DR. Adrian Garfoot

– in the House of Commons at 7:45 pm on 16th March 2009.

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Motion made, and Question proposed, That this House do now adjourn. —(Mark Tami.)

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Photo of Henry Bellingham Henry Bellingham Shadow Minister (Justice) 9:17 pm, 16th March 2009

I wish to raise the case of my constituent, Dr. Adrian Garfoot, and to discuss in a little detail his dealings with the General Medical Council.

Dr. Garfoot is a very distinguished constituent of mine; incidentally, the Reverend John Garfoot, his father, is a popular and well-known Methodist minister. Adrian trained at the Royal Free Hospital school of medicine and served as a GP in a number of locations—in Yarmouth, Sevenoaks and Kilburn. During that time, he became increasingly aware of and involved with the plight of drug users. He saw that many users and addicts were very sad figures and had often been rejected and failed by NHS treatment centres; I am talking about the 1970s and 1980s. There were long waiting lists. Many of the drug addicts became ever more ill and many ended up in prison.

Tragically, quite a few of the young addicts with whom Adrian came into contact at that stage, when he was a GP, died from their addiction. He wanted to do something about it, so he decided to move from general practice to specialist drug treatment. Inevitably, that meant moving into the private sector, which he was reluctant to do. It was, however, the only way in which he could get involved with drug addicts from his position as a GP. As a result of his decision, the Laybourne clinic was born. It was launched in 1990 and after a while it moved into London docklands. I had the pleasure of visiting the clinic on a number of occasions. It soon became a centre of excellence and during its first 10 years it treated more than 1,200 patients, whose typical age was 37 and a half—substantially older than 29, which was the average age of patients in NHS drug clinics.

The overwhelming majority of Dr. Garfoot's patients were long-term addicts who had been injecting themselves for between 20 and 30 years and maintaining their habit through crimes such as theft, burglary, dealing in drugs, prostitution and so on. Most had already spent lengthy periods in prison. At one point, it was calculated that 270 patients at the clinic had between them spent more than 600 years in prison—a fairly staggering figure. Many had been committing up to four crimes a day—in other words, well over 1,000 crimes a year. However, it is interesting that the recidivism rate for drug addicts at the end of a treatment at the Laybourne clinic was only 7 per cent., whereas for those coming out of the prison system it was 54 per cent.

Dr. Garfoot was rebuilding the lives of many people, dealing with serious medical conditions and restoring family relationships. He enabled those people to get on with a normal life and keep out of trouble. In fact, I worked out that during those 10 years he probably saved the country well over £10 million. Many testified that he actually saved their lives in the process.

I want to mention some of the achievements of addicts who underwent treatment at the Laybourne clinic. One reformed addict ended up playing the violin in an orchestra; another founded a national charity; another completed an MA degree in computer studies at the age of 30; and two gained places at medical school. That is a fairly remarkable list of achievements.

I should like to read out a tribute paid by Gary Sutton, who was one of the addicts treated at the Laybourne clinic. I met him on one of my visits to the clinic. His account refers to a particular occasion in 1996. A patient who was in the clinic with him at the time was being treated at St. Mary's hospital and discharged himself with a butterfly needle still in his arm. A few hours later, laboratory results were returned showing that he had a potentially life-threatening infection. The police were alerted and called to the patient's address, but were unable to find him. The hospital rang up Dr. Garfoot. As it was a Sunday morning, Dr. Garfoot was at his home, but he drove up to London and spent seven hours trying to track the patient down. He eventually found him and took him to Homerton hospital. The following day the consultant rang up Dr. Garfoot and personally commended and thanked him for saving this person's life.

Dr. Garfoot had a prescribing policy that was based on harm reduction and non-coercive user-friendly protocols. Above all, he used his clinical judgment and independence. He put in place voluntary and supervised withdrawal programmes. It is interesting to examine the guidelines from the National Treatment Agency for Substance Misuse. When it refers to injectable prescribing, it makes it clear that the recommended daily dosage is between 60 and 120 mg, which is within the effective therapeutic range. Certainly, what Dr. Garfoot was prescribing was within that limit. None of his patients died of any overdose, and there was no evidence whatsoever of diversion of drugs into the wider community. His philosophy was one of maintenance prescriptions with gradual reductions. Let us not forget that many of his patients had been on 12 or more failed oral treatment courses over periods of addiction of 20 to 25 years.

