Helen Webberley - hearing continues

[ItsLateHumpty]

See the original thread here:
www.mumsnet.com/Talk/womens_rights/4288795-Helen-Webberley?

And now Helen Webberley is back in court as the GMC seeks to extend her suspension until August 2022

Gender GP thread starts here:

twitter.com/GenderGP/status/1466049063099510790

GenderGP @ GenderGP
We're covering the hearing re Dr Webberley. There has been a failure of the GMC to disclose the full bundle, counsel for the GMC is explaining this is due to page limits put on submissions.

GMC Counsel is requesting an extension of the suspension for a period of 8 months. Dr Helen's counsel asks why the case won't finish for a year. GMC Counsel says that question is irrelevant to today's hearing.
12:48 AM · Dec 2, 2021·Twitter Web App

And Helens own Twitter here:

twitter.com/MyWebDoctorUK/status/1465727253392805893

Dr Helen Webberley 🏳️‍⚧️🧜‍♀️🏳️‍⚧️ @ MyWebDoctorUK
I have been unable to work as a doctor since May 2017 because of the GMC investigation into my work. The original restrictions were in place for 18 months and that has been extended many times to allow for delays and processes.
3:29 AM · Dec 1, 2021·Twitter for iPhone

I've no involvement with the MPTS at all, but I am on a panel for another regulator. We've had no - zero - training on anything related to trans/gender identity or related issues. There was a brief flurry of some of the support staff using pronouns in their emails but that seems to have pretty much stopped.

We have had (very good and thorough) training on the relevance of domestic abuse to fitness to practice and trust in the profession, where it was suggested we should view it very seriously indeed.

As I say, can't speak for the MPTS, but it's not somethign that has arisen in the training for the regulator I sit with.

The fact he uses the word "transgenderism" suggests he is not simply taking a framing given in training. Or if he is influenced by trainers he is not using the approved language very well.

I wonder if the findings go beyond what a tribunal is supposed to do? Are they supposed to decide which medical treatment path is correct when professional bodies and clinicians disagree? He could have come to the same conclusion but expressed it more like this - the field is changing, there is some disagreement & a range of approaches taken by different ppl & bodies. Webberley took an approach at one end of the range of acceptable treatment methods, but her approach was supported by this evidence, and this professional body, so she was within her rights to do so.

Instead he concluded webberley was right and the others were wrong and behind the times. But current developments actually show things are changing again and the more cautious approaches are the vanguard, webberley is behind the times.

It seems bizarre and inappropriate to me.

I wonder if the findings go beyond what a tribunal is supposed to do? Are they supposed to decide which medical treatment path is correct when professional bodies and clinicians disagree?

It is their job to listen to the various evidence and experts and come to a decision based on the evidence they have heard and in relation to this specific case. Sometimes you have two experts saying completely different things so it is not a straight forward process. This panel must've preferred the evidence that HW's experts gave in relation to the appropriateness of treating such young patients with PBs and cross sex hormones.

His comments remind me somewhat of the allegations in the original tribunal’s findings about maya F with respect to her views being unacceptable. Making value judgments.

rather than phrasing it in the kind of way the PP outlined.

He could have come to the same conclusion but expressed it more like this - the field is changing, there is some disagreement & a range of approaches taken by different ppl & bodies. Webberley took an approach at one end of the range of acceptable treatment methods, but her approach was supported by this evidence, and this professional body, so she was within her rights to do so.

Actually I see what you mean. It would be easy to say that one approach is acceptable without saying that another approach is wrong.

Agreed. It does feel like an overreach on behalf of the tribunal to be passing comment on such things. I don't know what the mechanism is which would allow that to be challenged, I'm presuming there's some sort of appeals process for either side.

It does have that feel, doesn't it. He couldn't just comment, he had to denigrate.

Mmm!

Yes.

I don't know what the mechanism is which would allow that to be challenged, I'm presuming there's some sort of appeals process for either side. Would that be for the gmc to appeal? But they would have to be believe he made an error in the finding itself, aswell as the justification / arguments for it, I should imagine.

