from patients" ". The particularity of Clifford Ayling's case is that the Ayling Inquiry was set up after he had been through a criminal trial which was, on the face of it, run independently of any NHS complaints procedure. However, it is submitted that the Inquiry took into account and presented in its report evidence from former patients that was contradictory or that was submitted to it either by or for women whose allegations had led to the acquittal of Clifford Ayling at the criminal trial.
iii) The third extract of patient evidence on page 56 of the Ayling Inquiry Report is seemingly that of Patient M. Her allegations only constituted one count on the indictment of Clifford Ayling and at the trial led to an acquittal. The evidence quoted by the Inquiry is nearly word for word that to be found in Patient M's police statement made on 14th December 1998:
Ayling Inquiry Report page 56:
"I told Ayling about the thrush and he said that he wanted to take a swab. He told me he wanted me to remove all my clothes below the waist. I did so as I had had smear tests before and I knew that this was the common procedure…Ayling then asked me whether I had ever had a breast examination. I told him I had not. He said "we'll do that while you are here". He told me to remove the rest of my clothes, including my bra. I sat on the couch and did so. I was very embarrassed at being completely naked in from of Ayling so I held my top tightly over my bottom half".
Police statement of Patient M in December 1998:
"When I told him about the thrush he told me he wanted to take a swab, he told me to take all my clothes off at the bottom, I did so, I knew the procedure as I have had a smear test before…He then said to me "Have you ever had a breast examination. I told him, "No". He said, "we'll do that while you are here". He then told me to take the rest of my clothing off including my bra, I sat on the side of the couch and did so, I was so embarrassed being completely naked in from of Doctor Ayling I held my top tightly over my bottom half".
iv) The ethics of presenting as reliable evidence the statements of women whose allegations led to an acquittal in a criminal trial are questionable. The implications for the perceived reliability of the findings of inquiries that take into account even lesser proof of guilt than do civil courts cannot be ignored. This was highlighted by the case of a Mr. Orr that was reported in the Daily Mail in 2005. Mr. Orr was awarded £80,000 compensation to be paid by the Police for the investigation that led to his conviction after being accused of rape. Mr. Orr "was cleared by an appeal court in 2003 and looked forward to picking up the pieces of his life…But his accuser had also lodged a civil case for compensation against him which resulted in him being ordered to pay her more than £10,000. The civil court needed lesser proof of guilt and made its decision on the grounds he was 'probably' guilty. 'How can this be justice?' Mr Orr said at the time. 'I have been asked to pay damages for something I didn't do'. But a higher court has now put that ruling aside and ordered the police to pay him compensation for the investigation which led to his ordeal".
v) The Inquiry Ayling Report refers to the case of Patient I in a number of instances and refers to the transcript of Clifford Ayling's criminal trial. On page 78 of the Report there is reference to the "reading" of Patient I's contemporaneous complaint in 1993. All that complaint contained about a breast examination was "He then proceeded to examine my breasts, which I was expecting, however he made another strange comment at this stage…". At the criminal trial in 2000, before describing the breast examination, all Patient I said with regards to a breast examination was that Clifford Ayling had asked her to remove her blouse and bra so he could examine her breasts. The comment that she had expected a breast examination had disappeared. In April 2002 Solicitor Sarah Harman signed a Particulars of Claim for Patient I against the Health Authority which said Clifford Ayling had asked Patient I to undress from the waist up, then asked her if she intended to breast feed her baby, then proceeded to "fondle" her breasts. There was no suggestion in the Particulars of Claim that Patient I did not expect or resisted a breast examination. In October 2002 when Patient I applied to the Court for permission to sue the Health Authority, it was said in the press that "She agreed she told Mrs Darling…that her complaint was of abuse; not sexual abuse". In November 2002 patient I was quoted in the media after having got permission to sue the Health Authority as saying "It is very important that I succeed because there are so many victims". Then in the Ayling Inquiry Report it is claimed that "Patient I gave evidence to us…She describes telling Mrs Jed [in 1993] that she had been pressurised by Ayling into undergoing an internal examination and that he had touched her breasts inappropriately, having coerced her into a breast examination . In her view she made it clear to Mrs Jed that Ayling had behaved indecently towards her during the consultation". In the contemporaneous complaint 'read' by the Inquiry Patient I had written "I do not wish for my complaint to be seen as one of sexual abuse against Dr Ayling…". One can see how a gradual fine-tuning process can fabricate an allegation out of nothing. Patient I's concern in 1993 was solely that Clifford Ayling had insisted heavily on an internal examination (that she allowed him to perform because she refused to sign her notes to confirm that she did not want the examination). She also specified in 1993 that she did not wish her concern to be seen as being of a sexual nature. However, by 2003 Patient I was asserting that in 1993 she had also been coerced into a breast examination and had clearly stated at the time that she was complaining of indecency.
11. It is submitted that the Ayling Inquiry Report contains contradictory conclusions and recommendations about complaints handling and that the promotion of the use of "soft intelligence" will encourage unfair practices in the work environment that constitute harassment of health professionals by colleagues or management staff.
i) The Ayling Inquiry Report implicitly (by ignoring evidence of how the case against Clifford Ayling was mounted and failing to comment adversely) or explicitly advocates the following:
" The use of historic oral complaints about alleged incidents by staff without the knowledge or consent of the patient involved, thereby denying the person attacked or their legal representative access to medical notes that might contain important information or contemporaneous comments.
" The existence in personnel files over a number of years of informal information that is not investigated and is not made known to the member of staff involved.
" Allowing rumours about a health professional to spread as a means of mounting a case against the said health professional, contrary to the ethics of medical codes of practice.
" Leaving on personnel files records of complaints that have been formally investigated but not upheld.
" The use as formal evidence of a GP's informal personal notes that have no administrative status and contain hearsay information which has not been put into the patients' medical records.
" Allowing management to 'sit' on a formal written complaint without informing the health professional involved of the existence of the complaint within the time limits set down in policy documents.
" The non-investigation by a health authority for many months of a formal complaint then use of the same still non-investigated complaint within disciplinary proceedings formally instigated to coincide with police arrest but that cannot go forward to a NHS Tribunal hearing because Counsel to the said health authority advises that its case against the health professional is "not robust enough
" The use of hearsay allegations without patient knowledge or consent as a valid reason to refer a health professional to the General Medical Council.
" Attributing an anonymous complaint to a specific health professional when no health professional has been named by the complainant and there is insufficient information to formally identify the health professional complained about.
" Encouraging suggestible patients to make specific types of complaints about a health professional and then pressurizing them to take the complaint further.
" The re-direction and transformation of a complaint about hospital treatment not involving the patient's GP to one about the complainant's GP when the solicitors consulted are mounting a case against the said GP and realise he is the patient's doctor.
" The transformation of a formal complaint about an allergic reaction due to a wrong prescription into a complaint about indecent assault because the complainant is a woman and is asked if she has ever had an internal examination by the same GP.
B. Role of the Ayling Inquiry
8. It is submitted that the Ayling Inquiry and other inquiries to which it has been linked were specifically designed to restore public confidence in the NHS following the publication in 1996 of the 'Access to Justice Final Report' by Lord Woolf.
i) Chapter 15 of Lord Woolf's report dealt with the special area of Medical Negligence. The report said that "early in the [Woolf] Inquiry it became increasingly obvious that it was in the area of medical negligence that the civil justice system was failing most conspicuously to meet the needs of litigants in a number of respects:
(a) The disproportion between costs and damages in medical negligence is particularly excessive, especially in lower value cases.
(b) The delay in resolving claims is more often unacceptable.
(c) Unmeritorious cases are often pursued, and clear-cut claims defended, for too long.
(d) The success rate is lower than in other personal injury litigation.
(e) The suspicion between the parties is more intense and the lack of co-operation frequently greater than in many other areas of litigation."
ii) The SIN website (Sufferers of Iatrogenic Neglect) explained in 2004 that Lord Woolf said in his Inaugural Lecture on 17th January 2001 that "the courts can no longer rely on hospitals and the medical profession to resolve patients' justified complaints justly…".
C. Complaints Procedure and Handling
10. It is submitted that at great public expense the Ayling Inquiry Report did little more than selectively expand on the contents of a special report entitled 'Cause for Complaint' that appeared in Which? Magazine in September 1997.
i) The Which? report said "The NHS complaints system has been reformed. We've put the new set-up under the microscope - and found it's in need of some intensive care". The Which? survey was based on questionnaires completed by 542 patients, 491 of whom had actually made a complaint about the NHS under the new system. All the following was covered in the review:
* The prescription for change.
* No clean bill of health.
* Sorry's still the hardest word.
* New procedures, old attitudes.
* Come-back and compensation.
* Lack of information.
* Lack of independence.
* Signs of improvement.
* How to complain to the NHS.
* What outcome do you want?
- an explanation / apology / assurances?
- disciplinary action against the person involved?
- financial compensation?
* The complaints procedure.
* Who to complain to.
* Dealing with the complaint.
* Lay conciliators.
* Placing the blame.
* Speed of response.
* Satisfaction with the outcome.
* Explanations and apologies.
* Disciplining staff.
* Dissatisfaction with outcome.
* Independent review panel.
* Role of the convener.
* Refused a review.
* Satisfaction with the review.
* Outcome of the review.
* The final report.
* Community Health Councils
ii) Which? Gave the following opinion: "On paper, the new NHS complaints system is clearly better than the old one, but in practice, the NHS is simply not following its own guidelines. Complainants are not being informed about how to pursue their complaint if they are dissatisfied with the outcome of it or how to get help to do this. Time limits for responses to grievances are regularly exceeded and there is little evidence of action being taken to prevent the problems recurring. Our survey shows that people are reluctant to complain directly to the people their grievance is about. Consumers need a more independent complaints system and access to a lay conciliator if they request one. We'd also like to see community health councils given more power in providing help with NHS grievances. The NHS should consider awarding consumers financial compensation through the complaints system."
iii) The Ayling Inquiry Report said "The experience of the Ayling patients is supported by the results of a survey, conducted in 1999, by the Public Law Project "Cause for Complaint" (Wallace/Mulcahy, 1999) which identified similar concerns about the requirement to complain directly to the practice". This point had already been made in the Which? survey also called "Cause for Complaint" reported in 1997. The conclusions of the Ayling Inquiry appear to be a repetition of the conclusions of previous reports and surveys on complaints handling and procedures that would have been known to the Department of Health. The remit of the Ayling Inquiry, in the light of the unreliability of much of the information contained in its report, appears to have been inappropriately applied to the case of a doctor accused of indecent assault. A number of its recommendations are unrealistic and unethical. The extent to which the contents of the Ayling Inquiry Report are misleading, factually incorrect, or presented in such a jumbled or confusing manner that chronological unity is lost, suggests that the Inquiry ran into numerous difficulties that led it to betray its purported inquisitive mindset. Stopping the Inquiry on the grounds that the persons who brought it about were involved in some form of vexatious action or abuse of process would have put the integrity of the judicial and political process at stake.
9. It is submitted that conclusions contained in the Ayling Inquiry Report were not based on proper investigation and objective assessment but were designed to vindicate claims made prior to the evidence gathering phase of the Inquiry.
i) On 8th July 2003 (i.e. before the end of oral evidence gathering by the Inquiry) Mr Justice Gray at the High Court in London allowed the group claim against the Health Authority by 31 women represented by Sarah Harman to proceed "on the assumption" that they would be able to establish that by 1993 there existed "a wealth of information, known to some at least of the health care workers…, about the kind of threat which Dr Ayling posed for women under his treatment". Solicitor Sarah Harman said her clients were delighted: "The claimants hope for a settlement as they feel the health authority had a moral and legal obligation to protect them and failed dismally" (Source: Former patients of disgraced GP receive go-ahead to sue health authority, The Lawyer.com, 13th July 2004).
ii) In the Particulars of Claim presented in April 2002 by the firm Harman & Harman for the claim by Patient AG against the Health Authority, it was erroneously stated that Clifford Ayling "was employed as a clinical assistant at the Hospital from around 1980". It was implied that there was immediate cause for concern as reference was then made to a formal complaint in 1980 (i.e. that of Patient C). The Particulars of Claim rested mainly on the allegation that the Health Authority had acted negligently in 1980 because it "failed to have in place and operate proper procedures in relation to the appointment, supervision, training, monitoring and, where appropriate, disciplining and removal of clinicians at the Hospital" and the allegation that the Health Authority failed "to remove Dr Ayling from his position as Practising GP in the region by the time of the delivery of the Claimant's baby on 27th April 1987". The Particulars of Claim further said it was the Health Authority's "responsibility to have in place appropriate procedures to enable patients and staff at the Hospital to voice legitimate complaints and concerns regarding clinicians and to operate such procedures reasonably through to a proper and effective conclusion" and that "Full details as to each and every such complaint made or known about during the period is sought together with full disclosure of all documentation recording, evidencing or otherwise relating to same. Here again the Claimant reserves the right to further particularise her allegations upon receipt of same".
iii) The existence of such a clearly defined agenda for pursuing civil claims against the Health Authority as early as April 2002 together with calls by 'victim' support organisations for health professionals who fail to report incidents concerning colleagues to face disciplinary measures will have put considerable pressure on health professionals called to give evidence to the Ayling Inquiry.
