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Dr Adrian Garfoot

Volume 407: debated on Wednesday 25 June 2003

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4 pm

I am conscious of the fact that this is the Minister's first appearance on the Front Bench in Westminster Hall with her current brief. [Interruption.] It seems that it is not. Well, I should like to congratulate her on her move anyway—she has been kept busy. I had the pleasure of seeing the Minister in action when she was at the Department of Trade and Industry and was most impressed by what I saw. I wish her well with her new post.

I should like to examine not only the case of my constituent Dr. Adrian Garfoot, but the Government's wider drugs policy. The tragic, sad case of Dr. Garfoot has received a great deal of local publicity but must be aired in Parliament, at least to record what marvellous work he did and what has happened since.

Dr. Adrian Garfoot was trained at the Royal Free hospital school of medicine. He was a general practitioner in Great Yarmouth and Kilburn, and during that time he developed a deep interest in and awareness of the drugs crisis and the plight of drug addicts. In 1990 he opened the Laybourne clinic in east London. He was brought up in Norfolk and his father is the well known Methodist minister in King's Lynn, the Reverend John Garfoot.

The Laybourne clinic soon became a renowned centre of excellence. During the 10 years from 1990, the clinic treated more than 1,200 patients, the typical age of whom was 37 and a half, which was substantially older than the average age of patients in NHS drugs clinics, which was 29. The overwhelming majority of Dr. Garfoot's patients were long-term addicts who had been injecting themselves for anything between 20 and 30 years, and maintaining their habits through crimes, such as theft, burglary, dealing in drugs, prostitution and so on.

4.2 pm

Sitting suspended for a Division in the House.

4.16 pm

On resuming—

I had made a bit of progress in my speech; I had spoken for two minutes when the Division was called. I had said that the overwhelming majority of the patients whom Dr. Garfoot was treating had been injecting themselves for between 20 and 30 years, and had maintained their drug habit through a life of crime. Most had already spent lengthy periods in prison; at one point, it was calculated that 270 patients had, between them, spent more than 600 years in prison—a pretty staggering figure. Many had been committing up to four crimes a day—well over 1,000 crimes a year.

However, what is interesting about the Laybourne clinic is that the recidivism rate for the drug addicts at the end of treatment was only 7 per cent., whereas for those coming out of the Prison Service, recidivism was more than 50 per cent. Dr. Garfoot was able to rebuild the lives of many people, deal with serious medical conditions and restore family relationships. Most important, he enabled those people to get on with a normal life and keep out of trouble. I calculated, with the help of several independent experts, that Dr. Garfoot probably saved the country more than £10 million. Many testified that he saved their life in the process.

I shall mention some of the achievements of addicts who underwent treatment at the Laybourne clinic. One reformed addict ended up playing the violin in an orchestra, another founded a national charity, another completed an MA degree in computer studies at the age of 30, several ran in the London marathon and two gained places at medical school. Those are remarkable achievements.

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

Dr. Garfoot had a prescribing policy that was based on harm reduction and non-coercive user-friendly protocols. Above all, he used his clinical independence. What he was putting in place were voluntary and supervised withdrawal programmes, and, yes, methadone was often used. It is interesting to examine the latest May 2003 guidelines from the National Treatment Agency for Substance Misuse. When they refer to injectable prescribing, they make it clear that the recommended daily dosage of between 60 and 120 mg is within the effective therapeutic range. Certainly, what Adrian Garfoot prescribed was within that limit. No patient died of an overdose during his time at Laybourne clinic. There was one suicide when medication was seized by the police, and the result was that the local hospital refused help. That was, of course, tragic, but no patient died from overdosing.

