The change of status of the Inquiry in the Ayling case was of importance because the change of status occurred prior to the end of the evidence gathering stage of the Inquiry. However, this information was not provided at Court by the Inquiry representative when Clifford Ayling attempted to obtain the right to attend the Inquiry as a witness, and the information was only made public (as far as I am aware) on the date of the publication of the Ayling Report. Anna Pauffley in the Ayling Inquiry Report consistently used the term 'unfortunately' in connection with not having had the benefit of testimony from Clifford Ayling. However, the change of status of the Inquiry gave her full powers to oblige Clifford Ayling to attend the Inquiry. His initial refusal to do so was a totally irrelevant issue after the date on which those powers were given. As Clifford Ayling was at the time in prison, had Anna Pauffley and her inquiry team wished to hear from him as a witness, he would have been produced. Full responsibility for having failed to obtain evidence from Clifford Ayling at the Ayling Inquiry rests with Anna Pauffley.

Joan,

Thank you for your response to my FOI request.

Are you aware of (is there) any real difference between Inquiries constituted under s.2 of the NHS Act 1977 that write to the Health Secretary to invoke his/her powers of compulsion under s.84 and those Inquiries that are constituted under s.84 from the outset? Do both end up with the same powers?

Ah, I think the light is going on (with me!). So, if an Inquiry is set up under s2 of the NHS Act 1977 and that Inquiry writes to the Health Secretary for powers to compel documents and witnesses under s.84 then that Inquiry is said to be "reconstituted under s.84 (of the NHS Act 1977)"?

What I still don't understand then is that the Inquiry Report, which of course is published at the end of the Inquiry process, still refers to being constituted under s.2 (with NO power to compel witnesses or documents) but does mention elsewhere that the Inquiry wrote to the Health Secretary for increased powers. This is still very confusing for me...

Have you ever seen the film "JFK" when Kevin Costner talks about the report of the investigation into JFK's alleged murder? Well, the Ayling Report is just like that: "...incredible testimonies ignored, leads never followed up, its conclusions selective...it's one of the sloppiest, most disorganized investigations I've ever seen...".

So it is not at all surprising that you should be confused, and I firmly believe that it was intentional.

If you look at the site about the case (www.fdrgp-cliffordayling.com)in the section "Fight for Judicial Review", you will see that we found at least 77 ERRORS OF FACT, 82 FALSE AND MISTAKEN IMPRESSIONS, and 8 INCONSISTENCIES. There are many more that are minor or that we do not know about simply because there has been no access to the evidence.

Dwelling on the fact that the Ayling Inquiry had the power to compel witnesses might lead a reader to question whether the Inquiry actually wilfully failed to obtain proper evidence from Clifford Ayling.

Joan,

Thanks for your quote. Are you saying that the Ayling Inquiry had the power to compel Clifford Ayling to give evidence to the Inquiry? That the Inquiry did not compel Clifford Ayling to give evidence? That the Inquiry recorded the lack of evidence from Clifford Ayling as his refusal to engage with the Inquiry?

APPENDIX 7 of The Ayling Inquiry Report, 'ATTEMPTS TO ENGAGE WITH CLIFFORD AYLING' is very confusing to me for a couple of reasons. Firstly, it says that Ayling could not participate in the Inquiry process because he would not sign a confidentiality undertaking. This seems rather odd, given that Dr. Ayling already knew the medical histories of his own patients and was surely already aware of the information contained in their medical records? I doubt if the act of "signing" a confidentiality agreement makes it any more binding. As a doctor, surely he already had a duty to preserve patient confidentiality anyway? I fail to understand the point the Inquiry tries to make there in Appendix 7.

Secondly, Appendix 7 is entitled, 'Attempts to Engage with Clifford Ayling' but the page hardly addresses this point at all, instead most of it focuses on Dr. Ayling's failed attempts at seeking judicial review. Again, that seems strange. What has his application for judicial review got to do with the Inquiry's attempt to engage Ayling in the Inquiry process?

Returning to the point about Judicial Review, the reasoning for refusing to grant that is as contrived as the Inquiry's Terms of Reference. That is, the Inquiry was tasked with investigating complaints about Clifford Ayling's conduct, but not to consider his culpability. How could anyone investigate the effectiveness of the reporting of what went wrong (complaints) unless they scrutinise the incidents themselves (each act complained of)? As each act was said to have been a crime committed by Ayling, then surely Ayling had the right to Judicial Review? I don't understand, from the Inquiry Report, why the European Convention of Human Rights did not apply.