12. It is submitted that the Ayling Inquiry Report's recommendations about the use of chaperones are too general and that the Ayling Inquiry failed to consider fully the implications involved for the medical profession.
i) Media interest in the Ayling Inquiry Report has focused greatly on the issue of chaperones as a means of protecting female patients from indecent assault. The right to patient choice with regards to the presence or not of chaperones was also highlighted by the Report.
ii) The Royal College of Obstetricians and Gynaecologists 1997 report on Intimate Examinations
in 1997 stated that "If the patient prefers to be examined without a chaperone this request should be honoured and recorded in the notes
". However, the report also stated that "the presence of a chaperone protects doctors against false allegations of sexual abuse
iii) On 20th June 2004 the Sunday Herald
carried an article entitled Anger at plans for nurses to chaperone doctors - New rule an impracticable over-reaction, say staff
. The article said "the plan has been branded "unworkable" and "unrealistic" by the nursing profession. One practice nurse in Fife said: "It would be a ridiculous situation. A practice nurse is very busy. We don't have time to be asked every half-hour or hour to sit in on an examination." She said it would be adequate to have a nursing auxiliary present at examinations. "It should not have to be a registered nurse. That would be an over-reaction…male GPs are examining female patients every day without a chaperone, without any problems."…Stephanie Brown, an adviser to the Medical Protection Society, said: "What happens in an emergency when there is no one there to chaperone? The doctor will have to act in the best interests of the patient"
iv) The impracticalities highlighted in the article cited above and the impossibility of guaranteeing the presence of a chaperone can be found in new official guidelines laid down since the publication of the Ayling Inquiry Report. Chaperoning Guidelines for Clinical Staff ratified in May 2006 by the Management Board of the Ashford and St. Peter's Hospitals NHS Trust say that "If patients request that a specific intimate procedure should be carried out by a member of staff of the same sex, efforts should be made to arrange this. If it is not possible, due to lack of appropriate staff or workload priorities, a chaperone should be provided. (A professional judgment may need to be made in clinical emergencies or urgent situations).
" These guidelines are clearly unsatisfactory in the context of suspected false allegations of inappropriate behaviour by health professionals or when it is alleged that an examination was not clinically indicated.
13. It is submitted that the Ayling Inquiry Report failed to address the issue of false allegations within the context of complaints handling or to make recommendations as to how to deal with a complaint made by a patient who specifically chose not to have a chaperone.
i) For example, it would be wise if the patient were to actually sign their notes and add "All ok" at the end of any intimate examination, whether carried out in the presence of a chaperone or not. This would prevent patients with malicious intent from requesting that an examination be performed without the presence of a chaperone in order to then complain that the doctor had behaved unprofessionally or used inappropriate language. It would also protect both the health professional and the chaperone from accusations of collusion or of failure to report an incident. A number of Clifford Ayling's former patients who made representations to the Ayling Inquiry claim to have been indecently assaulted in the presence of a nurse, midwife or chaperone but none have provided corroborative evidence.
14. It is submitted that the Ayling Inquiry Report failed to specify that some identified nurses and midwives who were present when women claim to have been assaulted gave evidence prior to the Inquiry in support of Clifford Ayling or informed the Inquiry directly or indirectly that they had not seen Clifford Ayling behave in anything other than a proper manner.
i) Former surgery staff and at least one colposcopy nurse made statements to Clifford Ayling's solicitors stating that Clifford Ayling acted in a professional manner. The evidence of these persons was given directly to the Inquiry or indirectly in documentation or information provided to Joan Ayling to be passed on to the Inquiry.
15. It is submitted that the Ayling Inquiry Report failed to address the question of the status of evidence provided by chaperones when dealing with complaints about health professionals.
i) The Inquiry failed to question allegations that were not corroborated by the chaperone's account of the consultation at which it is alleged the patient was indecently assaulted. The Ayling Inquiry Report makes no recommendations about how evidence from chaperones should be handled or the implications for complaints handling of formally involving in a complaints procedure a health professional who may be lower in the hierarchy of the workplace than the health professional complained about.
16. It is submitted that the Ayling Inquiry Report failed to address same sex situations and the implications of such situations for complaints handling, specifically in the context where the female complained of fulfils the conditions recommended by the Report to act safely as a 'chaperone'.
i) The Ayling Inquiry had in its possession a complete copy of the formal complaint about a midwife made by Patient J in 1994. The complaint, though presented as such in the Ayling Inquiry, was not
an indirect complaint about Clifford Ayling. Contemporaneous documents directly related to the complaint by Patient J, which the Inquiry had in its possession, confirm that the nurse referred to was a midwife.
ii) The following statements by Patient J in her contemporaneous complaint made with the help of the Community Health Council were not cited and not explored or analysed in the Ayling Inquiry Report, yet the allegations about the midwife fall squarely into what the Ayling Inquiry Report implies should be defined as inappropriate comments and touching that constitute 'sexualised behaviour':
"I was weighed and then taken into a room with a nurse. The nurse started to enter my details on a form and then asked me intimate questions about my sexual history. I told her about my children and their dads and then she asked me about the father of the baby I am expecting. I told her that he was not the father of my daughters, […]or […] and she said "You go through men, don't you", and then, "You've had more men than I've had hot dinners"…I was totally shocked and made to feel very inadequate and "guilty". I went in to see the doctor…I was all clear and was just about to put my bra on when the same nurse started trying to put it on for me, I got annoyed at her familiarity, but just put on the rest of my clothes…Also, when I asked for a copy of the book relating to childbirth, which I understand is readily available to all pregnant mums, she was very reluctant to let me have one…I am attaching a photocopy of my antenatal notes which were completed by this nurse. From these you will see that I have crossed out the reference to "unstable" under Years Married.
E. NHS Policy
17. It is submitted that the Ayling Inquiry Report failed to study how the implementation of NHS policy affects the behaviour of health professionals and failed to ascertain whether this was a possible factor to be taken into account when investigating the Ayling case.
The example of smear testing
i) The Ayling Inquiry discussed the evidence of Dr Pickering and referred to entries made by Dr Pickering in personal notebooks about why patients wished to transfer from Clifford Ayling's practice to the White House Surgery. The day before Clifford Ayling's arrest on 11th November 1998, Dr Pickering signed a statement made for the East Kent Health Authority to support its statement of case that Clifford Ayling should be disqualified from the Authority's list. In his statement Dr Pickering said he was "making this statement following a meeting with a representative of East Kent Health Authority on Monday 9th November
" and claimed he had interviewed 30 women who had "requested to join our surgery because of alleged sexual harassment by Dr Ayling
". One of the entries earmarked in the copies of Dr Pickering's notebooks produced by the Crown Prosecution Service was dated 1st February 1988 and said "Doctor keeps telling her must have smear - can't cope with this
ii) In 1988 a systematic call and recall system was introduced and an NHS Cervical Screening Programme National Co-ordinating Network was set up. In 1990 the GP Contract set targets upon which payment for cervical screening depends. A GP Pocket Guide to Cervical Cytology 1990
produced in association with the Marie Curie Cancer Care organisation explained that "Eligible women who have smears taken outside the practice, eg in hospital or health authority clinics, will count towards the targets but not for payment. Women who refuse to have a smear and women who have never been sexually active are included in the target list
". Problems linked to the GP Contract and cervical screening target were flagged up as early as 1992 in the second edition of Cervical Screening
(Oxford University Press) by Joan Austoker and Ann McPherson, a guide produced in association with the Cancer Research Campaign and the Imperial Cancer Research Fund. The guide concluded that "The introduction of targets has been very controversial. It has led to a marked increase in cervical screening activity, but raises many problems…An additional problem concerns the criteria for exclusion. Women who say 'no' cannot be excluded, and remain in the denominator of the target calculation. This creates a conflict, in that it goes against the spirit of enabling women to make informed choices about whether or not they wished to be screened
iii) Clifford Ayling was a GP specialised in Obstetrics and Gynaecology and a number of his female patients registered with him specifically because of his qualifications or a history of gynaecological problems that indicated smear tests. Item 6/91 in the minutes of the twenty-second meeting of the South East Kent Health Authority Cytology Co-ordinating Sub-Committee held on 6th March 1991 at the William Harvery Hospital in Ashford said the following:"Dr Farebrother informed the committee that she had received a letter from Dr Peter Savege, the Medical Director of the FHSA, detailing GP practice figures of the percentage achievement in cervical screening, but she was concerned about their accuracy. The district cytology computer supplied all GPs with a list of their smeared patients in the previous five and a half years in April 1989. Since that time GPs had been supplied with this information on a three monthly basis in order to assist them in making their claims. It was therefore felt that the figures should be accurate. However, Dr Ayling's surgery figures were totally wrong, raising doubts as to the remainder of the information given by the FHSA. Dr Farebrother agreed to write to Dr Peter Savege, quoting Dr Ayling's case, and asking for comments.
" Dr Farebrother subsequently wrote to Clifford Ayling on 18th April 1991 with details of the response from Dr. Savege: "You will remember we discussed the list of General Practitioners who the F.H.S.A. said had reached the various targets at the last Cervical Cytology meeting. We were all very surprised tot see that your practice was among those who was said not to have reached a target at all! I have checked with the F.H.S.A.'s Medical Director and, in fact, this was a mistake and you should haven on the list of those reaching the 80% target!
". Dr Farebrother's letter was copied to Dr Padley.
iv) The 1992 guide Cervical Screening
presented the problem that targets posed to GP practices by describing the following range of possible reactions:
< 50% - why bother?
- give up screening?
50-75% - settle for 50% and retain 'ghosts' rather than aim for 80% ?
> 80% - settle for 80% and retain 'ghosts' rather than aim above this level?
75-79% - use 'coercive' tactics to achieve 80 per cent?
The information in point iii) above clearly put Clifford Ayling's practice into the last two categories of practices with regards to cervical screening targets as presented in the 1992 guide Cervical Screening
v) On 16th June 1998 BBC News reported that "Researchers claim some GPs - motivated by money - vigorously persuade women to have a smear test…Writing in the Journal of Medical Ethics, the authors call for the system of payments - which rewards GPs for convincing women in their practice to have a smear test - to be modified. Authors…say: "Under such circumstances it is hardly surprising if a small minority of GPs put thee "refusers" or "defaulters" under considerable pressure to accept a smear." And they suggest GPs gain payments for refusers who have been counselled and signed a form…GPs stand to gain £2,655 each if they take smears from 80 per cent of the women in their practice but those who only reach 50 per cent get £885
vi) Nearly ten years earlier in September 1989 an article in The Sun newspaper said "Our GP can pick up money for almost anything…Giving you an injection gets him about £4 a time…Smear tests are worth £8.90, prescribing the Pill £11.65, fitting a coil £39. At a low estimate, it makes him a total £2,000 [a year]. A pregnant woman earns him more than £136 a time. Three a month comes to £4,896 a year…
vii) The introduction to the Pulse Blue Book 1990
said "April 1990 saw the biggest shake-up in general practice for a quarter of a century. And with the new contract, a new ethos has been thrust upon GPs. Failure to carry out the correct procedure or to meet targets can lose the practice thousands of pounds
". Amongst advice given to doctors in the Pulse Blue Book 1990
on the page relating to the Registration Examination, it said "Define policy about acceptance of patients who may default on cytology and immunisation targets
viii) The Ayling Inquiry, advised by the large number of experts listed in Appendix 13 of its report, cannot have been in ignorance of the controversial question of targets introduced in government policy relating to primary health care. Rather than suggest that insistence on tests or examinations in the field of Obstetrics and Gynaecology amount to 'sexual' harassment it would be more helpful to define insistence on the need for tests or examinations in any field of medical care or treatment as 'medical' harassment. However, this would not resolve the problem of patients who, as did Patient I, refuse to sign their notes to confirm that they declined an intimate examination and then subsequently accuse the doctor of having forced them to undergo the examination. If a patient refuses an examination they must be prepared to assume the responsibility for any problems that might arise if it is averred that the examination of a diagnostic nature would have picked up pathology had there been any pathology related to the presenting symptoms.