The doctor's philosophy was one of maintenance prescriptions with gradual reductions. Let us not forget that many of his patients had been on 12 or more failed oral treatment courses over periods of addiction of up to 25 or 30 years. It is worth examining exactly what the National Treatment Agency for Substance Misuse has said in its recent guidelines and press releases. Professor John Strang, the chair of the NTA heroin expert group, said:
"The message for specialist clinicians is that yes, injectable heroin and injectable methadone have a role to play in the treatment of drug misuse—but it's a limited role and one that needs to be developed very carefully".
The NTA's press release states that the guidance now offered is
"based on a fresh examination of the latest national and international evidence and best practice and represents a consensus of expert opinion on injectable prescribing".
The summary to the guidelines states, first, that
"injectable maintenance treatment is most appropriate for long-term heroin addicts who have not responded to oral maintenance treatment";
and secondly, that
"where injectable heroin and methadone maintenance prescriptions are provided as part of a comprehensive treatment programme, both may have beneficial effects on health, social functioning and crime reduction".
Those guidelines entirely sum up and endorse what Dr. Garfoot had been doing in his clinic.

There was no evidence at all, during Dr. Garfoot's time at the clinic, of any diversion of drugs. He was always incredibly assiduous in preventing the diversion of prescribed drugs to the wider community. That was recognised on a number of occasions when he had clashes with the authorities. Back in 1992, there were complaints. Later there were further allegations, and he was summoned before a Home Office misuse of drugs tribunal on charges of alleged irresponsible prescribing. There was a disgraceful raid on the Laybourne clinic that was heavily criticised at the time, in Parliament among other places.

After the analysis of 1,500 prescriptions, there was no sign of any discrepancies whatever. Dr. Garfoot was cleared by the Home Secretary, and there was also a finding of "abuse of process" against his accusers. The cost of that case ran into thousands of pounds. In 2000, the interim orders committee of the General Medical Council imposed serious restrictions on Dr. Garfoot. He then went to the professional conduct committee of the GMC in September 2001, and there was a finding that he should be erased from the medical register on the grounds of serious professional misconduct. He took the decision to appeal to the Privy Council, and unfortunately lost. It is worth pointing out that more than 20 other doctors were also struck off in 2001.

It goes without saying that this has been a total disaster for Dr. Garfoot. I shall return to that in a moment. It has, however, been an even bigger disaster for the patients of that clinic. The clinic carried on for a while after Dr. Garfoot left, but it was unable to continue providing the same level of treatment. A number of patients left. Six of those have subsequently died. Many others have gone back into a life of crime and prostitution and are now back on the conveyor belt that leads to crime, inadequate treatment and back to crime again. There have been six tragic deaths as a consequence of that. I could outline all those, but the hon. Member for Bolton, South-East (Dr. Iddon) has mentioned them in a previous debate in the House.

One should also consider the tragedy affecting Dr. Garfoot. He has been struck off. It is extraordinary that in Norfolk, in my constituency, where there are many GP shortages—in the Heacham, Dersingham and Snettisham practice there are two—Dr. Garfoot is living in Gaywood with his father, a Methodist minister, and doing his best to find ways of earning a living, although he is finding it difficult. He would love to do locum work and help in the community.

The extent to which the goalposts have been moved is absurd. Dr. Garfoot could have been reinstated after 10 months, until the new guidelines were issued by the Secretary of State in April 1999, when that period was altered to five years. That is the case, even though the GMC dealt with the alleged offences in a tribunal that was, in my opinion, flawed in many ways—and that decision was upheld on appeal by the Privy Council, with procedures that were likewise flawed. The alleged offences related to events and incidents that took place before the Secretary of State changed the guidelines.

There is an overwhelming case for natural justice; for the Secretary of State to say, "Look, the old 10-month rule can apply to those doctors whose alleged offences were complained of and dealt with by the GMC before the guidelines were changed." I ask the Minister to consider carefully the situation of doctors like Dr. Garfoot, who is badly needed back in the community dealing with drug addicts. That is vital. He also needs to earn a living. It makes no sense for him to be sitting around not helping patients in the community when we have GP shortages.

