GENERAL MEDICAL COUNCIL

FITNESS TO PRACTISE PANEL (PROFESSIONAL CONDUCT)

Thursday 29 November 2007

Regent’s Place, 350 Euston Road, London NW1 3JN

Chairman: Dr Jacqueline Mitton

Panel Members:

Mrs Leora LloydMr Alexander McFarlaneMr Arnold Simanowitz

Legal Assessor: Mr Robin Hay

CASE OF:

SOUTHALL, David Patrick

(DAY THIRTY)

MR RICHARD TYSON of counsel, instructed by Messrs Field Fisher Waterhouse, solicitors, appeared on behalf of the Complainants.

MR KIERAN COONAN QC and MR JOHN JOLLIFFE of counsel, instructed by Messrs Hempsons, solicitors, appeared on behalf of Dr Southall, who was present.

(Transcript of the shorthand notes of T. A. Reed & Co.Tel No: 01992 465900)

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I N D E X

Page No

APPLICATION FOR ADJOURNMENT, Cont.

SUBMISSION – MR TYSON 1SUBMISSION – MR COONAN 5ADVICE OF THE LEGAL ASSESSOR 6DECISION 7

SUBMISSION – MR COONAN

SIMON CHARLES PARKE, Affirmed

Examined by MR COONAN 34Questioned by THE PANEL 37Cross-examined by MR TYSON 39Further questioned by THE PANEL 40

JOHN MARSHALL BRIDSON, Affirmed

Examined by MR COONAN 42Cross-examined by MR TYSON 45Questioned by THE PANEL 46

SUBMISSION – MR COONAN (Cont)

ADVICE OF THE LEGAL ASSESSOR 53

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THE CHAIRMAN: Good morning. When we adjourned last night the matter was still with Mr Coonan, who was making an application. Mr Coonan, I just wanted to give you the opportunity this morning to say whether there is anything else you wanted to say or whether you had completed your submissions on this application to the Panel?

MR COONAN: Madam, that is very kind, but I have nothing further to add.

THE CHAIRMAN: It is now for Mr Tyson to respond.

MR TYSON: The complainants have two main reasons for opposing an application to adjourn. One global head is under principle and the second global head is under practical matters.

In principle I make four main points. Firstly, this case has been going on for over a year now and my clients have been awaiting a decision for a considerable amount of time and they, and I suspect even Dr Southall, needs, if I can use the jargon, closure on this matter. It has been hanging over a lot of heads for a long time.

The second matter in principle I would suggest is that it is wrong and unfair for submissions on SPM and sanction to be separated by an unknown period of time.

The third point I make is that it was no surprise to Mr Coonan that I was going to introduce the Attorney General matter. The cat was already out of the bag, if I can put it that way, because the fact that the Attorney had called in the SC files was told to the July 2007 review panel. You can see reference to that in the determination at C27/37. Secondly, I in fact told Mr Coonan that I was going to mention the SC matters before I rose to make my submissions yesterday. Not only did I tell him that I was going to raise it, I told him how I was going to raise it, so he knew both the form and content of what I was going to say. I have to say that he did not tell me that if you are going to say that then I need an adjournment.

The fourth matter is this. I am happy for you to assume on behalf of the complainants if need be that the Attorney’s review finds nothing wrong with Dr Southall’s disclosure in criminal prosecution cases because that is not the point I was seeking to make to you to ask you to make any assumptions about the content, but if you want to make assumptions about the content of any ultimate report I am happy for you to assume that it completely exonerates Dr Southall from any non-disclosure in any criminal prosecution cases that he was involved.

The point I was making was a much simpler point. Rather than speculate, which I do not ask you to do about what the result is, but the much simpler point is that the very fact that there were 4,449 SC files was sufficiently disturbing or serious that the Attorney called for a review in the first place. That is why I was making my submissions on the subject under SPM because it shows, in our submission, one serious aspect of holding SC files in the first place, namely that there is a risk that important clinical information might remain in an SC file, nowhere else, and become undisclosed when needed. I would submit to you that there is no prejudice to Dr Southall if you

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proceed, if you have to, on the basis that the ultimate report is favourable on this particular topic to Dr Southall.

Then I come to much more mundane matters which are simple practical matters as to how long do we adjourn to?

Can I ask you to look at C26 which is the bundle containing the Attorney matters at page 6. This is the Attorney’s letter at 1 November and it indicates, as my learned friend relied on, in the second paragraph that:

“A report has been submitted to the Attorney General who has indicated the course she considers it appropriate to take. A copy of the report has been supplied to Dr Southall’s representatives for them to consider the factual accuracy (only) … His representatives have made a number of suggestions …”

It is the next paragraph on which I rely:

“The report makes a number of recommendations for action by other Government departments. Recently we had a meeting with the concerned departments and have asked them to consider what they wish to do about the recommendations. We anticipate hearing from them in about a fortnight and will not be taking any further action until we hear from them.”

That was two weeks from 1 November in which they were gathering recommendations from other departments. Then of course the Attorney would have to consider what the other departments said and whether to change any of their recommendations and even when they have done the internal matter of considering what other departments have got to say about it, then we have got to find parliamentary time thereafter in order for the Attorney to make her statement back to parliament. That is made clear at page 8. We see that that is an email from a member of the Attorney’s team:

“At this stage there is little that we would want to add to the work of the GMC as our priority is to ensure that Parliament is made aware of the review findings first. Without wishing to be bound on timescales, I would suggest that this will happen in a matter of weeks rather than months.”

I think we can all take the equivalent of judicial knowledge that finding parliamentary time for matters is not a matter that is certainly in our control and is not in the control of any department who wants to sponsor anything in Parliament in any event. We do not know how long to adjourn to and even if we did know, let us say it was going to be after the winter recess and Parliament was going to hear about it in, say, January, we still do not know thereafter when we all in this room could foregather to carry on the matter further. Not only is there the practicality of when the Attorney is going to respond to Parliament, then there is the further practicality of when coordination can take place to get everybody back in this room together.

My submission to you is that it is all so uncertain that it is impossible now to adjourn to a fixed date which would be the only way which one could adjourn to, and one does not need to adjourn, in my respectful submission, because provided, I submit, there is no prejudice to Dr Southall and if you deal with it in the way I suggest then there will and

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cannot be any prejudice to Dr Southall. I would add finally that as far as Mrs M is concerned, which is of course the most serious part of SPM as far as I am concerned, she has nothing to do with SC files in any event. Those are my submissions.

MR COONAN: May I take what my learned friend has described as matters of principle first. The question of closure of course is a matter which applies to Dr Southall at least the same as the complainants, if not more. The application is made by him quite simply on the basis that he feels that you should have this report. Any delay is not his fault and any perfectly understood need for closure, putting it in a rather journalistic way, cannot cut across what you judge to be in the interests of justice. The fact that an adjournment, if it be granted, may have to go off as matters stand for an unknown period of time cannot be wrong or unfair if that is consistent with the interests of justice. It may be tough on those who are involved in this case; that is not the same as saying it is wrong in principle or unfair, or contrary to the interests of justice. That is the major observation I make about the issue of principle.

As to observations made by Mr Tyson about the element of surprise, I have not suggested for a minute that I was taken by surprise. Mr Tyson is right, he did tell me that he was going to introduce it, but that is a matter for him. If he wants to introduce it, then he takes the consequences. I told Mr Tyson that I did not consent to it going in and I said to him that if it goes in then certain consequences may flow and the obvious consequence is that I will apply for an adjournment.

I am under no obligation to spell it out or spoon-feed my learned friend, if I can put it that way, as to what precisely I am going to do. I conduct the defence as I see fit. I do not say any more about that, because that in my submission does not go to matters of principle, but is just a matter of observation.

The ultimate question, I suspect, for you at this stage is whether or not not granting an adjournment might create prejudice to Dr Southall. That is coupled therefore with the concept of the interests of justice which I referred to. That may have to be looked at in two parts.

First of all, whether there may be fact be prejudice or whether in fact, to put it another way, there would be a perception on his part that prejudice may result and that the Panel have not been fully apprised of the matters which arose from the SC file issue, as we now know. A great deal of time was spent in this case upon the SC files and their implications and risks and impact upon medico-legal processes. My learned friend referred during the course of his lengthy opening and indeed in closing to the impact on, for example, criminal prosecutions. It is precisely that that this report as we understand it goes to.

Therefore I cannot, because of the reasons I indicated yesterday, because of the constraints upon me, make any comment based on the content of the report, or the draft report, as I understand it to be. All I can say is that at the very least Dr Southall may go away with an understandable sense of grievance that the Panel have not been provided with this document which arises out of one of the major planks of the complainant’s case as it was put to you back in 2006 and which has formed the basis of your findings in stage 1. Those really are the points of principle.

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As to matters of practicality, I entirely agree with Mr Tyson. We do not know. We do not know at the minute. The most up to date position we have is on page 28 of C26. Whether matters may move on and it may be that inquiries might be made, if I can put this quite properly and I do not mean any disrespect, not merely by Field Fisher Waterhouse, but by the General Medical Council itself, one might actually acquire rather more information. I do not know. That is simply a matter which I am floating, that the statutory body itself may be able to have a short conversation with the Attorney’s office and be able to advise us with more particularity as to the up to date position. But that is pure speculation. I cannot advance the argument one way or another therefore as to when this matter may come before Parliament. Once it is before Parliament of course, then we can refer to it, but not before.

Madam, those are the submissions that I make in reply.

THE CHAIRMAN: Thank you, Mr Coonan. We will be calling on the Legal Assessor to give legal advice before the Panel goes into camera to consider your application. I understand the Legal Assessor may want a few minutes to consider his advice. Yes. The Legal Assessor has indicated that he would like 20 minutes to consider his advice, so we will take a brief adjournment and we will call you when we are ready, but we expect it to be of the order of 20 minutes.

(The Panel adjourned for a short time)

THE CHAIRMAN: I am now going to invite the Legal Assessor to give the Panel legal advice before it retires to consider Mr Coonan’s application for an adjournment.

THE LEGAL ASSESSOR: In accordance with rule 27(2), the Panel’s task at this stage is to decide whether, based on the facts found proved, the doctor has been guilty of serious professional misconduct. If it does so decide, it must then consider the question of sanction.

Pursuant to rule 28(1), Mr Tyson has addressed the Panel as to the circumstances leading to the facts found proved and the extent to which those facts are indicative of serious professional misconduct. In doing so, he relies on the fact that the Attorney General has conducted a review of cases where the doctor has been involved as a prosecution witness. This is with particular reference to the SC files. Mr Tyson says the fact that the Attorney General has called for a review is in itself an indicium of the seriousness of the existence of those files. The report on the review is apparently in draft, but cannot be disclosed until presented to Parliament and no date has been set for this to be done. The draft has been made available to Mr Coonan, but on terms that it may not be disclosed to others. It follows that Mr Coonan is the only person involved in the case who is aware of its content.

Mr Coonan applies for an adjournment until the report is published. He says that it is important to his client’s case that the Panel should see the report. This, he says, is because Mr Tyson has relied upon the fact of the review as relevant to serious professional misconduct. Mr Tyson opposes the adjournment on the basis that he does not rely on what may be the findings in the report. Of course, he is not aware of what they may be. Indeed, he invites the Panel to assume for the purposes of this submission that the report will exonerate the doctor.

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It is open to the Panel to adjourn the hearing at any stage, provided it is in the interests of justice to do so. As I have said, the Panel’s task is to decide whether, on the facts found proved, the doctor has been guilty of serious professional misconduct. I therefore advise the Panel that the fact that the existence of the SC files may have caused the Attorney General to set in hand the review is not a matter relevant to its decision. It is for the Panel to use its professional judgment in deciding whether the matters proved do in fact amount to serious professional misconduct. The fact that the review has been undertaken and whatever may be the content of the report are not matters which should in any way affect the Panel’s judgment. In particular, they should not be held to the prejudice of the doctor.

It follows that although it is a matter for them, the Panel members may well conclude that no prejudice to the doctor can arise if the report is not before them and that, as a consequence, there is no need for an adjournment until it is published.

THE CHAIRMAN: Thank you, Legal Assessor. Does either counsel wish to comment upon the legal advice?

MR COONAN: No, thank you, madam.

MR TYSON: No, thank you.

THE CHAIRMAN: The Panel will now go into camera to make its decision on this application.

STRANGERS THEN, BY DIRECTION FROM THE CHAIR, WITHDREW AND THE PANEL DELIBERATED IN CAMERA

STRANGERS HAVING BEEN READMITTED

THE CHAIRMAN: Mr Coonan, Mr Tyson, before I give the Panel’s determination, the Legal Assessor wishes to make a small correction to his legal advice.

THE LEGAL ASSESSOR: I inadvertently referred to the wrong rule when setting out the task of the Panel. It should of course be rule 29(1). That was when I was referring at the outset to the Panel’s task, which is to decide about serious professional misconduct.

THE CHAIRMAN: Thank you. I will now give the Panel’s determination.

DECISION

THE CHAIRMAN: The Panel has considered the submissions made by both counsel and has also considered the legal advice. The Panel has accepted the Legal Assessor’s advice. The Panel has concluded that no prejudice to the doctor will arise if the report in question is not before them. As a consequence, the Panel has decided that an adjournment is not necessary and your application has therefore been refused.

Mr Coonan, do you require another short adjournment before you address us?

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MR COONAN: No, madam, I do not.

THE CHAIRMAN: The Panel nevertheless would like another 15 minutes, because there was a certain amount of uncertainty about what was happening. We will reassemble at 11.25. Thank you very much.

(The Panel adjourned for a short time)

THE CHAIRMAN: Mr Coonan, thank you.