F. Defining Sexualised Behaviour
18. It is submitted that the Ayling Inquiry failed to explore all the plausible possible causes other than alleged sexual motivation for behaviour that it is implied in the Ayling Inquiry Report should be defined as "sexualised"
i) For example, one of the claimants against Clifford Ayling in Canterbury Count Court in January 2002 when cross-examined about a colposcopy examination performed in the presence of a nurse said that "Patting my thigh…holding the samples up…there is a fine line between putting someone at her ease and being over-familiar and patting my thigh I think was a bit over-familiar
ii) In 1992 the Letts Self Support Series published a book called Positive Smear
by Susan Quilliam. It had a foreword by Dame Josephine Barnes who was at the time President of the Women's Nationwide Cancer Control Campaign. The following paragraph is in a section with the title Punch Biopsy: "The doctor takes a tiny snippet of cells from your cervix, and will sometimes take more than one sample. It is hard to predict whether you will feel any pain at this stage, since it depends on a number of things: your doctor's sensitivity, your reaction to pain, the size and number of the samples the doctors like to take. One woman described it as being 'like a bad period pain', another said 'it wasn't at all painful, and I'd been warned it would be.' One very positive suggestion reported in The Lancet was that if warned at the exact moment that a biopsy is taken, you can cough, which tenses you against the pain and also distracts you. Try asking the doctor to give you a count-down to the 'snip', and also to tap the inside of your thigh as s/he cuts; this will hopefully both reduce any discomfort and give you a feeling of involvement in what is happening
19. It is submitted that the Ayling Inquiry failed to recognise that diagnostic examinations by Clifford Ayling that have been described as being indicative of sexualised behaviour were similar to those performed by contemporaries in Folkestone and the surrounding areas and that this could be ascertained from the sets of medical notes of former patients that were produced by the Crown Prosecution Service during the police investigation in 1998-2000 or by the firm Harman & Harman during civil litigation.
i) Patient AC last saw Clifford Ayling in January 1995 and registered at The New Surgery in Folkestone in October 1995. The first consultation recorded was on 4th October 1995 and it was noted that the patient's last smear test had been in January 1995. At this first consultation the doctor performed a breast examination of both breasts, examined the patient's chest and examined the patient's abdomen. The notes show that the patient also had a smear test performed at her new Practice on the same date.
ii) Patient AA attended the Accident & Emergency Department of the William Harvey Hospital on 12th September 1995 when she was eight weeks pregnant with pelvic bleeding and abdominal pain and no sign of acute abdomen or other infection. The diagnosis of the symptoms was possible threatened abortion. The treatment was to refer to the "gynaecological team for internal examination and further management
". Clifford Ayling, as a trained Obstetrician and Gynaecologist, would have carried out the same internal examination on a GP patient presenting with the same symptoms before deciding on further management or hospital referral/admission.
iii) On 31st March 1998 Patient K was seen by a Locum Consultant Gynaecologist at the Royal Victoria Hospital in Folkestone because of problems with irregular bleeding. She had done a pregnancy test a week earlier that was positive. The report addressed to her GP said "On examination her general condition was satisfactory. Abdominal and pelvic examination revealed a bulky uterus of 14 weeks size, cervix was healthy and the os was closed. There were no obvious adnexal masses. I am making arrangements for a pelvic ultrasound, a copy of which should be sent to you and no doubt you will be referring her to the formal anti-natal clinic for booking as she wants to keep this pregnancy
". The Locum Consultant Gynaecologist, despite the possibility of and referral for a pelvic ultrasound, performed an internal examination on a pregnant woman and found no pathology. Clifford Ayling acted a number of times throughout his medical career as Locum Consultant Gynaecologist. He was qualified to carry out the same examinations on a GP patient attending with the same symptoms and in the absence of pathology would not have referred the patient to a hospital clinic other than for a pelvic ultrasound scan or the routine ultrasound scan between approximately 12 and 18 weeks of pregnancy depending on the hospital workload.
iv) On 3rd April 1998 Patient K's GP in Folkestone, Dr Maitra, wrote to a Consultant Obstetrician at the Royal Victoria Hospital thanking him "for booking this 43 year old lady for delivery at William Harvey Hospital and seeing her in your antenatal clinic in Royal Victoria Hospital…I will be looking after her from my side
". Pregnant patients attended the antenatal clinic for booking and their GP would be responsible for their routine interim antenatal care. Despite having no specific gynaecology or obstetrics qualification, Dr Maitra appears to have looked after the care of his pregnant patients himself.
v) On 12th April 1998 Patient K called out a SEADOC doctor because she was 8 weeks pregnant and had started bleeding. The on-call doctor performed an internal examination and noted a diagnosis of threatened miscarriage the doctor suggested the patient call back if there was any further bleeding. The treatment was bed rest and the patient was to see her GP for a scan. The clinical information, diagnosis and treatment on this SEADOC slip were more or less identical to that for Patient X who was seen by Clifford Ayling when acting for SEADOC in July 1998. Patient X made a police statement in December 1998 but Clifford Ayling was not charged in connection with her allegations. In 2002 she was one of the claimants against Clifford Ayling. Her solicitor Sarah Harman (who also represented Patient K in the same proceedings) signed a Particulars of Claim that stated "The Defendant purported to carry out a legitimate examination of [Patient X] during which she was unlawfully and wrongfully assaulted".
Patient AD had an ovarian cyst in 1984. In 1987 Patient AD's Consultant was Mr Ursell at the William Harvey Hospital in Ashford. A few weeks before her delivery date Mr Ursell wrote to Patient AD's GP saying "I saw your primigravida patient who has a persistent breech presentation today…At present the pelvis and baby size are such that a successful vaginal delivery should be possible but this will be re-assessed during the labour if the breech is still presented at that time". Patient AD had a forceps delivery in July 1987 with an episiotomy because of fetal distress. She then had a smear test done by a doctor at the Guildhall Street Surgery in Folkestone at one of her postnatal visits. Patient AD had a further delivery at the William Harvey Hospital in June 1988 with no complications. Patient AD again had a smear test at a postnatal visit to the Gyuildhall Street Surgery but it was heavily bloodstained and so was to be repeated mid-cycle. In August 1990 Patient AD requested a termination of pregnancy and was booked but she failed to go to the hospital and had a normal delivery in March 1991 with a graze to the perineum that was not sutured. Patient AD failed to attend her postnatal visit check and was sent a reminder. Having changed GPs, her postnatal smear was taken by a doctor in Hythe. In August 1995 Patient AD presented with pelvic and lower abdominal pain in Milton Keynes and had a high vaginal swab taken. In March 97 Patient AD was admitted as an emergency with lower abdominal pain and 6 weeks amenorrhea at Gateshead Hospital. She had a ruptured right ectopic pregnancy and was operated on. In January 2000 Patient AD had a normal delivery at the William Harvey Hospital in Ashford. She had another normal delivery in January 2001 at the William Harvey Hospital with labial laceration and then the midwife at the White House Surgery in Folkestone took a high vaginal swab. The obstetrics history of Patient AD shows that a forceps delivery is associated with an episiotomy and that smear tests are carried out at postnatal visits. It also shows that lower pelvic pain with amenorrhea and no other symptom can indicate ectopic pregnancy.
vii) In the light of the above examples it is submitted that the public was misled on 15th June 2001 when the solicitor Sarah Harman told the reporter Sandy Fleming of Meridian TV
that Clifford Ayling was "still justifying the assaults and saying that he did them for clinical purposes and it's clear from the evidence that he was doing them for his own sexual enjoyment
20. It is submitted that the Ayling Inquiry failed to take into account information about whistleblowing and the public expression of concerns that might explain why the health authority was hostile to Clifford Ayling in the late 1990's.
i) The SIN website (Sufferers of Iatrogenic Neglect) claims that health professionals are instructed that they must not acknowledge that a serious error with damage has occurred - they have a duty of allegiance to the Trust. SIN also claims that "Denial of work is a common punishment for whistle blowing health professionals
ii) An article in the Folkestone Herald
in July 1994 about Health Authority plans to close St. Mary's Hospital said "A member of staff at St. Mary's told the Herald staff had been warned by health bosses not to speak to the press. Mr Wild [Director of Operational Services for the new South Kent Hospitals Trust] explained that staff are not allowed to raise concerns with the media about health provisions without first raising them with their own bosses. There is a general rule throughout the NHS that newspapers should speak to an official
iii) Claims that Clifford Ayling was an isolated practitioner with little peer contact are false. Clifford Ayling was an active member of the Folkestone Medical Society. He was both President and Secretary and coordinated the accreditation of meetings for Postgraduate Education Allowances. Clifford Ayling was the GP representative on the local GP Ward Users Committee and was a member of the Shepway Locality Commissioning Team and the Cytology Co-ordinating Sub-Committee. He attended East Kent Health Authority meetings and regularly raised concerns with health authority officials, MPs and the local newspaper. The responses he obtained were passed on to the appropriate health official or committee for discussion.
iv) Clifford Ayling took an active interest in patient concerns. One of his surgery staff (not his wife) told his solicitors "Dr Ayling always had time to speak to his patients and would take great trouble to sort out their problems. I know that he has occasionally upset the Health Authority because he sticks up for his patients and if he believes in something he will take action. For example he has fought against the local GP ward being closed
v) Between 2nd October 1997 and 21st May 1998 at least 28 articles and 30 letters appeared in the Folkestone Herald
that were directly related to the East Kent Health Authority's plans to review hospital based services in South East Kent. On 2nd February 1998 an article said the local MP Michael Howard was opposed to plans to move a hospital psychiatric unit to Folkestone's Royal Victoria Hospital. On 26th March 1998 an article with a photograph of Clifford Ayling in front of his surgery appeared under the title DOCTOR LAUNCHES BLISTERING ATTACK ON HEALTH AUTHORITY PLAN
. The article said "[Dr Ayling] claims that if the Arundel high dependency unit must move it should go to Dover's Buckland Hospital, which could offer a better level of service…Dr Ayling feels the Royal Victoria Hospital should concentrate on Shepway's large elderly population. He said… "Shepway are being given this option as a 'take it or leave it'. If not accepted there is the threat that the hospital will be closed and sold and some other premises acquired in Shepway for Out Patient services. Clearly it is part of health care to ensure that patients have visitors and this should be facilitated. Elderly visitors are unable to undergo journeys of any great distance. Many of these people are on low incomes and do not have a means of transport…
vi) On 16th April 1998 a letter from Clifford Ayling appeared on the letters page about the proposed mental health unit. He mentioned the CHC, the training of junior staff, the Dean of the Royal College of Psychiatrists who had written in a letter that "acute beds are generally much better placed within a district General Hospital
", a Consultant in A & E at the Kent & Canterbury Hospital, a working party on new In Patient Units and security concerns that reached a peak in 1993 when an occupational therapist was killed by an in-patient in Devon.
vii) On 7th May 1998 a further letter from Clifford Ayling was published in which he wrote "Reducing the cost of the health of the nation may increase the cost to the nation…What really is ignored is the effect of all these changes on human beings in the form of mental and physical distress…Years have been spent developing services, forming teams of professionals who work together, and it is just not possible to take a service away from one place, plonk it in another and expect to achieve a streamlined, seamless gold standard…
21. It is submitted that the Ayling Inquiry failed to explore the possibility that unmeritorious complaints against Clifford Ayling made in 1998 that were not made known to him for many months were viewed by the Health Authority as a means of putting pressure on Clifford Ayling to retire and stop his public involvement in campaigns that opposed health authority policies or plans
i) On 15th June 2001, the day Clifford Ayling was struck off the medical register, the reporter Sandy Fleming of Meridian TV
said in a news item that the Health Authority had offered Clifford Ayling early retirement on health grounds.
H. Hospital Midwives
22. It is submitted that the picture presented in the Ayling Inquiry Report is not truly representative of the relations that existed between Clifford Ayling and Hospital Midwives.
i) Throughout his time as a Clinical Assistant in Canterbury and Thanet, Clifford Ayling lectured to student and pupil midwives, gave talks, assisted in examinations and organised training sessions in fetal monitoring.
ii) In 1985, about a year after he began working as a Clinical Assistant at the William Harvey Hospital in Ashford, Clifford Ayling was asked by the Senior Nursing Officer Midwifery Teacher, who knew him because she had previously worked at Canterbury and Thanet, if he would help out by giving a set of lectures. She wrote to Clifford Ayling after the lectures with some feed-back as he had asked and said "The students admired your enthusiasm and overwhelming keenness, you were never late for lectures and often did more than was required…We shall certainly be asking you to help us out with the next set of student midwives".
iii) Whilst at Thanet, the Nursing Officer for Midwifery Teaching wrote to Clifford Ayling in 1981 to say she was "delighted to learn that you are agreeable to covering the lectures for the new set of senior student midwives". Earlier still, in 1977, the Senior Nursing Officer at Canterbury wrote to Clifford Ayling to thank him for "joining us at the Midwives' Study Day…Your session was of great benefit to course members, and the day generally went well. My thanks for your help and co-operation."
ii) Clifford Ayling was invited to speak on fetal monitoring at Royal College of Midwives Refresher Courses at Folkestone. One of the tutors in the Education Department wrote to him to say the midwives "enjoyed and appreciated your talks" and looked forward to having him on their next course.
I. Medical career structure
23. It is submitted that the solicitor Sarah Harman used her position as representative of women making allegations about Clifford Ayling to make unfounded representations to the Ayling Inquiry and in the public forum with a view to defaming Clifford Ayling's character and engendering bias against him.
i) For example, it was claimed on the Harman & Harman website in early 2004 that "Ayling's two year contract [in the Middlesex Hospital in London] [in 1971] was terminated after only one year suggesting that already by this time his practice was considered suspect
". When this allegation became public, prior to the submission of the Ayling Inquiry Report, further evidence including a copy of a letter dated October 1971 renewing Clifford Ayling's appointment at the North Middlesex Hospital "for a further year from the 28th December 1971
" was sent to the Inquiry team. The response from the Inquiry Secretary on 20th April 2004 was to write that "as you know…the closing date for evidence to the Inquiry has long since passed
ii) The above claim made by Sarah Harman was not referred to in the Ayling Inquiry Report. It was nevertheless wrongly suggested that "Little is now known about this period of Ayling's hospital practice
" and that there were "serious questions about Ayling's practice as an obstetrician…towards the very start of Ayling's work as a hospital clinician
24. It is submitted that the Ayling Inquiry Report failed to position the different stages of Clifford Ayling's career within any objective study of the average career timescale of contemporaneous Obstetricians and Gynaecologists.
i) Clifford Ayling was employed from 1963 to 1975 (i.e. 12 years) in training posts. He then became a part-time Clinical Assistant (not a training post) and simultaneously pursued research until he went into General Practice in 1981.
ii) The Ayling Inquiry Report failed specifically to compare the timescales of Clifford Ayling's hospital career with that of other doctors known to the Inquiry. For example, on page 239 of the Report it is indicated that a Dr Badkoubei was a Senior House Officer and Registrar from 1976 to 1991 at Thanet District Hospital. That means Dr Badkoubei was in the same level training post for 15 or 16 years in the hospital where Clifford Ayling was a Clinical Assistant at Registrar level. Dr Badkoubei did not move on to a Consultant post but in 1991 he became a Staff Grade Doctor, still at Thanet District Hospital.