There are a number of flaws in the way in which the GMC conducted the hearings and the Privy Council conducted its hearing. I will not deal with those now, because they are detailed and complicated. I shall give just one example. One of the allegations made to the GMC was that Dr. Garfoot's patients were very different from others and difficult to treat, but it heard from non-expert witnesses, who gave evidence that I find totally unconvincing. The fact is that many of Dr. Garfoot's patients were much older than those attending NHS clinics. Consequently, they had a longer drug-taking history and a much more severe set of conditions. None of the so-called expert witnesses examined during the hearings had any contact with people who had seen the patients. They did not look at any independent evidence that was made available to the hearing. That was just one example of how slapdash the committee was, and how unprofessionally, in my judgment, it dealt with Dr. Garfoot. There were many other procedural flaws, which I will not trouble the Chamber with now.

I would like the Minister to say clearly that she will consider this case. We have a drugs crisis in this country. The Government are making some progress, but we dearly need people like Dr. Garfoot to be rehabilitated from the appalling slurs on his character. He needs to be allowed to go back into general practice, and the drugs communities in this country certainly need him to set up another clinic like the Laybourne, which did so much to help its patients and saved so many lives.

4.29 pm

I will not hold up the Chamber for long.

We must remember that this doctor was practising before the National Treatment Agency for Substance Abuse was set up. Only 6 per cent. of heroin addicts were in treatment at that time and they were mainly desperate people. It is not often that I would defend a doctor practising in the private sector, but in this case I do. Without Dr. Garfoot and the 18 or 19 other doctors who have similarly been struck off, we would have had some very chaotic heroin addicts wandering around places such as London. Everything went wrong after the Shipman murders. He was correctly convicted of misusing opiates, but the General Medical Council then set up the interim orders committee, which started to pick off those doctors one by one. That has been very unfair. Will the Minister look at the case of Dr. Adrian Garfoot and the procedures adopted by the General Medical Council to pick off those private doctors one by one?

There has been nowhere else for such patients to go. They are chaotic patients. I know Dr. Adrian Garfoot personally and I defended him at the interim orders committee of the General Medical Council, which shows how strongly I felt about his case. Dr. Garfoot told me that one of his patients came at him with an axe one night. He talked him down, got him stabilised and kept him that way.

The national health service was not—at that time—capable of dealing with that type of patient. I do not believe that it is capable of doing so now. We are talking about long—standing heroin addicts, many of them middle-aged. As soon as the doctors, including Dr. Adrian Garfoot, stopped practising, one by one their patients began to die. Within a few days, certainly under two weeks, at least three of Dr. Garfoot's patients were dead because he was no longer available to treat them. I make the plea again to the Minister to look at this case, but also to examine why the General Medical Council is taking that action.

4.31 pm

Only 5 per cent. of all drug addicts currently receiving treatment are being treated by doctors, according to a response that I received from the Department of Health only two weeks ago. I have three points to make. The first is that this is an individual case, but at the heart of it is the philosophy that we have in this country about drugs treatment. In congratulating the Minister on her new post, I urge her to look at a fundamental overhaul of the National Treatment Agency for Substance Misuse and the philosophy behind it. I question why there is no medical majority on the agency's board, which I think is a fundamental flaw.

Secondly, only two weeks ago a GP in my constituency, where we have above the average number of heroin addicts, told me that she was not prepared to prescribe, because she was terrified of being struck off. That is something that I have heard repeatedly throughout the country. Instead, social workers and psychiatrists are taking medical decisions in the place of GPs.

My third point is that, at a conference on this subject attended by 200 people three weeks ago, the prescribing of methadone cited ranged from 25 to 50 mg. The Government recommend a minimum dose of 60 mg. The Dutch suggest that 80 to 100 mg should be the minimum dosage prescribed. That is happening under our system at present and we must look at that, rather than penalising those GPs who are valiantly battling to keep people out. The alternative happens in my constituency. The drug action team and the treatment agency have achieved 0 per cent. success. They cannot cite one person that they have successfully treated during their existence. That is the fundamental flaw. The case, which has been most eloquently put forward, has much wider implications.

