Wednesday, February 1, 2012

Day 23 GMC Fitness to Practice hearing for Andrew Wakefield



Wednesday 15 August 2007

Regents Place, 350 Euston Road, London NW1 3JN

Chairman: Dr Surendra Kumar, MB BS FRCGP

Panel Members: Mrs Sylvia Dean
Ms Wendy Golding
Dr Parimala Moodley
Dr Stephen Webster

Legal Assessor: Mr Nigel Seed QC


WAKEFIELD, Dr Andrew Jeremy
WALKER-SMITH, Professor John Angus
MURCH, Professor Simon Harry


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


MS SALLY SMITH QC and MR CHRIS MELLOR and MR OWAIN THOMAS of counsel, instructed by Messrs Field Fisher Waterhouse, solicitors, appeared on behalf of the General Medical Council.

MR KIERAN COONAN QC and MR NEIL SHELDON of counsel, instructed by Messrs RadcliffesLeBrasseur, Solicitors, appeared on behalf of Dr Wakefield, who was present.

MR STEPHEN MILLER QC and MS ANDREA LINDSAY-STRUGO of counsel, instructed by Messrs Eastwoods, Solicitors, appeared on behalf of Professor Walker-Smith, who was present.

MR ADRIAN HOPKINS QC and MR RICHARD PARTRIDGE of counsel, instructed by Messrs Berrymans, Solicitors, appeared on behalf of Professor Murch, who was present.


Page No





THE CHAIRMAN: Good afternoon, everyone. Ms Smith, I know that you have been involved in a lot of legal argument this morning.


THE CHAIRMAN: Where are we now?

MS SMITH: Sir, may I first of all thank the Panel very much indeed for their patience this morning. I do realise that it must have seemed like a very long gap. There were a considerable number of matters to discuss, and I am pleased to say that having discussed them all it has been very, very helpful and indeed time saving in relation to matters that we are putting before the Panel. So, as I say, I am grateful for your patience. As you know, the reason that we did not have a witness today was for this very reason, because we were anticipating that unavoidably we would be taking a little while.

Sir, the next thing that I propose to do with you is to make an application to read a statement from Dr Clifford Spratt. The reason I am making the application to read is on the same basis as one of the statements that has already been read, and that is on the basis that he is unable and unavailable to give evidence because of his ill health, not because is agreed between the parties. I am going on this occasion simply to read to you the two relevant medical reports. They come from Dr Spratt’s GP, who is a Dr McBride, who practises from XXX. It is dated 1 July 2007 and it is addressed to Miss Emmerson, who is my instructing solicitor at Field Fisher Waterhouse.

THE CHAIRMAN: Are we going to be provided with copies?

MS SMITH: I am not going to provide you with copies, sir, because they contain some extraneous material which is not relevant.

THE CHAIRMAN: Before you read, just to make sure, can I ask the views of the defence – Mr Coonan, Mr Miller and Mr Hopkins – on what Ms Smith has just suggested.

MR MILLER: Sir, may I suggest that Ms Smith reads the medical evidence first, because that obviously is the condition precedent to asking you to allow the evidence to be read rather than calling the witness. Perhaps she could read that into the transcript.



“Dear Miss Emerson

Re. Dr Clifford Spratt, DOB 19-02-44

Dr Spratt has shown me your letter to him of 23rd May 2007 and he has brought me up to date regarding the assistance he has been giving you over the past three months with some three witness statements. …

I confirm that Dr Spratt has been my patient for many years and we know one another well. He has moderately symptomatic ischaemic heart disease, with a past history of myocardial infarction and subsequent angioplasty and stenting, following a prolonged and very difficult time in his working life. More recently he has developed maturity-onset diabetes as part of a familial metabolic syndrome, with associated ischaemic heart disease. Most significantly in this is a paternal history of sudden cardiac death at age 63.

For these reasons, with my support, he took early retirement in early 2006 from his very taxing consultant paediatric post at XXX. Although he is responding to the continuing use of medication, he remains at high risk of further cardiac complications.

In my opinion, in light of his current state of health and his very significant family history, he is not medically fit to undergo further potentially stressful direct legal examination in the pursuit of your case before the General Medical Council and I have given him firm advice not to agree to do so.

Yours sincerely” –

and that is signed by Dr McBride.