25. It is submitted that the failure of the Ayling Inquiry Report to refer to a major NHS policy document that was highly relevant to the period the Inquiry was to investigate may lead to unfounded and generalised assumptions that any hospital doctor of Clifford Ayling's generation who did not become a consultant was deficient in clinical ability or performance.
i) In its assessment of Clifford Ayling's hospital career, the Ayling Inquiry Report failed to refer to the contents of the NHS policy document published in October 1987 called Hospital Medical Staffing - Achieving a Balance
. This document was described in 2000 by Professor Peter Hill as "arguably one of the several most important policy documents in the lifetime of the NHS". Professor Hill explained in 2000 that this document "saw the underlying problem of medical staffing as due to the basic conflict between two principles: that all junior doctors seeking a hospital career are in training for consultant posts; and that all consultants should have adequate support…[the] document proposed a range of measures which, it was hoped, would bring the hospital staffing structure into balance in relation to consultant expansion, the number of registrars, and the need for support for consultants without training doctors for non-existent posts…[the] document placed special emphasis on the concept of doctors unlikely to make further career progress. These so-called 'stuck doctors', a widely used though somewhat stigmatising and unfortunate term, were not precisely defined
ii) A paper dated 1993 by P. Hill and L. Donaldson described the characteristics of applicants for the first cohort of staff grade posts in the Northern Regional Health Authority in 1989 and 1990 as having a mean age of 43 years and a mean time since qualification of 18 years. In 1975, when Clifford Ayling obtained his non-training post of Clinical Assistant at Canterbury and Margate, he was exactly 43 years old. He had qualified as an Obstetrician and Gynaecologist only 5 years earlier and obtained his first medical qualification 12 years earlier. It is misleading to suggest that Clifford Ayling spent more time in hospital training posts than contemporaneous colleagues.
iii) In the absence of any disciplinary measure against Clifford Ayling throughout his hospital career and in the light of the findings of the 1987 white paper Hospital Medical Staffing - Achieving a Balance
, it was misleading of the Ayling Inquiry Report to suggest that Clifford Ayling's "inability to progress further within the profession" may have been "due to deficiencies in his clinical ability or performance
25. It is submitted that the term "expedient use of a rolling contract" used in the Ayling Inquiry Report gives a false portrayal of the employment status of Clinical Assistants.
i) The Junior Hospital Doctors Association industrial relations service explained in the medical newspaper On Call
of April 14th 1977 that "clinical assistants have exactly the same protection under Employment Law as all other employees. In general these rights depend on the length of time in post, and employers usually cannot evade their responsibilities by talking loosely about posts which are renewable at one yearly intervals…although the clinical assistant post is nearly always described as one yearly renewable, employment rights are cumulative
26. It is submitted that the Ayling Inquiry failed to take into account its own expert material and apply it to the evidence it was asked to assess.
i) For example, under the heading What is a clinical assistant?
in Annex 3 of the Ayling Inquiry Report, it is explained that "Clinical assistants are career grade doctors employed on permanent contracts in hospital and community health services, who are not consultants or doctors in training
". Despite this knowledge of the status of Clinical Assistants, the Ayling Inquiry Report does not question the specific content of a letter it cites, dated 15th September 1993, that informed Clifford Ayling of the non renewal of his Clinical Assistant contract in March 1994. The opening sentence, as follows, was in direct contradiction with the Inquiry's own expert material: "You will know that clinical assistantships are the subject of reasonably frequent turnover so that the mutual learning process which takes place between hospital and general practitioner clinicians can be more widely shared.
27. It is submitted that the Ayling Inquiry Report failed to position the dates on which Clifford Ayling's two Clinical Assistant contracts were not renewed within any objective study of NHS budget policy.
i) In the absence of any disciplinary measure against Clifford Ayling throughout his hospital career and in the absence of any proper study of landmark dates in health budget policy in Kent, it was misleading to suggest that the non renewal of Clifford Ayling's Clinical Assistant contracts in 1987 and 1994 were the direct result of alleged concerns about unprofessional behaviour or deficiencies in performance.
ii) The termination of the Clinical Assistant contract at Canterbury and Thanet in 1987 is dealt with elsewhere in these submissions.
iii) Clifford Ayling's Clinical Assistant contract for colposcopy sessions at the William Harvey Hospital in Ashford was terminated on 31st March 1994 and the Health Authority officially became an NHS Trust on 1st April 1994. Clifford Ayling's colposcopy sessions were taken over by Dr. Kumi, a hospital staff grade doctor who also did antenatal clinics. The alleged 'spate' of complaints that occurred in 1992 and 1993 appear to have been encouraged by the Director of Nursing Merle Darling in conjunction with the Unit General Manager Mark Addison. Merle Darling and Mark Addison appear to have dealt informally with complaints and made 'in-house' investigations that were not referred to higher management. They also had hospital staff that propagated rumours about Clifford Ayling in unsolicited remarks made to vulnerable or apprehensive patients. It is possible that complaints were encouraged and embroidered to put pressure on Clifford Ayling not to resist the axing of his Clinical Assistant post when the Health Authority became a Trust.
J. Evidence to the Inquiry
29. It is submitted that a person closely connected to a participant to the Inquiry misled the Committee of Inquiry and potential participants into believing that a hospital doctor was to give evidence against Clifford Ayling.
i) On 6th November 2002 in Folkestone at the Inquiry Preliminary Meeting a man stood up and said: "My name is Dr. [B]. In 1977 I was involved in what I thought was a botched delivery. Only recently I found out that it was Mr. Ayling. It is a procedure question. Do I make a statement through Sarah Harman or is there another facility?
" The name of Dr. [B] does not appear in the list of witnesses referred to in the Ayling Inquiry Report and no hospital doctor is cited in the body of the report as having given evidence that they witnessed a 'botched' delivery. However, "Dr." [B] appeared in a photograph with his wife, Patient B, in a Kent regional newspaper on 12th September 2004 under the title Our Lost Baby Woe
. The press article explained that Mr and Mrs [B] hoped the police might "prosecute for manslaughter
". Mrs [B] made no contemporaneous complaint and did not come forward until after Clifford Ayling's conviction. Both Mr and Mrs [B] were described on BBC News
in September 2004 as 'teachers' and the title "Dr" was not used. It would seem Mr [B] is a doctor, but not of medicine.
30. It is submitted that the Ayling Inquiry Report includes a number of ambiguous descriptions that were designed specifically to convey a false impression of the evidence it had in its possession.
i) For example, Patient C was quoted anonymously in the press in September 2001 as saying she felt "lucky to be alive and to have a healthy son after Ayling's conduct
". It was claimed in the same press article that in 1980 Clifford Ayling had performed "a brutal delivery
" and "a shambolic Caesarean section
". However, the contemporaneous complaint written in 1980 by Patient C's husband said the delivery had been performed by a "Dr [M]
" and that "They delivered the baby successfully and everything was fine
". The Inquiry was provided as early as February 2002 with a copy of the complaint by Patient C's husband as evidence that Clifford Ayling had not delivered the baby and that the delivery, performed by Dr [M], had not been shambolic. Notwithstanding this evidence, the Ayling Inquiry Report described the complaint by Patient C's husband as having been about "the conduct of the delivery of their baby
" and it failed to specify that the delivery was not performed by Clifford Ayling, thereby allowing the logical assumption that it was.
31. It is submitted that the Ayling Inquiry Report unfairly gives credit to uncorroborated hearsay evidence.
i) For example, it is claimed that Dr Calver told the Inquiry he had been told about two complaints made to GPs but could only recall the name of one of the GPs and he "pointed out that this was fourth-hand information and that he had nothing in writing
32. It is submitted that the overall impression given by the Inquiry's assessment of witness evidence is that corroborating statements saying something had not happened was interpreted as evidence that it had.
i) The underlined words in the following extract from the Ayling Inquiry Report is one example:
"[Medical manager[s] for SEADOC]Drs Colledge and de Caestecker recalled that Dr Colledge received an [informal] complaint from Dr Moffat, a GP in Ashford, which related to a female patient of his who claimed that Ayling had examined her in an unprofessional manner while working for SEADOC…it was decided that Dr de Caestacker should speak to Dr Gary Calver who was then the Chairman of the South East Kent GP division…Although the patient concerned is clear that she never [raised the matter with Dr Moffat], and Dr Moffat does not remember her case, it seems to us that it may have been this incident which reached Dr Moffat and was then reported to SEADOC…
33. It is submitted that consistent use of the words "agreed that" and "accepted that in the Ayling Inquiry Report betrays aggressive cross-examination of lay witnesses who appear to have been called to give oral evidence not with the view of compiling a complete and comprehensive narrative of what happened but with the view of coercing witnesses into accepting that alleged incidents had occurred and that they should have done something.
"Mr Fullman agreed that…
"Mr Patterson ultimately accepted that he must have been extremely naïve…
"We found Mr Homeshaw to be a reticent witness, who was unwilling to contribute constructively to our investigation of complaints…we found this surprising and unhelpful. [His] approach to us contrasted with that of Dr Peter Savage…Dr Savage was willing to reflect on his actions or lack of actions and to agree that, in certain respects, he was found wanting.
"Dr Pickering…should have raised concerns about Ayling's conduct. Dr Pickering was taken through many of these [interviews from 1985] in detail while giving evidence and on a number of occasions he accepted that what had happened was wrong…
"Mr Addison candidly accepted that if…
"Dr Farebrother acknowledged that she had not…
"She accepted that with hindsight she should have…
"She also accepted that she should have…
"Dr Savage fully accepted that his actions…left a great deal to be desired
"…he conceded that he should have…
"…Dr Savage agreed that he should have…
ii) The Inquiry Procedures as set out in Appendix 9 of the Ayling Inquiry Report explained that the Inquiry would indicate in writing what issues or topics would be addressed in questioning prior to the witness giving oral evidence. However, informal reports from some participants to the Inquiry show they felt 'ambushed' when they attended to give oral evidence. In at least one case the witness was not given the opportunity to provide further evidence on matters that had not been raised in writing prior to their attendance at the Inquiry and which led to an unfair adverse comment in the Ayling Inquiry Report.
33. It is submitted that the omission of reference to expert evidence concerning Clifford Ayling's obstetric expertise that was within the knowledge of both the Health Authority and the solicitor Sarah Harman distorted the Ayling Inquiry's assessments regarding the quality of Clifford Ayling's obstetric work in the 1980's.
i) The website set up by Sarah Harman's firm in 2001 updated its background section when the Inquiry's evidence gathering stage had concluded. In April 2004 the website contained an allegation that in 1987 Clifford Ayling attended "the delivery of a baby during which he caused serious damage to the mother by a forceps delivery instead of undertaking a caesarean. The woman concerned had to have a repair operation and made a complaint, which was not acted upon
". The only reference to this allegation in the Ayling Inquiry Report appears to be in one sentence in paragraph 3.107 saying "We have received other evidence that investigation of complaints was not done as appropriately or as contemporaneously as good practice would demand
". However, a letter dated 23rd July 1987 from the Medical Defence Union to Clifford Ayling indicated that the complaint was being dealt with by that date. A letter from the firm Harman & Harman to the Health Authority in May 2001 indicated that in 1989 the patient's "previous solicitors considered that there was no case to proceed
ii) The woman concerned [referred to as Patient AG] was represented by Sarah Harman from February 2001 onwards in litigating a claim for about £20,000 against the Health Authority. The Health Authority made an out of Court settlement in 2002 or 2003 when Patient AG "in fact changed her case and reverted to her claim that Caesarian section should have been performed
", although there was no allegation in Harman & Harman's Letter of Claim dated 9th May 2001 that the patient should have had a caesarian section.
iii) The Consultant Obstetrician and Gynaecologist instructed by the solicitors acting for the Health Authority wrote in August 2001 that he could not "find any reference to the alleged advice given to [Patient AG] with regard to her needing a Caesarian section…The last entry in the antenatal clinic record suggests that the foetal head was engaged within the pelvis. I do not believe, therefore, that elective Caesarean section would have been a sensible option here… I would have no criticism of the delivery of this baby or the performance of an episiotomy…[Patient AG's] baby was delivered using Kielland's rotational forceps. This in itself is a delivery for an expert…The very fact that [Clifford Ayling] was aware that traction could be applied to the foetal head whilst still in a malposition in order to find a station within the pelvis where rotation was achievable, would suggest to me that he was well used to using Kielland's forceps…I have no doubt that Dr Ayling and indeed Mr […] very much regret the sequelae to the infected episiotomy but this does not mean that Dr Ayling was uncaring in his attention to [Patient AG]
iv) The solicitor Sarah Harman instructed the Consultant Obstetrician and Gynaecologist who had acted previously as expert witness for the Crown Prosecution Service at Clifford Ayling's criminal trial. His report on Patient AG's allegations was dated April 2001 and said "There are no absolutes in the hectic and subtle world of labour ward care…the management of labour seems to have been good…the labour was fairly long…It involved a difficult forceps delivery and the necessary cut of thick, unyielding maternal tissues associated with obesity…There is reason to think that Dr Ayling carried out the delivery with some expertise, (Kielland's forceps and shoulder dystocia) and I would not wish the whole blame to lie with him, especially bearing in mind that the delivery occurred at 5.25 a.m.