It is worth looking at what the National Treatment Agency for Substance Misuse has said. According to Professor John Strang:

"The message for specialist clinicians is that yes, injectable heroin and injectable methadone have a role to play in the treatment of drug misuse—but it's a limited role and one that needs to be developed very carefully".

Its guidelines say that

"injectable maintenance treatment is most appropriate for long-term heroin addicts who have not responded to oral maintenance treatment" and that

"where injectable heroin and methadone maintenance prescriptions are provided as part of a comprehensive treatment programme, both may have beneficial effects on health, social functioning and crime reduction".

That sums up what Dr. Garfoot was doing.

It is also telling to have a look at the 2008 drugs strategy. Page 6 mentions the need to

"make sure we are supporting the treatment that is most effective, targeted on the right users—with abstinence-based treatment for some, drug-replacement over time for others, and innovative treatments including injectable heroin and methadone where they have been proved to work and reduce crime".

In Dr. Garfoot's day, the officially preferred and enforced treatment was low-threshold, short reduction therapy. He was struck off for higher-dose long-term maintenance treatment and injectable prescribing, which is now sanctioned. I will come on to his being struck off in a moment, but it is worth pointing out that what he was doing during his years running the clinic was very much in line with current drugs policy, as outlined in the 2008 strategy.

As I have mentioned, there was no evidence whatever of any diversion of drugs during Dr. Garfoot's time running the clinic. He was always incredibly assiduous in preventing the diversion of prescribed drugs to the wider community. That was recognised on a number of occasions when he clashed with the authorities. There were complaints back in 1992, and later there were further allegations. He was summoned before a Home Office misuse of drugs tribunal under the Misuse of Drugs Act 1971, on charges of alleged irresponsible prescribing. There was even a raid on the Laybourne clinic, but after analysis of 1,500 prescriptions there was no sign of any discrepancy whatever. Dr. Garfoot was cleared by the then Home Secretary, Mr. Straw, and there was also a finding of abuse of process against his accusers.

At that stage Dr. Garfoot took the view that he would be left alone, but unfortunately it was not to be. In 2000, the interim orders committee of the General Medical Council imposed serious restrictions on Dr. Garfoot after a number of a complaints against him. He was then taken to the professional conduct committee of the GMC on 11 September 2001—a date that none of us will ever forget, for other, tragic reasons. The finding was that he should be erased from the medical register on the grounds of serious professional misconduct. He decided to appeal to the Privy Council, and lost. I do not want to go into great detail about the GMC's findings. Suffice it to say that it agreed that he had believed that he was acting in the best interests of his patients. It also agreed that there had been no diversion of drugs and accepted that no one had died of an overdose while under his care.

In due course, the clinic closed. What happened was obviously a disaster for Dr. Garfoot, and I shall turn to that in a moment, but it was an even bigger disaster for the many patients of the clinic. It carried on for a while after Dr. Garfoot left, but it was unable to continue to provide the same level of treatment. A number of patients left, and six of them have subsequently died. Many others have gone back into a life of crime and prostitution and back on to the conveyor belt that leads to crime, inadequate treatment and back to crime again. What has happened is a tragedy, because many of the adults and youngsters concerned had nowhere to go once the clinic had closed down.

It is worth briefly examining the wider drug situation in the UK, as it puts into perspective the work that Dr. Garfoot was doing. The cost to the UK of drug abuse is absolutely massive. I have had a look at a York university study that puts the total annual cost at £19 billion, which is £850 for each household in the UK. I know that that might not sound a vast amount of money given the billions being thrown at the bank bail-out scheme, but it is a very large amount. It includes the cost of drug-related crime, which comes to £12 billion, and the extra burden on the police, prisons and the NHS. Interestingly, the study also found that 99 per cent. of that cost was caused by a hardcore group of roughly 280,000 users. That puts the nature of the problem into perspective.