MR COONAN: Could I begin by making a number of observations about the first issue for you under the rules. It is the question of serious professional misconduct. It is trite law that, not only have you to be satisfied of the existence of professional misconduct, but you have to be satisfied that it is serious. The authorities make that absolutely clear. You have received most recently the advice of the learned Legal Assessor which I respectfully accept. In the light of that, and given your primary findings of fact in Part 1 of these proceedings, Dr Southall accepts that there is evidence before you from which you can come to a conclusion that he is guilty of serious professional misconduct. It is a factor, that position, which may – and I do stress that word – “may” assist you in your assessment of him in terms of insight and realism. That is his position. However it is, perhaps, still appropriate for me to make a number of comments on the facts as you have found them. In doing that, I do not seek to go behind the findings of fact. It may be helpful to make a number of observations, not least because it may be relevant to your view eventually on sanction but, equally importantly, it may be relevant to your narrative determination. A narrative determination performs many things. Not least it lets the doctor know the full basis upon which your decisions are being made, but also, in addressing the public interest, makes the wider world, the wider public, aware of the basis of the findings of fact. These observations are limited but, as I say, you may find them relevant. The first is in relation to the special cases files. You have heard a lot of evidence about those. For these purposes I am going to put wholly on one side any consideration of the Attorney General’s review. You have made findings of fact in relation to two cases out of 4,500. It would be quite wrong to speculate about the content of the other special cases files. I think you had some evidence to the effect that only one per cent of the files, certainly that went from the Brompton to Stoke, would have been concerned with child protection matters. There is no evidence placed before you of any adverse impact, as a matter of fact, on the medical care of either Child D or Child H. That is a matter of some public interest and importance, we would suggest. Equally important, and we would invite you to this view, and it is not in any way attempting to go behind your findings of fact as I have stressed earlier, it is open to you to acknowledge that Dr Southall’s approach to the special cases files was indeed, it may be said, idiosyncratic but, nonetheless, developed in a vacuum certainly up to January 1997. I refer in that regard to the Keele, the Stoke, policy of January 1997.

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The allied matter there is – and I invite you to an important matter which is going to establish the theme throughout my submissions – that his whole approach to the special cases files was, in effect, motivated and driven by this view that he has had, on the evidence, about child protection. However flawed the policy, his view was coloured by his experiences and attitude to the whole issue of child protection, an attitude which the Panel may think has been erroneously directed, but it is, nonetheless, a factor which in our submission looms large in this case. The next matter, which I hope I can take shortly in relation to the special cases files, concerns the undertaken which was given in November 2006. You have your bundle at C25 put in yesterday. Although I can take it shortly, I think it deserves a number of observations. First, as you have heard, it came about because the General Medical Council made representations to Dr Southall and his legal team back in November 2006 in the light of the evidence which had emerged and been placed before you.

With alacrity, and I stress that, Dr Southall was more than willing to voluntarily provide an undertaking in the terms to which you have been taken. You have seen the terms of that set out on Day 16. Immediately following that, and I say this less there be any confusion about it, the special cases files for Child H and others were already in the possession of Field Fisher Waterhouse. Field Fisher Waterhouse have had the special cases file ever since then, so there was no need for that to go back to Brompton. All the other special cases files were delivered to the Brompton Hospital on 16 March 2007. You will see that at C25, page 9. They were delivered at the first reasonable opportunity because it required the cooperation of the Brompton Hospital to receive these files, some 2,500 in round terms. In addition there were the tapes. Once again, because of arrangements that had to be made on a purely pragmatic basis at the Brompton, the tapes were ultimately delivered, by agreement, in October 2007 (C25, page 10). But, and here was the slight fly in the ointment, twenty-one tapes relating to Child H were missed at Stoke for the purposes of delivery down to the Brompton; they were missed from that delivery in October 2007. As things have turned out, they were delivered to the Brompton and I can tell you, with confidence, that they were delivered to Brompton on 23 November 2007. The mechanical reasons for why they were missed matters not greatly, we would suggest, otherwise they would have gone with the rest of the tapes in October 2007. Everything has been done, by agreement with the Brompton, when the Brompton were ready to provide storage space to receive them. Therefore, the reason for dealing with this is that we are in a position to say to you, and to the GMC who sought the undertaking which was freely given, that there has been compliance with it. I do not wish it to be the case that there is now any position which suggests that there has been non compliance; we say there has. That is all I say about special cases files. I now turn to the Mrs H, Dinwiddie, letter. I make three observations about this. First, this was a case which arose in 1990, it is a long time ago. Secondly, there is no evidence called before you to the effect that there has been any adverse impact on the medical care or welfare of Child H because of the sending of the Dinwiddie letter to Gwent. That, we would submit, is an important feature. The third matter is that, as you have heard on the evidence, Dr Southall’s motive in sending the letter again arose out of his own child protection concerns. That

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is not to submit that the concerns were necessarily justified but they arise out of those concerns. In fact, as you know, there were bases for child protection concerns in the documents which were placed before you – Dr Dinwiddie’s letter of referral and the subsequent material. For these purposes I am not concerned with justification or otherwise; I am concerned with what was the springboard for the sending of the letter. That is all I say about Mrs H.

Mrs M

The matters before you occurred in 1998, which was two years before the events in the Clark case. The second matter which I draw to the Panel’s attention is that once again, as you have heard in extenso, that Dr Southall’s whole approach to this question that the M case threw up, his approach from the beginning, his motive, his intention, arose out of child protection concerns. As to that, I entirely agree with Mr Tyson that it does indeed have echoes of the Clark case and it would demonstrate on any view a degree of zealous enthusiasm and conviction that he was right. That much I agree on the evidence. That is all I say about Mrs M.

Therefore, standing back for the moment, all three of the elements of the matters before you involve child protection as the wellspring for Dr Southall’s approach; every single one of these cases and so did the Clark case. Whilst it is right to talk about a pattern or a sequence, they all have, including the Clark case, a common source: the operation of Dr Southall in the field of child protection. That factor, we would submit, is crucial to your approach and I shall develop it when it comes to the question of sanction. I would invite you to have that fact in the back of your mind when addressing the other features.

At this stage it may be of assistance if I place before you a little more background for the decision which was made by the Professional Conduct Committee (as it then was) in August 2004 in reaching the decision in principle that conditions – I am using that in short form – were appropriate. It is quite clear, both from the decision of the Professional Conduct Committee as illustrated in the judgment of Mr Justice Collins that the Panel, and indeed the administrative court, rely very heavily upon the evidence which was placed before the Professional Conduct Committee of the Medical Director, Dr Chipping. I am going to ask you to receive an extract of the evidence given on behalf of Dr Southall in that hearing and I am going to take you through it, if I may.

THE CHAIRMAN: This will be D24. (Document D24 marked and circulated)

MR COONAN: May I give you some background. Dr Chipping was called during the case for the complainant to deal with matters of fact and then I called her as part of the defence case to deal with matters relating to character and also to deal with the workability, if I may put it that way, with a system of conditions. May I take you through this. You will see on page 32 at F exactly what I have just said that she had given evidence before the Committee at an earlier stage. She gave evidence between G and H of the investigations which the Trust had carried out during the time that Dr Southall was suspended. In 1999-2001 he was suspended, as we will see, for two years.

At page 33:

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Q You have described how that fell into three categories – research, personal and child protection – is that right?A That is correct.

Q On each of those three areas, Professor Southall was exonerated.A That is correct.”

At C, she tells us that Dr Southall returned to work in October 2001 when the suspension was lifted. At D, she explained that the Trust had arranged an attachment at another trust to enable Professor Southall to regain his clinical confidence.

“He has returned to work very specifically in the areas of general paediatrics with his particular interest in respiratory medicine. He has not been undertaking child protection since that time.”

Could I ask you to note that that has been the position ever since. It has been the position ever since as a result of, firstly, the Trust’s own conditions latterly superseded by the decision of the Professional Conduct Committee as amended by the Administrative Court. Picking it up again at E:

“He returned to work … I think it would be February 2002.

Q How has he performed in the field of general paediatrics?A All of the indications that I have (and this is confirmed by discussion with colleagues throughout the child health directorate) is that his opinion is highly valued. He is an extremely competent general paediatrician, and that has been brought home to me repeatedly. I should also add that not only has he taken up those reins, but he had done so with enthusiasm and with extreme hard work, and taken on some additional responsibilities for a colleague who is on long-term sick leave.

Then she deals with the rota arrangements at G-H. Page 34/A:

Q You said that he had not carried out any child protection work.A No.

Q You spoke last time [a reference to the evidence she gave earlier in the day) about the category 1 and category 2 types of work.A Yes.

For those who may not know, category 1 work is NHS work; category 2 is work where the doctor, in short form, is instructed as an expert by third parties.

Q Let us look at that a little more closely. During the time he has gone back to work, have you had any complaints about his conduct from anybody?A No.

Then she deals at C:

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Q During work as a general paediatrician, it might arise that a child appears with bruising or with a fracture and so on, which might raise a question of non-accidental injury.A Yes, indeed – I think that is almost inevitable in paediatric practice.

Q Do you have any arrangement within the Trust to deal with that issue … so far as Professor Southall’s involvement in child protection issues is concerned?A Yes. Generally, we run four on-call rotas for paediatrics.

She deals with the paediatric register system. I turn now to the question at E:

Q So far as Professor Southall is concerned, has that structure effectively prevented him from doing what may be called, generically, child protection work?A Yes. What has happened is that if Professor Southall has concerns that this might be a child who has been abused, he is clearly instructed to contact the trust child protection doctor on call at that time. I have in fact spoken just yesterday with the Trust’s child protection doctor, who happens, also, to be the head of division for women and children, which is just slightly above the clinical director. This individual confirmed that there is a very robust system at work, and that appropriate referrals have been received. She is confident, as I am, that this system has worked robustly.

Q Are there any breaches by Professor Southall?A No.

Q I want to take you to this question of Professor Southall and the imposition of conditions on practice.

Over the page at B the question was whether the system adopted was workable and capable of being policed if there was a system of conditions imposed and the answer was:

A We have, effectively, had the system in place for two years. I am confident that it has worked and, therefore, I believe the Trust could reassure the Committee that it could work.

Q I go so far as to ask you this, and answer, if you are able, wearing the Trust hat: would you like to see that work?A Yes.”

Then my learned friend cross-examined her and at D the question arose about concern, justifiably raised, about controlling Dr Southall’s ability to do category 2 work. She said:

A That would be more difficult. It would of course be possible to insist that no such work was taken on and, certainly, to my knowledge, at the present time, no new work has been taken on in the last two and a half years since Professor Southall has been back at work.

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The question is pressed again and the next answer is:

A It is obviously more difficult – there is no doubt about that. On the other hand, I believe that the Trust now has a very robust working arrangement with Professor Southall, and if a requirement of the Committee was that, in some way, that was a condition of any form of limitation on practice, then, as Medical Director of the Trust, I would wish to work with the General Medical Council to ensure that that was happening. The reason that I would be so keen to do that is because I do not wish to lose Professor Southall’s very considerable contribution to general paediatric work within the Trust.”

Then Mr Tyson dealt with an extract from one of the character witnesses, Professor Anderson, over the page, picking up the extract that Mr Tyson uplifted from the character reference:

“All of this previous experience shows that David is unprepared to view things as a spectator if he considers that certain aspects have failed to receive the attention that they deserve.”

That is the nature of the beast, is it not, Dr Chipping?A It is a very interesting point. I think that one has to agree with Professor Anderson. The extraordinary thing is that that appears to be the nature of the beast when one looks particularly at child protection work. It is not really when one comes to look at general paediatrics. In fact, Professor Southall’s determination to arrive at an appropriate diagnosis appears, when he tackles general paediatric work, to result in very thorough, well thought through and detailed diagnostic work. In one sense, it is the nature of the beast, but it could also be, and would appear in his general work, as far as I am able to comment, bearing in mind I am not a paediatrician, to be a strength rather than a weakness.

Q The fear which I have to put to you is that if Professor Southall feels strongly about anything, he will go and do it. That is his past and, in many ways, one of his strengths, which has been commented upon.A It is – I have to say that it is a strength or a weakness which, as a Trust, we have addressed with Professor Southall. I have always recognised (and I recognised at the time that suspension was lifted) that if Professor Southall was going to return successfully to practice within the National Health Service, within the Trust, it was an issue we had to address, and we have done so both together and with external assistance. I believe that… I am not saying that leopards change their spots, but I do think there is some learned behaviour that actually has occurred, and I have been most impressed by the diligence and the care by which Professor Southall has taken his rehabilitation into the Trust. It is clear to me that however painful it would be (and it would be) for Professor Southall’s registration to be restricted so that he was not able to undertake child protection work, I believe that he does understand that if he were to, in any way, breach a condition that was placed on him by this Committee, that I will be the first person that reported him back to the General Medical Council.

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Q There must be a risk, bearing in mind his forceful nature and personality, that some bureaucratic restraint would be ignored if he felt strongly that the ultimate object was more important.A Yes, it is a risk. Do I think it is a significant risk – no I do not, and the reason I do not think it is a significant risk is because we have successfully worked with this system for the last two and a half years to, I believe, the considerable benefit of the children of North Staffordshire and beyond.

Q You say you can restrict, as it were, his clinical work, whilst he is an employee, to general paediatrics, do you have any control over the nature or extent of his research work?A I do not, but Professor Southall is not currently undertaking any research and, indeed, his contract, or his funding stream at Keele, has changed, such that he is supported by postgraduate education monies not research monies.

Q But you would have no control over that aspect – it is a Keele University matter, as it were.A Yes and no – except that we work in extreme collaboration with the University of Keele in research matters, and I would be confident that if there was research where there was the slightest concern, the research governance structures that are now in place in North Staffordshire are probably one of the most rigorous in the country.”

As you know, Professor Southall’s academic tenure with the university has terminated.

I now look at some of the issues raised by the Committee. There are a number of general observations until we go down between F and G:

Q Does it therefore follow that if no restrictions are placed on Professor Southall’s practice, in terms of the type of work that he could do, you could also make that work?A If he were to return to practice … I am not actually sure there would be very much difference if he were to return to unrestricted practice, because … I think probably the chances of Professor Southall doing a lot of category 2 work in respect of child protection is vanishingly small. In terms of work within the Trust, I would probably wish, as the Medical Director of the Trust, to retain the present working practice we have anyway.”

Then we come to a series of questions by the chairman on page 38.

“THE CHAIRMAN: The present arrangement that you described to us is where Professor Southall works in general paediatrics, and does not involve himself in child abuse type work – child protection work – and also does not do ITU work.A Let me clarify – the not doing ITU work was by mutual agreement because, I think you will appreciate, paediatric intensive care unit work is extremely onerous. There was nothing at all about my lack of confidence in Professor Southall that would have restricted his access to PICU work. It was by mutual agreement.”