I'm appalled by this. Who sits on the tribunal panel? Are they medically qualified? They are parroting obvious nonsense. I think those of us who were following tribunal tweets on Twitter thought the evidence against Webberley to be damning.

This - along with the "assigned at birth" judge in the Allison Bailey case - makes me think we've been getting overconfident. We may have government on our side, but the judiciary, NHS, universities etc have all been captured. It's going to be a long, hard fight.

We’re one election away from every front bench minister being captured. No time for over-confidence, I agree.

along with the "assigned at birth" judge in the Allison Bailey case

what happened? I didn’t get to watch on Monday.

The judge (apparently) gave people the impression they might be stonewalled by talking about ‘people assigned female at birth’.

Infuriating if true, not least because the case is going to take weeks. If the judge is biased it would be helpful if they could say so upfront!

Oh ffs.

Might as well get fundraising for the appeal because AB isn’t going to give up if the facts support her side but the judge is a TRA.

To add to NitroNine's info about the World Health Organisation's revision of ICD-10 leading to the changed categorisation from Mental Health to Sexual Health in ICD-11.

This was done entirely:

• to "reduce stigma"
• as a result of political lobbying

Ray Blanchard had some interesting things to say about this when he appeared on "The Mess We're In" (Graham Linehan's YouTube Series):

The Mess We're In Ep. #90: Ray Blanchard
20 Oct 2021

"Without question the people involved in the WHO are politicos first and clinical researchers second.

Some of them, that whose names I've seen, as being involved in decisions regarding human sexual behaviour in the, on the ICD, the document you're talking about, really have no particular credentials that I know about.

So, you know, nothing would surprise me in WHO, because I know that they have politics in mind first and foremost when they're modifying clinical categories that pertain to human sexuality, you know"

Link to this point in the video:

(Credit: found on Twitter:
mobile.twitter.com/SuspendDisbeli2/status/1474657833274822657 )

==========

A fuller explanation can be found here:

"Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations"

Geoffrey M Reed, Jack Drescher, Richard B Krueger, Elham Atalla, Susan D Cochran, Michael B First, Peggy T Cohen-Kettenis, Iván Arango-de Montis, Sharon J Parish, Sara Cottler, Peer Briken, Shekhar Saxena

World Psychiatry, Volume 15, Issue 3, Oct 2016, pages 205-221

Abstract:

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

1/5

(ps. I cannot Preview posts so apologies for any errors or messed-up formatting)

Relevant Extract (my bolding):

PROPOSED CHANGES TO F64 GENDER IDENTITY DISORDERS

Over the past several years, a range of civil society organizations as well as the governments of several Member States and the European Union Parliament have urged the WHO to remove categories related to transgender identity from its classification of mental disorders in the ICD-1151-53.

One impetus for this advocacy has been an objection to the stigmatization that accompanies the designation of any condition as a mental disorder in many cultures and countries. The WHO Department of Mental Health and Substance Abuse is committed to a variety of efforts to reduce the stigmatization of mental disorders 54. However, the stigmatization of mental disorders per se would not be considered a sufficient reason to eliminate or move a mental disorder category. The conditions listed in the ICD Mental and Behavioural Disorders chapter are intended to assist in the identification of people who need mental health services and in the selection of appropriate treatments1, in fulfillment of WHO's public health objectives.

Nevertheless, there is substantial evidence that the current nexus of stigmatization of transgender people and of mental disorders has contributed to a doubly burdensome situation for this population, which raises legitimate questions about the extent to which the conceptualization of transgender identity as a mental disorder supports WHO's constitutional objective of “the attainment by all peoples of the highest possible level of health” 55. Stigma associated with the intersection of transgender status and mental disorders appears to have contributed to precarious legal status, human rights violations, and barriers to appropriate health care in this population 56-58.