". There was no reference in this report to the option of caesarean section and the focus was clearly on whether or not earlier administration of antibiotics would have prevented infection of the episiotomy.
K. Lay witnesses
35. It is submitted that the fear of blame propagated by the dynamics of the Ayling Inquiry and the threat of being singled out as Defendants in ongoing civil litigation coordinated by the solicitor Sarah Harman on behalf of her clients led some witnesses to be overly submissive or to allege the involvement of higher management in the handling of alleged complaints Clifford Ayling.
i) One example is the evidence as reported of Dr Savage in relation to the Police Complaint in 1991. Dr Savage claims that Kay Heatherington of the Kent Family Health Services Authority was the recipient of the Police referral, that he received a memo from Kay Heatherington and that the referral letter was copied to Mr David Homeshaw. In a "supplemental
" statement Dr Savage said Professor Peter Higgins was to liaise with Mr Homeshaw in discussions about how to deal with the information received. The Ayling Inquiry Report concluded "it is clear to us that the incident was not taken sufficiently seriously by the FHSA's senior management and that there was a significant failure on their part to ensure appropriate investigative or supervisory action
ii) Kay Heatherington gave written evidence to the Inquiry but it is not referred to in the report. Professor Higgins also gave written evidence to the Inquiry and said he had no recollection of a Police referral. Mr Homeshaw gave oral evidence to the Inquiry. He said he had no specific recollection of the matter and did not remember any conversations about it with Dr Savage or Professor Higgins. The Inquiry concluded that "Mr Homeshaw's actions were not those which might be expected of an experienced Chief Officer
iii) The Ayling Inquiry Report contains a specific reference to a letter dated 11th June 1991 from Dr Savage addressed to Clifford Ayling. A copy of this letter was amongst documents handed to the Inquiry Secretary by Joan Ayling on 6th November 2002. The first sentence of the letter suggests strongly that the Police referral was made direct to Dr Savage: "The events of 9 January in respect of [Patient R] have been referred to me by the Kent County Constabulary.
iv) Another example of a health professional involving other persons whose evidence does not corroborate their own is that of Dr Calver in the section of the Ayling Inquiry Report that deals with SEADOC and an anonymous complaint allegedly relayed in 1996 . The Report says "Dr Calver felt that his first approach should be to speak to the LMC and he believed that he spoke to Dr Ashton, then its Assistant Medical Secretary…One of the comments…was "Is he the Doctor that examines without gloves, the man from Cheriton?" At this stage Ayling's name had not been mentioned.
v) Dr Ashton made a formal statement to the Inquiry dated 18th March 2003. In this statement Dr Ashton said Dr Calver had telephoned him in 1997 about a complaint about a GP in Folkestone, without naming the GP, who was malfunctioning. Dr Ashton said the complaint had been relayed to Dr Calver by SEADOC. Dr Ashton said Dr Calver did not specify in what way the unnamed GP was malfunctioning. He said he advised Dr Calver to look into the complaint and then either refer to the GMC or come back to him for further guidance. Dr Ashton heard nothing more from Dr Calver. Dr Ashton specified in his statement to the Inquiry that "Before 1998 I was not the recipient of any information by way of direct report or by way of gossip about Ayling or indeed any other general practitioner in my area who was said to be committing any sexual impropriety with his patients
vi) There was no reference in Dr Ashton's statement with regards to Dr Calver's telephone call to either Dr Moffat (mentioned by Dr Calver to the Inquiry) or Cheriton. Dr Ashton's written evidence to the Inquiry did not corroborate Dr Calver's version of events. The Ayling Inquiry Report makes no reference whatsoever to Dr Ashton's written evidence or to oral evidence given on his behalf by the Clerk to the Kent Local Medical Committee in connection with Dr Calver's allegations about complaints as reported in paragraph 3.346 in the section of the report on SEADOC (pages 94 to 98).
vii) It is submitted that it was partial of the Ayling Inquiry to conclude that Clifford Ayling was the person alluded to in an anonymous complaint made by Dr Calver about an unnamed doctor in Folkestone in 1996 which did not contain any detail of how the said doctor was alleged to have been malfunctioning.
viii) In 1996 there were at least six GPs working in Cheriton (and many more throughout Folkestone). Four of the doctors working in Cheriton were at the White House Surgery. Among the doctors at the White House Surgery was a Dr Jonathan Chappell. Dr Chappell was struck off for professional misconduct after a hearing before the General Medical Council in September 1996. A local press report said "it was claimed that Dr Chappell asked inappropriate questions about a patient's personal life, gave her pornographic videos and was responsible for inappropriate or indecent behaviour both at the White House Surgery, in Cheriton High Street, and at the patient's home. The hearing heard that Dr Chappell hugged and groped the 31-year-old patient, known as Mrs A for legal reasons, and made her perform a sex act
36. It is submitted that some of the health professionals who were participants to the Ayling Inquiry and gave evidence that claimed they had knowledge of complaints about Clifford Ayling in the 1980s or 1990s had previously informed the Police during the investigation prior to Clifford Ayling's criminal trial that they did not have knowledge of any 'victims'
i) This is the case particularly for Dr Maitra who was contacted by Detective Constable Beautridge on 3rd December 1998. The police action sheet states that Dr Maitra was spokent to on the telephone and did "not have details of any victims". He therefore did not provide a police statement. This is somewhat surprising as he was the GP of the patient who made the first complaint to the Health Authority in 1998. In her written complaint dated 23rd February 1998 the patient wrote of the following about her first consultation at her new surgery: "During my conversation with Dr Maitra regarding th transfer of my medical records, he asked me the reason why I changed from Dr Ayling. I did not volunteer any reason, as I did not want to discuu this embarrassing experience. Dr Maitra then asked 'was it sexual?' I was surprised that he volunteered this reason, I then confirmed that this was the case. Dr Maitra then told me that he is well aware of Dr Ayling's conduct as several women have changed to him and other GPs for this reason.
" The fact that Dr Maitra told the Police he had no details of 'victims' means that the allegation made by the patient in her complaint was not corroborated.
37. It is submitted that information about Lay Witnesses in Appendix 3 of the Ayling Inquiry Report is unreliable, incomplete or misleading.
i) Ayling, Ms Jeannette Evelyn - Practice Manager, Cheriton High Street, (1977-2000)
Mrs Ayling was never Practice Manager. She was a receptionist at the Practice and also Practice Administrator from 1985 to 1998. Her role and work were clearly defined in her statement to the Inquiry that was provided through her legal representative. Mrs Ayling had no managerial duties and no decision-making power. As Practice Administrator she dealt solely with routine administrative matters. Clinical matters were dealt with by the GPs and the Practice Nurse. The recommendation on page 25 of the Ayling Inquiry Report that Primary Care Trusts should "pay particular attention to developing and supporting the independence of practice managers in single-handed practices, including the acknowledgement and resolution of potential conflicts of interest which may arise where the manager is the spouse or a close relative of the practitioner
" cannot be interpreted in any manner as being a reflection on the work of Mrs Ayling or on how she dealt with patients. The Inquiry correctly referred to Mrs Ayling as the Practice Administrator in paragraph 4.21 and was therefore not mistaken as to her position and limited role within the Practice.
ii) Brace, Mr John Charles - Consultant Obstetrician and Gynaecologist, North Middlesex Hospital (1971)
Mr Brace is referred to in the Ayling Inquiry Report only as Patient A's consultant in 1971. However, Mr Brace was the consultant that Clifford Ayling worked under during the whole two years of his appointment at the North Middlesex Hospital throughout 1971 and 1972. Considering that Mr Brace gave evidence to the Ayling Inquiry, the claim that "Little is now known about this period of Ayling's hospital practice
" is misleading, as is the single year 1971 in the entry for Mr Brace in Appendix 3 of the Ayling Inquiry Report.
iii) Mr Roger Varley Clements - Consultant Obstetrician and Gynaecologist, North Middlesex Hospital (1973-1974), Clinical Director (1988-1991), Medical Director (1991-1994) North Middlesex Hospital NHS Trust.
Clifford Ayling was a Registrar at the North Middlesex Hospital from 28th December 1970 to 14th January 1973 and worked under the Consultant Mr John Brace. For Mr Clements to have been at the North Middlesex Hospital at the same time as Clifford Ayling, his appointment would have had to start at some point between 1st and 14th January 1973. However, in 1971 Mr Clements was a Lecturer at the Samaritan Hospital for Women (part of St. Mary's Hospital) in London. It was he who performed a surgical repair on Patient A, referred to in the Ayling Inquiry Report. This repair was carried out on 1st July 1971 following a delivery at the North Middlesex Hospital in February 1971. Patient A was discharged from the Samaritan Hospital for Women on 5th July 1971 and was to be seen again in one week's time. Patient A claims to have written to her consultant Mr John Brace in "strongly critical terms
" some weeks after the delivery at the North Middlesex Hospital asking for an explanation of what had 'gone wrong' but cannot recall whether she ever met Mr Brace to discuss this. There is no reference whatsoever to Mr Clements in the Inquiry's discussion of Patient A's allegations. His opinion on the nature of the surgical repair he performed would clearly have been invaluable and he would most certainly have been the obvious recipient of a complaint by Patient A in July 1971 had she really written to Mr Brace soon after the delivery in February 1971 and received no satisfactory response. The Expert Witness Institute website contains information that says Mr Clements "has made over 3,000 Medico-Legal reports in Civil Litigation (plaintiff and defendant), Crime, Disciplinary Inquiries and Industrial Tribunals and has given oral evidence on some 60 occasions in the High Court, County Court, Disciplinary Inquiries, General Medical Council and Industrial Tribunals". Mr Clements's opinion on the surgical repair he carried out on Patient A in 1971 would have been invaluable, given his degree of expertise in medical litigation. It would also seem that Mr Clements was a Registrar working for the same Consultant as Clifford Ayling in 1964 when the latter was House Surgeon in the Surgical Unit of University College Hospital. If this was the case Clifford Ayling would have assisted him when he did operations.
iv) Lethbridge, Ms Helen - Community Nurse (1997-1998) based in Clifford Ayling's Surgery
Ms Lethbridge gave the following information at the start of her witness statement for the Inquiry made in January 2003: "September 1997-1998 worked as a Community Nurse, looking after the over 75's. I was based at Doctor Ayling's Surgery. Nov 1998 -2000 (December), worked as Doctor Ayling's Chaperone, whenever needed. I helped him when the Practice Nurse was off duty." Within her statement Ms Lethbridge said "I never had anyone complain to me about Doctor Ayling in the time I worked at the surgery…he was a good doctor and cared very much for his patients and their welfare, and put in many extra hours to help people out…I was a patient since 1991, and never had any problems…I don't think [systems within the NHS for complaints-handling] have improved. Doctors are in such short supply, and struggling to cope with ever growing surgery numbers. Most doctors don't have chaperones, and again it must all be down to cost and time. They will always be very vulnerable to anyone who wishes to cause trouble
". No reference is made to the bail chaperone's evidence within the body of the Ayling Inquiry Report and in the light of the importance accorded to the role of chaperones by the Inquiry, the omission of Ms Lethbridge's appointment as chaperone in Appendix 3 cannot be due to an oversight.
v) Tonge, Dr Jennifer - Medical Student, Kent & Canterbury Hospital (1963)
Clifford Ayling did not work at the Kent & Canterbury Hospital until 1973 and Jennifer Tonge never worked at the Kent & Canterbury Hospital at all. Jennifer Tonge was a medical student at University College Hospital (UCH) from 1959 to 1964 and apparently believes Clifford Ayling was a Registrar on the Obstetric Unit when she did her Obstetrics appointment. However, the only time Clifford Ayling was a Registrar at University College Hospital was when he once acted as Locum Registrar for just under a month during the 1970's, by which time Dr Tonge had already been working as a GP and family planning doctor for nearly ten years (as indicated in the 2006 Who's Who). Information in the 2005 Medical Directory appears to indicate that Dr Tonge has no specific Obstetrics or Gynaecology qualification and therefore is unlikely to have been a junior doctor in an Obstetrics Unit. If she came into contact with Clifford Ayling and "worked alongside" him it would have been in her final year as a student at UCH when Clifford Ayling was doing his first pre-registration hospital appointment for six months as House Surgeon to the Surgical Unit at UCH. On 6th May 1964, the Director of the Surgical Unit who was also the Consultant that Clifford Ayling had worked for during this appointment wrote: "I am glad to recommend Mr. C.R. Ayling for a second pre-registration house appointment. He has nearly finished a six month appointment as House Surgeon in this Unit and his work has been consistently good. He is careful and conscientious in looking after his patients and does his administrative work competently. I think he should make a good House Physician". The Ayling Inquiry Report stated that under its Terms of Reference it began in 1971 and it is not known on what basis Dr Tonge's name appears in the lay witness list. Clifford Ayling recalls having written to Baroness Tonge from prison in about 2003 when it was publicised that she had raised an issue about women's health in Parliament. The information about Dr [now Baroness] Jennifer Tonge in Appendix 3 of the Ayling Inquiry Report is grossly inaccurate. The entry for Dr Tonge is the only entry in the list of witnesses that refers to a medical student and as such can be taken to correspond to the witness referred to in paragraph 4.49 of the Ayling Inquiry report.