I wish to say a word or two about Dr. Garfoot himself and what has happened to him since. He has been unemployed since he was erased from the register. He has been lost to the profession. I also feel that he has been extraordinarily unfortunate because his case was heard on 11 September 2001 and, since then, the rules have changed.

An amendment to the Medical Act 1983 was made in 2000 in statutory instrument No. 1803, which came into force on 3 August 2001. It provided that a 10-month suspension would be replaced by a five-year suspension. Of course, that was the Government's response to the Shipman disaster. The minimum period of suspension—erasure—was previously 10 months, but was increased by the then Secretary of State for Health to five years.

It is interesting to note that, on 2 November 1998 and again on 10 January 2000, Dr. Garfoot was supplied with a copy of procedure rules, which were dated July 1997, on which proceedings against him would be conducted. Paragraph 28 stated that

"a direction to erase remains effective unless and until the doctor makes a successful application for restoration to the Register. Such an application cannot be made until at least 10 months have elapsed since the original order took effect."

Paragraph 30 states:

"Application for restoration may legally be made at any time after 10 months".

Dr. Garfoot was not informed of that until after his appeal to the Privy Council was heard. In other words, the proceedings against him in 1998 and 2000 were conducted under the unamended 1983 legislation—the statutory instrument did not come into force until 3 August 2001.

Through me, Dr. Garfoot contacted the then Home Office Minister concerned, Mr. Hutton. In his reply, the Minister said that although there was a provision for exempting doctors who had submitted applications for exemption before 3 August, there was no such provision for doctors whose cases were in progress at the given date. I believe that that is incredibly unfair—the goalposts were moved while the process was continuing. It is not only unfair but arguably a breach of article 7 of the European convention on human rights, which states:

"No one shall be held guilty of any criminal offence on account of any act or omission which did not constitute a criminal offence under national or international law at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the criminal offence was committed."

Of course, we are not considering a criminal offence, but the GMC professional conduct committee made it clear that it was applying criminal standards of proof. Dr. Garfoot was unfortunate in the timing of the statutory instrument. He takes the view that he and a small handful of other doctors should not have been treated in that way and that some extra flexibility should have been shown.

I have spoken about Dr. Garfoot's marvellous work, the lives that he saved and the small part that he played in trying to tackle the UK drugs crisis. I want now to refer to a couple of matters that relate to the GMC. Last year, Dr. Garfoot applied for reinstatement, and the hearing took place on 10 March 2008. Before attending the hearing, he was advised that he should not try to challenge the judgment of the original case. He assumed that the outdated "Form S148", which had been sent to him some time previously, still stood. It stated:

"In the eyes of the law, and of the Professional Conduct Committee, you were guilty of the charge found proved against you. There is no point in arguing to the Professional Conduct Committee that the decision to erase your name was a mistake."

He arrived at the hearing unrepresented, while the GMC had a top barrister to represent its interests. I question whether there should be an effective inequality of arms in such a tribunal. Dr. Garfoot could not afford legal help, yet the GMC had a battery of lawyers to help it.

He had no wish to delve into the past, but fully anticipated that the GMC very much would want to. He was shocked, as well as totally unprepared, when two of the four pages of the panel's determination amounted to a rehash of the PCC's original determination from September 2001 and the reasons given by the Privy Council for dismissing his appeal in May 2002.

The barrister had been instructed by the GMC with the specific intention of putting Dr. Garfoot down and thus presented in his speech a completely one-sided view of Dr. Garfoot's work and his philosophy. When Dr. Garfoot realised what was going on and wanted to put his side of the story, so as to explain his work to the panel—to talk about the patients whose lives he had saved, those whom he had saved from prison and those whose lives he had saved from spiralling out of control—he was told by the GMC that he could not put that part of his argument. He was then silenced quite disgracefully by the chairman, who cut off his microphone. That was an unfortunate state of affairs in March 2008.

