I have been asked to provide a comment on the current ongoing case of the GMC v Dr H Webberley. The Tribunal hearing is being held at the Medical Practitioners Tribunal Service (MPTS).
Firstly, this blog is an opinion on matters as they proceed, and I have no part in the case.
I am merely viewing aspects from the outside, like many others. I am preparing this in a non-professional capacity, but I do have some experience in giving expert evidence at tribunal over many years.
I am getting updates from ‘live Tweets’ from the hearing provided by the Tribunal service and will see if I can get a press update as well.
In this case, and current tribunal hearing, Dr Webberley (Dr W) is accused of practising medicine outside the rules and regulations of the General Medical Council (GMC) during the period March -November 2016, A failure to hold a proper safeguarding policy, and (2018) a failure to be registered as a practice in Wales.
But there is more to it than that.
The case brings into sharp focus the manner in which some departments of the NHS are run, steered, and funded, how this affects the treatment of patients, young and old, and the impact of the type and quality of the care provided. This is especially important where removal of that care can have life-threatening consequences and/or mental health and longer-term issues.
Why is this case important?
It’s to do specifically with the treatment of transgender patients and those with Gender Dysphoria (GD) who were or weren’t having treatment via the GIC (Gender Identity Clinic)/GIDs (Gender Identity Service) as part of the NHS. The GIDs is also known as Tavistock (or Tavi) and is one of the few NHS gender clinics in the country, but this one tends to represent children and younger adults. This aspect is important as later court judgements have removed the ability to prescribe Puberty Blockers (PB) to children.
What is this about?
We all have to abide by rules; that’s how the law works. However, the interpretation of those rules and judgement on the same is what keeps the legal establishment and journalists in work and the wine bar.
For some, rules are important, to be understood and followed to the letter. For others, the interpretation maybe a little more lax. Like taking the occasional trip to Barnard Castle or to hug and kiss another in the corridors of power, but essentially getting away with it.
The hearing, currently at Day 9, Is set to run for about 55 days. So, a few twists and turns left, yet no doubt. Day 10 is an unscheduled reading day for parties to ‘catch up’ on new documents presented, but more of that later.
So where are we, and what has happened so far?
The tribunal hearing is at the early first stage. Evidence is being collated and presented to establish the list of formal charges that will be used for the second, formal part of the hearing, and those will be the charges and allegations put to Dr W for her and her legal team to defend.
It’s a bit like boxers sizing each other up in the ring before a bout.
Who are the protagonists of this court based real-life drama?
There is the tribunal panel. These are the ringside officials led by the ‘Chair’ The panel will eventually decide the outcome of this case and the charges put before it. The chair is the ref and rings the bell to start/stop proceedings as it moves forward.
In the red corner is the prosecution team (The GMC), with their ‘second’, Counsel for the prosecution known as SJ.
In the blue corner is the defence team (Dr W ) and her second, Counsel for the defence, known as IS.
These barristers question and cross-examine the witnesses at each stage to establish the facts and find weaknesses in the evidence and statements given. Always understand, a Barrister will never ask a question of a witness that they don’t already know the answer to.
The pathway of questions is to establish facts to prove their case (to examine) or to find holes and weaknesses in the evidence (cross-examine). I had a barrister ask me a question once on something he thought he knew the answer to. He was wrong, as I told him, and he abruptly stopped his questions and moved on, fearing he was about to undermine his case more than he already had. It's rare but does happen.
So far, various witnesses have given evidence. These range from professors (PGB) and leaders at the GIDs of the NHS, GPs of patients treated by Dr W and the NHS GIDS/Tavi. In time, patients (known by letter) and parents of patients will be questioned.
DR W will also take the stand at some point before the tribunal consider what charges will be heard. That will then end of the ‘informal’ stage of the hearing. The boxers can retire to the corners, take a drink, have brows mopped with the fluffy towel and limber up for the main event.
What have we learned so far?
Despite having over FOUR years to bring its case, the evidence, paper trail and availability of documents thus far presented by prosecution witnesses have been very poor. The tribunal has stopped many times due to a lack of/missing or incomplete documentation. This includes witness statements and records. IS has made it clear on several occasions he has not been provided with full information or documents. This is why day 10 is an unscheduled reading day.
It is accepted that there will be many trees sacrificed for this hearing, but the coordination and paper trail thus far is poor.
There also seems to be a lot of muddled thinking and many false trails being put up by the prosecution team. This may be deliberate, as it’s a bit of a ‘cat and mouse game really.