The WHO's 2015 report on Sexual health, human rights, and the law 58 indicates that, in spite of recent progress, there are still very few non-discriminatory, appropriate health services available and accessible to transgender people. Health professionals often do not have the necessary competence to provide services to this population, due to a lack of appropriate professional training and relevant health system standards 59-61. Limited access to accurate information and appropriate health services can contribute to a variety of negative behavioural and mental health outcomes among transgender people, including increased HIV-related risk behaviour, anxiety, depression, substance abuse, and suicide 62-65. Additionally, many transgender people self-administer hormones of dubious quality obtained through illicit markets or online without medical supervision 66, 67, with potentially serious health consequences 68-70. For example, in a recent study of 250 transgender people in Mexico City, nearly three-quarters of participants had used hormones, and nearly half of these had begun using them without medical supervision 71.

In spite of WHO's concerted advocacy for mental health parity 54, a primary mental disorder diagnosis can exacerbate problems for transgender people in accessing health services, particularly those that are not considered to be mental health services. Even in countries that recognize the need for transgender-related health services and where professionals with relevant expertise are relatively available, private and public insurers often specifically exclude coverage for these services 58. Classification as a mental disorder has also contributed to the perception that transgender people must be treated by psychiatric specialists, further restricting access to services that could reasonably be provided at other levels of care.

In most countries, the provision of health services requires the diagnosis of a health condition that is specifically related to those services. If no diagnosis were available to identify transgender people who were seeking related health services, these services would likely become even less available than they are now 72, 73. Thus, the Working Group on Sexual Disorders and Sexual Health has recommended retaining gender incongruence diagnoses in the ICD-11 to preserve access to health services, but moving these categories out of the ICD-11 chapter on Mental and Behavioural Disorders (see Table 2). After consideration of a variety of placement options 72, these categories have been provisionally included in the proposed new ICD-11 chapter on Conditions Related to Sexual Health.

Table 2. Classification of conditions related to gender identity in ICD-11 (proposed), ICD-10 and DSM-5

(see screenshot)

2/5

The Working Group has recommended reconceptualizing the ICD-10 category F64.0 Transsexualism as Gender incongruence of adolescence and adulthood 72 and the ICD-10 category F64.2 Gender identity disorder of childhood as Gender incongruence of childhood73. The proposed diagnostic requirements for Gender incongruence of adolescence and adulthood include the continuous presence for at least several months of at least two of the following features: a) a strong dislike or discomfort with primary or secondary sex characteristics due to their incongruity with the experienced gender; b) a strong desire to be rid of some or all of one's primary or secondary sex characteristics (or, in adolescence, anticipated secondary sex characteristics); c) a strong desire to have the primary or secondary characteristics of the experienced gender; and d) a strong desire to be treated (to live and be accepted as) a person of the experienced gender. As in the ICD-10, the diagnosis of Gender incongruence of adolescence and adulthood cannot be assigned before the onset of puberty. The duration requirement is reduced from two years in ICD-10 to several months in ICD-11.

The ICD-11 abandons ICD-10 terms such as “opposite sex” and “anatomic sex” in defining the condition, using more contemporary and less binary terms such as “experienced gender” and “assigned sex”. Unlike ICD-10, the proposed ICD-11 diagnostic guidelines do not implicitly presume that all individuals seek or desire full transition services to the “opposite” gender. The proposed guidelines also explicitly pay attention to the anticipated development of secondary sex characteristics in young adolescents who have not yet reached the last physical stages of puberty, an issue that is not addressed in ICD-10.

The proposed ICD-11 diagnostic requirements for Gender incongruence of childhood are considerably stricter than those of ICD-10, in order to avoid as much as possible the diagnosis of children who are merely gender variant. All three of the following essential features must be present: a) a strong desire to be, or an insistence that the child is, of a different gender; b) a strong dislike of the child's own sexual anatomy or anticipated secondary sex characteristics, or a strong desire to have the sexual anatomy or anticipated secondary sex characteristics of the desired gender; and c) make believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The third essential feature is not meaningful without the other two being present; in their absence it is merely a description of gender variant behaviour. These characteristics must have been present for at least two years in a prepubertal child, effectively meaning that the diagnosis cannot be assigned prior to the age of approximately 5 years. The ICD-10 does not mention a specific duration requirement or a minimum age at which it is appropriate to assign the diagnosis.