I would like to pick up on a couple of the points that the panel put to Dr. Garfoot. One of the complaints against him, which was also one of the reasons he could not be reinstated, was that he had not had enough recent practical experience, such as attending at a surgery or using new IT systems. As it happens, it is difficult for any GP who has been struck off to get any practical experience. Dr. Garfoot wrote to his postgraduate tutor and asked whether he could sit in on his surgery, but the offer was withdrawn shortly before the practical experience was about to take place.

It is difficult for any GP to keep up to date with medical knowledge without hands-on clinical experience. As for experiencing new IT systems, the British Medical Association runs courses for that purpose, but they are open only to doctors registered with the GMC. Therefore, although Dr. Garfoot did his level best to keep in touch—he did a great deal of reading and a lot of work on the internet, as well as talking to many of his former colleagues in practice—he was told by the panel that he had not done enough to keep his skills up to date. That reinforces the point that if he had been able to reapply for reinstatement after 10 months, the chances are that those criticisms would not have applied.

There is another point that I would like the Minister to have a quick look at, because it could be within his jurisdiction, so to speak. Apparently, the panel had no power to impose conditions on Dr. Garfoot's re-registration—indeed, it made that point to him. He argued that he had no intention of going back into drugs treatment, even though that is where his heart lies. Having gone through the experience that he did with Laybourne, all the heartache of the misuse of drugs tribunals, and eventually the hearings before the GMC and the appeal to the Privy Council, he realises that it would not be right for him to go back into treating drug addicts.

However, Dr. Garfoot wanted to go back into general practice. Even if he could not have been accepted in a local doctor's surgery in my constituency, there could have been many other opportunities, such as working as a locum or an adviser to companies doing medical assessments in the private sector. A host of opportunities was available to him, but unfortunately the panel said that it could not re-register him with conditions. In many ways, the panel would have liked to say, "We will allow you to become reinstated, but the condition is that you can't go back to treating drug addicts." However, the panel was unable to do that.

Will the Minister sit down with the GMC and discuss that? It is not just my constituent Dr. Garfoot who is affected. We are talking about 100 or so doctors who have been struck off in this period and 40 or 50 doctors who have been struck off, suspended or erased for similar instances of alleged misconduct in the field of drug treatment as those involving Dr. Garfoot. There is a large pool of talent out there. It might not be appropriate for some of those doctors to be reinstated, but some certainly want to be reinstated. Some of them are even anxious to be reinstated, yet they have no chance whatever of succeeding in that. Dr. Garfoot will be reapplying this year and I will do my best to support him. I know that other hon. Members, particularly Dr. Iddon, who has also looked into the case very carefully, will be doing the same.

My next point on the GMC relates to its use of draft determinations and predetermined sentences of erasure. It has now been admitted by the GMC's own solicitors that the assistant registrar, who was also the secretary of the professional conduct committee, would either write or direct clerks to write draft determinations some weeks prior to the professional conduct committee sitting. The draft would then be handed by the committee secretary to the chairman and the panel to be read out as the final determination. In these cases, the draft also contained the predetermined sentence of erasure, which basically means that many of these hearings were effectively a complete sham.

I have looked into a number of other cases, as well as Dr. Garfoot's. It was interesting to have a close look at the GMC paperwork in Dr. Garfoot's case. The findings are listed by way of a decision. One should note that, at that point, the panel concluded for the day. On the following day, there was the mitigation and then the panel read out the determination, which bore very little relation to the decision. Exactly the same pattern of events—the use of draft determinations and predetermined sentences of erasure—happened in the case of Dr. Jennifer Colman. As it happens, she is not my constituent, but I have met her in Norfolk; she is a resident of mid-Norfolk. It was the same in the case of Dr. Hickey.

I have to say that I find this quite extraordinary. Here we have a very important and prestigious professional body predetermining the outcomes of professional hearings. That seems to me to be quite staggering. Another case, known as the Munday case, went right up to the House of Lords, and it was held that a magistrates clerk should not retire with magistrates. In the case of the GMC, the clerks were retiring, and in the earlier case they dealt with the screening process, the intermediate process of preliminary proceedings and then sat as committee secretaries on the PCC, as well as drafting the draft determinations that ended up as the final determination. It is certainly worth looking at that case, which has governed the way in which many other professional organisations operate. Clearly, something has gone very badly wrong.