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Then the next question was:

“Q …. was that because of conditions imposed by the Trust?A That was because of conditions imposed by the Trust because I believe, as the Trust Medical Director, that although the report that was described to you earlier found no matters of substance with regard to the Professor’s child protection work, it was very clear to me that there were a number of inquires ongoing with the General Medical Council. I did not believe it would be appropriate for Professor Southall to return to child protection practice whilst those were ongoing. In terms of the rest of the work that was done, we worked together to decide on exactly how we would manage the return to work process and, from the Trust’s perspective, it has worked very well indeed.”

Then:

“Q …. was that an easy thing to do or difficult?A It was very straightforward. I suppose one of the… I have to say that I think Professor Southall and I have developed a close understanding, shall we say, and a mutual respect, actually. He has recognised that maybe a trust medical director is somebody of wisdom, and I do regard my role as Trust Medical Director to protect doctors from themselves. Professor Southall is not the first person I have done that for. It is important, and I suppose the Committee might have some concern, therefore, would any sort of arrangement that was put in place work if I was not the Trust Medical Director, and I think that is something you would have to think through. I  am not planning to step down immediately.”

Pausing there, she is still in post. The answer continues:

“It was not a difficult thing to put in place. Professor Southall understands my concerns, and I think has also been advised by his legal team that this is an appropriate way to move forward. It certainly was the case on return from suspension. There was no difficulty in getting this arrangement into place, and I have to say that Professor Southall had been most careful to keep me informed if there were any matters of concern as regards child protection whatsoever.

Q One of the things that Mr Tyson has emphasised this morning (and you have probably heard it) is that one of Professor Southall’s problems appears to be his lack of insight, and lack of insight perhaps in relation to this particular area.”

I draw attention to that.

“Based on the fact that you have had this ongoing working relationship with him while things have changed, do you have any comment about his insight? Do you feel he has more insight now into this side of his work than he had previously, or would you subscribe to the fact that he does not have any insight?

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A No, I would not subscribe to the fact that he does not have any insight. I think he has good insight, but I think he is a man who does not change his mind easily, and I think that is a slightly different thing. One of the things that I am sure will have come out in the testimonials is that Professor Southall is actually a man of great principle. He will not change his mind if he does not think his mind should be changed. Does he have an insight into the impact he has on others – I think he probably has a better insight than he did earlier in his career, yes.”

I invite attention to that answer. Then:

“Q Lastly, if there was a system of conditions in place, even though it could be argued that you could not police things that were happening outside his NHS working hours, presumably, issues like this would be likely to come to your attention.A I would have thought they would be the first thing to come to my attention, yes.”

Then the next answer:

“A They would certainly come to my attention through local processes, because I actually hold the child protection lead as the Director, with responsibility to child protection for the Trust so, in that respect, they would come to me officially. I actually have that lead director role, so that any communication through the chief executive with regard to child protection matters comes to me anyway. What would not necessarily come to my attention was if the request was from a remote area… remote from North Staffordshire. In other words, if Professor Southall were engaged in a child protection case in a different area, that would not come to my attention unless it was made very specific that should such a approach be made, it would have to be reported to me. I have no doubt that if that were a condition, then it would be reported to me. I am also aware that when we stopped Professor Southall from taking on new child protection cases before he was suspended, he did bring to my attention those cases where he was involved. Therefore, I do not have a difficulty in believing that that would happen. I believe it would and could happen.

Q Presumably, a global restriction on being involved in child protection would cover all aspects of it, be they category 1, category 2, or any other category people could think of.A Absolutely – if that was what the Committee decided, indeed, it would have to apply right across the board, if that is what the Committee felt should happen, yes.”

Then the Chairman says:

“I am just trying to explore the facility of any possible findings we might make, and you clearly have expertise in this area.A I appreciate that, but it would have to cover NHS and all medico-legal work, yes.”

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Then over the page at page 40, in answer to a question by Mr Tyson about other employment outwith North Staffordshire, at A:

“A He would not be able do so without a reference from his present employer, and a reference from his present employer would need to make very clear the condition that was imposed not by the Trust, but by the General Medical Council.”

Then there was a short piece of re-examination during which there was a question which related to a group of others monitoring or policing Professor Southall, an action group, and her answer was:

“A They are out there. There is still a very active lobby of opinion around Professor Southall, and the Trust is regularly contacted by that group.

Q Still focusing on the underlying proposition, the Committee of course is primarily concerned with protecting patients.A Yes.

Q I want you to focus on that need for the moment, and also the point that you have raised about protecting Professor Southall from himself. Can you take those two points together.A Yes.

Q To what extent, in your opinion – again not trespassing on the Committee’s function – is any proposal for the imposition of conditions going to satisfy those twin principles?A As we have explored, the complaints around Professor Southall have centered on his research, which he is not currently undertaking, and child protection work, which is the business of this Committee now. In terms of protecting in the event of child protection work, then I believe this can be made to work. I believe we would have Professor Southall’s co-operation, and we would work closely in line with whatever the General Medical Council imposed, to make sure that we could police this. Would it protect Professor Southall from himself – sadly, I have to say, yes, I think it would, because I think it is in the area of child protection where Professor Southall has a particularly passionate belief based, quite understandably, on some of the work that he has seen. I can understand why he is so passionate about the issue of child protection, but I do have to say I believe that the imposition of this particular sanction will be extremely painful for Professor Southall – I do know that. Equally, it would have support from me, as Medical Director of the Trust …”

Madam, that gives a substantial element by way of the background which quite clearly influenced the Professional Conduct Committee in coming to the decision which you know it did. In particular, the focus then – and you can see how that marries up with the focus I have drawn attention to a few moments ago – was on child protection as being the problem. I have to accept – and I do and I move forward on this basis, in

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the light of your findings of fact – that by definition child protection today is the problem.

I now need to move back, please, if I may, to C27, which is the judgment of Mr Justice Collins, which you will find at page 10 of that document. Mr Tyson quite rightly took you through a number of passages in the judgment and I hope you will forgive me if I go back to a number of those passages, because they are, we would submit, of extreme importance in considering the position which has now been reached, bearing in mind this background. Mr Justice Collins was being invited to review the decision of the Professional Conduct Committee, which had decided, in the light of the facts found, which Mr Tyson summarised yesterday quite accurately, to impose conditions, that the imposition of conditions imposed by the Committee was appropriate or not. Using the legal terminology, whether they were unduly lenient. In a nutshell, the Administrative Court reviewing that came to the conclusion that that was not an unduly lenient decision to take and the General Medical Council, which was the main respondent to the appeal, agreed with the Panel’s decision; it defended the Panel’s decision and there was no attempt to agree with the super regulator that it was unduly lenient.

Some of the passages – and again, I apologise, if I, as it were, bring them to front of house again, but they are important – can I just, as it were, move through the judgment and start at paragraph 13? Paragraph 13 deals with the subject of testimonials and in due course I shall be placing before you some testimonials and this sets the scene for your consideration of those. Taking it from the fourth line down:

“Testimonials in the case of a doctor can go much further than in the case of a solicitor, since they can show that he has been and is, apart from the misconduct in issue … ”

I just want to pause there. The misconduct in issue.

“ … a thoroughly good doctor. It is clearly in the public interest that doctors who are competent and for whose skills many patients and colleagues have nothing but praise should not be precluded from practice altogether if that can be achieved with no danger to the public and with no damage to the reputation of the profession.”

Then there is a reference to the case of Bijl v General Medical Council and an extract from the opinion of Lord Hoffmann, the introduction to which is at the bottom of the page. Then over the page is the extract itself:

“The Committee was rightly concerned with public confidence in the profession and its procedures for dealing with doctors who lapse from professional standards. But this should not be carried to the extent of feeling it necessary to sacrifice the career of an otherwise competent and useful doctor who presents no danger to the public in order to satisfy a demand for blame and punishment. As was said in A Commitment to Quality, A Quest for Excellence, a recent statement on behalf of the Government, the medical profession and the National Health Service:

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The Government, the medical profession and the NHS pledge … without lessening commitment to safety and public accountability of services, to recognise that honest failure should not be responded to primarily by blame and retribution but by learning and by a drive to reduce risks for future patients.”

Then I take you down to paragraph 14 on the same subject, the learned judge, drawing on the opinion of Lord Hoffmann, said:

“It follows that in my view testimonials can in the case of doctors be accorded greater weight than in the case of solicitors. The requirement of absolute honesty so that there can be absolute trust in a solicitor is obviously of paramount importance. That he may be a good solicitor is obviously something to be taken into account, but the public interest in him being able to continue in practice is not so important. Thus testimonials which establish that a doctor is, in the view of eminent colleagues and of nursing staff who have worked with him, one who is not only competent but whose loss to the profession and to his potential patients would be serious indeed can, in my opinion, be accorded substantial weight.”

I think at this point it may be helpful just to look at the submissions being made at that time, which are summarised in paragraph 15 and which, if I can just, as it were, rush to the end before looking at the middle, the learned judge rejected.

“I must now consider the misconduct which was established in more detail. It has led the Council …”

That is not the General Medical Council, madam, but the regulator –

“ … to submit that Professor Southall abused his professional position by, in effect, misusing his eminence in the field of child abuse, that he violated conditions imposed by the Trust under which he was having to conduct himself at the time, that he had shown no remorse and so lacked insight that what he had done was wrong and that a message ought to have been sent to the profession that such conduct could not be tolerated. The only result in all the circumstances which could have followed the findings was one of erasure. If that meant (Professor Southall being 57 years old) that he would never practise again, it was an inevitable and justifiable result of the serious professional misconduct of which he had been found guilty. The loss of his services as a first class paediatrician was unfortunate but it was a price which had to be paid in the light of his misconduct and in particular because his arrogant attitude that he was right and, despite the findings made against him and his knowledge, because of matters put to him in cross-examination, that his theory that Mr Clark killed his sons was seriously flawed, his failure to accept even that he might be wrong showed that there was a real danger that he would do something similar if, in his work as a paediatrician, he came across a case which he believed indicated child abuse. Thus to impose the condition did not adequately protect the public since he had already breached a similar condition in acting as he had and certainly did not send out the right message to satisfy

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the public that they could be sure that there was no risk of irresponsible reporting of alleged child abuse.”

That equally has echoes, does it not, in the submissions made by Mr Tyson yesterday, perhaps not surprisingly, bearing in mind the conduct complained of in the Clark case is in effect the same conduct which you have been concerned with in the round. May I take you, please, to page 24, the second part of paragraph 25. I will come back to this particular topic later, but the judgment is now dealing with Indicative Sanctions. In paragraph 25, the judge sets out the guidance which is in your Indicative Sanctions document, with the bullet points which Mr Tyson drew attention to yesterday, quite rightly. He quotes under the heading of “erasure” the particular bullet points. An important matter which I just draw your attention to, a matter which no doubt your learned Legal Assessor will in due course find it necessary to deal with, the sanctions are set out, because that is the way the statutory provisions require the PCC to approach its task: in reverse order of seriousness. In other words, you do not start with considering the question of erasure, you work from the bottom up. Then the judge summarises the bullet points and at the beginning of the next paragraph, within paragraph 25, the judge said:

“Miss Carss-Frisk submitted that four out of the six bullet points were involved (that is to say all except offences of a sexual or violent nature and dishonesty).”

Just pause there. That is exactly the submission that Mr Tyson made to you yesterday. I make the point at this stage that, whether or not it be three or four out of the six under this heading, the learned judge took the view that that did not require the sanction of erasure to be imposed. The reason we will see in a minute.

I pick it up at paragraph 30 on page 26. If I could mention in passing that in paragraphs 28 and 29 the learned judge there set out passages from the evidence of Dr Chipping, to which I have already taken you in the document handed out to you a few moments ago. I turn to paragraph 30:

“Absence of remorse and contrition is likely to be indicative of a lack of insight or of maintenance of unreasonable views. In either event, it may show that a risk of repetition exists. This is clearly relevant in deciding on the appropriate sanction. But lack of remorse should not result in a higher sanction as punishment. Punishment may be an inevitable effect of whatever sanction is imposed but it must not be an element in deciding what is the appropriate sanction.”

Then this:

“The PCC must decide whether the risk of repetition does really exist. Provided that they have properly considered all the relevant circumstances and have had regard to the correct principles and reached a conclusion which is itself reasonable, the court will not interfere.”

At the top of the page 27 I take you to this:

“Furthermore, the Guidance is just that...”

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I pause for a minute. It is “Guidance”, it is not to be read like a statute:

“... the Guidance is just that and it does not...”

This is my emphasis:

“... it does not automatically follow that erasure must follow if any of the bullet points set out apply.”

Again, if I can pause. Mr Tyson submitted to the contrary yesterday. Our submission is that the judge’s observations are to be preferred. In fact, if I may continue with the observation, it is absolutely clear that there may have been at least some of the bullet points satisfied under the heading of erasure in this Clark case and yet the Professional Conduct Committee were not prepared to erase and the judge upheld them.

“The overarching principles must be taken into account and they include a recognition that the public interest may, despite a finding that he has been guilty of serious professional misconduct, indicate that a doctor should be able to return to safe work (my emphasis). And the conduct must, if erasure is to be justified, be fundamentally incompatible with being a doctor.”

At paragraph 35 on page 29:

“For Professor Southall preclusion from child protection work was a severe penalty. His reputation had to a great extent been built on his pioneering work in this field and it must have been a humiliation to him to be found guilty of serious professional misconduct in connection with child protection.”

I pick it up two lines down:

“They were ... entitled to consider that there was no (my emphasis) real risk that the condition excluding him from child protection work would be broken. The flaws disclosed by Professor Southall’s misconduct, serious though they are, do not prevent the view reasonably being taken that they should not prevent him continuing to practise as a paediatrician, provided that there is no real risk to patients or others if he is permitted to do so. Thus erasure was not in my view an inevitable view of the misconduct which the PCC found proved.