The proposed diagnostic guidelines for both Gender incongruence of adolescence and adulthood and Gender incongruence of childhood indicate explicitly that gender variant behaviour and preferences alone are not sufficient for making a diagnosis; some form of experienced anatomic incongruence is also necessary. Importantly, the diagnostic guidelines for both categories indicate that gender incongruence may be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, particularly in disapproving social environments and where protective laws and policies are absent, but that neither distress nor functional impairment is a diagnostic requirement.

3/5

The area of transgender health is characterized by calls for change in health system responses 58, 74, 75, by rapid change in social attitudes in some countries, and by controversy. As a part of this work, the Working Group on Sexual Disorders and Sexual Health received proposals and opinions from a wide range of civil societies, professional organizations, and other interested parties 72, 73. The most controversial issue has been the question of whether the childhood diagnostic category should be retained 73. The main argument advanced against retaining the category is that stigmatization associated with being diagnosed with any health condition − not just a mental disorder diagnosis − is potentially harmful to children who will in any case not be receiving medical interventions before puberty 76. A more substantive critique is that, if it is the case that the problems of extremely gender-variant children arise primarily from hostile social reactions and victimization, assigning a diagnosis to the child amounts to blaming the victim 77. This latter concern suggests a need for further research as well as a broader social conversation. The Working Group has recommended retaining the category based on the rationale that it will preserve access to treatment for this vulnerable and already stigmatized group. Treatment most often consists of specialized supportive mental health services as well as family and social (e.g., school) interventions73, while treatments aimed at suppressing gender-variant behaviours in children are increasingly viewed as unethical.

The diagnosis also serves to alert health professionals that a transgender identity in childhood often does not develop seamlessly into an adult transgender identity. Available research instead indicates that the majority of children diagnosed with DSM-IV Gender identity disorder of childhood, which was not as strict in its requirements as those proposed for ICD-11, grow up to be cisgender (non-transgender) adults with a homosexual orientation 78-80. In spite of the claims of some clinicians to be able to distinguish between children whose transgender identity is likely to persist into adolescence and adulthood and those likely to be gay or lesbian, there is considerable overlap between these groups in all predictors examined 80, and no valid method of making a prediction at an individual level has been published in the scientific literature. Therefore, while medical interventions are not currently recommended for prepubertal gender incongruent children, psychosocial interventions need to be undertaken with caution and based on considerable expertise so as not to limit later choices 59, 81, 82. The inclusion of the category in the ICD-11 is intended to provide better opportunities for much-needed education of health professionals, the development of standards and pathways of care to help guide clinicians and family members, including adequate informed consent procedures, and future research efforts.

Finally, the ICD-10 category F64.1 Dual-role transvestism − occasionally dressing in clothing typical of another gender in order to “enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change” 4 or accompanying sexual arousal − has been recommended for deletion from the ICD-11, due to its lack of public health or clinical relevance.

("Fetishistic transvestism" was also deleted from ICD-11, as part of the revision of F65 DISORDERS OF SEXUAL PREFERENCE. This is a separate section in this document dealing with paraphilias. "The Group proposed that the paraphilic disorders included in ICD-11 consist primarily of patterns of atypical sexual arousal that focus on non-consenting others, as these conditions could be considered to have public health implications".)

4/5

Comparison with DSM-5

The most important difference between the proposals for ICD-11 and the DSM-5 is that the latter has retained the categories related to gender identity as a part of its classification of mental disorders. Both childhood and adult forms of Gender identity disorder in DSM-IV have been renamed in DSM-5 as Gender dysphoria, defined by “marked incongruence between one's experienced/expressed gender and assigned gender of at least 6 months’ duration” and “clinically significant distress or impairment in social, school, or other important areas of functioning”3. Both the name of the DSM-5 condition − dysphoria − and the diagnostic criteria, therefore, emphasize distress and dysfunction as integral aspects of the condition. They are also the central rationale for classifying these conditions as mental disorders; without distress or dysfunction, gender dysphoria would not fulfill the requirements of DSM-5's own definition of a mental disorder.