Sir, just so that you know the context, Miss Emerson wrote making an enquiry as to whether it would be appropriate for the GMC to have a consultant opinion on Dr Spratt rather than the general practitioner’s letter, or in addition to the general practitioner’s letter, and she received this reply. It is again from Dr McBride, dated 15 July 2007:

“Dear Miss Emmerson

Following our telephone conversation I write to confirm that at present Dr Spratt is not under the care of a cardiologist and that I am the sole medical practitioner responsible for his care. XXX has in recent years had an unsatisfactory situation of cardiology cover with locum consultants and, although quite recently a new full time cardiologist has been appointed, he has not seen Dr Spratt and has no knowledge of his case. I am therefore in the best position to advise you … and it is my opinion that it would be prejudicial, potentially seriously so, to his health to have to undergo cross-examination at the hearing or by video link.”

That again is signed by Dr McBride. So, sir, it is in those circumstances – and I know it is difficult to take in something that has simply been read out – you will recall the history of serious heart condition leading to interventional procedures, and with a paternal history of sudden cardiac death at age 63. This general practitioner says that Dr Spratt’s health is such that it is not appropriate for him to give evidence, and in those circumstances I make the application that I read the statements.

THE CHAIRMAN: Thank you. Mr Coonan?

MR COONAN: Sir, just a couple of observations. Of course we have had the advantage of seeing the medical evidence beforehand, and we are not in a position to go behind that. That being the case, we take the view that the evidence is, as a matter of law, admissible before this Panel.

However, it would have been the case that we would have wished to ask questions of Dr Spratt. So the position is, although the Panel may receive this evidence, we do not accept the accuracy of the evidence as a whole, and as the case unfolds you will see where there may be differences. But ultimately, as in the case of Mr Phipps, it will fall to the learned Legal Assessor following submissions, I have no doubt, to give you appropriate advice as to the weight to be attached to this evidence in the light of other evidence.

Sir, that is our position on behalf of Dr Wakefield.

THE CHAIRMAN: Thank you. Mr Miller?

MR MILLER: Sir, my position so far as Professor Walker-Smith is concerned is that it is our wish that Dr Spratt should give live evidence before this Panel, because we wanted to have the opportunity to cross-examine him on a number of matters which are not contained in his written statement. His evidence, as Mr Coonan said, is not agreed and not admitted by the defence, but we recognise that the GMC has satisfied the terms under section 116 of the 2003 Act in relation to a witness who is unfit to attend because of his bodily condition, and therefore it would be open to you to permit his evidence to be read, with appropriate directions in due course being given to you by the Legal Assessor about the weight to be attached to it.

Sir, you will recognise that we have been deprived of the opportunity of cross-examining Dr Spratt, and that position cannot be completely remedied by simply having his statement read to you; but it can be partly addressed by introducing further correspondence between Dr Spratt and Field Fisher Waterhouse and between Dr Spratt and Professor Walker-Smith, which we propose to do. We all consider that it is better to introduce that correspondence, and I shall introduce it sometime in the course of next week, so that that correspondence can be put in its proper context; so I put a marker down as to that. There will be further correspondence that will be given to the Panel, and it is probably better to wait until other witnesses give their evidence before I ask the Panel to have a look at it.

THE CHAIRMAN: Thank you. Mr Hopkins?

MR HOPKINS: Sir, as you will have ascertained, Dr Spratt’s evidence does not impact on the allegations that Professor Murch faces, and therefore we have no observations.

THE CHAIRMAN: Ms Smith, you have heard the observations from all three counsel for the defence. You have seen that they have expressed their reservations, but there is no objection to the admissibility of this evidence, and I am sure in due course of time the Legal Assessor will advise on the weight that should be given to this part of the evidence.

MS SMITH: Thank you, sir.

In those circumstances I propose to read Dr Spratt’s three statements – his main statement and two very short supplementals. Sir, he does refer in them to medical records, which I would like to take you to. Happily, I think I am right in saying, they are all in the same bundle, and that is in the records of Child 9. You should have a volume of local hospital records, volume 2 – there are two volumes and you need the second volume for XXX General Hospital. While you are doing that I will ask Miss Emmerson to hand round copies of the statements.

THE CHAIRMAN: Ms Smith, there is no paginated number on this statement, so are you advising us to put it in the bundle of papers or are you going to ask us to give it a separate number?

MS SMITH: It should have a separate exhibit number. It will be C9, I am told.