A reasonable observer would appreciate that the sanction was for him severe indeed and that it would produce a sufficient deterrent effect and send out the right message. As the testimonials showed, it was in the public interest that Professor Southall’s great skills as a paediatrician should not be lost if that could be achieved without danger to the public. The PCC’s decision that it could be achieved seems to me to be entirely reasonable in all the circumstances.”

Pausing there, that is an issue which we are inviting you to address in the context of this case. The judge goes on:

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“It was however essential that the conditions imposed should be tightly drawn so as to prevent any involvement in child protection work.”

He goes on, picking it up four or five lines down:

“He had already been prevented from involving himself from child protection work in category 1 and had not involved himself in any category II work since September 2000.”

Finally, page 31, paragraph 38, on the second line, the final judgment by the Administrative Court, “Erasure was not required” on the second line. That judgment was reached against a consideration, as I have said, of, first, the testimonials which, as the judgment makes clear, were extremely impressive; secondly, the evidence of Dr Chipping; and, thirdly, evidence which was directed towards the nature of the conduct that was in issue, namely the child protection work, but a recognition of Dr Southall’s great skills in general paediatrics.

As you know, the Administrative Court, in addressing all those features, came to the conclusion – in addressing the same question that the Professional Conduct Committee had and agreeing with the principle that the Professional Conduct Committee had arrived at – that it was essential to have tightly drawn conditions. The only result of that was that the conditions were, indeed, more tightly drawn by the court. They appear in your C27 at pages 32 to 34.

Those conditions, and I am not going to invite you at this stage to look at them in any detail, I am going to invite you, when you retire, to look at them in detail, are indeed very tightly drawn. They have the effect of preventing Dr Southall from carrying out any child protection work at all and they have within them a mechanism or mechanisms which require careful study, mechanisms for ensuring that that is adhered to and that thus the public interest, the public protection, is ensured. It recognises the root of the problem which two Professional Conduct Committees have now found to be the case. We know that not only had he been adhering to the Trust’s arrangements in relation to child protection, as Dr Chipping explained in the clip of her evidence that I have placed before you up to the date of the Professional Conduct Committee hearing in October 2004, but we also know that no such work was done, no child protection work was done, even after the Professional Conduct Committee hearing in August 2004. We know that because of the judgment of Mr Justice Collins and we also know that from the review hearing which took place in July this year. You have in your bundle at C27 the determination of the review, but I just want to hand in, by way of additional background, a short letter, also from Dr Chipping, which informed the Panel on 23 July 2007.

THE CHAIRMAN: This letter will be D25. (Document distributed and labelled D25).

MR COONAN: As you can see, this was addressed to the solicitor at Field Fisher Waterhouse, those solicitors instructing my learned friend, from Dr Chipping:

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“I enclose for your information the reference that I have recently provided to the Fitness to Practise Directorate of the General Medical Council. I can confirm that Dr Southall has complied fully with the first condition on his registration as far as any NHS work within this Trust is concerned. Dr Southall has undertaken no child protection work outside the Trust for, example category 2 work, and has not done so since conditions were imposed on his registration. You will be aware that Dr Southall undertakes a considerable amount of overseas work, most recently in the Gambia and Pakistan. I understand that this work is an emergency maternal and child healthcare programme run jointly between Child Advocacy International/The World Health Organisation/The Government of Gambia and Pakistan and the advanced Life Support Group. Dr Southall is the Project Director. This is clearly about emergency child health and is not in any way related to child protection issues.”

There are then instances which she deals with, specific cases and she notes that one case – and I am looking at the first four or five lines – that Dr Southall made strenuous efforts not to be involved, a potential child protection case, and so on. At the last paragraph:

“I made further enquiries and understand that Dr Southall has seen no cases involving Child Protection since April, the date of my last report, and thus has not handed any cases to colleagues. I am thus confirming Dr Southall’s continuing compliance with the conditions placed on his registration.”

That provides, as I say, some little background to the decision made by the Review Panel in July of this year.

What emerges from that, we would submit, are two things. First, if the task of the Panel at this stage – and that has to be a separate issue – is that they are concerned with an area of this doctor’s work which raises, if unrestricted, public interest issues and public safety issues, then it is capable of being rendered safe by the imposition of, to borrow Mr Justice Collins’s phrase, “tightly drawn conditions”. In asking the question rhetorically, as you will be bound to do, what is the risk of breach, the answer to that is to be found in the record to date against a background of a very tightly drawn condition. The background to date demonstrates full compliance by Dr Southall with those conditions. So, that answers the point raised by Mr  Tyson yesterday that the Panel could not be sure that there would not be a risk of repetition.

Indeed the Professional Conduct Committee in 2004 were satisfied that there would be no risk of breach because otherwise the decision would have been different. But you have the benefit of one thing they did not have, or not as much of, and that is the further passage of time. Now, a further three years has gone by since the original decision of the Professional Conduct Committee when there has been full compliance by Dr Southall. We would submit that there is no risk at all of him transgressing any such conditions and no risk of him at all even being involved in child protection work, painful though it may be to him, as the judge pointed out. You should know that his present position is that he does work as a general paediatrician at Stoke and he sees children on an acute basis but, and one has to look carefully which I invite you to do, at the conditions drawn

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up by the General Medical Council and the regulator following the Administrative Court hearing which sets out the mechanism by which Dr Southall goes nowhere near cases involving child protection. So there is an ability to police it and to manage it and, thus, to borrow again a phrase from Mr Justice Collins’s judgment, “to achieve safe working”.

The next matter I would like to deal with concerns the question of character evidence. Perhaps we could begin by inviting you to receive a bundle of testimonials.

THE CHAIRMAN: D26. This is one document is it?

MR COONAN: It is. (Document distributed and labelled D26)

Madam, in relation to this document you will see there are a significant number of authors who are pleased to provide testimonials. I do not propose to take you through every single one of these documents. What I propose to do is to invite you, through me, to look at a number of the passages in these documents in fairness to Dr Southall, this being a public hearing, so that those who have an interest in reporting the proceedings can see exactly what it is that people are saying. Very often if the document is simply read by you in private the wider world hears nothing about them and so that is what I am going to do.

One of the authors, Dr Parke, I anticipate I may be in a position to call and I will skip over his, but I want to take you to page 3. This is a letter written by Dr Armstrong, consultant paediatrician at the University Hospital of North Staffordshire. He sets out how long he has known Professor Southall. On page 4 he says this:

“In the time that I have known Professor Southall I have always been impressed by his commitment and dedication to the care of children. The care of the child has always been his paramount concern.”

He refers to Dr Southall being at personal risk during trips to war affected countries in his work for Child Advocacy International.

“This has not, however, prevented him from continuing to be a strong children’s advocate.”

Madam, you will see phrases such as that peppering many of these testimonials which may, I suggest, throw a strong light upon a side of Dr Southall’s personality and approach to matters involving child protection.

At page 5, from Dr Britton, consultant paediatrician, at the Good Hope Hospital in Sutton Coldfield:

“I find him one of the most intellectually honest doctors that I have ever come across. His clinical approach has been superb. He will go to enormous lengths in order to thoroughly and most properly investigate problems with children and their families. He will make a very thorough assessment and give an exceedingly well considered clinical opinion. He will always have the child’s best interests at heart.

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He has an international reputation for his work in child advocacy and he has been particularly prominent in raising the concerns about children’s health in war zones, especially in the area of the former Republic of Yugoslavia and the Balkans. This work has been recognised and rewarded nationally.”

On page 7, from Dr David Brookfield, a consultant paediatrician:

“Professor David Southall is an extremely industrious paediatrician, both in the clinical field and the research field. He has been a great innovator in bringing new treatments in to help children with serious illnesses and has achieved a great deal of good for the benefit of sick children. He is very altruistic and has used some of his own money to help establish a hospital for sick children in Africa. He has always put the welfare of children first both in this country and abroad. He worked in extremely difficult circumstances in war areas such as Bosnia and Afghanistan.

Dr Southall is a doctor of high integrity and is prepared to speak on behalf of children when other adults may not be acting in the child’s best interests but their own self-interest.”

His clinical standards are high and from my perspective Dr Southall has never acted maliciously and has acted in good faith.”

On page 8, from Dr Cameron, another consultant paediatrician in Conwy and Denbighshire, in the fourth paragraph:

“Through paediatric circles I became aware of his work in Child Advocacy International. He was a founder member of this extraordinarily impressive organisation and has driven it forward with enormous energy. It has proved a very effective and well run charity and I have supported through membership for some time. I believe that his determination in setting up Child Advocacy International stems from a deep and passionate concern about children and their health needs on an international perspective.”

He concludes on page 9 by saying:

“In summary, I feel that Professor Southall is a unique, dynamic and inspirational paediatrician. It would be a tragedy if he were removed from the medical register.”

On page 10 Dr Cheetham also refers to Child Advocacy International:

“Since I retired I have joined CAI, the charity which David set up, and have been honorary country director for that charity in Bosnia. I have seen first hand the work which the charity has done to lift the paediatric services out of the terrible mess which happened as a result of the civil war. Many improvements in standards and medical morale were due to David’s energy and determination. He is remembered not only for what he did, but also because he stood by them in their darkest moments.

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He is a hard worker who is absolutely determined that the health of all children wherever they are shall be protected and enhanced. The GMC will no doubt have heard of the new course training doctors in disadvantaged situations that David has developed. This is transforming medical practice in the care of mothers and newborn infants in Pakistan and Africa and is typical of the drive and imagination which accompanies David’s determination to look after ill and vulnerable children.

If action were to be taken which prevented David practising as a paediatrician, the world’s children would be worse off. His sense of purpose is really quite exceptional.”

The testimonial at page 11 from Dr Chipping brings matters up to date to November 2006 and we have her consent that the matters set out there still apply. She says in the first paragraph:

“Dr Southall is an extremely competent general paediatrician and has been a most valuable member of the consultant of the week team who undertake general paediatric admissions at this trust. If Dr Southall were removed from the medical register it would be an enormous loss to the children of North Staffordshire since his experience of assessment and treatment of children within this deprived community remains of the utmost value. In addition, he is a skilled teacher and his teaching sessions are greatly appreciated by the medical students who attend this hospital.”

Then she deals with the investigations carried out in 1999-2001 in the middle paragraph and I take you to the seventh line:

“I have been directly involved in monitoring Dr Southall’s compliance with this order from the GMC. He has been most punctilious in ensuring that all patients in whom child protection issues might be considered have been referred to practitioners in the field of child protection. He has been scrupulous in maintaining his compliance with the requirements of the GMC.

Dr Southall is therefore an extremely valuable member of the consultant paediatric team of this trust and in addition continues to undertake significant overseas involvement on a charitable basis. He is most unusual in that all money earned from his child protection work when he was undertaking this in the 1990s was donated to his charity Child Advocacy International and he has undertaken work overseas of such high quality that this has been recognised by the award of the OBE.”

On page 12, from a registered nurse at the East Lancashire Primary Care Trust, Mr Andrew Clarke, who is an honorary director of Child Friendly Healthcare Initiative, in the third paragraph he says:

“In my opinion Professor Southall is a man of enormous energy, vision, intellect and compassion. He is committed to the wellbeing of all children, but

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particularly those most disadvantaged and/or in need of care and protection – for whom he is a committed advocate on many fronts.

In my experience he is one of a minority of people who not only talks about difficult issues but has the drive, courage and ability to bring about necessary changes in practice.”

On page 13, from Dr Paul Davis, a consultant community paediatrician, in the second paragraph:

“Professor Southall has for many years been a highly respected and influential authority on respiratory paediatrics, intensive care management and neonatal management of children with respiratory difficulties. His work in this field has been substantial, influential and he has been a leader in this field. This is extremely valuable work which has greatly benefited large numbers of children over many years and continues to do so. His research publications in this area have been very highly valued and his clinical expertise, including the provision of tertiary opinions and his willingness to support clinicians in other parts of Britain in managing their difficult cases has been, and continues to be, exemplary.

Professor Southall has also taken a very important lead in international child health and child advocacy. He has been a leader and an example in this respect and has raised many issues affecting children internationally. He has acted as a voice for some of the most needy children in the world and in some instances has had a significant impact on the welfare of large numbers of children.

I consider it crucial within the field of paediatrics and child health both nationally and internationally that this work is recognised and valued and is allowed to continue. It would be a travesty if any restrictions were placed on Professor Southall’s ability to continue to work in the interests of children and to advocate for them.”

I move on to page 18, from Dr Bridget Edwards, again a paediatrician, paragraph 4:

“In my view, Professor Southall is a very dedicated and expert paediatrician who cares deeply about the health and welfare of children and their families. As one of the main authors of the EMCH training modules he takes great pains to consult all of us to ensure that they are evidence based and will be effective in improving standards of healthcare in countries with poor resources in order always to reduce avoidable deaths and disability of babies, children and their mothers. This really matters to him and he devotes an enormous amount of his time as well as a not inconsiderable amount of his income to achieve this.”

On page 19, Dr Danya Glaser, a well-known consultant child and adolescent psychiatrist, in the second paragraph:

“Professor Southall has made a very significant contribution to the welfare of children who have been subjected to maltreatment. His commitment to children and their wellbeing has been exemplary and remarkable. A strong leadership of

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the nature which Professor Southall has provided in this field has been an invaluable attribute.”

On page 20, from Dr Goldstein from the Birmingham Children’s Hospital:

“I am privileged to write a supportive testimonial for Professor David Southall. He is a paediatrician held in the highest regard by many colleagues, including myself, for his genuine and passionate concern for children throughout the world. He is a man of much wisdom and boundless energy and thousands of children (possibly indirectly hundreds of thousands of children) have benefited worldwide as a result of this.

He has been a tremendous inspiration to me and colleagues in the field of international child health and advocacy for children internationally. I have heard him speak at major meetings and have had several one to one conversations regarding our responsibility as paediatricians and human beings to protect children who are harmed as a risk of war, famine or poverty. Professor Southall, I know, puts such children beyond his own personal hardships with regard to travel or working in difficult or war torn environments. He is an inspiration to us all.

I personally know of his work as a founder member of the Child Advocacy International, his campaigns against international child poverty, children who are harmed as a result of landmines and the terrible plight of refugee children. I have read his books on emergency maternal and child health and international child health. These give clear and simple guidelines to those working in resource poor countries and contribute to the health and lives of children throughout the world.