4.33 pm

I congratulate the hon. Member for North-West Norfolk (Mr. Bellingham) on securing a debate on this important topic and my hon. Friends the Members for Bolton, South-East (Dr. Iddon) and for Bassetlaw (John Mann) on their contributions. I hope that I can reassure the hon. Gentleman and my colleagues that the Government are committed to tackling drug misuse with all the resources at their disposal.

First, I must make it clear that I cannot make comments on the individual case of Dr. Garfoot. I understand that the case has been subject to disciplinary proceedings at the General Medical Council, as the hon. Member for North-West Norfolk mentioned. It was subsequently looked at by the Privy Council. Therefore, it would be inappropriate for me to comment or to intervene.

I understand, however, that the issue underlying the case was one of prescribing to drug misusers. I will give more detailed information on what is being done by the Government to support those GPs and other professionals who are involved in that activity. The remarks of my hon. Friend the Member for Bassetlaw are relevant to the concerns that people have expressed.

In Government, we recognise the challenges for health professionals in engaging with drug misusers. Many of those drug misusers have chaotic lifestyles associated with their addiction. The benefits of successful engagement with treatment services are enormous, both for the individual and for their community. We have no doubt that treatment works, and that view is supported by research. The national treatment outcome research study—the most important United Kingdom research into drug treatment—shows the enormous benefits to individuals who have completed treatment. We know that most drug misusers who are retained in treatment show a significant improvement in health and social functioning, and reductions in criminal activity and drug use. In addition, from an economic perspective, the findings show that every£1 spent on treatment saves£3 of expenditure within the criminal justice system.

We are the first Government to allocate substantial funding for the purpose of treating drug misusers. In this financial year alone, the pooled drug treatment budget has risen to £243.1 million, allowing an average increase to primary care trusts of 23 per cent. That supplements minimum increases of 30 per cent. in the previous financial year. I am pleased that Norfolk primary care trust has benefited greatly from the increased funding, receiving an increase in its pooled drug treatment budget of 33 per cent. in 2002-03, with a further increase in excess of 20 per cent. in this financial year.

As the hon. Member for North-West Norfolk must be aware, the additional funding for treatment has a target attached to it, which is to double the number of drug misusers in treatment by 2008. There is also an interim target. Although there is no room for complacency, I am pleased that the latest figures show that we are currently on track to meet that target. We also recognise that it is not enough to get more people into treatment; we must also improve the quality of treatment and, for that reason, have also set a target to increase the numbers who successfully sustain or complete treatment programmes. To support the Government's commitment to increasing the quality and availability of drug treatment services, in April 2001 we set up the National Treatment Agency for Substance Misuse, which has the specific remit of driving forward improvements in the quality, availability, accessibility and effectiveness of drug treatment in England.

I listened carefully to the points made by my hon. Friend the Member for Bassetlaw, and his comments on the treatment services available through his local drug action team. I give him an undertaking to look closely at what is happening in his area. He has been a passionate advocate of the need to tackle the problem of drug misuse in his community.

However much money the Government put into drug treatment services, it can be effective only if we can meet the demand for treatment in every area of the country. One of the biggest barriers to increasing both the quality of, and access to, drug treatment is the need for sufficient trained staff to work within treatment services. That should not surprise us, as shortages of staffing are experienced in many other areas within the NHS. The National Treatment Agency for Substance Misuse is implementing a work force strategy to encourage professionals to work in drug treatment, and I am pleased to inform you, Mr. Deputy Speaker, that drug action teams have reported an increase of 1,088 people working in drug treatment services in 2002-03 and are projecting a further 680 between 2003-04. That is ahead of expectations.

The hon. Member for North-West Norfolk will appreciate how important it is that the medical profession is fully trained to respond to patients with drug problems. The Royal College of General Practitioners has been funded by the Government, with a total of £3 million being made available to provide accredited training for GPs and other health care professionals to help them in their work with drug misusers. In the first year, 440 GPs completed that course, and with the additional funding that the Department of Health has made available, more than 1,000 health care professionals will have completed the course by the end of this year. I am particularly pleased that the course has been adapted to allow other groups supporting primary care—such as pharmacists and nurses—to take part.