Taking each point in turn:

Yes, the Ayling Inquiry had the power to compel Clifford Ayling to give evidence and this power was given about a month prior to the date fixed as the end of the evidence gathering phase of the Inquiry.

The 'confidentiality undertaking' participants to the Inquiry were asked to sign was not only concerned with patients' medical notes. Participants were basically bound not to pass on or make public any documents or statements they were presented with by the Inquiry to comment.

Also, the criminal trial only dealt with allegations by former GP patients in the 90s. When the Inquiry began strange allegations came out in the media about supposed incidents in the 1970s and 1980s by former hospital patients or colleagues. By not compelling Clifford Ayling to give evidence, the Inquiry was able to withold from him all information about the allegations as these allegations had never been treated by the Police or in court. So effectively Clifford Ayling was denied by the Inquiry the opportunity of 1)knowing exactly what allegations were being made against him and 2) of putting in any form of defence.

Clifford Ayling tried twice to obtain the right to give evidence to the Inquiry at a date prior to the end of the Inquiry process. The first time the Inquiry argued that Clifford Ayling had forfeited his right to attend by refusing to sign the confidentiality undertaking, and the Inquiry apparently failed to inform the Court that by then they had already obtained the power of compulsion. The second time the Inquiry argued that it was too late because it was about to present its report, which was codswallop because they knew very well the amount of evidence they had gathered would take much longer than expected to process. I would also imagine by then that the Inquiry knew full-well that there had been a miscarriage of justice and obtaining evidence from Clifford Ayling would make it impossible to produce the whitewash report that they were intending to produce. It is of note that the Inquiry Chairman (Anna Pauffley) was made a dame in the period between the end of the evidence gathering phase of the Inquiry and the publication of the Report. I would imagine anyone would need a large incentive to accept to put their name to a report produced with millions of pounds of public money that contains so many factual errors.

As far as crimes supposed to have been committed by Clifford Ayling are concerned, you will notice that in a number of cases the witnesses who gave evidence to the Inquiry gave evidence that would lead a normally balanced analysis to conclude that nothing had happened. In such instances the Inquiry stated that it remained (subjectively) convinced that an incident had occurred. The Court argued that the Ayling Inquiry Report and the ensuing white papers did not establish culpability, but the same documents do clearly say "crimes" were "committed".

It is not possible for Clifford Ayling to take the case to the Human Rights Court if he has not attempted to appeal his criminal convictions. This was not possible in the months after his arrest because the firm Harman & Harman had all his assets frozen and it was not possible for him to instruct a lawyer to the extent that would have been necessary in a case of this size. Then with all the media coverage and political ramifications of the case, plus the fact that the solicitor acting for claimants had a sister in Government, solicitors just wouldn't take on the case. One solicitor experienced in criminal cases told me that many cases that should do not go to appeal simply because the cost is too high. When one sees how the Health Authority, the Police, the CPS, the solicitor Sarah Harman, the Law Society, the Department of Health, the British media and the British legal system went to great lengths to protect former patients who made false allegations, it is easy to see why there comes a point when it seems impossible to take the case any further.

Joan,

Thank you for providing more information. I understand (as you say in another request note) that Clifford Ayling is your father and, I hope you won't be offended by my saying, it seems from your posts that you are talking about some sort conspiracy involved in the Ayling case, that I find far-fetched. For example, you write:

'Then with all the media coverage and political ramifications of the case, plus the fact that the solicitor acting for claimants had a sister in Government, solicitors just wouldn't take on the case...When one sees how the Health Authority, the Police, the CPS, the solicitor Sarah Harman, the Law Society, the Department of Health, the British media and the British legal system went to great lengths to protect former patients who made false allegations..'

What are you saying exactly? What is this great "conspiracy"? Is it simply that a solicitor, whose business depends on seeking compensation for clients, successfully found a large group of clients (Ayling's patients) to represent with the help of her media savvy skills and that this solicitor happened to be well-connected in that she has a sister who is a member of parliament?

That doesn't explain why an innocent man would be jailed. I wonder if you believe that the government had, around the time the allegations were made against Ayling, already had experience of using adverse events within the NHS (such as the "Bristol Babies" case and the Shipman case) to introduce major reform of the NHS and that the government needed another adverse incident (or all 3 of the Inquiries that were linked by shared resources) to bring in more reform?