Any restriction in the way that Professor Southall is allowed to practise paediatrics will significantly put at risk his international child health work and the lives of the children for whom he advocates.”

At page 22 is a testimonial from a previous president of the Royal College of Paediatrics and Child Health, Professor Sir David Hall. He sets out that he is familiar with the charges on which Professor Southall has appeared before the GMC. She says that during his term of office as President he became familiar with his work because of the various complaints made against him.

“Dr Southall’s early research career involved extensive use of physiological monitoring of cardio-vascular and respiratory functions in infants and children. He was highly regarded as one of the brightest and most rigorous of clinical researchers.”

At page 23, in the middle of the second paragraph:

“My personally impression of David Southall was that he was a thorough, original and careful researcher, but at the same time I saw him as a pioneer – a man who was not afraid of new ideas though at the same time was keen to test them thoroughly.

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It is a tribute to David Southall’s careful maintenance of research records, ethics committee approvals, consent forms, etc, that by the end of the process [this is relating to the investigations at the trust) I learned from conversations with his employers that both his clinical work and his research had been found to be of a high standard.”

In the next paragraph he deals with his knowledge of Dr Southall’s work in Child Advocacy International. Right at the bottom of the testimonial he says this:

“David Southall is one of the increasingly rare exceptions. It will be a bad day for the professional – and ultimately for the public in general and children in particular – if such people are penalised because their views or their actions are unpopular.”

At page 24, from Dr Patrician Hamilton, who is the current President of the College, she says in the first paragraph:

“I have known him in my role as an officer and now President of the Royal College of Paediatrics and Child Health. He set up Child Advocacy International and I sat on that committee for a time.

In all aspects of his work, David has shown complete dedication to the welfare of children, both in this country and abroad. In his research and his clinical work his first priority was the wellbeing of the baby or child. He personally put in an enormous amount of work into all his enterprises, often to personal cost in time, resources and emotional energy.

I can only say that his personal zeal and energy, as well as his lively intelligence, has led him into a high profile in extraordinary circumstances. His actions were not deceitful, malicious, nor done for self-gain or self-publicity. It would therefore send a seriously discouraging message to paediatricians if he were to be removed from the medical register.”

Madam, I note the time. Would you wish to rise now?

THE CHAIRMAN: We would wish to rise. I sense that you have at least a little way to go.

MR COONAN: Yes, I have.

THE CHAIRMAN: We will break now for lunch and resume at 2 o’clock.

(Luncheon adjournment)

THE CHAIRMAN: Mr Coonan, are you taking us through any more of the written testimonials?

MR COONAN: A few, yes. Of course, I shall be inviting the Panel to read the totality when you retire.

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THE CHAIRMAN: Perhaps I could ask you this question now before you begin. It is a question which has occurred to the Panel, and that is, is it possible for you to indicate whether the writers of these testimonials who have not expressly said so were aware of the charges when they wrote the testimonials?

MR COONAN: Yes. I can deal with that straightaway and with confidence, because I have taken specific instructions on this. You will notice that the testimonials are directed to Dr Southall’s solicitor. What happened was that each of the potential authors of these testimonials were alerted in terms to the allegations made against Dr Southall in, my choice of words, a letter of instruction, if you like. So they were all on notice and therefore, irrespective of the date on the top of the letters, all knew full well the background.

Madam, before proceeding with this part of the submission, could I just correct one thing that I said earlier? I had not been brought up to date. I said that Dr Chipping was still in post. In fact, she handed over the reins before three to four weeks ago to another medical director at Stoke.

Madam, I was just looking at a limited selection of these documents which I would like you to look at for present purposes. At page 26, Dr Chris Hobbs, a well-known consultant community paediatrician in Leeds, writes in the second paragraph:

“David Southall is an exceptional leader and pioneer in his work and someone to whom paediatricians in the UK look to for leadership and direction. His work is very well respected both in the UK and overseas notably in North America who acknowledge that he has led the field in the investigation of intentional suffocation of infants.”

If I can then take you on, please, to page 28. This is a letter written by Dr Charlotte Howell, a consultant anaesthetist at University Hospital of North Staffordshire. I take you to the bottom of page 28:

“David Southall is an extremely able clinician. He has continued with hands on care throughout his career, despite being a medical academic. He has now moved to general ward based paediatric emergency care where I now work in my role as paediatric anaesthetist. It is a delight when he is on call as he has such wide experience of looking after the sickest of children, and is easily available for advice.”

Then on page 29, halfway down:

“David Southall is not an ordinary doctor. You meet them occasionally – people with the ability and energy to motivate others around them to effect change. He is someone who actually gets things done rather than just talks about doing things. He is someone with a high degree of personal integrity and a great dedication to the care of children and their families. He is highly motivated interest he quest for the prevention and relief of suffering of children. He is immensely hardworking and a very generous colleague in terms of time and support, with no regard for personal financial gain.”

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Then at the bottom of the next paragraph:

“I know that many of his nursing colleagues would wish me to express their support for him as a very popular member of the medical team. I very much hope he will be able to continue to contribute to our hospital and the children under our care.”

Then moving on to page 34, a letter from Dr Hilary Klonin, a consultant paediatric intensivist. She writes in the third paragraph down:

“I believe in the clinical arena, Professor David Southall has always been something of a trailblazer. As years go by the importance of non invasive ventilation, the avoidance of hypoxia and attention to patient comfort at all times has become increasingly recognised and mainstream paediatric practice now reflects the ideas which I learnt over twelve years ago in Stoke-on-Trent.

Moving on to his wider charitable work, I think he has not faltered from a pathway of advocating continuously and effectively for children. HIs work on bringing to the world’s attention the desperate plight of children, particularly children in war zones, must at the very least be admitted and I believe has influenced our own paediatric college to take a wider view of child health and advocacy.

He has produced an advanced paediatric life support video, which he has made freely available to healthcare professionals in the developing world in the form of a copyable CD. In my experience this is an almost unique approach to educational tools, most of which, in this day and age, have a financial cost attached for the recipient.”

Then looking at the last paragraph:

“Professor Southall is prepared to question accepted practice, backing up his questions with appropriate research, submitted for peer review. I believe David Southall has never shrunk from a duty of advocacy. He is prepared to ask uncomfortable questions about child deaths either individually in child protection case or generally in the case of children in war zones. This makes him a controversial figure, but it is absolutely vital for the vulnerable and the unprotected that someone does have the courage to take on this difficult work.”

On the next page at page 35, Dr Barbara Ley, a consultant paediatrician, writes in the second paragraph:

“ … he is an amazing paediatrician and I have been inspired greatly by his work and his attention to detail when dealing with children. He has great experience in most areas of paediatrics and is an extremely good general paediatrician. He is always generous with his advice and someone who I would go to for advice in the care of difficult patients. David is an extremely enthusiastic man and is always acting as an advocate for the child. His keenness to care for children and make sure what happens to them is also shown in his work with Child Advocacy

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International for which we are all in awe and I am very happy to give this testimony.”

Moving much further on to page 44, this is a letter also from the West Midlands, the Good Hope Hospital, from Dr Meran-Talabani, consultant paediatrician. I skip over a lot of the text and take you right to the end, page 44:

“On a personal note, I found Professor Southall to be very humble, friendly, professional, capable and extremely knowledgeable. He is very kind, patient and understanding when dealing with colleagues and he is totally committed to his profession as a paediatrician. I consider him to be a colleague of very high calibre and I think it would be a great loss to the profession to lose such a highly talented, highly qualified, enthusiastic, motivated, active and considerate paediatrician. I would hope that all these points will be taken into account …”

Then on page 45, from Dr Jacqueline Mok, consultant paediatrician at Edinburgh. In the third paragraph down:

“David has along and distinguished career in paediatrics … [he] was able to shed light on the complex respiratory physiology in newborns and infants. His research and integrity are well respected, both in the UK and internationally. He has published widely on many aspects of paediatrics, is a respected academic, as well as a caring and committed children’s doctor.”

In the last paragraph, she says:

“As chair of the Child Protection Special Interest Group of the Royal College of Paediatrics and Child Health, I invited David to address our session at the College’s annual spring meeting in April 2004.”

Pausing there, that was before the hearing of the Professional Conduct Committee.

“The large hall was packed, and he received a standing ovation from fellow paediatricians at the end of his lecture – a tribute to his achievements and a mark of the warmth, respect and support of paediatric colleagues around the United Kingdom.”

At page 47, Dr Moy, who is a senior lecturer in community child health at the University of Birmingham and also a convenor of the international child health group of the college, as he says in paragraph 2:

“ … as the Convenor of the International Child Health Group which is a special interest group of the Royal College of Paediatrics and Child Health. David has been a member of this Committee for several years and has contributed greatly to its activities. I am also a member of Child Advocacy International which was founded by David and therefore know something of his great contribution to the human rights and well being of children worldwide.

David is passionately committed to ensuring that the rights of children are enshrined in the United Nations Conventions on the rights of the child are

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upheld worldwide. His personal experiences during the Bosnian campaign led him to found Child Advocacy International which serves to provide care for children in war and disaster-affected areas of the world and in areas of extreme poverty. He has often gone to these places to establish services and provide training (sometimes at considerable personal risk to himself).”

Over the page, the second paragraph:

“David has also been the driving force behind a new textbook on International Child Health, developing training programmes in emergency child and maternal health and in developing training materials on emergency care in the innovative format of a CD-ROM.

David has been a powerful advocate for children living in war zones and in extreme poverty within the Royal College of Paediatrics and Child Health. To this end he has conducted research on the effects of the arms trade on child health which has been published in the British Medical Journal.”

Page 49, from Dr Meriel Susan Nicholson, now retired consultant in paediatrics. In the penultimate paragraph, she says:

“I know from direct experience that he is committed to improving the global health of children and is also a superb clinician, teacher and researcher. He is an advocate for children individually and globally always putting their best interests first, often at his own expense.

In my opinion he is a man of great vision, courage and integrity who is often at the difficult forefront of medical developments, policy and decision-making, ‘the cutting edge’ … It would be a disaster for paediatricians and the speciality of paediatrics and child health if they were to be deprived of his continuing contribution to the welfare of children in an active capacity.”

Then, madam, at page 62, the author Dr Elliot Shinebourne, consultant paediatric cardiologist at the Brompton, dated November of last year. In the first paragraph, he says:

“David Southall is an outstanding paediatrician with whom for 10 years I had the pleasure and privilege of working with.”

Then on the second page:

“As the panel will be aware his views have at times been unpopular and indeed he may not always have been correct but nonetheless his integrity is undoubted and he is motivated by a burning desire to protect children from abuse of any kind.”

Madam, on page 72, from Dr Williams, consultant paediatrician at the Doncaster and Bassetlaw Hospital in Nottinghamshire. In the second paragraph:

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“I do not personally know Professor Southall but he has influenced the practice of paediatrics in Bassetlaw in several ways because of his outstanding contributions to paediatrics. I have met Professor Southall on one occasion I think in 1984 when he gave a lecture … and I have spoken to him on the telephone about clinical matters on four or five occasions since then.”

Then on page 73, in the middle paragraph, he says:

“Another great influence that Professor Southall has had on our unit is the publication of his landmark paper where he describes a series of babies in whom he performed covert surveillance. I insist that all my junior doctors read this paper because nobody who has not read it can understand the difficulty that paediatricians face in investigating child abuse. It is clear that these parents … ”

And so on. Then finally:

“I write this testimonial about David Southall because I consider him the most imaginative clinical researcher of our generation in paediatrics. His work has been of huge benefit to the population and I know of no other clinical researcher who has had anywhere near the same influence on my clinical practice as David Southall.”

Madam, I have deliberately not taken you to every one of those testimonials, but I would invite you and your colleagues, after you have retired, of course to absorb in your own way the rest of the bundle. I have simply attempted to highlight the theme which appears to run through these documents.

Madam, could I call briefly, please, Dr Parke?

SIMON CHARLES PARKE, AffirmedExamined by MR COONAN

(Following introductions by the Chairman)

Q Dr Parke, can you give the Panel your full name?A Dr Simon Charles Parke.

Q Your professional address?A My professional address is University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent.

Q You are a registered medical practitioner?A I am indeed, yes.

Q Dr Parke, what is your current position?A I am a consultant paediatrician with special interests in haematology and oncology at the University Hospital of North Staffordshire, where I am the clinical lead for general and specialty paediatrics within that trust.

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Q Dr Parke, the Panel have the advantage of having seen already – it is in front of them – a letter from you in relation to Dr Southall. What I want to do is to ask you a number of questions arising out of that and to, as it were, add to what you have written. The first thing is this. Are you aware of the findings of the Panel in relation to Dr Southall in this hearing?A Yes, I am.

Q Are you still willing to provide and make the observations you have in that document?A Yes, I am.

Q First of all, can I ask you about your responsibilities in the Trust? What do you do?A In addition to my clinical work, I am a member of the management team within the department of paediatrics, women’s and children’s division. In terms of my clinical management responsibilities, I am responsible for the day to day management of clinical situations, especially things relating to, for example, staffing, infection control and things like that on the wards. In relation to medical staffing, I have a supervisory role over junior medical staff and I am responsible for the appraisal of my consultant colleagues, who also work within the general paediatric department, including Dr Southall.

Q Are you aware, in one or other of your roles, that Dr Southall currently practises subject to conditions imposed by the General Medical Council? A I am aware of that.

Q Can you, from your standpoint, tell the Panel and express an opinion as to whether he has or has not complied with those conditions? A As far as I am concerned, and from the point of appraisal of Dr Southall, I am convinced wholeheartedly that he has fully complied with the restrictions on his licence to practice. It is extremely difficult within general paediatric practice to avoid the awareness and intrusion of child protection investigations into your clinical practice. Dr Southall has acted above and beyond the call of duty in his attempts to pass immediately on any cases, where such an investigation was going to be necessary, onto colleagues who are specialised within that field.