THE CHAIRMAN: So the statement from Dr Henry Clifford Spratt will be C9.

MS SMITH: There are three statements, sir, but I would think they could all go in under C9 – three statements from Dr Spratt. (Documents handed and so marked).

Sir, the first one that I am going to be reading, which is the one which exhibits the medical records – which I will go to in due course – is the main one, dated 12 May 2005.


“I, Dr Henry Clifford Spratt will say as follows;

1. I hold the medical qualifications MD, FRCP, FRCPCH and have held the post of Consultant Paediatrician at the General Hospital since 15 September 1978.

2. I came to know Professor John Walker-Smith first by reputation in the mid-1970s, and later personally, as a trusted senior colleague and friend from about 1980. I have a very high opinion of his integrity and clinical ability in the sub-speciality of Paediatric Gastroenterology.

3. In that capacity, I have referred several patients to him for expert medical advice over the years, with excellent outcome; and I would say that although we meet infrequently nowadays, especially since his retirement 5 years ago, we know one another well.

4. I received a letter from Professor Walker-Smith dated 11 September 1996 which I considered was an invitation to refer a patient of mine, resident in XXX, [Child 9], to his clinic in London. I attach this letter as exhibit ‘CS1’.”

That is in the local hospital records, volume 2, at page 182. I do not propose to read them all out, but I will just refresh your memory as to this one. It is dated 11 September 1996, from Professor Walker-Smith to Dr Spratt:

“We recently have become aware of a syndrome of enteritis and disintegrative disorder or autism. We have in fact investigated two children so far and during treatment they both had evidence of bowel inflammation. Whether this relates to Crohn's disease or whether it is related to measles immunisation or measles itself is quite unclear. However, I have heard from Dr Wakefield that there is a child called 9 who is resident in XXX whose parents would be quite keen for us to investigate the child in our procedure. I am just wondering whether you think that this is at all appropriate. If you felt it appropriate I would be happy to see the child.

Just in case you may be interested, I am enclosing a copy of Dr Wakefield’s detailed proposal. I look forward to hearing your comments.”

Then reverting to the statement at paragraph 4:

“5. In that letter, Professor Walker-Smith informed me that he and his team had recently become aware of a syndrome of enteritis and disintegrative disorder or autism, and that they had already investigated two children who proved to have evidence of bowel inflammation.

6. From the letter dated 11 September 1996, it was my understanding that Professor Walker-Smith had been informed of [Child 9]’s case by Dr Wakefield, who was one of his colleagues, and that the child’s parents had already expressed a willingness to attend with their child, for medical investigations, at the Royal Free Hospital.

7. The letter dated 11 September 1996 was accompanied by a copy of a protocol for related research which Professor Walker-Smith and Dr Wakefield, and others, were contemplating at the time, in which [Child 9] would be involved. The protocol was entitled. ‘A new syndrome: enteritis and disintegrative disorder following measles and measles/rubella vaccination?’. I attach this protocol as exhibit ‘CS2’.”

That, sir, follows on immediately from the letter that you have been looking at and is at page 183. It is, of course, a document with which you are familiar. I do not propose to read any of it.

“8. I decided to accept the opportunity to refer my patient, who had severe autism, which in my view was of unknown causation.

9. Consequently I wrote to Professor Walker-Smith on 25 September 1996 telling him that I would follow his advice whether or not to refer [Child 9] to Dr Wakefield’s service. I attach this letter as exhibit ‘CS3’.”

And continuing in the same bundle, but going back, that is at page 181. I will just give you a moment to look down the letter. (After a pause) Then going on to paragraph 10:

“10. After my initial exchange of notes with Professor Walker-Smith in September 1996, I heard again from him again about six weeks later when I received a letter from his clinic dated 8 November 1996. I attach this letter as exhibit ‘CS4’.”

That, sir, is at page 180. It is a letter from Professor Walker-Smith dated 8 November.

“I duly saw [Child 9] in the outpatients. From a gastrointestinal point of view it is interesting that he does pass 1 loose stool a day which in fact seems to be his pattern from the age of 2. He also has screaming attacks which are clearly related to food which his parents attribute to abdominal pain, it is difficult to interpret this. As you know his diet has become severely limited but despite this he is gaining weight and growing to above average with height and weight both above the 90th centile. We have now seen several children with autism and gastrointestinal symptoms, all of whom on gastrointestinal investigation have proved to have some kind of bowel inflammation. It is quite difficult to relate this directly to autism, Dr Wakefield as you know, believes that immunisation may play some part, although I remain neutral on this issue for the moment. However the parents are keen that we should endeavour to investigate [Child 9], and I have therefore arranged for him to come in to have a colonoscopy. He will be admitted on the 17th November we will then be endeavour to follow this by barium meal and follow through and also to do a repeat lumbar puncture. We will let you know the results of these investigations.”