In contrast, the proposal for ICD-11 is to include child and adult Gender incongruence categories in another chapter that explicitly integrates medical and psychological perspectives, Conditions Related to Sexual Health. The proposed ICD-11 diagnostic guidelines indicate that distress and dysfunction, although not necessary for a diagnosis of Gender incongruence, may occur in disapproving social environments and that individuals with gender incongruence are at increased risk for psychological distress, psychiatric symptoms, social isolation, school drop-out, loss of employment, homelessness, disrupted interpersonal relationships, physical injuries, social rejection, stigmatization, victimization, and violence. At the same time, particularly in countries with progressive laws and policies, young transgender people living in supportive environments still seek health services, even in the absence of distress or impairment. The ICD-11 approach provides for this.

A challenge to DSM-5 conceptualization of Gender dysphoria is, therefore, the question of whether distress and dysfunction related to the social consequences of gender variance (e.g., stigmatization, violence) can be distinguished from distress related to transgender identity itself83, 84. A recent study of 250 transgender adults receiving services at the only publicly funded clinic in Mexico City providing comprehensive services for transgender people71 found that distress and dysfunction associated with emerging transgender identity were very common, but not universal. However, more than three-quarters of participants reported having experienced social rejection and nearly two-thirds had experienced violence related to their gender identity during childhood or adolescence. Distress and dysfunction were more strongly predicted by experiences of social rejection and violence than by features related to gender incongruence. These data provide further support for ICD-11's conceptualization and the removal of gender incongruence from the classification of mental disorders.

Finally, there are several technical differences between the proposals for ICD-11 and DSM-5 in relation to these categories. The most substantive is that the DSM-5 diagnosis of Gender dysphoria of childhood requires a duration of only six months, in contrast to two years in the ICD-11 proposal, and does not specify a lower age limit at which the diagnosis can be applied.

=========

Links to Full Text (Open access) here: pubmed.ncbi.nlm.nih.gov/27717275/

5/5

END

Pretty upsetting that the WHO are ideologically captured along with (a large chunk of) the judiciary and frontline nhs services

Thanks fir the explainer. I had wondered why the differences between dsm5 and icd 11 proposals and now i know.

Re HW, anyone have a feel for the likely sanction? I also hate the mpts verdicts and find the process arbitrary. (if HW were to be of a different skin colour I wonder if the result would be different)

I. Think one reason she's not been as severely criticised is because the families /parents are on her side. This doesn't mean she's right though!

Anyone know if the result can be appealed?l

I think those of us who were following tribunal tweets on Twitter thought the evidence against Webberley to be damning.

This - along with the "assigned at birth" judge in the Allison Bailey case - makes me think we've been getting overconfident

I would also like to know if the chair is a medical or a lawyer. How does it normally work? Lawyer I think.

I think there is a mismatch between how we see things & how they can be perceived by others including judges, which is worth remembering. Alot of ppl on the other side followed live tweeting, and they thought it went really well, saying she was 'schooling' the court on how to provide care. Ibtelligent ppl (!) not just anime avatars who say 'lmao' alot. She was able (rightly) to defend herself and explain everything from her own perspective. She has obviously persuaded the chair by how she came across and what she said. He came to agree with her view of the treatment they do.

But still, 36 counts proved.

A bit if a tangent but as an example, Allison Bailey said she didn't want to be referred to as cis. The case is about beliefs & it's a bit like not wishing to be called an infidel, heretic, gentile or whatever. But she also said she would refer to individual tw as men because that's her belief (yes I know we think it's a fact but the other lot think it's an erroneous belief, and that's the realm that the case is in). So I don't know how that will go down with the judge. Are witnesses not allowed to use the language & framing of their own belief to call Allison cis, but they have to accept the language & framing of her belief to call them a man even if they don't believe it. Surely the witness has to be able to use their own language in giving evidence even if it's about Allison? So I didn't cheer about that when I read it in the tweets.