Q The Panel have heard something about those arrangements and, indeed, the machinery for it is enshrined in the conditions themselves. Can you help the Panel, just to bring it alive for us, how does that mechanism work? A Child protection and child abuse are, unfortunately, extremely common in paediatric practice, especially in a large, busy, general paediatric population such as is served by the University Hospital in Stoke-on-Trent. Rarely a day would go by without child protection concerns being raised. Within our Trust we run a separate child protection on-call consultant rota, so there is always a consultant on duty, 24 hours a day, 365 days a year, who will have responsibility for the initiation of a child protection investigation. If the child is, therefore, referred in by, for example, the police or social services, they will pass directly to that consultant and will not pass under the care of the general paediatricians at all.

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However, clearly, a great number of children present with concerns of a child protection nature that present to general paediatricians. It is part of our job and our duty to recognise those. Since the licence restrictions have been imposed on Dr Southall, whenever such concerns have been raised by a junior member of medical staff, a member of the nursing staff, a consultant colleague or if Dr Southall has developed any concerns of those nature during the course of his clinical practice, that has immediately been passed on to the relevant consultant responsible for child protection.

Q Can you give an assurance to the Panel that Dr Southall has not been engaging in child protection issues? A I can guarantee that with 100 per cent certainty.

Q Can I ask you about your knowledge of Dr Southall. First, I think you say in your letter that you had been, at the time of writing the letter, a consultant colleague for three years, so that would take us up to four years now?A That is correct.

Q Prior to that, you were specialist registrar at the same hospital for two years or one year. Others have expressed their views about him, but it may be helpful for the Panel to receive your view about him.A I have known Dr Southall for several years. I was a junior doctor at the hospital back in 2000/2001 and, as you correctly said, I was appointed consultant at University Hospital nearly four years ago. During that time, I have had an excellent working relationship with Dr Southall. He contributes fully to a very busy paediatric department. I found him to be an extremely helpful, kind, considerate and at all times professional colleague. His opinion is highly valued as is his experience within the department. He is unstinting in his efforts to support the work of the department. He will always be the first colleague to volunteer if somebody goes off sick, to come in and do extra shifts, to cover extra on-call arrangements. Nothing is too much trouble with regard to help for his colleagues, and nothing is ever too much trouble with regard to the support which he gives to his patients as well. I have complete confidence in his clinical care of his patients. I have received numerous testimonials from patients who I have jointly cared for with David, or when letters have been sent to the departments expressing thanks and expressing admiration for the professional, courteous and all round excellent care that he has given to them.

Q Does the Trust know that you are here giving evidence? A The Trust does know I am here. I have spoken to my Clinical Director, my immediate managerial superior last night, and the Medical Director of the hospital last night.

Q Do you know of any first-hand knowledge of any publications that Dr Southall has been involved in? A Dr Southall has been involved in numerous publications, many of which I have read over the years. Are you referring to published articles in medical literature or published books?

Q Anything that strikes you that you may have an association with.

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A I was a co-editor with Dr Southall of the manual of International Child Health which was produced, gosh, five years ago now, following work that I had done in Uganda. We are in the process of, hopefully, re-editing a new edition of that.

Q In a word or two, what is that publication directed to?A That publication is a unique publication in international medical literature. It is produced entirely for the benefit of doctors working in developing countries and for doctors who are going to work in developing countries. The contributors are unpaid and have written excellent evidence-based articles and chapters which attempt to be written in a practical, user-friendly, manual format so they can be readily applied on the ground in disadvantaged countries. The unique way this book has been published enables the cost of the book on the ground in disadvantaged countries to be offset by the cost of sales in the developed world. Through this arrangement this manual has been distributed throughout the world and has proven extremely popular in disadvantaged countries. You cannot underestimate the uniqueness of this as a publication. This something that is done entirely for the good of the people working on the ground. Where medical text books, as I am sure the Panel are aware, can cost £200 - £300, to produce something which costs a couple of dollars for use in the developing world, is a huge resource.

MR COONAN: Dr Parke, thank you. There may be some further questions for you, but that is all I ask you at this stage.

MR TYSON: No questions.

Questioned by THE PANEL

THE CHAIRMAN: It is possible that the Panel may have questions for you and, if so, I will introduce them. Mrs Lloyd is a lay member of the Panel. MS LLOYD: Good afternoon Dr Parke. I would like some clarification of some of the rather fast responses that you gave to Mr Coonan. If I could take you back to the question you were asked about Dr Southall passing on cases. First, you were saying that he passes on cases where a CP issue may be involved, and you also said that when concerns are raised by nurses and junior staff, those are also passed on. I would like to clarify whether the nurses and junior staff are first passing on their concerns to Dr Southall and Dr Southall is passing them on. I would really like to understand the process and methodology involved in how these concerns are raised, how they are passed on and who they are passed on to.A In our Trust, at any one time, we have four paediatricians on call. So one paediatrician has responsibility for the Neo-natal Intensive Care Unit; one for the Paediatric Intensive Care Unit; there is the rota that myself and Dr Southall participate on, which is the General Paediatric On-call Rota; and, in addition to this and entirely separate to this, there is a Child Protection Consultant On-call Rota. If a child comes in where there is an initial suspicion, or even less than that, if someone has a concern and wishes to consult for advice, if it is in the nature of a child protection query, typically it would be unusual for the nurses to directly speak to the child protection consultant on call, they would typically speak to the registrar on duty. That registrar would always go to the child protection consultant on call. I am in a similar position to Dr Southall to some extent in that I am on the General Paediatric On-call Rota and I do not get calls

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about people on child protection. My colleagues in the child protection rota take those on straight away.

Q How is it actually passed on, is it passed on verbally or is it passed on in writing?A It is the same as any on-call rota, so if a junior doctor wishes advice from a senior they will telephone them.

Q So Dr Southall could well be involved in concerns that he then verbally passes on to somebody else?A If, for example, there was a patient on the ward who there were child protection concerns about, that would go straight to the child protection consultant. As members of the general paediatric rota, we would not see that child on the ward round, to be honest with you. That child would be dealt with by the child protection rota. If one of the general paediatricians was doing a ward round and became aware, during the course of performing routine medical inquiries, that there may be child protection issues, if it were myself, then I would take that directly to the child protection consultant on call. Because of the restrictions on Dr Southall’s licence, at the merest suspicion of anything like that, he would immediately contact one of the other general paediatricians to pass that on to the child protection consultant on call or they would get involved straight away.

Q So it would be Dr Southall having a suspicion of somebody he was seeing which would lead him to make the decision to pass that on to the relevant responsible officer or medic. Is that what you are saying? A If you imagine a situation as we have in Stoke-on-Trent where you admit thirty children in a day, it is possible that some of those children who present with a medical symptom, if you like, have, in addition to that, got social and child protection concerns. As a paediatrician, we have a primary responsibility for addressing their medical concerns. For the rest of us on the general paediatric rota, we would do the initial history taking with regard to child protection. Because of Professor Southall’s restrictions, he would not do that and would defer that immediately to another colleague.

Q He would not do the history taking. Is that what you are saying?A He would not do history taking with respect to child protection.

Q But I am really trying to clarify this, and it is very important because on the one hand we are being told that, by the conditions he had, that this does not involve child protection issues so, as a Panel, we have to be very clear, very clear, about what involvement there is coincidentally in the role he has now. So, as I understand it, what you are saying is that he will see a patient and whilst taking the history if he has any suspicions that there may be child protection concerns, he stops at that point and hands over the case to another colleague. Is that what you are telling the Panel?A Essentially, yes.

Q How is that explained to the patient and the mother who --- A I think that experienced paediatricians have skills to be able to terminate a consultation unfinished. It is not unusual, for example, in another clinical situation to be presented with a piece of information that requires further background information to be sought to fully evaluate that piece of clinical information. So, for example, somebody

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might say, “Oh, this happened two years ago when he was admitted for asthma”, and the consultant might say, “That is very interesting, I need to know about that asthma, I will go and consult your clinical notes and come back and speak to you later. I will go to the colleague who looked after you at that time, they will be able to come and speak to you later”. It is not unusual for senior doctors, senior paediatricians, to be presented with a piece of information which necessitates the truncation of that consultation.

Q In terms of reaching the point where Dr Southall might be passing on concerns, you have just said that that is done verbally, so there is no requirement to put those concerns in writing. Therefore only the person he is reporting those concerns to will know what Dr Southall has said, is that so?A In practice what happens is that the junior doctor who is attending the ward round, will speak to the child protection consultant on call.

MS LLOYD: Thank you.

THE CHAIRMAN: There are no other questions from the Panel. Are there any questions from either counsel arising from Mrs Lloyd’s questions?

MR TYSON: There is no question arising from Mrs Lloyd’s question, but a question has occurred to me which has nothing to do with Mrs Lloyd’s question. I was wondering if I may ask it?

THE CHAIRMAN: I am sure that would be all right. There is no objection.

MR COONAN: No.

Cross-examined by MR TYSON

Q You say in your letter, Dr Parke, that you have been involved in Child Advocacy International in the past with Dr Southall, so you are familiar with what that charity does. Is that fair? A That is correct.

Q The question I put to you is, as I understand it, Dr Southall’s role in that is that he sets up programmes, he obtains funding for them and he, as it were, drives the programmes and produces various text books to assist children, or doctors of children, in various foreign parts. Is that fair?A That is fair enough, yes.

Q The question that arises out of that is, in order to do that important work, does Dr Southall have to be a registered medical practitioner?A Yes.

Q Why?A I think if you are ... It is important to clarify how Child Health Advocacy International is at variance with many of the larger NGOs, such as Save the Children Fund, Oxfam. There are two very important differences. One is a difference of skill and one is a difference of on-the-ground activity. The difference of skill is that the Child Health Advocacy International is a very small non-governmental organisation

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which has very little in the way of support staff. The people who work for the organisation are hands-on practitioners who go into disadvantaged countries, into war zones and practice health care, both for the direct benefit of the patients they may see but also as role modelling and education for the professionals from the local area that they work with. That unique structure allows a huge amount of capacity building amongst those individuals. The second important difference is that Child Health Advocacy International is an organisation largely composed of doctors, paediatricians, with other allied health professionals, but largely it is paediatricians. It is an organisation which has worked very closely with other paediatric organisations, like the Royal College, to support paediatricians going and doing that work. Dr Southall goes and leads by example and goes into areas to teach and to practise.

There are two reasons why you need to be a registered medical practitioner because of the nature of Child Health Advocacy International. The first is a credibility issue. If you are a doctor trying to enable other doctors to provide that level of care, you need to have the credibility of being an up-to-date registered practitioner within your own country to sustain that credibility.

The second point is that when you are teaching, enabling, working within a healthcare setting in a disadvantaged country the weight of morbidity, the rapid throughput of patients and the fact that so many of those patients are desperately unwell means that it is almost inconceivable that at some point you will not be called upon as the outside expert to lend a hand actually physically helping providing healthcare for those children.

Q You set out two grounds – the credibility ground and the occasional need for the hands-on help because you happen to be there. Dealing with the latter, if you were the medical director dealing with setting up other doctors to do this work and setting up programmes, you do not necessarily in those circumstances have to be a registered medical practitioner yourself, do you?A I think it would be a stretch of credibility to not be a registered medical practitioner.

Q I can see what you say about credibility, but it could be said that Dr Southall has enormous credibility in this field in any event whether or not he is a current registered medical practitioner.A I think without being a current registered medical practitioner it is impossible to guarantee that you are meeting the criteria of Good Medical Practice in that you are not under a process of appraisal, review, being forced to keep up-to-date, being forced to use your skills on a daily basis.

MR TYSON: I will take it no further. Thank you very much indeed, Dr Parke.

MR COONAN: I have no further questions, thank you.

Further questioned by THE PANEL

MR SIMANOWITZ: This is something that occurred to me as a result of the questions you have just been asked. I think you said because the organisation is a small

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organisation Dr Southall can be called on to do hands-on work in these countries, is that right?A That is true, yes.

Q What would the position be if he came across child protection concerns in that situation?A I cannot conceive of any situation in which child protection concerns require an emergency intervention. What I am talking about is mainly hands-on if somebody stops breathing in front of you. Child protection, whilst being urgent, is rarely like-threatening in that immediate setting.

Q I probably misunderstood you because I thought you dealt with it in two ways: the second way was when Dr Southall might be called upon in an emergency situation but I thought you said to Mr Tyson earlier on because it was a small organisation he did actually go in and do hands-on work, not simply in an emergency situation. Did I get that wrong?A The people who work for Child Healthcare Advocacy International go in and do hands-on work. Dr Southall, as the director, will go in and do hands-on work in disadvantaged countries when he comes out and inspects and sets up projects. However, the majority of that work will involve the setting up of educational projects. The situation which I am talking about with regard to providing emergency healthcare would be a situation when, for example, you are touring a facility that has been built for the care of children within a disadvantaged country and a child stops breathing in front of you. That may seem farfetched but actually that is what happens and it was not unusual when I was in Uganda to have ten to 12 children have cardiac arrests during the morning.

Q I understand that. I am sorry to press you but you said the majority of the work he goes in to do will be largely educational. Are you differentiating between that and this emergency situation or would he do ordinary hands-on work because he was there?A I cannot comment on all of Dr Southall’s projects. All I can comment on is the project that I was involved with. When Dr Southall came out and inspected the projects on which I was working part of that inspection involved being shown round the unit which we had developed alongside local paediatricians in the hospital in Kampala. The situation is when you are walking round a unit like that where there are maybe 200 very unwell children is that there is a necessity to pitch in if a clinical emergency arises. That is not the per se purpose of the visit which is to essentially ascertain whether or not the people who are working for the non-governmental organisation or producing the goods in the setting but the inevitable nature of the work means there will often be clinical emergencies arising whilst somebody is there. It is incredibly empowering I think for doctors in disadvantaged countries to see somebody who is a medical director of an organisation come in, roll their sleeves up and perform basic life support, put in drips and do all the emergency life-saving procedures because I think one of the difficulties in disadvantaged countries is often the lowest cadre of doctors are left looking after the sick patients – maybe that is true in Britain as well – and it is a very, very empowering and part of the process of enablement to have somebody senior being seen to get stuck in.

Q What you are saying is there are no circumstances in which Dr Southall in the project that you were involved in would come across child protection concerns.

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A There were no circumstances not conceivable.