If that is the point you're trying to make, and going by the policies for reform recommended by the Ayling Report, say the government wanted to introduce its Duty of Candour and Redress Scheme and it needed a high profile case (or 3) to justify that: was your father just unlucky to live and work in the same area as Sarah Harman? Could that have happened to another GP in Kent?

I'm just trying to work out what it is you're saying/why you think a lawyer, the alleged victims, the police, CPS, Court, Dept. of Health, an Inquiry team etc. would ruin an innocent man's life by putting him in prison, bankrupting him and leaving him with virtually nothing in his old age? Why Ayling?

I accept that your reasoning for the lawyer and the victims pursuing the allegations was financial gain. I can accept the notion that the government wanted to introduce reform in the NHS and had had success with using adverse incidents to do this prior to the Ayling case. I can also see the link between the solicitor, victims and the government (the solicitor's sister being an MP)...so this could have happened to any doctor? I just don't understand why Ayling.

Dear Amanda,

You ask the question « why Ayling ?».

I think there are a lot of reasons, which revolve around the following issues:

Clifford Ayling could be described as someone who had been a thorn in the Health Authority’s side for a number of years. He regularly contributed to the letters page of the local newspaper when he believed HA policy was not in the best interest of patients, and in 1998 (the year he was arrested) a whole article had appeared about his views on the HA’s plans to close the local hospital and replace it with a mental institution. Other GPs in Folkestone (and also the local MP Michael Howard) were also against the plans but tended to express themselves publicly in groups, which made them less vulnerable.

If you are going to falsely accuse a GP of indecent assault, for whatever motive, a qualified gynaecologist working in the GP setting who has many female patients presenting with female health problems because of his speciality, would appear to be the obvious target.

Contrary to what is said in the Ayling Report, the Family Planning Clinic used to send women over to Clifford Ayling’s Surgery because of his speciality, despite the presence of another Surgery literally a few buildings further on, which had four GPs, including a woman GP. And the HA continued to allocate patients to Clifford Ayling even after he had been arrested and at a time when it is claimed in the Ayling Report that the HA was trying desperately to have him prevented from working.

Michael Howard was informed regularly of the concerns expressed over the handling of the Ayling case and would simply respond with requests that he be informed of developments. One can only imagine that the political stakes for him at the time were such that he could not take the risk of getting involved in such a high profile case about indecent assault. However, Michael Howard did publicly support the group set up for alleged victims of Rodney Ledward who passed over funds (if I remember rightly) to support the alleged victims of Clifford Ayling in their ‘fight’ for a public inquiry.

At the time the case was mounted against Clifford Ayling, the case of Rodney Ledward, who was a consultant in gynaecology and was struck off in 1998, was all over the local news. Clifford Ayling had been a clinical assistant for Rodney Ledward at the hospital in Ashford.

The solicitor Sarah Harman represented former patients of Rodney Ledward at the Ritchie Inquiry. She would therefore have had access to medical notes and would have seen that Clifford Ayling had been the clinical assistant of Rodney Ledward. The claimant represented by Sarah Harman in whose name the bankruptcy order against Clifford Ayling was made in 2002 had been a patient of Rodney Ledward. It is not said in the media, but this claimant obtained money in a claim against the HA in connection with Rodney Ledward, then she obtained money in a civil claim against Clifford Ayling, then she obtained money in the group claim against the HA in connection with Clifford Ayling. She also obtained legal aid. This woman claimed negligence in connection with a smear result but had failed to inform the Surgery that she had moved away.

Further allegations about Rodney Ledward after his death were put together by the solicitor Jane Loveday, who got struck off over the case. It would be difficult to imagine that there was no cross-over of information or clients between the firm of Harman & Harman and Loveday’s firm. Sarah Harman’s firm was on to the Ayling case many months before the criminal trial (and had at least one related client on their books prior to the trial). At least one complainant made a CCRC application whilst the police investigation was going on. The similarities between the workings of Jane Loveday’s firm and that of Sarah Harman’s are striking, and I believe it is Sarah Harman’s connections in high places that probably saved her from the same fate as Jane Loveday.