This is an interesting analysis of the determination...

voidifremoved.substack.com/p/no-competence-needed?s=r&utm_campaign=post&utm_medium=web&utm_source=direct

The Helen Webberley tribunal has started again. They are hearing evidence to decide whether & what the sanction or remedy should be.

Tribunal tweets have been live tweeting but I have not followed as yet so don't know what's been said.

mobile.twitter.com/tribunaltweets/status/1534218628454928384

I've been watching. The questions that the committee asked HW were quite revealing I thought. Especially in relation to the criminal conviction and working without being regulated and how would she do things differently now if faced with the same situation. They show a worrying lack of insight (which isn't a huge surprise). I can't see how the committee could possibly conclude that there was no risk of repetition....

C - took a bit longer. We have one or two questions.

P (panel member) - one area - requirement to liaise on shared care or multiple professionals.
If I understood your evidence if there’s a risk of drug interaction, that’s when sharing is important and also consent.

Q1 - is it your position that Professor Butler didn't need to know you were prescribing testosterone to pt A.

Q2 if faced with a situation in the future where pt was withholding consent, [does] the dr pt imperative override the liaison [with colleagues] imperative?

HW - is it that Prof B did not need to know abt testosterone for Pt A?

Obviously, not a yes or no answer. So all should be aware - best care all come together and collaborate - best for Pt A.

HW - In UK, we lack protocol, clinical guidelines, the only guideline is the NHS working to GIDS. UCLH and GPs - clearly said Pt A wasn’t allowed the treatment.
Prof B was already against that treatment for Pt A.
Protocol also says highly unusually, NHS care would be withdrawn.

HW - Quite unusual. I was faced I was operating different clinical guidelines,
UCSG, Endocrine Society and WPATH and I was faced a Pt who was desperate. To have that care, I feared for his mental health.

HW - It wasn’t that Prof B didn’t need to know. It was that his care would have been withdrawn. The family couldn’t afford the blocker privately. So he’d have gone through a female puberty. He knew what was the case. They [pt and his mother] didn’t want him [Prof B] to know.

HW - The reason I gave the roaccutane example. If Pt continues with PB, no interaction with [my prescription]. Might have come to light[if pt developed] facial hair & dropped voice.

But not a risk of harm if other prescriber not aware.

HW - In beginning, people are very scared. Then we discuss more collaboratively, the acute distress - when that’s the [goal]. Then it’s the time to have that discussion and Dr Deane's persuasive words - not time zero or never.

HW - In terms of future - the first priority safety of Pt - that Pt ends up with best care, whatever that best care is. It’s important to work on patient doctor relationship, know you’ve got their [confidence] will reach the best outcomes.

HW - The only time you’d break that is if at risk of harm.

My relationship with pt is utmost importance and outcome is most important. To risk breaking that in favour of a doctor doctor relationship.

HW - There have been times in my sexual health practice, where I have to break it, and I can tell you about times when I have.

P - you’ve clarified that very well. If [you have the] dilemma [of a pt] withholding consent, will you take advice from a colleague or a supervisor?

HW - I haven’t had experience of immediate danger in my transgender work. Best made with [lists types of colleagues, primary care etc] and medical defence union] even then ask is that what you would do.

HW - Have I got that right? Increased doctor communications - not just next door or on phone. Many ways [for advice online].

Grateful you clarified.

C - in 2016/17 - you spoke of large clientele - you mentioned GPs having 6k pts,. How many gender pts?

HW - You’ve picked on something which is definitely not my forte. I would be guessing 500 or maybe 1,000. Asked in
PACE interview. I don’t recall. Quite difficult.

HW - Not everybody is on medication - some accessing support or questions, accessing [counselling] Marianne Oakes and Avril Collet. Every GP has around 6k. It wasn’t that many but it was a significant number.

P - where did you get 6,000 pt number from?

HW - I think that’s what the average list is in the valleys in wales.

P Are you aware Wales have less pts than in England?