Is the Minister aware that the GMC's professional conduct committee was operating by using predetermined recommended sanctions, including erasure, during the 1990s? Is he aware that those draft determinations were written by assistant registrars weeks before the hearings? Does he approve of that practice and does he know whether it is still in operation? Does he agree that if that was indeed happening—we have no reason to believe otherwise, as that is what the GMC's own solicitors are telling us—it surely represents a breach of article 6 of the European convention on human rights on the right to a fair trial. That right is not only laid down and encapsulated in that convention, but is part of our own law as a result of the Human Rights Act 1998.

I would be grateful if the Minister answered those questions about the GMC, as they are pretty fundamental. Here we have a hugely prestigious and important organisation, sitting in judgment on the lives of its members. I have looked at the workings of a number of professional bodies, which obviously have to adopt the highest possible standards of procedure. It is essential that they do so to maintain the confidence of the profession. I submit to you, Mr. Speaker, that if the GMC has behaved and is behaving in this way in a number of cases, it is most certainly a complete breach of natural justice—never mind the European convention on human rights and our own human rights legislation. I also put it to you that the treatment of Dr. Garfoot at the reinstatement hearing was a complete disgrace, particularly when the chairman cut him off from expressing his point of view—another breach of natural justice.

I have spoken at some length because I want to put on the record the work done by my constituent, and his passionate commitment to people suffering from drug abuse at a time when this country has an appalling problem with drug addiction and drug abuse. The sadness is that since the clinic closed, many of those patients have returned to a life of crime; some have even died. Many patients who might have gone to the clinic and been treated have not been able to do so. I wonder how many other doctors are in the same position as Dr. Garfoot, who could have played a vital part under the 2008 drugs strategy in improving the lives of many hundreds of people—and surely, at a time when there is a critical shortage of doctors in some parts of the country, it is not a good use of resources to prevent such doctors from being reinstated.

I hope that the Minister will answer my questions. I also hope that he will join me in paying tribute to the doctors in this country who work so incredibly hard to help drug addicts. It is not a fashionable part of medical practice, but, day in day out, those doctors are putting their careers on the line, saving lives, working extremely hard to make other people's lives better and helping this country in the war against the total evil that is the drugs trade, which leads to drug addiction, drug abuse and the ruining of young lives.

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Photo of Brian Iddon Brian Iddon Labour, Bolton South East 9:46 pm, 16th March 2009

Dr. Adrian Garfoot came to my notice almost immediately when I arrived in Parliament in 1997. In the summer of that year, a young boy hit not just the national but the international headlines. Dillon Hull, aged five, was shot dead in my constituency in August 1997. The bandits were actually after his father, who owed a considerable amount of money for the heroin that he had been selling, but unfortunately Dillon copped it instead.

The event in that summer was felt by the whole nation, and, as I have said, became an international event. It precipitated me into the drugs debate. I had 12 years' experience of research on opiates through my students at the University of Salford, so I knew something about the subject professionally as well. Given that I had been elected a Member of Parliament and given my professional background, it was inevitable that The Guardian, "The World This Weekend" and a number of other television and radio shows would ask me to contribute to the debates that raged after Dillon Hull was tragically shot. That is how I came to the notice of people such as Adrian Garfoot, who wanted to explain to me what they were doing.

It should be borne in mind that those times were different from these, just 12 years later. I would not say that there was nowhere for chaotic drug addicts to go in the 1980s and early 1990s, but it was extremely difficult for them to obtain treatment. It is difficult for some people today, but I dare say that that is partly their fault because they have not accepted that they are ready for treatment. At that time, even those who desperately wanted treatment and begged people such as me to find it for them could not obtain it. I have seen no such cases in the last five or six years, but in 1997 and 1998 parents came to me begging me to help their sons—usually sons, but sometimes daughters—to obtain treatment, here, there or anywhere. That was before the Government established the National Treatment Agency for Substance Misuse. Thank goodness, things are very much better today.