You may have noticed that group claims for alleged indecent assault against GPs tend to target doctors who are just off retirement age. The HA apparently offered Clifford Ayling early retirement on full pay, just after he had been arrested, but he refused. Presumably this is similar to the tactics used in cases of constructive dismissal. It is also presumed by potential claimants that by this time assets such as houses are no longer subject to mortgage payments.

It is documented that one former patient of Clifford Ayling was approached in the summer of 1997 by another former patient who said that she was intending to make a complaint against Clifford Ayling. The former tried to make a police statement but eventually desisted because the Police was insistent on what the statement should say, and she believed this was an attempt to make her produce a statement that could be used against Clifford Ayling instead of for him, which was not her intention. The latter it turned out was the woman who made the first complaint to the HA in 1998, claiming to have been indecently assaulted in 1998 (not 1997).

The HA lost control of the case when it was handed over to the Police and went public, because the intention appears to have been that the HA would handle complaints and then encourage people to go to the Police. The first woman to make a police complaint in 1998 was a Health Authority employee who worked in Maidstone but had moved to Folkestone. She was not registered with Clifford Ayling but she rang the Practice on a Monday morning and insisted on a new patient appointment for that same afternoon for a chest infection she had apparently had for at least six weeks. The next day she made a written complaint to the HA and a week later went to the Police. Her medical notes were never produced for the criminal trial but turned up two years later at the civil hearings for compensation. The contents would have been of great interest to the Defence team and allowed them to cover in cross-examination aspects of her relationship with medical professionals that she (and obviously the CPS too) did not want aired. Another patient told the HA Clifford Ayling had been surprised when she had taken all her clothes off for an examination. This element was not present in the Police statement she made, and by the time Sarah Harman was producing statements it was implied Clifford Ayling had forced the same patient to take all her clothes off.

The juicy aspect of the case appears to have motivated the Kent Police officers handling the allegations. They were on the hunt and hoping to “hang the good doctor” as one policeman wrote in a note. The officer in charge of the case got promotion on it and moved on to Dover. Early on it was decided by the CPS and the Police not to interview surgery staff or nurses who had acted as chaperones when former patients claimed to have been indecently assaulted. This after having obtained a first statement from a chaperone that totally contradicted that of the complainant. The Defence solicitors had to repeatedly request a copy of the said statement from the CPS, until it was finally passed over. At the civil case in 2002 one claimant finally admitted that the reason she said in her statement that she did not know whether the doctor had had an erection or not was because the Police had asked her about the subject. Another woman apparently informed the Ayling Inquiry that she had gone to the Police to complain of something else and had ended up making a statement about indecent assault simply because she had been examined by Clifford Ayling in the past and the policeman who dealt with her told her she had probably been assaulted.

Doctors are notorious for not being good at helping their Defence team and Clifford Ayling was no exception. And it is evident that the CPS withheld crucial material and it would seem also further statements. Having said that, there was a lot of material the Defence team did have at its disposal that it should have gone into further. However, it is significant that the solicitor in charge of the case went on maternity leave and was replaced by another who then also went on maternity leave. Nobody appears to have actually had a full grasp or understanding of the available material, and it is documented that this was the first case of its kind that the firm had had to deal with.

The fact that the Defence was paid for by the Medical Defence Union is relevant because the CPS had indicated that the criminal trial would last 3-4 weeks. In fact it took nearly that long just to get through the Prosecution witnesses. It is documented that the Judge was being slow at the trial, that the MDU became concerned at the rising cost as the trial dragged on, and that some members of the Defence team were expected on other cases in January 2001. These would seem to be the reasons that motivated the extraordinary advice given by the Defence team to Clifford Ayling not to call any witnesses for his Defence, which could lead to nothing other than his conviction. From what I gather the team basically told Clifford Ayling that if he decided to call the witnesses for the Defence (who had been asked to come to the Court by the Defence team and were waiting to give evidence), he would be “on his own”. Despite the absence of any witnesses for the Defence, the verdicts were far from clear cut against Clifford Ayling. And quite amazingly the transcript of the criminal trial has big holes in the summing up by the Defence for weird reasons, like the Defence was on the other side of the courtroom, or the tape jammed, or just no reason. Nothing like that happened when the Prosecution was summing up, apparently.