MRS LLOYD: As a result of my colleague’s question I wanted to clarify something you said when you were being asked about the contact Dr Southall might have with child protection work in these regions. You said that you could not conceive of any situation where child protection would be an emergency situation. You said that whilst it is urgent, it is not a life-threatening situation. I wondered if you could clarify what you meant by that?A I am talking about a directly life-threatening situation. I mean if somebody stops breathing, if somebody requires immediate resuscitation, those would be the circumstances under which someone would feel medical obligation to be involved in the resuscitation. If there was a child protection concern within a disadvantaged country where a project was ongoing, then that would need to be dealt with by whatever local procedures were on the ground. There would be no need for someone to call this as an emergency. It is no less important but it is a different level of urgency. When we get a child who has come in having sustained a life-threatening abusive injury, our immediate concerns are securing the airway, breathing and circulation of that child. Any investigation will be consequent to that. That does not mean it is not important but it means that it is not the essential life-saving behaviour which has to happen at that time on the spot.

THE CHAIRMAN: Mr Coonan, do you have any questions?

MR COONAN: No, thank you.

(The witness withdrew)

DR JOHN MARSHALL BRIDSON, Affirmed Examined by MR COONAN

(Following introductions by the Chairman)

Q Is your full name John Bridson?A John Marshall Bridson. It is a Manx name.

Q Is it Dr Bridson?A Yes.

Q You are a registered medical practitioner.A Yes.

Q Did you practise in the field of paediatrics?A Yes.

Q When did you retire from that?A Finally yesterday.

Q Dr Bridson, if we can go through a few of the stepping stones in your appointments in your career, when you were in either full-time or part-time practice as a paediatrician where did you practise?

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A Barnsley.

Q Were you a consultant?A Yes.

Q For how many years did you practise in Barnsley?A From 1976 until yesterday.

Q I think you have a connection with what is now called Child Health Advocacy International.A Yes, that is correct.

Q Are you currently the chairman?A Yes, I am the chairman of the board of trustees.

Q I think it used to be called simply Child Advocacy International.A That is correct.

Q Do you have any particular responsibility for any particular region in the world?A Yes, Albania.

Q Help the Panel about the reach of the CHAI. What is the geographical reach of it across the world?A Our aim is to work in either war-torn or countries with extreme poverty. We reach as far as South East Asia, we reach sub-Saharan Africa and we do work in the Balkans.

Q Does that include Pakistan?A Yes.

Q I will come back to that in a minute but I want to ask you about your knowledge of Dr Southall. How long have you known him?A Since the mid Eighties.

Q How did you come across him?A Initially there was a research project being carried out in our part of Yorkshire looking at the physiological monitoring of young babies, newborn babies and I met him through that.

Q Over the years since the mid Eighties have your paths crossed?A Yes, on quite a few occasions dealing with difficult cases, including one particularly difficult one which I did not understand at all which he helped me sort out.

Q Apart from your paths crossing in the UK, help the Panel about your knowledge of Dr Southall in the context of CHAI.A It is CAI. I answered an advert in 1998 to join the organisation because I was looking for something to do as I came up to retirement and I finished whole-time work in 2000. At that time I became involved with Albania as the honorary country director for Albania. Then we were working in numerous other countries. After a couple of years I was invited to be a trustee and I got to know the organisation much better. I am

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aware of Dr Southall’s work, particularly initially in Bosnia from I think it was 1995 or 1996 and subsequently in Bosnia until this day I am aware of his work in Sri Lanka, especially in the Tamil regions of Sri Lanka. I am aware of his work in Uganda and other sub-Saharan African countries – this is not current – and I am aware of his work in Afghanistan and Kabul and also in Pakistan where he has done a formidable amount of work with great success.

Q Just help the Panel about that.A In the time of the Afghan war, a lot of the Afghans moved to refugee camps in the North West Frontier territories in Pakistan and we had health facilities set up in some of the camps in the North West Frontier territories and this was done by CAI led by David and also by particularly skilled doctors within Afghanistan. Within the North West Frontier territories camps an idea was germinated for the development of maternal and child health programme that looked at emergencies that mothers face during pregnancies, that newborn babies faced and that children faced both from illness and trauma. The idea sprung out in the refugee camps and then came to fruition gradually over a few years.

Q How would you assess the contribution that he made in Pakistan?A The emergency maternal and child health programme developed into a very well recognised and accepted programme. We worked with the advanced life support group and we worked with the WHO. It was piloted. It looks at the golden hour – that is the time immediately after somebody who is acutely ill presents at a facility, be it in a village or in a district hospital or in a tertiary hospital. The programme was developed in the UK by a working group and then introduced as a pilot in Pakistan some years ago now. The pilot was very successful and it has been taken on by the Pakistani Government and the World Health Organisation in Pakistan to be cascaded across the country. What he has done is introduced the programme there. Its evaluation has been good and it is now remaining sustainable in the country as part of the fabric of their family health education programme.

Q You have given a number of examples of Dr Southall’s contribution in various countries and various projects. What about your view of him as a professional?A I think he is a professional of the highest order. I would have no criticism of him whatsoever. He is humble and he needs to be. He is highly able. He has an enormous amount of drive. He has absolute integrity and honesty and I emphasise that and he is excellent at developing programmes and implementing programmes and he is well-respected in the medical community.

Q You are aware, are you, of the findings by the Panel in relation to Dr Southall in this case?A Yes.

Q Does that inhibit you in any way from expressing the views that you have expressed?A Not at all.

Q I want to ask you, please, on a particular point about Dr Southall’s role under the umbrella of CAI and the requirement or otherwise – it is for you to say in your opinion –

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for him to be a registered medical practitioner when he were to practise, for example, in Pakistan or in Uganda. Do you have a view about that?A Yes, I understand the question. First of all, he is the medical director. He is the founder member of the trustee and he is the medical director. That is his position and that is the position that a doctor fulfils. Secondly, he introduces programmes into countries across the world and requires to be a hands-on up-to-date practising doctor to do that even if you might imply that he is just doing training schemes, he has to have the skills, he has to be at the cutting edge, have his CME up to date in order to do the job properly.

Q CME means?A Continuing medical education. But on top of that, there was an example of when hands-on care were needed when you cannot avoid doing that. We were recently in the Gambia looking around the country at the medical facilities. We were in one hospital in a particular area – I am not sure if David was there this time, but other doctors were there with me – a boy fell out of a mango tree just before we arrived at the hospital, was very severely injured and clearly required hands-on care from us, which was given. Those circumstances cannot be predicted and may occur at any time, whether we are doing training programmes or whatever in other countries. So for two reasons. One, for keeping up to date and holding respect and the other, being able to do it if and when you have to and you have no option.

Q If Dr Southall would be removed from the register, the UK register, what would you say would be the possible result?A I think it would be difficult for him to carry out his international work adequately. I think it would be a loss for the international community. I think the work he and others are involved in saves the lives of mothers who are dying all over the place in sub-Saharan Africa; it is almost carnage, saves the lives of babies and children. This is not just me exaggerating for effect. This is the truth. Such is the work that we train people to do in the golden hour, that would be with mothers in obstructed pregnancy or haemorrhaging and so on.

MR COONAN: Dr Bridson, that is all I am going to ask you, but there may be further questions.

Cross-examined by MR TYSON

Q I represent the complainants in this case, doctor. Can I just explore your last answer? You were asked by Mr Coonan about the effect of Dr Southall losing his registration and the subsequent work with CAI. You said it would be difficult to carry out work adequately. Can we just split that down? He would certainly be able to open up new programmes in different countries, for instance.A No. I am saying that he has to remain at the cutting edge of practising medicine to be able to efficiently develop and open programmes. I am saying also that he has to be qualified in order to deal with emergencies which arise in front of him without any ---

Q I understand the mango tree argument. It is just the other one. In order to provide, say, funding for your organisation, that does not require him to be a registered medical practitioner, does it?

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A For the organisation to attract funding, we have to have a reputation of a high standard.

Q I fully accept that. In order to devise programmes and indeed to train people in those programmes, you do not have to be a registered medical practitioner, do you? I understand you have more respect, credibility and so on.A Yes. I understand the question. I do not think it is just him having more respect. I think it is having the current abilities to practise at the cutting edge of medicine which enables you to devise the programmes adequately. These are cutting edge programmes and it enables you to teach them with a basis of active knowledge of what you are doing now still in your profession.

Q As I understand it, you are not teaching local paediatricians or local doctors cutting edge matters; you are teaching them very basic matters, so that they can handle things at a basic level.A Absolutely.

Q You are not teaching them cutting edge medicine.A I think the development in basic life support does have a cutting edge of its own.

MR TYSON: Thank you very much.

THE CHAIRMAN: Mr Coonan, do you have any re-examination?

MR COONAN: No, thank you.

Questioned by THE PANEL

THE CHAIRMAN: Mrs Lloyd is a lay member of the Panel.

MRS LLOYD: Good afternoon. You said you have known Dr Southall since the late 1980s.A Yes.

Q Can you just clarify when you became involved in the charitable project?A 1998.

Q Can you give the Panel some idea of – you said he spent a considerable amount of time setting up these projects – how much time Dr Southall devotes to this?A I think as part of his working contract he had time to do international ---

Q Can you give us an idea? Is it six weeks a year, ten weeks a year?A I see. He would spend – this is guessing and there is not much point – maybe ten or 12 weeks a year away. Equally, he would spend a large amount of his time in the UK, both working time and private time, working on the charitable project.

Q You gave great emphasis to his integrity and honesty.A Absolutely.

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Q Could you give the Panel a couple of examples of how you can vouch for this, please?A That is a good question and one I was not expecting. I would have to think about it. I have never known him be dishonest, put it like that. I have always known him to take what I would say was the honourable course of action at a particular time. He has done his work always to the best of his ability. He supports his colleagues within the charity absolutely. He does not let people down. But specific instances are not easy to recall.

Q My final question: from your knowledge, and obviously you have been involved with the charity for some time, how many other child advocacy charities are there operating internationally?A There is no other Child Advocacy International.

Q I am not talking about the specific project. How many other services offering support to children throughout the world are you aware of?A There are probably a large number. There 250,000 charities in this country alone. The NGO Child Advocacy International was set up in 1995 or 1996 to fulfil a niche which was not filled in the international field. The niche was that of the acute care of children in hospital. Let me explain why it needed to be. Most of the major agencies look after primary care or public health. This is in the aid field. So vaccination, immunisation, clean water, all that sort of stuff. There was a gap in the field. Ten per cent of children attending a primary care clinic in difficult places need referral for specialist care and this specialist care was not available. We at that time were the one aid agency providing this sort of hands-on work and training work. I do not know of another that does the same thing.

THE CHAIRMAN: Mr McFarlane is a medical member of the Panel.

MR McFARLANE: You say that you are Chairman of the Board of Trustees of this charitable organisation.A Yes.

Q How many trustees are there?A Eight.

Q Are they all medically qualified?A No.

Q How many of the eight are medically qualified?A There is Dr Southall, myself, Dr Rob Moy, who is a community paediatrician in Birmingham, Dr Joanne Moran, who is a paediatrician in the Midlands as well, but also an Iraqi. I have a problem I have to tell you about. This may sound stupid, but I am hopeless at lists and when I am asked to reel off lists of people or lists of things, I do not do it well. The other trustees, one is the chief executive of an NHS trust, another is a retired businessman – partially retired – of great experience and then there is an executive with John Lewis, a business analyst with John Lewis. That may be seven. That is a particular problem I have.

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Q Please do not be worried by this. I do fully understand and I am not trying to trick you or anything like that. As you can see from my title, I come from a surgical background. This is purely a hypothetical question, but if, for instance, you had room for another trustee and you wanted a surgeon and you were foolish enough to ask me to do it and then I were to find myself and my registration called into question by my professional registration organisation, I would feel duty-bound to have to not only inform you of this, but to formally tender my resignation from your organisation because I have been found wanting. Has any member of the board of trustees tendered his resignation since you have been chairman?A Firstly, I missed out a trustee. We have an obstetrician on the board. Secondly, people have resigned from the trustees board while I have been involved.

Q Have any offered their resignation due to the fictional scenario which I was portraying just a moment ago?A That they faced that?

Q Yes.A No. We do have plans to deal with any eventuality.

THE CHAIRMAN: Mr Simanowitz is a lay member of the Panel.

MR SIMANOWITZ: Good afternoon, doctor. I only have one question. You told Mr Tyson that it is necessary for Dr Southall to remain at the cutting edge in order to do his work.A I think so, yes.

Q I am not at all clear why that is and I wonder if you could elaborate for me.A If you have not been a doctor, I may not be able to use the same sort of parallel in your career, because I do not know what your career was and I may not be able to make a comparison which you accept, except to say that if you are doing training work, it is far better and much easier if you are kept up to date and if you have been recently practising the work that you are teaching. There is no doubt about it. I have no doubt about it. Often in the professions that I work alongside, people are taken away from what you might term the shop floor during the gestation of their career. So a teacher might leave teaching and go into admin, a social worker might leave on the floor social work and go into administration. Doctors generally stay active consultants, participating in their career until they retire. Those doctors are the ones who continue to know exactly how to do, how to train. If you move away from the clinical field, the difference rapidly becomes apparent in the skills in the sorts of things we are talking about. So I have no doubt. I am not just making it up to suit the situation I am in for what I want. I firmly believe this. I have watched it throughout my career. I have seen teachers become people who will no longer be any good as teachers; I have seen social workers do the same thing. Those are the other two professions I mainly have experience of. But in doctors, the consultant is still operating until the day he retires and that is to my mind essential both for his skills and for his teaching.

THE CHAIRMAN: I think Mrs Lloyd may have an additional question.

MRS LLOYD: I forgot to ask you what kind of CP issues arise during your work?A CP?

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Q Child protection issues.A Child protection issues arise during the practice of most paediatricians. As far as I understand, that issue has been dealt with in this case. Do you mean in the work abroad?

Q Yes, I did mean that. I am sorry I was not clear in my question.A We do within our courses have teaching on domestic violence. This is a very difficult topic to teach and talk about, for instance, in Peshawar or in Kabul or wherever it is you are doing it. So family violence does come into the teaching, but it will not come into the hands-on care, put it like that, unless somebody was dying in front of you as the result of an assault.