I had the impression that Dr. Adrian Garfoot was in the wrong place at the wrong time, and so were a lot of doctors like him. He was unconventional in the way in which he treated people, but he was treating the most chaotic heroin addicts in London and in the home counties, for people travelled some distances to see him at the Laybourne clinic.

I was suspicious, thinking that this was a private clinic and that Dr. Garfoot might have been in it just to make money, but I soon realised that money was not the driving force behind his life. He had an almost missionary role, and felt for those people, with whom no one else wanted to deal. The national health service certainly did not want them. General practitioners did not want them anywhere near their surgeries. But someone had to deal with them, and one of those people was Adrian Garfoot. I remember him telling me some stories. He sometimes worked late at night, and he told me a dreadful story about a young man coming at him swinging an axe. He was able to deal with people such as that, but it is little wonder that other general practitioners did not want to deal with them.

I congratulate Mr. Bellingham on bringing Adrian Garfoot to our attention this evening. He managed to stabilise all his patients. Their chaotic lives became almost normal—although not quite normal in most cases. Some of his patients were stabilised on injectable heroin and then oral heroin, and—believe it or not—they were able to work; a lot of his patients went back to work. He also brought families back together again. Wives had to try to live with chaotic husbands. Families separated, but he managed to bring them back together. I thought that he had an almost missionary zeal. Sadly, however, one of his patients then died, and that incident came to the attention of the General Medical Council. As the hon. Member for North-West Norfolk said, Dr. Gurfut's relapse rate was extremely low, whereas in other areas of treatment in this country at that time, relapse rates were exceedingly high. That must have said something about what Dr. Adrian Garfoot was doing at the time. I was convinced he was doing a good job, therefore, despite this tragic death. That did not surprise me, in view of the kind of patients he was dealing with. It seemed inevitable that there would be a patient death at the Laybourne clinic among the 1,200 patients he was dealing with at that time.

There was no ready access to public treatment for drug addiction then, so quite a number of private doctors were operating. I thought some of them deserved to be struck off. A few of them—perhaps more than a few of them—were in it to make money. I do not think Adrian Garfoot was one of those people, however. That is why I say that he was just in the wrong place at the wrong time. I was convinced, therefore, that I had to go and defend him at the GMC hearing. It lasted 35 minutes or so—I cannot remember how long, but it seemed an eternity. The people who were sat around were all "ologists" of one kind or another—gynaecologists and so forth. However, while talking to them I got the impression that they did not really know the world that Dr. Adrian Garfoot had been living in. Therefore, I was not surprised that the GMC at that time struck him off. I did think, however, that it was due to a misunderstanding and—let me repeat for the third time—due to the fact that he was in the wrong place at the wrong time. He has truly suffered over the past 12 years or so, and I plead with the Minister to have a look at this case and, perhaps, to have a word with the GMC, because we are talking about a man who is committed to medicine and who has done his best to re-educate himself—although I have not talked to him very recently. I ask my hon. Friend to look at the case of Adrian Garfoot in particular.

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Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 9:53 pm, 16th March 2009

Let me start by congratulating Mr. Bellingham on securing this further debate on the case of Dr. Adrian Garfoot and the General Medical Council.

My Department's "Clinical Guidelines" and "Models of Care" guidance promote a range of drug treatments by those competent to prescribe, and the Government fully support appropriate clinical freedom within the constraints of the independent mechanisms to regulate professional practice. The GMC is responsible for regulating medical practice, and its primary purpose is to protect the public. That principle was reaffirmed last year by Members on both sides of the House during the passage of the Health and Social Care Act 2008. It is important to make clear at the outset that the GMC is an independent statutory body, and that it is not directly accountable to Ministers.

The hon. Gentleman has understandably concerned himself with the case of Dr. Garfoot, and I commend him for the detail of his research and the care he has taken in preparing for this debate. May I commend the work of my hon. Friend Dr. Iddon, too? I have the greatest regard for him and he speaks a great deal of sense on drug issues in general.