On a number of occasions, the prosecution team have relied on information, protocol, and judgment from the 2017 Bell v Tavi case (judgement to prevent PBs being prescribed to those under 16). As the Dr W case is brought from 2016, that wasn’t in place at the time and is a null and void argument. They should know this. The point being the allegations for this aspect can only be based on circumstances at that time and not what may or may not have happened since.
So far, IS has been doing a sterling job and picking holes in the evidence and has made the GMC case look particularly shabby at times. That’s his job. Putting together a series of punches and moves to outsmart his opponent. Of course, SJ will get his opportunity to do likewise in due course.
He has established that despite the GMC and others requiring Dr W and others to have specialist knowledge and training when it comes to treating young trans people and suggesting she is in breach of the rules for not doing so, there is actually NO such training available. More than this, a specialist panel set up by the GMC over 5 years ago to consider, prepare and produce such specialist training has yet to produce any!
The Tavi Clinic isn’t fit for purpose.
Because, it is becoming clear, the gatekeeping, control freakery and lack of funding are strangling the chance of any care being properly given.
It is apparent that there are internal struggles within Tavi about who is in control, who can give what care and who doesn’t like trans kids anyway.
There is distinct implication that the Tavi is being hollowed out from the inside and allowed to fail to get removed. But what then for the people it treats? This is before the case gets a mention of waiting times.
None of those things is in any way beneficial to the patients they treat. It also has to be said, this is unlikely to occur in other forms of medicine or treatment in anywhere near the same way.
Dr W’s fundamental case is, if you aren’t going to treat them, I will. Because if I don’t, no one will and they will be left to self-medicate, or self-harm or worse. This is an important issue in this case. At times, it could be argued that there is a potential case for ‘failure to treat’ that could be made of the NHS.
The battle will be over who was responsible to treat, what rules were in place and what happens when treatment is withdrawn.
The threats made to GD patients for or considering getting treatment outside the NHS (Via Dr W and others) is awful. Its tantamount to blackmail and taking home the jumpers that form the games goal posts. It has been established that GD patients have either had threats to and/or been discharged from NHS care for obtaining treatment outside the NHS. Bear in mind, that in most other branches of medicine, anyone is free to obtain this privately, at a cost. For some reason, the treatment of trans people and especially children this is frowned upon with malice.
Share care agreements seem to mean many things, and the rules surrounding them are both complex and open to interpretation at the same time.
GPs don’t seem to have read many of the documents Dr W had sent them regarding the patients they treat, and they seem to have a distinct lack of understanding of trans people and GD issues. All of the latter goes to prove, despite what GCs would have everyone believe that trans people are relatively rare in the wider day to day medical world.
That the Healthcare Inspectorate Wales (HIW) are persistent in their cause whilst being totally non-pragmatic in interpretation and also taking umbridge if the rules are not followed, despite mental health consequences that are likely to occur to patients.
The rules would seem to allow a practice (based in Wales) to practice whilst NOT being registered, but if registration is applied for (to practise legally), then ALL treatment is meant to cease until registration is received, at which point it can recommence. That’s fine to a point, but where do patients go in the meantime, and what is the difference to the patients from one status to another?
The HIW then will review the registration. If they decide if it is the right registration (but won’t tell you if it isn’t), they will consider and agree on the registration. That takes about 12 weeks.
If it's wrong, they will reject it, but not tell you why.
The registration is important to allow proper practice, but everyone is in limbo until the clique boys club decide whether to let you in or not. If you annoy them (as Dr W seems to have done), they will reject the application – just because. Not tell you why just reject. And a repeat application is needed. Yet more draconian gatekeeping to keep ‘everyone in the club’ and admit ‘the right sort’?
So far, there seems to be no suggestion that Dr W is unfit to practice as a Dr nor has ill-treated patients in her care. It's ALL about following rules, procedures and guidance that doesn’t fit her criteria, making her have training that doesn’t exist, and her not being part of the ‘boys club’, which is complicated only by the fact she’s a woman.
Sometimes, especially with trans people, when things don’t fit the rules, the rules are probably wrong or out of date. As such, it’s the rules that need to change, not the people. That’s how the amendment and making new laws, rules, and guidance works. It changes to suit changes in lifestyle, circumstance, and society. Unless you are part of a downtrodden minority, then it seems to be different. Parliament makes/amend the law, judges clarify or interpret the law.
The case continues…