Q How does it not come into your view in this work?A In the teaching work?

Q Yes.A I said domestic violence in all its forms does come into the teaching work and it is an integral part of the course, but in general it does not involve the first hour for presentation with an acute emergency in a hospital or in a village facility. It is seen and seen by the people in the countries where we teach as an integral part of the course, particularly because they have particular problems with violence towards women.

Q Non-accidental injury would not be covered in your teaching, to raise people’s awareness of it?A I do not teach on the course. I know that domestic violence is in it and I would imagine that all aspects of domestic violence are covered in the course. I hope that is clear.

THE CHAIRMAN: Does either counsel wish to come back?

MR COONAN: No, thank you, madam.

MR TYSON: No, thank you.

THE CHAIRMAN: In that case, thank you for giving your evidence. You may stand down and you are formally released from your oath.

(The witness withdrew)

MR COONAN: Madam, that completes the testimonial evidence which I seek to place before you. May I just close this part of what I have to say to you by making a number of observations?

It is quite clear from the material, we would submit, that you are dealing with a man of outstanding ability as a clinician and not only as a clinician, but as a teacher as well as a researcher. He has contributed enormously to the health not just of children in this country, but also to the health and welfare of children abroad and is capable of so doing. He is highly skilled and altruistic. He has been driven – that is a word which one other

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person at least has used in these testimonials – by an enthusiasm for the protection of the interests of children as he saw it. Two matters arise from that.

The first is that taking the body of the testimonial evidence, both documentary and oral, which you have received, Dr Southall is entitled, you may think, to have accorded substantial weight to that material, borrowing the phrase precisely of Mr Justice Collins in paragraph 14 of the judgment. Substantial weight. That is one side of the coin.

The other side of the coin, as the testimonials demonstrate, is that it is the drive to protect the interests of children, the advocacy of children, his approach to child protection which, when transferred to a UK clinical setting, has caused the problems, as you have found them to be.

The very qualities which on a broad sense are to be applauded, we would submit, have led to the errors you have found in the precise context of child protection in the UK. It is in that respect therefore, a description which I used before the Professional Conduct Committee in 2004 and I repeat it now, his Achilles heel. That is not to say that his overall competence, ability and value as a registered practitioner should be valued.

I want to turn for a moment or two, before completing my final submissions, to the question of Indicative Sanctions. I have already indicated, and your learned Legal Assessor will no doubt emphasise this, one has to approach it from the bottom up. One has to look, first, at reprimand. I am not suggesting for one moment that reprimand is appropriate.

One has to move up and that is why the first realistic, available sanction, we would submit, is the question of conditions. In approaching this, you have to be guided by the principles of proportionality. You have to consider, do you not, the PUBLIC INTEREST in retaining his registration; the public interest in retaining that registration subject to tightly drawn conditions which translates as – to borrow the phraseology of Mr Justice Collins – safe working and, at the same time, to ensure that the reputation of the profession is not damaged by the imposition of conditions.

We would submit, in broad terms, that the imposition of conditions in these circumstances of itself does not damage the reputation of the profession. In any event it would send a very strong message not only to Dr Southall, we take that as read, but also to the general public. In that regard, in considering your approach to Indicative Sanctions, we would suggest that taking what may be called – in fact it was Mr Tyson’s expression – a mathematical approach is unhelpful. One has to look at the conduct and, we would submit, look a little more closely not just at the conduct but what is the cause of it. If the cause can be, in effect – this is my expression – nipped in the bud so as to prevent any errors in the future, that is a matter which we would submit is in the public interest. Furthermore, as I have already indicated, your approach to Indicative Sanctions is not simply a box-ticking exercise, nor is it a question of, as it were, circling the bullet points. The guidance on Indicative Sanctions is indeed guidance. There is no obligation to follow the precise wording of the document. We have one example of this already in the judgment of Mr Justice Collins. In relation to the phraseology used in the erasure

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section, where the reference is made to “any one of the bullet points being satisfied”, the learned judge in that judgment has said that that is not an automatic imposition of the sanction of erasure, so one has to be extremely careful about the application of those particular sections. Can we look briefly at the question of Indicative Sanctions at page S1-13 dealing with conditional registration. I move through with a number of comments in relation to these bullet points. As to the first one, it may well be that you will find on the evidence that there are some attitudinal problems. It may be, I make no submission that there are none, but, equally, that was the position in what I may call the Clark case too, there was evidence of an attitudinal problem.

Secondly, the question of assessment or retraining. There was no suggestion in the Clark case that there was an identifiable area suitable for retraining. It is the case that it was Dr Southall’s position then and indeed now, however hard it may have been for him, never to practise in the field of child protection again. So the question of retraining does not arise. Nor did it arise in the case of Clark.

As to the next one, that is not applicable. As to the next one, that is correct, there is no evidence of general incompetence. The next one is an issue relating to retraining. Once again, that is not an issue in this case, the question of retraining, nor was it an issue in the Clark case.

The question of danger, either directly or indirectly, as a result of conditional registration itself, again the parallels with the two cases are acute. That was satisfied in the Clark case and we say would be satisfied in this case by the imposition of suitably tightly drawn conditions and, indeed, has been the position – and one must not lose sight of it – of the Review Hearing already in July 2007. Similarly, as to the next bullet point:

“The conditions will protect patients during the period they are in force.”

We say, subject to the type of conditions that one draws, the answer is “Yes” that is satisfied just as it was satisfied in the Clark case. Similarly, the last bullet point follows from the previous one, the answer is “Yes” just as it was in the Clark case.

Therefore, that allows me, on behalf of Dr Southall, in considering the bold print, to consider, “Will the imposition of conditions on the doctor’s registration be sufficient to protect the patients and the public interest?” We would say “Yes”, just as it was in the Clark case; just as it was, not only as what I call companion to the Clark case, but just as it was when Mr Justice Collins put his slide rule over the elements in the decision of the Professional Conduct Committee and just as the Review Panel have been satisfied to continue.

I say in passing that all the matters which were covered this afternoon by Dr Parke as to the mechanics had been covered by Dr Chipping at the Review Hearing. So there is no concern at all about those matters which led, no doubt quite rightly, to the questions put by Mrs Lloyd this afternoon. That has been examined and the Panel in July 2007 has given further approval to it.

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On the other end of the spectrum is the question of erasure on page S1-15. I have mentioned the introductory context of this twice already and I do not shrink from saying it again. The reference to the word “any”, the reference you need for that is the judgment of Mr Justice Collins at paragraph 30. As I began to say, this is not to be construed as a dicta, it is not to be construed as a statute. You will remember that it was asserted in the course of the judgment of Mr Justice Collins that four out of the six out of the relevant six bullet points were satisfied. Whether they were or were not, Mr Justice Collins still held that the decision was appropriate.

In this case if we go through them we can see the extent to which any of these bullet points may be satisfied. As to the first, the answer is probably “Yes”. As to the second, there may be an argument about whether serious harm may have been caused – and I do not propose to make substantive submissions about that, that is a matter of impression for the Panel – but even if it were satisfied, again that was one of the bullet points relied on in the Clark case before Mr Justice Collins. As to 3, that is probably satisfied. Numbers 4, 5 and 6 do not apply in this case. Number 7, apart from the word “persistent” may be said to be capable of being satisfied.

Leaving aside my cavils in respect of those bullet points, taking them at their highest, you are dealing with four at the most because numbers 4, 5 and 6 do not apply, four at the most. It is the same four that applied in the Clark case. The approach, as you know, was the imposition of conditions. Madam, that brings me to my closing observations. This matter is looking, in effect, at the same cause of what may be said to be the same problem that your findings have demonstrated. It is the same area, child protection, the same problem. We would invite you to adopt the same solution, not as originally imposed by the Professional Conduct Committee, but the same solution imposed by the Administrative Court by Mr Justice Collins.

We say that the drawing of conditions – whether some subtle or change in those conditions which appear in your bundle which you can see in C27 – are fully set out in the document following the judgment which we have not looked at in detail, but I would invite you, when you retire, to pour over those. Those conditions, therefore, have been proved to work. There can be no basis, provided they can be said to work, for the view that, therefore, there is a risk of repetition. There have been no complaints about his behaviour relating to events after July 2000, which was the time point for the Clark case, July to September 2000. These matters, and this is an important matter, pre-date the Clark matter, they go back in time. There is no proper basis, we would say, for making any real distinction between what happened in the Clark case and what has happened in this case.

Dr Southall is capable, therefore, of being permitted to engage in safe working because anything else will lead to the loss of a great talent and will lead to the loss of somebody who is capable of providing care, well needed care, to other people less fortunate. I am not referring just to international work, I am also referring to nearer home, to the children who are treated to this day in general paediatrics and acute paediatrics by him. You have received a glowing testimonial from the witness box this very day from Dr Parke who brought it all to life.

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The testimonials are, in our submission, superb. They were superb before the Professional Conduct Committee in August 2004 and again, if one looks at the judgment of Mr Justice Collins, the observations made there by him were to the effect that they were truly impressive, as indeed these are.

What we say is, and this is no way going behind the facts that you found, in no way suggesting that you must be very concerned by what you have heard, not to suggest that these matters are not themselves serious, I do not make any of those submissions, to the contrary, even accepting those, there is a method by which this can be dealt with to provide safety to the public and at the same time preserve the reputation of the profession. It does not require, it is not necessary – and that is an important word – it is not necessary to pass over conditions and go for erasure in order to satisfy the public interest with which you are charged in preserving. Madam, those are the submissions that I make.

THE CHAIRMAN: Thank you, Mr Coonan. The next thing will be to call upon the Legal Assessor for legal advice before we go into camera. I think we should take a short break now. I think legal assessor would appreciate that to put the final touches to the legal advice he wishes to give to us, given the time. We will adjourn until 4 o’clock to take the legal advice then.

(The Panel adjourned for a short while)

THE CHAIRMAN: I will now ask the Legal Assessor to give his advice to the Panel before we go into camera to deliberate.

THE LEGAL ASSESSOR: The Panel must now decide whether, in relation to the facts found proved, it finds that the doctor has been guilty of serious professional misconduct.

I remind the Panel that serious professional misconduct is conduct which, by omission or commission, falls well short of the standard expected amongst registered medical practitioners and that such falling short must be serious.

I further remind the Panel that its decisions must be based solely on the allegations that it has found proved. It is for the Panel to decide whether individually or collectively they do amount to serious professional misconduct. It follows that although individual findings may not in themselves amount to serious professional misconduct, collectively they may do so.

It has been accepted by the doctor that in the light of the findings of fact there is evidence that can amount to serious professional misconduct. Notwithstanding that concession, it remains the duty of the Panel to reach its own finding and, as I have said, in doing so it should consider all the matters found proved. It is for the Panel to use its own professional judgment in deciding whether the matters proved do in fact amount to serious professional misconduct.

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The Panel is aware that in 2004 the doctor was found guilty of serious professional misconduct in relation to the Clark case. The facts of that case were subsequent to the matters before this Panel and should be disregarded when the question of serious professional misconduct is now considered.

The Panel has seen testimonials and heard evidence from the doctor’s professional colleagues. They speak of his personal and professional qualities. Furthermore, no criticism has been made of his professional competence; indeed, the evidence in this regard is significantly to the contrary.

I advise the Panel that matters of personal mitigation are not relevant to the question of serious professional misconduct. These are matters which should not be used to downgrade what would otherwise amount to serious professional misconduct. Personal mitigation is relevant only to sanctions and should be viewed separately from material relevant to serious professional misconduct.

If the Panel concludes that serious professional misconduct has been made out, it must decide whether it is necessary to postpone its deliberations in order to obtain further evidence of the doctor’s conduct. If it decides that postponement is unnecessary, it must consider whether it is sufficient to make no direction and conclude the case.

If the Panel members determine neither to postpone, nor that it is sufficient to conclude, they must consider their direction in accordance with Rule 31 in the order set out in that rule. In so doing, the Panel members should have in mind the General Medical Council’s Indicative Sanctions Guidance. The guidance, as its title indicates, is a guide and no more. Thus, the existence or absence of specific bullet points contained in the guidance is not of itself conclusive as to the finding that the Panel should make. It is for the Panel members to use their own judgment in reaching their decisions. They should have in mind the duties and responsibilities of a doctor as set out in Good Medical Practice.

The Panel should be conscious that the purpose of sanctions is not punitive but the protection of patients and the public interest. Sanctions should be considered from the bottom upwards on the scale of seriousness. In this context the Panel may find relevant the doctor’s response to the existing conditions imposed on his registration.

The public interest, which should be at the forefront of the Panel’s mind, includes not only the protection of patients, but also the maintenance of confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. It can also include the doctor’s return to safe practice.

In deciding which sanction, if any, to impose, the Panel must apply the principles of proportionality, weighing the interests of the public with that of the doctor.

THE CHAIRMAN: Does either counsel have any comment on the legal advice?

MR TYSON: No, madam.

MR COONAN: No thank you, madam.

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THE CHAIRMAN: Shortly the Panel will retire into camera. Before that happens, I will just raise some housekeeping matters. In practice, the Panel does not intend to deliberate this afternoon, having determined that these are weighty matters and it would not be appropriate to begin that at this late hour.

Further, the Panel will not deliberate in the morning as one member of the Panel needs to receive dental treatment. We will therefore be starting our deliberations tomorrow at 1.30 pm.

Further, having considered the time that may be required in order to be of assistance, we are proposing to say that we would release you now until 2 o’clock on Tuesday unless you wish to make representations to us otherwise. We will update you as to whether it will be later than that, but that would be the earliest.

Would either counsel wish to make a comment on those suggestions?

MR TYSON: Madam, that timetable seems both realistic and fair and I would adopt it.

MR COONAN: Madam, I agree.

THE CHAIRMAN: We are actually going to adjourn now. We are going into camera but we are in practice going to adjourn until 1.30 tomorrow afternoon to commence our deliberations then.

(The Panel adjourned until Friday 30 November 2007 at 1.30 pmat which point the Panel will convene in camera)

(Parties released provisionally until Tuesday 4 December at 2.00 pm)

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