L. 'Incidents' allegedly witnessed by hospital staff in 1980 and 1988
38. It is submitted that the evidence to the Ayling Inquiry of Sister Penny Moore that alleges she witnessed an incident involving Clifford Ayling in the Antenatal Clinic at Thanet in the early part of 1980 was fabricated for the purposes of the Inquiry.
i) The 'incident' is the substance of uncorroborated evidence given to the Ayling Inquiry by a midwife who was not involved in the police investigation that led to Clifford Ayling's criminal trial. The evidence as reported in the Ayling Inquiry Report claims the incident took place in a clinic that was never part of Clifford Ayling's timetable. The Ayling Inquiry specified in it assessment of the alleged incident that it must "avoid any risk of identifying individuals concerned
". Both Consultants named by Penny Moore denied having heard of the incident at the time and Mr Patterson is reported as having said that Penny Moore disliked Clifford Ayling.
ii) Towards the end of July 2003 the reporter Holly Lewis presented a Meridian TV
news item saying that "the hearing is into its fourth month but the victims' solicitor says new evidence submitted by a nurse about an incident she and a colleague witnessed is extremely important
". The solicitor Sarah Harman then said "The significance of this is that in sexual abuse cases there's often no corroborative evidence, it's just the victim's word against the perpetrator. But this is very serious because clearly what happened was witnessed by two other nursing staff and it should have been acted on and Ayling should have been stopped at that point.
iii) Sarah Harman's statement implied that Penny Moore's evidence was corroborated but there is no indication in the Ayling Inquiry Report of evidence obtained from either the patient involved or the nurse whom it is alleged urgently called Penny Moore to the antenatal clinic.
iv) The allegation by Penny Moore was presented in the media in July 2003 as "new evidence" but it is indicated in Appendix 3 of the Report that Penny Moore provided both written and oral evidence to the Inquiry. Whatever the form or the timing of Penny Moore first making her allegations, they were made within the Inquiry proceedings and solely for the purpose of the Inquiry and should not have provided a basis for claims for compensation.
39. It is submitted that the evidence to the Ayling Inquiry of Dr Voysey that alleges she was the recipient of a complaint about an alleged incident involving Clifford Ayling in the Colpscopy Clinic at Thanet in the summer of 1988 was fabricated for the purposes of the Inquiry.
i) On 31st October 2002 the Folkestone edition of the Kentish Express
carried an article about Patient I's attempt to obtain permission to sue the Health Authority despite her claim being out of time. The article contained the following: "Doctor Ayling was dismissed by the Kent and Canterbury Hospital in 1987…Stella Fisher, the East Kent Health Authority's legal services manager, told Judge Poulton that she had received confirmation in the last week that Dr Ayling's contract with the K& C had ended in that year. Cross-examined by Paul Stagg, counsel for [Patient I], Mrs Fisher said she was in no doubt that Ayling had been dismissed. Asked by Mr Stagg if she knew there had been an industrial tribunal, whether she had contacted the tribunal and if not, why not, she said: "It didn't occur to me to do so." Andrew Miller, counsel for the health authority, said Ayling's contract at the K&C had not been renewed because of a clinical judgement that his work was falling below general standards…Ayling was also running his own practice, and he had too much to cope with. There was no instance of his having problems with women patients, so it was not relevant to [Patient I]'s case. Mr Stagg expected the forthcoming inquiry into the Ayling affair to be searching and more powerful than the courts.
ii) There appears to have been no reference to work by Clifford Ayling in Thanet after June 1987 until Dr Voysey gave evidence to the Ayling Inquiry. On 6th November 2002 at the Inquiry Preliminary Meeting the solicitor Sarah Harman told the Inquiry Panel that she "was on telly last week mentioning - wrongly, as I found out - that Ayling was sacked from the Kent & Canterbury for clinical misconduct. The lady who sacked him from Thanet District Hospital rang me up and said, "You have got it wrong", and she gave me other people to contact
". This signifies that there was informal contact prior to the Inquiry between Sarah Harman who was representing claimants litigating against the Health Authority and persons who had held managerial posts within that same Health Authority.
iii) On 28th November 2002 the Folkestone Herald
reported that "solicitor Sarah Harman said the health authority did know about other assaults and should have known Ayling had been sacked from the Thanet hospital. Ms Harman said the doctor was booted out in 1987 after molesting a young woman in the colposcopy unit while carrying out an examination
". This allegation of an alleged incident in the Colposcopy Unit in Thanet in 1987 does not appear to have been repeated.
iv) On 29th January 2003 Joan Ayling sent the Inquiry a bundle of documents that included correspondence between Clifford Ayling and his solicitor in connection with the Industrial Tribunal. In November 1987 after discussions with Acas it seemed that the Health Authority wished to settle the matter and Clifford Ayling was asked whether he would wish to receive compensation or reinstatement so that his solicitor could be fully prepared for negotiations. In January 1988 Clifford Ayling wrote to his solicitor saying it was over six weeks since the date for the Industrial Tribunal and he had heard and received nothing. He further added that he had heard "nothing regarding the colposcopy session at Margate which I stipulated should be considered as part of the settlement to which I agreed
v) In July 2003 Joan Ayling travelled to Essex to the Industrial Tribunal archives and obtained two certified copies of the Industrial Tribunal documents relating to the end of Clifford Ayling's contract in June 1987. One set was handed in person to Mr John Millar, Assistant Inquiry Secretary, on 1st August 2003. The agreement, dated 29th December 1987, was signed by Clifford Ayling's solicitor. The agreement, made in respect of an application to the Industrial Tribunal by Clifford Ayling against the Canterbury and Thanet Health Authority, said that "the respondent shall pay the applicant the sum of £5,584.57p (which includes the sum of £2484.57p being the residue of a car purchase loan which is now written off) in full and final settlement and satisfaction of any claims that the applicant could bring against the respondent as the result of the termination of the applicant's employment on 30.6.87. The application to the industrial tribunal is consequently withdrawn
". The agreement contained no reference to either reinstatement or colposcopy work.
vi) Documentation handed to the Inquiry on 1st August 2003 also included further documentation about the termination of Clifford Ayling's Clinical Assistant contract in 1987. Accompanying submissions made by Joan Ayling said the following: "Dr Ayling never undertook the Colposcope session and has said to me in a letter that at the time Mr Patterson had not been happy about "what they did". This suggests that when Mr Patterson wrote "I did promise you that I would contact you before making any further advances to anybody else" it was in good faith but that there was never any intention on the part of the administration of giving Dr Ayling a colposcope session and it was but a ploy to delay Dr Ayling in any claim he might make to the Industrial Tribunal so that it would be past the 3 month time limit from the date of dismissal
vii) It is submitted that the Ayling Inquiry failed to explore the possibility that the termination in 1987 of Clifford Ayling's part-time contract as a Clinical Assistant was directly related to cost-cutting plans by the NHS and a single adverse event of a clinical nature. The documentation the Inquiry had in its possession suggested strongly that Dr Voysey was actively involved in the constructive dismissal of Clifford Ayling in 1987. There is no corroborating evidence for Dr Voysey's non contemporaneous allegations. The Kent & Medway Strategic Health Authority confirmed in 2005 that it had no information relating to Clifford Ayling about Colposcopy work in the hospital setting after June 1987. Documentation obtained from the Pensions Agency in 2006 confirmed that it also had no information relating to the alleged contract for Colposcopy on a weekly basis in Thanet in 1988.
M. Compensation Claims
39. It is submitted that the Ayling Inquiry Report was used as an instrument to further civil claims brought against Kent & Medway Strategic Health Authority by clients of the solicitor Sarah Harman.
i) The Ayling Inquiry Report failed completely to address the question of compensation within its study of the handling of complaints about alleged inappropriate behaviour. When complaints are made that lead to large out of Court settlements paid out of public funds, there must be some analysis of the motivation behind complaints made by persons who have not suffered objectively quantifiable damage or who are reluctant to disclose details of previous sexual history or alleged abuse that may be the cause of residual trauma.
ii) Considering that the Ayling Inquiry was at least the third health inquiry at which the solicitor Sarah Harman represented participants and that many of Sarah Harman's clients also brought civil claims against health authorities that led to large settlements, the corollary must be that health inquiries and claims for compensation are intrinsically linked and are symbiotically dependant upon each other: the former need allegations to assess or they will lose credibility and the latter want a large public body with a guaranteed source of funds to claim against.
iii) This explains why many of the initial claims that centred on allegations of indecent assault (which is a criminal matter) were subsequently conducted as allegations of clinical negligence (for which a health authority can be held vicariously liable). It also explains why Sarah Harman asked the Inquiry Panel in November 2002 "what facilities there are going to be to look at Ayling's obstetric work [e]ven if women have not come forward and complained
iv) In April 2002 in Particulars of Claim against the Health Authority for Patient I signed by the solicitor Sarah Harman, it was stated that Patient I "first approached solicitors for advice about a potential claim in February 2001
". Despite being strictly out of time, a claim was issued against the Health Authority. Patient I was not amongst the women who issued claims against Clifford Ayling at about the same time although at the ensuing civil proceedings in February 2002 Sarah Harman said her clients "should never have been abused not because of what the defendant was like but because of what the Health Authority failed to do
v) Two weeks after damages were awarded in April 2002 to the group of women who had claimed against Clifford Ayling the Particulars of Claim against the Health Authority for Patient I was amended to include a paragraph about Patient H which said that Patient H's complaint "was not dealt with effectively
" by the Health Authority.
vi) Patient I subsequently waived anonymity in October 2002 when it was reported that she had gone to Court to try to obtain permission to sue the Health Authority despite being out of time. Her solicitor Sarah Harman told reporters that "If the judge agrees, other cases against the Health Authority will come forward
". Another newspaper reported that "When [Patient I] heard in 1998 that Ayling was being investigated by police for indecency she was angry and called a Tunbridge Wells firm of solicitors for advice. She was told she could do nothing until the case against Ayling was concluded, she said. When the judge told her that the opposite was the case and a writ should have been issued immediately by the firm, [Patient I] said she did not know its name or to whom she had spoken…[Patient I] said she acted on the advice of the Tunbridge Wells solicitors and, as a police witness in the case, she could not speak to other witnesses until the case came to court in 2000
". This was in contradiction to the contents of the Particulars of Claim. Then in November 2002, a few weeks after the Inquiry's preliminary meeting, a newspaper report said Judge Poulton in Canterbury County Court had "ruled that although the woman's claim is strictly out of time she can sue the NHS when an independent inquiry into the Ayling saga is complete
vii) The case of Patient I exposes the fact that claims for compensation against the Kent and Medway Strategic Health Authority and the Ayling Inquiry were intricately interwoven and that the success of the claims hinged on the contents of the Ayling Inquiry Report.
viii) Patient I was involved very early on in the campaign for an Inquiry into the Ayling case with the aim of using it as a tool for attributing blame. The website of the firm of solicitors Harman & Harman set up in 2001 contained a message to the Secretary of State from Patient I that concluded "The Inquiry should be heard in public (although women should have the option of confidentiality). I gave my evidence in public at the criminal trial and those in the Health Service who failed to act should justify themselves in public at the Inquiry
N. Former Patients
40. It is submitted that the lack of input from former patients of Clifford Ayling whose allegations led to counts that were proceeded with at the criminal trial in 2000 should have led the Inquiry to question the decision by the Secretary of State not to assess the culpability of Clifford Ayling on a case-by-case basis.
i) It has been possible to formally identify 10 and informally identify 2 of the 12 complainants specifically referred to in the Ayling Inquiry Report as Patients 'A' to 'J', as the 'Police Complaint 1991' and the 'student midwife complaint'. One of the complaints was not about Clifford Ayling at all. Of the other 11 complaints, only two were related to allegations that were part of Clifford Ayling's criminal trial and each constituted only one count. Of those two counts, only one led to a unanimous guilty verdict.
ii) Patient A
did not come forward until after Clifford Ayling's convictions. She presented herself at the Inquiry Preliminary Meeting in Folkestone on 6th November 2002 and said: "I was a patient (or whatever) of Ayling's in 1970/71…I personally, put an advert in the newspaper which cost me, I think, 250 quid to try and get other people from my time to come forward…As far as I know, nobody has come forward from that…I wonder if this Inquiry is financed to do any sort of fishing exercise…
iii) Patient B
did not come forward until after Clifford Ayling's convictions. She waived anonymity in the media when the Ayling Inquiry Report was published. She was with her solicitor Sarah Harman in Folkestone when the latter gave a press conference on 9th September 2004. Patient B and her husband told reporters they were hoping the contents of the Ayling Report would lead the police to charge Clifford Ayling with manslaughter.