Everybody knew there was something wrong with the case. This is what a former member of a GMC committee said in a message sent to the website NHS EXPOSED:
"Interested you should raise that now. This broke when I was at the GMC- b[u]t the GMC didn't touch it until he was sent to jail and then they erased him as they had to. Another interesting thing is that Clifford Ayling turned up to his GMC hearing handcuffed to a prison officer. I heard about it at the time and it was something like I was surprised and shoulders were shrugged and a resigned sort of reply like he says he's innocent but he is serving time. Looking back I think the view of the PCC chair who I spoke to about it - don't know if he erased Ayling - but his view seemed to mirror that of yours - it is not as it seems.
So clearly there was something suspect about the whole thing. The other thing is East Kent Health Authority the one which covers the Medway Towns. Because if it is I have heard on good authority that the CHC used to prime patients over how to complain and even suggest they should. All very unpleasant in Kent a den of iniquity all round. I wonder how anyone ever got time to see or treat any patient under the circumstances!
And then there was the Ledward trial - he was similarly in Kent - apparently a lot of rumours in Kent and the Medway at the time. It's a very uncomfortable place to work for a doctor - but they seem to have swept a lot of them out now and repopulated with Irish doctors."
Very quickly after the criminal trial Sarah Harman got into gear and had all of Clifford Ayling’s assets frozen, which effectively prevented him from being able to instruct a solicitor as the Medical Defence Union indicated that it would not fund any further proceedings. Sarah Harman refused to allow sufficient funds to be released for Clifford Ayling to be represented at the civil hearings in 2002 by a solicitor who as a result had to take herself off the register, and Clifford Ayling had to cross-examine claimants himself. The judge exceptionally gave the claimants the right not to go into the witness box. A number of them decided to anyway. They then fuelled a media campaign portraying Clifford Ayling as some sort of monster who put the claimants through the ordeal of being cross-examined by him. That is how solicitors like Sarah Harman use the media to gain unfair public support for her groups of claimants. Never mind about Human Rights. Again, her connections in high places probably pull weight and frighten off reporters (or more to the point, their editors) who might be tempted to look into the other side of the story.

One of the difficulties with looking into alleged indecent assault by a qualified gynaecologist in the GP setting, is that when it was claimed Clifford Ayling did not examine a patient Sarah Harman accused him of negligence, and when it was claimed he had she accused him of indecent assault. Preventive medicine seems to have become a taboo subject, since the whole point of preventive medicine is doing checks to make sure there is nothing wrong, which means that you cannot accuse someone of indecent assault simply because they examined a patient and found no symptoms. And the nitty gritty side of patients who present with vaginal warts, for example, is totally glossed over in the discussion of alleged indecent assault in the GP setting. Had Clifford Ayling been examining women without gloves, as was claimed, he would have had warts all over his fingers. Nobody, absolutely nobody, claimed at any time to have noticed any such thing. And I who have seen a great number of the medical notes of the women who made allegations can say that quite a few presented with vaginal warts at some point or other.

Obviously, by the time Clifford Ayling had been arrested, convicted, struck off, sued and made bankrupt, lots of agendas were on the table. The only time things could have been put right would have been when the HA’s plans backfired and it lost control of the case. Documents show that the HA thought it would be working closely with the Police and the Police would share information. But that did not happen. The HA could not admit to having set Clifford Ayling up, and the Police knew full well he had been (and did the same), and from then on all the parties inadvertently involved in the case with a responsibility for supposedly finding the truth must have found themselves trapped in a chain of events they were put under pressure not to break.

I am personally convinced that Anna Pauffley was made a Dame just two months after the end of the evidence gathering phase of the Ayling Inquiry either as an incentive or for her protection. I do not believe a properly balanced, highly-educated person, presented with the evidence she had in her possession, would produce such a shoddy, one-sided, subjective, badly-written, contradictory and incorrect report without being encouraged in some form or manner to do so by the parties who would benefit from its publication.

Clifford Ayling has tried everything he can to get the Department of Health to make public the transcript of the hearings of the Ayling Inquiry. Seeing that the participants to the Inquiry had the right to tell the media anything they wanted about what was said at those hearings (see the judgment in the judicial review case in 2002 of the decision not to hold the Ayling Inquiry in public), it is argued that the transcript of the hearings should be made public. Numerous FOI requests have been made and a judicial review application in 2007 requesting that the transcript be made public was thrown out. So what is there to hide, why is the Government hiding it, and why are the Courts letting it be hid?

Amanda, I hope this goes some way to answering your question.