Reverting to the paragraph:

“In the letter, Professor Walker-Smith told me that he had seen my patient in outpatients. He described [Child 9’s] symptoms and told me that his group had now seen several children with autism and gastrointestinal symptoms, who on gastrointestinal investigation had proved to have some kind of bowel inflammation. He further informed me that Dr Wakefield believed that immunisation might play some part in the relation between the bowel inflammation and autism, but that he remained neutral on the issue.

11. Professor Walker-Smith also informed me that [Child 9’s] parents were keen that the group should investigate their child and that he would be admitted on the 17 November for colonoscopy followed by a barium meal and a repeat lumbar puncture.

12. I heard again from Professor Walker-Smith’s clinic when I received a letter from Professor Walker-Smith dated 31 December 1996. I attach this letter as exhibit ‘CS5’.”

That, sir, is page 179 of the medical records dated 31 December.

“[Child 9] was duly admitted. Endocrinology revealed a marked increase in size and number of prominent lymph nodes in the terminal ileum ie. lymphoid nodular hyperplasia. The colon was endoscopically normal except for an area at the hepatic flexure which was slightly erythematous.

Histologically there was an increase in chronic inflammatory cells throughout the colon with a moderate increase in intra-epithelial lymphocytes.

Other investigations were however normal and are being collected and you will have a discharge summary soon.

Our diagnosis is indeterminate colitis with lymphoid nodular hyperplasia.

A therapeutic trial of Mesalazine (Asacol) may be worthwhile.

We have now studied seven children all of whom have had some evidence of enterocolitis and disintegrative disorder following MMR. Two of these may have Crohn's disease. One of these has improved significantly on enteral feeding.

Clearly this is a difficult group of children and our work is only beginning but we will keep you informed.

I wonder if you have seen any other similar cases in XXX.”

Reverting to the statement:

“He informed me that [Child 9] had been duly admitted to the Royal Free Hospital. The letter informed me about the results of [Child 9’s] investigations, and that his diagnosis was ‘indeterminate colitis with lymphoid nodular hyperplasia’. I was also informed that the group had now studied 7 children all of whom had some evidence of enterocolitis and disintegration disorder following MMR.

13. Professor Walker-Smith also enquired as to whether I had seen any similar cases in XXX.

14. I received a further letter from Professor Walker-Smith’s clinic dated 14 January 1997 which was signed by a Register, Dr Mohsin Malik. This letter was in the form of a discharge summary. I attach the letter as exhibit ‘CS6’.”

That is at page 177. I will just give you a moment to look through that, and then read out Dr Spratt’s summary of it.

THE CHAIRMAN: Have we perhaps seen this letter before?

MS SMITH: That is correct, sir. It was when the case was opened.

THE CHAIRMAN: I remember actually when a member was asking some questions on this from a different witness. Am I thinking of the wrong letter?

MS SMITH: Yes. I do not think you have actually heard a witness deal with it, sir, but it was indeed referred to by me in opening. Then reverting to the statement at paragraph 15:

“15. Dr Malik’s letter contained the information that my patient had been admitted to the Royal Free Hospital for investigations, on 17 November 1996. I was informed that whilst he attended at the Royal Free Hospital he had a general physical examination which was unremarkable. He also underwent neurodevelopment assessment and a colonoscopy on the 18th which showed a marked inverse in size and number of lymphoid follicle in terminal ileum. Further investigations were normal except a very high lead level.

16. The letter also informed me that [Child 9]’s mother linked his mental regression at age 18-20 months to MMR which he was given at 16 months of age.

17. To the best of my knowledge [Child 9] did not attend again in London after the end of that year.

18. Sometime later than February 1998, I became aware that [Child 9]’s history had featured in an article in the Lancet 351: 637-641 entitled: ‘Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”. In that paper, to the best of my reading, the particulars of [Child 9]’s form of autism, and reported indeterminate colitis, and that of 11 similarly affected children, had been linked – by way of an interpretation – to the administration of MMR immunisation in infancy.