iv) Patient C
did not come forward until after Clifford Ayling's convictions. Patient C's husband wrote a letter of complaint in 1980 that was dealt with by the hospital. In July 2001 Patient C was a client of Sarah Harman whose firm wrote to the East Kent Hospitals NHS Trust requesting information as it was instructed by Patient C "with regard to the government investigation into the work of the former GP Clifford Ayling
". It was specified that "No claim is contemplated against the Hospital
". In September 2001 it was claimed in the press that Clifford Ayling had performed "a brutal delivery
" and "a shambolic Caesarean section
". In February 2002 Joan Ayling provided the Ayling Inquiry with a copy of the complaint by Patient C's husband as evidence that it was a Dr [M] who had delivered the baby and that the delivery had not been shambolic. In September 2003 a BBC reporter informed Joan Ayling that Patient C claimed she had received an apology and compensation from the Health Authority thanks to a letter Joan Ayling had provided to the Inquiry.
v) Patient D
is very probably the person who presented herself at the Inquiry Preliminary Meeting in Folkestone on 6th November 2002 as having met Clifford Ayling in 1981. Although it is alleged in the Ayling Inquiry Report that Clifford Ayling made sexualised and inappropriate comments, no specific example of such comment is cited. Patient D did not come forward until after Clifford Ayling's convictions.
vi) Patient E'
s allegations as described in the Ayling Inquiry Report were totally uncorroborated and much generalized. The Consultant who gave evidence to the Inquiry had no recollection of either the patient or the complaint and specifically rejected two of her allegations about Clifford Ayling. No attempt appears to have been made to enquire whether nursing staff who gave evidence to the Inquiry recalled the patient. If there was any trace of a complaint this would have been found in the patient's notes. Nevertheless, the Ayling Inquiry Report concluded it was "clear…she made a strong oral complaint…and…she was not offered any advice or support as to how to pursue her complaint formally by any member of staff…also…no steps were taken to record her concerns or to investigate…
vii) Contemporaneous documentation still in existence strongly suggests that Patient E is the woman who instructed solicitors to approach the Legal Services of the South East Thames Regional Health Authority in 1987 to make a claim subsequent to a retained swab. A letter from the Medical Defence Union to Clifford Ayling in 1987 said of the alleged complaints that "There is no doubt that these have been grossly exaggerated
". The letter went on to say that an opinion had been obtained from Dame Josephine Barnes (FRCOG, FRCS, DBE, advocate of women's health care) who stated that "the damage caused by the retained swab was very small
". The dispute rested solely on the question of the retained swab. The claim was pursued, the patient's solicitors issued a Writ and Statement of Claim, and it was proposed to settle the claim for a small amount.
viii) Patient F
and her husband were removed from Clifford Ayling's GP list at his request on 3rd April 1985. Patient F subsequently
requested that her family, including her children, be removed from Clifford Ayling's GP list. Patient F and her husband then went on a two week holiday to America and only over two weeks after their return, on 9th May 1985, did they see Dr Pickering of the White House Surgery to request a transfer. In April 1999 Patient F made a police statement "because of a recent conversation I have had with a Doctor Pickering
". Dr Pickering confirmed in a separate police statement that "At the request of the police I contacted [Patient F] on 5th April 1999 and she authorised me to release her details to police
". The Crown Prosecution Service provided Clifford Ayling's solicitors with 155 pages of copy medical notes for Patient F. All but two of these pages were copied normally. Two only of the pages were photocopied on such a dark setting that the entries are barely legible. Close perusal of these two pages show that they contain four entries by Clifford Ayling on 25.5.81, 8.3.82, 10.3.82 and 22.2.85. These entries were pointed out to the Inquiry in April 2003 in a formal statement paid for by public funds. This because Patient F claimed in her police statement that she could not remember having seen Clifford Ayling prior to 4th March 1985. With a clear disregard for contemporaneous documentary evidence that was initially produced by the Crown Prosecution Service and that the Inquiry had in its possession as early as February 2002, the Ayling Inquiry Report stated as fact on page 61 that Patient F "had seen Ayling for the first time on 4th March 1985
". It is therefore submitted that the Ayling Inquiry wilfully made a false statement in its Report and gave an incorrect version of events. Patient F made a statement to the police but her allegations were not part of the criminal trial in 2000 and she secured no conviction against Clifford Ayling. Patient F's medical records show that prior to being a patient of Clifford Ayling she had had endometriosis and an ovarian cyst removed. In her family history her mother had a breast cyst. Only four years after leaving Clifford Ayling's surgery, at age 42, Patient F began to have a history of chronic breast cysts and discomfort. She was diagnosed with breast cancer which led to mastectomy at age 50 with continued surveillance and recurrent cysts.
ix) The author of the Police Complaint 1991
(referred to as Patient R on the Clifford Ayling support site) said in her police statement in 1991 on the day she claimed to have been assaulted that she "then left the surgery and made an appointment to see [Dr Ayling] again
". The tapes of the police interview with Clifford Ayling in relation to Patient R's allegations were apparently destroyed. In a police statement made in December 1998 Patient R said she stood by her statement made in 1991. Then in May 1999 Patient R made another police statement containing only six lines to say "I would like to add that now…I do not believe I would have made a second appointment to have seen [Dr Ayling]". Patient R was an army wife in 1991. She had been married only one and a half years and she divorced in 1993. Her former husband was not approached to make a police statement during the police investigation in 1998-2000 because he and Patient R were apparently not on speaking terms. Three members of surgery staff, including the Practice Nurse, were present in the building at the time Patient R was seen by Clifford Ayling in January 1991. In her written statement to the Inquiry Mrs Ayling said the following: "I recall the incident in 1991 when I was covering the reception desk…When [Patient R] arrived she told me that she was having problems "down below" and thought she might be pregnant and that this would enrage her husband…[Patient R] was seen by Mr. Ayling…[Patient R] seemed perfectly happy and made a further appointment to receive the results [of the smear] before she left. She showed no signs of distress whatsoever and as I have said made another appointment. About ten minutes later a man…stormed into the surgery shouting "Why did the bastard examine my wife". Hearing shouting Mr. Ayling came out of his room and said, "Please talk to your wife". [Patient R's husband] went out muttering about calling the police.
" The appointments book with the appointment Patient R made before having spoken to her husband after having left the surgery was produced. As Patient R did not attend for the appointment she had made there was a cross beside her name instead of a tick. Only the evidence of Mr Homeshaw and Dr Savage is discussed in the Ayling Inquiry Report in relation to the 'Police Complaint in 1991'. This suggests Patient R was not a participant to the Inquiry although in April 2001 the solicitor Sarah Harman sought to contact her with the help of Sean Beautridge, the Detective Constable who was in charge of the police investigation that led to Clifford Ayling's criminal trial.
x) Patient G
did not come forward until after Clifford Ayling's convictions. She made a police statement at some point prior to May 2002 in which she named the health visitor anonymously referred to in the body of the Ayling Inquiry Report. Clifford Ayling was interviewed by the police about Patient G's allegations whilst in prison but not charged. It is of note that the health visitor Patient G alleges she complained to was in the past herself on Clifford Ayling's GP list and that she subsequently worked at the White House Surgery from 1992 to 1997. This was at a time when it is now claimed that serious concerns about Clifford Ayling's practice were well-known by the White House Surgery staff. The health visitor would undoubtedly have come into contact with former patients of Clifford Ayling who had transferred to the White House Surgery but the Ayling Inquiry Report says she only recollected "a question from 'one' of Ayling's patients (whom she does not name)
". The question was recollected only as about concern over "why Ayling had come to [the patient's] home to ask why she had left his GP practice
" and the health visitor "cannot recollect the patient's reasons for wanting to change GPs
". Although Patient G and the Ayling Inquiry Report claim alleged incidents in early 1991 led her to change doctors, a Health Authority document dated 9th March 1992 shows that Patient G was not deducted from Clifford Ayling's GP list until 9th March 1992, at which date her previous address was no longer valid. It would seem that on 2nd March 1991 Clifford Ayling was called to Patient G's home by her parents because she was in a state. Her step-sister and boyfriend had died in a car accident. Clifford Ayling recalls that the accident had been at night and the car had overturned into a ditch on the Romney Marsh and that the occupants had probably died from drowning. It is possible that the health visitor's insistence on a visit to the doctor was directly linked to the effect of the fatal accident on Patient G's state of health. The Inquiry did not investigate this possibility and the timescales and details given in the Ayling Inquiry Report are not fully coherent with what appears to have been in Patient G's post-conviction police statement.
xi) The complaint by the student midwife 1992
was referred to in submissions handed to the Ayling Inquiry on 1st August 2003. Midwife ST was actively sought out by the Police in 1999 to make a statement. Statements from two other nursing staff were taken but there were glaring inconsistencies in the three statements. In the submissions made to the Inquiry Joan Ayling wrote: "You may remember that I once told you on the telephone that the very first document I came across in my father's paperwork that trouble me was a copy of a statement from a nurse that did not tally with what I had seen in the case notes. I had no idea at the time of the extent of documents that I would find troubling. This document was left with the papers I was sorting at the time and I have been unable to find it. The above suggests strongly that what I saw was either a copy of Enrolled Nurse McDonald's statement to Merle Darling or that of another nurse. Again, either the file still exists and all documents can be produced, or it has been destroyed and no documents can be produced…From what I remember this statement said there were a number of people in the room and [Midwife ST] arrived last, the remark about sitting on Dr Ayling's knee had been said in a jokey fashion and that Dr Ayling had not touched the student nurse's buttocks but put his hands on her hips to move her so that she could look through the Colposcope properly.
" If the reference contained in paragraph 3.244 of the Ayling Inquiry Report alludes to the suggestion made by Joan Ayling that Nurse McDonald did make a statement to the health authorities at the time, then the statement by the Ayling Inquiry that "It could have been important contemporaneous corroboration for the student's allegation that Ayling's behaviour was indecent
" was an intentionally false and misleading inference to make. Midwife ST became a client of the solicitor Sarah Harman at some point between April 2001 and February 2002. On 20th February 2002, at the civil proceedings against Clifford Ayling in Canterbury, the transcript shows that Sarah Harman said the following: "…in fact a student midwife had complained…Your Honour, this is at 1A and it is at page 152. It is the defence in another set of proceedings which is actually against the Health Authority…".
xii) Patient H
did not come forward until after Clifford Ayling's convictions, although she made a "verbal complaint" in 1992-3 of which there are no available details. It is claimed Patient H was seen by Clifford Ayling in Buckland Hospital in Dover but histopathology forms signed by Dr Padley (who gave both written and oral evidence to the Inquiry) for patients seen in the same clinic as Patient H show that they attended the outpatients department of the William Harvey Hospital in Ashford. Patient H waived anonymity in August 2003 when it was reported by the BBC that she had been paid £10,000 by the former East Kent Health Authority. Information given in November 2003 by the solicitors who acted for the Health Authority showed the case had been settled on the grounds that the Health Authority failed "to take appropriate action in 1980 in respect of incident reporting
". The 'incident' alleged to have taken place in 1980 was not made known to Clifford Ayling until the publication of the Ayling Inquiry Report in September 2004 and is based solely on the uncorroborated evidence of the midwife Penny Moore. It is highly probable that information about the alleged incident in 1980 was obtained by Patient H or her solicitor through their involvement with the Ayling Inquiry. The use of this information prior to the publication of the Ayling Inquiry Report to further claims for compensation was contrary to the undertakings and agreements not to use material supplied by the Inquiry for purposes other than the Inquiry.
xiii) Patient I
made allegations that led to one count at Clifford Ayling's criminal trial. Patient I appears to have made three police statements, two in December 1998 and one in February 1999. The statement she made in February 1999 related to her contact with a GP patient of Clifford Ayling whom she had met at the William Harvey Hospital in late March 1998 and became friends with. The GP patient in question made a police complaint only three days after Patient I, but Clifford Ayling was not charged in connection with her allegations. A police statement was also taken in February 1999 from the auxiliary nurse who was present at Patient I's antenatal examination. The CPS index to unused material referred to this statement in which the named auxiliary nurse "explains that she has no recollection of the incident
". The statement by the auxiliary nurse was missing from the documents provided to Clifford Ayling's solicitors by the CPS. Patient I made a written complaint in 1993 following a telephone conversation with the secretary of Mrs Darling, Director of Nursing. In that contemporaneous complaint Patient I wrote "I do not wish for my complaint to be seen as one of sexual abuse against Dr Ayling
". The contemporaneous complaint explained that Clifford Ayling "proceeded to examine my breasts, which I was expecting
" and there was no comment whatsoever in the complaint about how the breast examination had been carried out. However, in her police statement in 1998 and at the criminal trial in 2000 Patient I gave a very detailed account of the breast examination, describing it as a "fondle
" and claiming that afterwards her nipples had hurt. With regards to her contemporaneous complaint, Patient I said the following during cross-examination: "I typed this…because I was asked to do it by the health authority; make a written complaint…there are spelling mistakes in here that I did not have Tippex, and I could not redo. I typed it off, and I sent it to the health authority…These corrections were done when, the health authority sent me a copy back, and I think, either when I was discussing it with Merle Darling, or when I had a copy sent to me before I reported it to the police.
xiv) Patient J
never made a complaint about Clifford Ayling and the documents concerning her case were anonymised and provided to the Inquiry by his daughter Joan Ayling as an example of what happens when health professionals spreading unfounded and defamatory rumours get caught out. Clifford Ayling was advised by the Medical Defence Union in August 1994 that "the remarks made by the nurse as documented by [Patient J] are injurious to your reputation
". Patient J attended the antenatal clinic at the Royal Victoria Hospital in Folkestone in December 1993 and was also a GP patient of Clifford Ayling. Patient J was totally shocked by the hospital midwife's comments about Clifford Ayling prior to being seen by him because she knew them to be untrue from her own experience as his GP patient. This was Patient J's third pregnancy. Patient J wished to complain about the midwife's comments and behaviour and when she next saw Clifford Ayling at his surgery he helped her to be contacted by the Chief Officer of the South East Kent Community Health Council who then helped Patient J to formalise her handwritten notes of the incident into a written complaint addressed to the Senior Nursing Officer of the South East Kent Health Authority. Far from being "corroboration for the contemporaneous concerns about Clifford Ayling's behaviour being sexualised
", as suggested in the Ayling Inquiry Report, the contemporaneous complaint by Patient J shows that rumours propagated by midwives were unfounded, shocking, and profoundly damaging to the emotional well-being of pregnant women. A letter addressed to the Medical Defence Union in April 1994 about Patient J's complaint explained that she "was "looking forward to showing off her bump" but not now because of the remarks made by the nurse. These remarks are making her feel ashamed and have spoilt her pregnancy
". The information provided to the Inquiry about Patient J's complaint has been trimmed and twisted to such an extent in the Ayling Inquiry Report that one is left with the distinct impression there must have been a great paucity of credible allegations for the Ayling Inquiry to investigate and little substance to write a report on.