The hon. Gentleman and my hon. Friend will be aware that Dr. Garfoot's situation was the subject of a debate in June 2003, as well as being cited as a case in point in several others: in March 2001, November 2001 and January 2005. It should not be and is not the Government's job to take sides in such a dispute. I cannot comment on the rights or wrongs of the case; indeed, it would be wrong for me to do so. The determination of Dr. Garfoot's fitness to practise was a matter for the GMC's fitness to practise panel, and those tasked with adjudicating in medical fitness to practise hearings have to make a judgment about the appropriateness of clinical interventions in the face of competing evidence and competing professional views. Their decisions are often extremely difficult, as there is often competing evidence and a range of views about appropriate clinical practice. In this case, those differing views have been well-aired.

When cases relate to the appropriateness of a clinical judgment, a fitness to practise panel has to make a judgment about whether a doctor is applying good medical practice in comparison with the norm in that specialty. In highly specialised practices, such as the treatment of older drug users, that judgment might be more complicated, but it was the clear finding of the panel that Dr. Garfoot's practice was impaired at the time. Let me quote from the finding of 11 September 2001:

"The Committee found that he had irresponsibly prescribed drugs of addiction and dependence to 12 patients between 1996 and 1999".

That followed the previous finding that those

"12 patients all displayed a pattern of excessive treatments, mostly over several years. Some patients became dependent on drugs which they had not taken regularly before".

The later ruling found that

"his pattern of clinical management and attitude to the need for his own education fell far short of the standard expected of a medical practitioner."

That took place at the hearing at which Dr. Garfoot's name was erased from the register. As the hon. Member for North-West Norfolk rightly said, Dr. Garfoot then went on to appeal to the Privy Council. On 19 June, the Privy Council dismissed his appeal against erasure, stating that

"the circumstances of the case were so serious that the order of erasure was entirely appropriate and inevitable and...there was no basis to justify setting it aside."

The Medical Act 1983, as amended by the Medical Act 1983 (Amendment) Order 2000, states that no application for restoration of a name to the register can be made to the professional conduct committee until five years from the date of erasure. Also, if an application has already been made and rejected, another application cannot be made for a further 12 months. That order took effect on 3 August 2000, which means that any doctor whose name was erased on or after that date must wait for five years before they can apply for restoration.

Dr. Garfoot applied for restoration at the end of the initial five-year period. His application was heard in March 2008, when he informed the panel that he had reflected on his prescribing practices and that he now considered them to have been "ridiculous". He also accepted the need to undertake further training in order to return to practice. However, the fitness to practise panel refused his application. In summing up, it remained very concerned about his lack of insight into general and fundamental problems and his failure to keep records, to monitor or review treatment and to keep his knowledge and skills up to date. He became eligible to reapply for restoration last week, on 10 March.

As I said, the new rules about applications for restoration raised by the hon. Member for North-West Norfolk came into force on 3 August 2000. The 2000 order included transitional arrangements for applications and the effect of those transitional arrangements was that the new rules applied unless erasure had already taken place by 3 August, even if the allegations related to an earlier time. That was the case even if the GMC had already started proceedings. The amendment therefore takes effect from the date that the decision is made and not the date on which the alleged incident or incidents took place. In Dr. Garfoot's case, his name was not erased from the register until 26 June 2002 and so it was clear that the new rules applied to him.

The hon. Gentleman raised concerns about the dual function that the GMC used to have of hearing and adjudicating on processes. The GMC provides clear and concise guidance for doctors on restoration following erasure by a fitness to practise panel, and that guidance is published on its website. The criticism that the GMC faced during the Shipman inquiry led to the putting in place of new procedures in 2004. However, we believed that public and professional confidence in the system of regulation had already been undermined. The GMC was quick to recognise that reform was needed to change that perception, and to do so it made significant changes, including moving towards an internal separation of its investigation and adjudication functions. However, given the level of—

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—( Mark Tami.)

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Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 10:00 pm, 16th March 2009

However, given the level of public concern, the Government felt that the creation of an office of the health professions adjudicator would send a strong signal to the profession and the public that decisions regarding a doctor's fitness to practise should be impartial and independent of those who investigate. We legislated to create the office of the health professions adjudicator in last year's Health and Social Care Bill, and we expect it to be fully up and running by 2011.