19. I identified my patient as likely to be [Child 9] in the Lancet paper of 28 February 1998 as I was aware that [Child 9] had been entered into a research study of this kind, by this group, and there was only one other child of the same age in the series. Also, [Child 9] had been stated to have erythema of the mucosa of the hepatic flexure of his colon. That endoscopic description matched the anatomical findings in my patients’ case, and the observation had not been reproduced in the reports of any other children.

20. I was unsure of these diagnostic associations and discussed my concerns with Dr Salisbury, of the Department of Health, some time ago. I do not recall ever having met Dr Salisbury but we shared the details of the care of one or more complex cases, when he was a Senior Register at Great Ormond Street Children’s Hospital about 15 years ago, and I have a lasting regard for his abilities as a perceptive and well informed paediatrician.

21. I contacted Dr Salisbury to [Child 9]’s case in his public health role, as although lacking in any sub-specialist expertise of my own, I was unconvinced of the clinical scientific weight which had been placed on the medical evidence on my patient’s history in the Lancet paper of February 1998.

22. In my view, [Child 9] had had a minimally symptomatic colitis; and for local logistical reasons I was sure that this child’s MMR inoculation, reportedly at 16 months of age, could not have caused any significant concern at the time. In a small community, with only one paediatrician (until December 1996), I would have been almost bound to be informed.

23. I am and was very reluctant to believe that [Child 9] could have been a vaccine-damaged child.

24. More recently I have come to consider that the retraction published by Professor Walker-Smith, and most of his colleagues, in the issue of the Lancet of 6 March 2004 has put the matter to rest.

25. I am not aware that [Child 9]’s parents have engaged in any legal dealing in respect of their child’s case history.

26. I understand that my statement may be used in evidence for the purpose of a hearing before the General Medical Council Fitness to Practise Panel, and for the purposes of any appeal, including an appeal by the Council for the Regulation of Health Care Professionals and confirm that I am willing to attend the hearing to give evidence if asked to do so.”

That is signed and dated 12 May 2005. It is pointed out to me that I should have read:

“I believe that the facts stated in this witness statement are true.”

I go on to the next statement, which is headed, “Supplemental Statement of Dr Henry Clifford Spratt” and is dated 20 February 2007.


“I understand, Dr Henry Clifford Spratt will say as follows;

1. I have been asked to clarify some issues raised in my first witness statement made in connection with this matter.

2. In paragraph 4 of my first statement, I have stated that I received a letter from Professor John Walker-Smith dated 11 September 1996. I can confirm that this was our first contact with one another about [Child 9]’s case.

3. Dr Cavanagh of the Chelsea & Westminster Hospital had mooted [Child 9]’s referral to Professor Walker-Smith about a year earlier. However, I had not taken up his suggestion as I was unconvinced that [Child 9] had Vitamin B12 deficiency (which was Dr Cavanagh’s understanding) – or in fact any gastrointestinal disorder at that stage.

4. I have been asked whether the parents of [Child 9] had said anything
to me about a study being conducted by Dr Wakefield/Professor Walker-Smith at the Royal Free Hospital prior to receipt of the letter from Professor John Walker-Smith dated 11 September 1996.

5. The short answer to this question is no. At more length: the approximate year between [Child 9]’s referral to the Chelsea & Westminster Hospital and Professor Walker-Smith’s letter to me in September 1996, represented a relative interruption in my association with [Child 9]’s parents and I do not recall any significant exchanges with them, or anyone else, about [Child 9]’s case over that time.

6. Apart from Dr Cavanagh’s mention of an interest in [Child 9]’s type of case history at the Royal Free Hospital, I was not aware of any related work being carried out there prior to Professor Walker-Smith’s letter of 11 September 1996, and do not know how [Child 9]’s parents and Dr Wakefield came to know of one another in 1996.

7. At paragraph 8 of my first statement I refer to [Child 9] as having severe autism which in my view was of unknown causation.

8. I have been asked to confirm whether I was aware of any gastrointestinal symptoms prior to [Child 9]’s referral to Professor Walker-Smith.

9. Again the short answer to this question is no. At more length: although I knew little about [Child 9]’s medical progress in 1995/6, at first hand, I remained in touch with school staff and others concerned with his care in XXX – as part of my ordinary general consultant duty of care to all seriously ill and/or handicapped children in the local community.