O. Media Coverage
41. It is submitted that at the opening of the Ayling Inquiry the solicitor Sarah Harman wnen speaking to television reporters used terminology that suggested she was overly implicated in the Ayling Inquiry decision-making process.
i) On the first day of the Inquiry in Ashford in 2003 Sarah Harman used the word "we
" when describing what the Ayling Inquiry was setting out to do. In an item presented by health correspondent Nigel Thompson on South East Today BBC News
Sarah Harman said: "What we're going to be looking at in the Inquiry apart from anything else is the culture of the Health Service, is why doctors are still regarded, in 2003, as gods. Why nurses when they complain are ignored. Why patients are not taken seriously…
42. It is submitted that during the Ayling Inquiry news items were broadcast in which the solicitor Sarah Harman expressed opinions that are contrary to the principles of Article 6 of the Convention for the Protection of Human Rights and Fundamental Freedoms.
i) On the day the Chief Executive of the General Medical Council (Mr Finlay Scott) gave evidence to the Ayling Inquiry, Sarah Harman appeared in a news item on Meridian TV
and said she was "very concerned about the attitude of the GMC. I mean this is the ultimate body to protect patients and although there was much talk today of a change of culture, a change of procedure, essentially what was said is…it's still doctors innocent until proven guilty
". Paragraph 2 of Article 6 of the Convention for the Protection of Human Rights and Fundamental Freedoms (November 1998) states: "Everyone charged with a criminal offence shall be presumed innocent until proved guilty according to the law
". The Ayling Inquiry was set up under Section 2 of the National Health Service Act 1977
43. It is submitted that during the Inquiry process information about oral evidence given to television reporters by parties other than the witness concerned were aimed at fuelling public speculation about the eventual findings of the Ayling Inquiry Report and were incomplete or misleading.
i) Mr Finlay of the GMC made no comment to reporters on the day he attended the Ayling Inquiry but reporter Ruth Hockey of Meridian TV
said he had told the Inquiry that the original allegations about Clifford Ayling were not serious enough to be acted upon. Ruth Hockey claimed a patient wrote to the GMC in March 1998 and the GMC could have suspended Clifford Ayling on an interim basis but did not.
ii) The patient referred to was amongst the persons filmed within the Inquiry rooms in Ashford and was therefore present at the Inquiry although there is no specific reference within the Ayling Inquiry Report to this specific patient having given evidence at the Inquiry. This patient is referred to on the Clifford Ayling support site as Patient K. Patient K was the first woman to begin proceedings against Clifford Ayling to obtain compensation to be paid from his personal assets and she officially instructed the firm of solicitors Harman & Harman in January 2001.
iii) It is claimed on pages 99 and 101 of the Ayling Inquiry Report that Patient K complained first to the East Kent Health Authority in February 1998 and that the EKHA immediately referred the complaint to the GMC, that Patient K herself wrote to the GMC, and that the GMC wrote responses to both the EKHA and the patient concerned in June 1998. However, there appears to have been no reference to the GMC or this correspondence in the documentation produced in connection with the EKHA's statement of case concerning Clifford Ayling to the NHS Tribunal in November 1998. There was no reference at all to the GMC in the Statement of Complaint signed on 10th November 1998 by Mark Outhwaite, Chief Executive of the EKHA, which set out the grounds on which presentation was made to the NHS Tribunal and which concluded "the first four [of five] incidents described above are currently being investigated by the Police
iv) In February 2002 during the civil proceedings against Clifford Ayling, Patient K was asked by the judge to produce the correspondence she had received in connection with her complaint made in February 1998. She produced five letters, with contents showing that the GMC referred her in June 1998 to a Senior Assistant at the South East Kent Community Health Council to assist her with obtaining her medical notes from Dr Maitra's surgery. The medical notes were sent by Patient K to the GMC a few days later with a letter indicating that the Senior Assistant at the CHC was "willing to help with future correspondence". The Senior Assistant of the CHC named in the letter is not listed as having given evidence to the Inquiry despite his central role in the handling of Patient K's complaint.
v) In her initial complaint to the EKHA in February 1998 Patient K wrote that following a speculum examination Clifford Ayling "inserted his whole hand into me
". An expert witness instructed by the Crown Prosecution Service wrote in a report dated June 2000 that "The patient has described how the doctor's "entire hand" was forced into the vagina. It is difficult to see how this was done unless the vagina was extremely lax
". In October 2000 when cross-examined at the criminal trial Patient K said "you don't know how large I am inside. You cannot judge, yeah?...let me point out to you, you do not know how wide I am inside. I am quite large, okay? I am quite large. You do not know". Despite assertions about largeness by Patient K, the expert witness's assessment of Patient K's allegation and the following description of the practice of putting one's hand into a person's vagina found on the Internet (fringe.davesource.com) explain why the contents of Patient K's complaint in February 1998 would have been treated by the GMC with great circumspection: "Placing or attempting to place the whole hand (or even both hands) into the rectum or vagina…In fact the hand is only formed into a fist, if at all, once it is fully inserted, a process that requires a great deal of gentleness, care and patience…it actually requires a good deal of collaboration to be successful
44. It is submitted that the solicitor Sarah Harman made unfounded assertions about Clifford Ayling's surgery staff to a television reporter in March 2004.
i) On 4th March 2004, when the Inquiry evidence gathering stage was completed and the Ayling Inquiry Report had not yet been submitted, Sarah Harman said in a special report presented by Victoria Macdonald on Channel Four TV that "Ayling was very plausible and persuasive - he managed to convince a lot of his colleagues that what he was doing was right and therefore he managed to convince his staff in the surgery that what he was doing was right
." There was no evidence produced either at the criminal trial in 2000 litigated by the Crown Prosecution Service or at the civil proceedings in 2002 litigated by Sarah Harman to this effect and there is nothing in the Ayling Inquiry Report about surgery staff having questioned what Clifford Ayling was allegedly 'doing'.
ii) In 2004 seven former members of Clifford Ayling's surgery staff, including two former Practice Nurses, provided Section 9 statements for production to the Law Society as evidence that the statement by Sarah Harman about surgery staff broadcast on 4th March 2004 was unfounded.
45. It is submitted that a former patient whose allegations led to the acquittal of Clifford Ayling at his criminal trial in December 2000 was presented in the media in 2004 in connection with the Ayling Inquiry as a 'victim'.
i) In a television documentary presented by Victoria Macdonald and broadcast by Channel Four TV
on 4th March 2004, women filmed entering and then filmed inside the offices of the firm Harman & Harman in Canterbury were presented as "victims
" of Clifford Ayling. One of these women (referred to as Patient M on the Clifford Ayling support site) waived anonymity in the Daily Mail
on 10th September 2004 and was presented alongside a former patient who did not come forward until after the convictions under the title "Victims of the molester
". The photograph that appeared in the Daily Mail
had been taken the day before when the solicitor Sarah Harman gave a press conference in Folkestone on the date the Ayling Inquiry Report was published. Photographs taken at the press conference showed Patient K to be sitting just behind Sarah Harman. An article in PA NEWS
on 9th September 2004 said "A group of women abused by disgraced GP Clifford Ayling said today they had settled their legal action against the health authority which employed him…Flanked by some of the claimants at a press conference in Folkestone today, Ms Harman said the settlement was not perfect, but it did constitute a victory
". If Patient K was part of the group action who obtained a settlement from the health authority in 2004 despite having failed to obtain a conviction against Clifford Ayling at his criminal trial in 2000, it is submitted that it is of public interest to know on what grounds public funds are used to make financial settlements to former patients who have no sustainable claim.
46. It is submitted that the media failed to present a balanced view of the Ayling case and the Ayling Inquiry by suppressing information brought to its attention.
i) On the morning of 6th November 2002 before the Inquiry Preliminary Meeting in Folkestone, Clifford Ayling's daughter Joan was filmed whilst she was interviewed by a BBC reporter. During the interview she told the reporter about the information she had already provided to the Ayling Inquiry team, her concerns about how the allegations against her father had been dealt with by the Health Authority and the Crown Prosecution Service, and her hope that the Inquiry would be impartial. The reporter was pleased with the interview but no part of it was ever broadcast. The reporter later informed Joan that his editor had prevented the interview from being used.
ii) On 7th November 2002 a letter signed by Joan Ayling and Jeannette Ayling, who were both present at the Inquiry Preliminary Meeting the day before, was sent to the editor of the Folkestone Herald
newspaper about writing a letter for the letters page. On 19th November 2002 the editor of the Folkestone Herald
told Joan Ayling he had to "check" with Sarah Harman that what she and her stepmother had said was true and that he would do this when he had "the time
". In the autumn of 2005 the Folkestone Herald
carried three separate articles about the Ayling case. The first was a short insert about the setting up of the Clifford Ayling website. There later appeared two longer articles following an interview with Joan Ayling and a separate interview with Clifford Ayling. Contact had been renewed with the newspaper to inform it of the existence of the website, but despite promises from the reporter neither of the longer articles contained the website address and there was only one reference to the website itself. However, a woman who made allegations about Clifford Ayling whom it was claimed "cannot be named for legal reasons
" was reported at the end of the second long article as having "urged Clifford Ayling's daughter Joan to give up her campaign to clear his name
" and was quoted as saying "I don't understand why [Joan Ayling] keeps defending [Clifford Ayling]. She may be trying to clear the family name, but the family name is down the drain. Just put the lid on it and walk away…
iii) On 19th February 2004 Joan Ayling travelled to London and was filmed giving an interview to Victoria Macdonald for nearly an hour. Joan told Victoria Macdonald about her grave concerns with regards to how the Inquiry had dealt with or ignored or returned information that had been provided and she discussed the more disturbing aspects of some of the allegations. She also talked about the distress caused to members of Clifford Ayling's family by the shocking tactics used by the firm of solicitors Harman & Harman in attempts to obtain information about Clifford Ayling's assets and to frighten them from involvement in the civil case against Clifford Ayling litigated by Sarah Harman. Joan was told that parts of the interview would be used in the forthcoming programme if they could be fitted in. The programme, that was "commissioned by Channel 4 News [as] a ten-minute film to go out on the eve of the publication of the Government Inquiry headed by Anna Pauffley QC
" was in fact part of a documentary feature broadcast on 4th March 2004. No part of Joan Ayling's interview was used but there were repeated scenes of the sea washing up the beach on the Kent coast.
47. It is submitted that the name of the website www.dr-ayling-inquiry.org.uk set up in 2001 by the firm of solicitor Sarah Harman was misleading in that it gave the impression of having been set up by the Inquiry itself and the effect was to give its contents the appearance of emanating from an authoritative source.
i) In May 2004 the 'Home' and 'Background' pages of the website www.dr-ayling-inquiry.org.uk continued to contain malicious defamatory allegations that were factually untrue and which the authors could not reasonably have believed to be true. There is no dispute as to the source of the said website as The Law Society confirmed in April 2005 "that the website "www.dr-ayling-inquiry.org.uk" was set up and run by Harman & Harman up until July to September 2004
ii) The solicitor Sarah Harman was omnipresent in media coverage of the Ayling case and regularly made misleading, inaccurate or defamatory statements. The type of involvement of the firm Harman & Harman or their clients with the media is apparent from the judgement of Dame Elizabeth Butler-Sloss P. in 2005 in [Uddin (A Child), Re  EWCA Civ 52 (24 February 2005)]
and the judgement of Mr Justice Munby in 2004 in Matter of B (A Child),  EWHC 411 (Fam) (19 March 2004)]
, and also in the contents of Question 149 in Annex A of the Select Committee on Public Accounts Minutes of Evidence for 10th June 1998.
iii) Concerns about the solicitor Sarah Harman and the media were conveyed to the Ayling Inquiry Solicitor in January 2003 in the following terms: "…the Inquiry is not concerned with what appears in the press but…Sarah Harman's name is omnipresent in articles and features connected with [Clifford Ayling]'s case and people associate her with the Inquiry. This is clear from discussions…with various people…"Ordinary" people who have received phone calls or letters from Harman & Harman fear that they may get into trouble in some way if they express support. Since any supportive material is also effectively "gagged" by the media people feel that they are an isolated case.