As I have already stated, Dr. Garfoot became eligible to reapply on 10 March. I understand from the GMC that he has not so far done so, but that would be the next step if he wants to get back on the register.

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Photo of Henry Bellingham Henry Bellingham Shadow Minister (Justice)

I am very grateful to the Minister for giving way and for some of the points that he has made, which are very helpful. Does he agree that it seems inflexible and too rigid for the GMC, in a reinstatement hearing, not to be able to reinstatebut with conditions? Obviously, its main concern inDr. Garfoot's case is not his suitability as a GP, but the way in which he ran the Laybourne clinic.

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Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I was just about to come to that, and I shall certainly reflect on the point that the hon. Gentleman makes and write to him in more detail about it. My understanding is that, if the GMC were able to do what he suggests it should, the problem would be that it refuses applications for initial registration where there is evidence that the applicant's fitness to practise may be impaired. Therefore, it would not be consistent to make provisions for restoring an applicant to the register with conditions if he or she would be refused registration in the same circumstances at initial registration. It would be unfair to those people who have to prove that they are completely fit to practise for the initial registration.

The council discussed erasure and restoration in November 1999 and agreed an important principle:

"Doctors who have been erased have been excluded from the profession indefinitely. Only exceptionally will any doctor be restored to the register following erasure."

The hon. Gentleman and my hon. Friend the Member for Bolton, South-East also raised the general issue of wider drugs policy. Both recognised that we have come a long way in the past 12 years or so in improving both provision and the general approach taken to helping drug addicts manage their addictions. We have increased substantially the number of people entering drug treatment, and the proportion of those who are receiving treatment that is having a long-term, positive impact in tackling their addiction continues to rise year on year. More than 202,000 people received treatment in 2007-08— 138 per cent. more than in 1998, when the figure was 85,000, and well in excess of our previous drug strategy public service agreement target, which was to double the number by 2008. We are keeping 78 per cent. of people in treatment for at least 12 weeks—we believe that that is an indicator of treatment effectiveness, with evidence showing that treatment of at least that length has a lasting, positive impact in tackling an individual's addiction—which is 3 per cent. more than in 2006-07. Collectively, that has led to improvements in the lives not only of the drug user but of the wider community, with drug-related deaths lower now than they were in 2000, following a doubling in the 1990s. Drug-related crime has also fallen by 22 per cent. since 2003.

We have raised a number of difficult issues today. There were a couple of detailed points that the hon. Gentleman raised that I am afraid I have not managed to respond to, but I promise to write to him about them—

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Photo of Henry Bellingham Henry Bellingham Shadow Minister (Justice)

The key point was the use by the GMC of draft determinations and predetermined sentences of erasure. If the Minister wrote to me about that, I would be very grateful, because it is probably the most important recent development.

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Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I will happily write to the hon. Gentleman. My officials did send me a helpful note on that, but it was not quite helpful enough for me to use. Either I did not understand it properly, or I did not think it a comprehensive answer to the point that he was making.

It is important that we all focus on what matters most: the protection of the public and patient safety. Public protection and patient safety require robust systems of professional regulation. In 2007, we published our White Paper "Trust, Assurance and Safety", which set out our intention to establish a new independent body to adjudicate in medical fitness to practise cases. There is often a difficult judgment call to be made about the acceptable degree of risk associated with certain forms of treatment. We believe, therefore, that it is right and proper that these judgments are made by a body that is independent of the individual and of the profession.

In future, there will be a clear separation between the GMC's investigation function and its decision-making process, and that separation of adjudication will ensure that there is no perception of bias on the part of the decision maker for or against medical practitioners. Although we have no reason to doubt the GMC's processes, independent adjudication will address the perception of bias in some quarters. Independent adjudication can only be seen as a positive development in cases such as Dr. Garfoot's, where competing opinions about the appropriateness of clinical intervention need to be weighed up.

Question put and agreed to.

House adjourned.

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