HW - No

P - you told them you’d not see new Pt. If similar situation occurs, how would you [handle it]?

I’ve learnt so much - not just dr needs to be regulated but also service. I will always make sure any service I have has the required regulation. I don't think I'd start up a new service. I‘d make sure any service would have the regulation.

P - how will you deal if it happens again. What about existing pts?

HW - I would like to think I’d never be in that situation that iId be needing to stop care. I don’t think the situation would arise again. Without making sure.

Hypothetically, if I was - I’d be faced with exactly the same situation. It’s horrible. Do I save myself or risk the care to pts. I’d like to hope. I’d never put myself in that situation.

P - were you able to get any help from any colleagues?

HW - I was heavily involved in the community.

That’s when [name] GIRES and [name] Unique write to HIW to express there were concerns - hurry up and get service registered - would be a safer outcome.

Discussing widely with colleagues and charities.

HW - I can't remember if I discussed it with my indemnity provider. They’d have had to have their treatment stopped, and I was scared of the harm that would [happen]. Even disappointment is a harm.

HW - This pt cohort have a very high rate of self harm and suicide. I thought I could help and can’t. Real risk of harm. I’ve seen and experience suicide on this pt group - I have to give big consideration to.

C - I realise the conviction is about managing the medical agency without being registered. Timing questions - HIW interview - some confusion about what company needed to be registered, and in matrix reference as to which provision to register under.

Q1 - to what extent if at all do you say problems over confusion one which company or relevant provision played a part in not applying earlier.

HW - No. Explain timeframe. Aug 2016 - crikey let me sort it out. I made inquiries. Who is service provider. Well I am. It needs to be a company. Yr websites need to be registered. What are the companies?

HW - There was confusion - I had company names mywebdoctor and Gender GP - but not trading. So we started 2 applications and then some time into it they said not trading.

HW - And I said I have Online GP Services ltd , which I used for tax - so new application went in. Confusion around the clinic and agency - 2 sets of legislation and HIW guidelines. I was seeing pts in Abergavenny. Newport and London. So I applied as a clinic.

HW - It wasn’t until April 2107 that I had notice of proposal to
refuse registration as 1) not fit and proper person and 2) does not fit scope of registration - not a clinic.

HW - I sought advice, discussion between my representatives and HIW - does this mean it’s an agency - eg offering flu jabs. Not fixed premises. As time went on - miscommunication - formal notice in August 2017 didn’t arrive. Went to my representative.

HW - Can I come and speak to you re agency or clinic? Kate Chamberlain HIW said no need for a meeting. If situation has changed, put in new application.

HW - for me I still didn’t know. I realised I wouldn’t get registration and I needed to secure safety of my pts. I think if application had gone forward in August - it would have been accepted as the other difficulty would not have come to light.

C - para 28 allegations March 16 to Feb 18 - you are saying you might have been registered?

HW - yes. 10 March is first letter. First letters said we are working out so you can continue while we work towards registration. So I believed we were working towards registration.

C - in term of sentencing remarks, I think subject of observations you made in a podcast. Yr complaint is your case wasn’t taken into account, the judge understanding why you were continuing to provide treatment, why you continued to look after yr cohort?

HW - I don’t think I’ve said he didn’t take it into account. He said in terms did I break the law yes - definitely. But reasons why I did it, this wasn't a charlatan, I was helping pts. Pts would have come to harm because of lack of service elsewhere.

HW - But reasons why I did it, this wasn't a charlatan, I was helping pts. Pts would have come to harm because of lack of service elsewhere. But his job - a service that require registration.

C - thank you. Any question arising from trib?

SJ - interesting issue on status of sentencing remarks. Judgment doesn’t bind a trib in context, but here these charges were pleaded to and admitted before the trib. Weight and consideration LJ Mostyn in a case - now in course of trib questions, touches on those.

Reconcile approach adopted by court proceedings and evidence from HW during the trib.

I’d want to check various matters.

C - So we need to adjourn for just under an hour to 2.30pm.

(from tribunaltweets twitter account)