To ensure that treatment is available to those who need it, we must also reduce the time that anyone who needs drug treatment has to wait before that treatment begins. That is crucial, as a delay in being able to offer treatment can lead to the drug user losing their motivation to enter treatment, with the result that, by the time the place is available, they are no longer interested and it is a missed opportunity. That is why the NTA set maximum waiting time targets against which DATs will be measured.

I should say a few words about prescribing, as hon. Members have focused on it. We place importance on the role of safe and effective prescribing in the delivery of drug treatment services, and that is particularly pertinent here. Research evidence clearly shows the effectiveness of prescribed opiate substitutes to replace the need for illicit heroin. Oral methadone maintenance treatment has the strongest evidence base in the treatment of heroin addiction in order to reduce harm and is recommended in Department of Health expert guidelines on the clinical management of drug misuse and dependence. The guidelines also include recommended dosages of methadone and other treatments, based on the evidence of their effectiveness.

We recognise that health professionals require support when delivering services to drug misusers. That is why the various initiatives that I have mentioned have been put in place. In addition, the NTA and Department of Health are currently developing support networks for specialists in the field.

We recognise that, while stable abstinence is the preferred goal of treatment for opiate addiction, patients may require prolonged maintenance treatment with oral opiate substitute medications as part of an overall package of care. A small number of heroin users who require treatment are currently stabilised on injectable methadone or heroin. That is accepted clinical practice in the UK in a group of about 350 severely dependent heroin addicts who have not responded to treatment and care with oral medication.

If I had had more time, I would have elaborated on this point in more detail. The Minister is now referring to the NTA recommendations on prescribing contained in the report published in May. If those guidelines had been in place when Dr. Garfoot went before the GMC, surely the outcome would have been different. I am not asking the Minister to comment on a specific case, but a number of doctors have been judged on the established thinking and philosophy at the time in cases of so-called prescribing offences, but the world has moved on. It is vital to bear that in mind.

I should be grateful if the Minister would touch on one other point in the closing few minutes. Could she consider the possibility of the Secretary of State examining the cases of the 21 doctors, who in the past have been struck off for only 10 or 12 months rather than five years?

The hon. Gentleman is trying to tempt me down a path that he knows I cannot go down. I have already said that I cannot comment on the judgment that was made and the GMC's decision. That is a matter for it, as I am sure the hon. Gentleman is aware.

The decision to prescribe heroin is based on the clinical judgment of the prescribing doctor, who must be licensed for that purpose. The Department of Health's clinical guidelines recommend that it should be initiated by a specialist practitioner.

In the last year, at the request of the Department of Health and the Home Office, the NTA has convened a consensus group of national and international experts to help it to develop guidance for practitioners on injectable heroin prescribing and to assist local DATs, commissioners and service providers. As a result of that work, the NTA issued guidance on the prescribing of heroin earlier this month.

I appreciate that the prescribing of heroin raises some concerns with those who believe that the aim of Government policy is substantially to increase the number of drug misusers who are prescribed heroin. In fact our aim is to ensure that the small number with a clinical need for heroin treatment can access it.

Local DATs and commissioners of services, including primary care trusts, are responsible for assessing local needs for GP involvement. That includes such issues as supervised consumption schemes, availability of the range of opiate treatments and the most appropriate service configuration.

I have described in detail how the Government have gone about providing drug treatment and guidance and training for doctors. While I cannot comment on the individual case, in the rare and unfortunate event that a medical practitioner appears to have failed to maintain the high standards expected of their profession, they are likely to be suspended and investigated by the GMC's professional conduct committee, an independent process over which, quite properly, I have no influence. It exists to ensure we can expect the highest standards from our medical practitioners.

It being fifteen minutes to Five o'clock, the motion for the Adjournment of the Sitting lapsed, without Question put.