10. I recall being informed by the Headmaster of our Special Needs School that [Child 9] was accustomed to a strongly self-preferred and remarkably unvaried diet of sandwiches and potatoes. However the Headmaster also reassured me that [Child 9] remained physically well, and I did not receive reports from other carers and staff (e.g. class teachers, resident staff Nurses, Health Visitors, Social Workers, and visiting occupational and physiotherapists) of any abdominal symptoms at that time. Nor from [Child 9]’s family doctor, whom I met from time to time – when of course [Child 9]’s case may not have come up in conversation anyway without due reason.

11. It is my impression that the information that [Child 9] had been suffering from attacks of what might have been abdominal pain, and loose stools – which was disclosed to Professor Walker-Smith in his clinic in November 1996 – was either unknown or not appreciated in context by professionals in XXX, during that year. It was unknown to me.

12. I have stated in paragraph 25 of my first statement that I was not aware that [Child 9]’s parents had engaged in any legal dealing in respect of their child’s case history.

13. Since making that statement, I have reviewed [Child 9]’s local hospital records again. In the records I found a photocopy of a letter from a firm of London solicitors addressed to the Medical Records Department of The General Hospital dated 15 April 1999. It is a request for copies of [Child 9]’s medical records referring back to an enquiry by another firm of lawyers of 14 August 1997, and has been dealt with by the Hospital management without my knowledge.

14. I can only assume that this letter, which was a copy, had been misfiled in [Child 9]’s clinical hospital notes. There was no other related correspondence and its discovery was a complete surprise to me.

15. However, it is possible that I might have been informed of non-medical matters in [Child 9]’s case in the more distant past, and have forgotten now. The Medical Director has told me that the managerial file about [Child 9]’s case goes back to 1994 and my memory of so long ago is not perfect”

and then he makes the same statement,

“16. I understand that my statement may be used in evidence for the purposes
of a hearing before the General Medical Council’s Fitness to Practise Panel, and for the purposes of any appeal, including an appeal by the Council for the Regulation of Health Care Professionals.

I believe the facts stated in this witness statement are true”

and it is signed by Dr Spratt and dated 20 February 2007.

Lastly, the third statement which is dated 21 April 2007.


“I, Dr Henry Clifford Spratt, will say as follows:

1. I have already made two statements in relation to this matter dated 12 May 2005 and 20 February 2007.

2. I have been asked to confirm whether the admission of [Child 9] to the Royal Free Hospital in 1996 (and any investigations performed there) was funded by the NHS.

3. I have checked my information and there is no question that [Child 9]’s referral by me, by letter to Professor Walker-Smith in September 1996, was a public patient under the ordinary day to day terms of the Health Services Convention (1976).

4. Our hospital’s records show that [Child 9] attended the Royal Free Hospital as an outpatient on 8 November 1996, and as an inpatient on 17 November and 16 December 1996.

5. These consultations, in London, were a continuation of my referral to my colleague, and were fully expected to have taken place on the NHS side.

6. That has been my recollection of circumstances throughout, and is unchanged, and was absolutely the understanding of our hospital staff in XXX at the time”

and again he makes the same statement,

7. I understand that my statement may be used in evidence for the purposes
of a hearing before the General Medical Council’s Fitness to Practise Panel, and for the purposes of any appeal, including an appeal by the Council for the Regulation of Health Care Professionals.

I believe the facts stated in this witness statement are true”

and it is signed by Dr Spratt and dated 21 April 2007.

MR MILLER: Sir, before we leave this witness, in order to be clear, in paragraph 3, I think there might better have been a “but” after “question” in the first line. I have checked my information. There is no question that Child 9’s referral ---

THE CHAIRMAN: Are you talking about the first statement?

MR MILLER: No, the last statement at which we have just looked. I only say this because I have seen other information. I think he is asserting there that this was, as far as he was concerned, an NHS referral and he says, “… there is no question” and I think it should be “but that [Child 9] …” I hope that counsel agrees with me that that is what he appears to be saying.

MS SMITH: Of course, I understand the point that Mr Miller is making but I have to say that I cannot be drawn into agreeing anything outside the words of the statement. I understand the point.

MR MILLER: I appreciate that but that looks to be the only sensible interpretation of that sentence particularly with what he says in paragraphs 4 and 5.

THE CHAIRMAN: Thank you. Are there any further observations? (None) We will obviously file this statement with our other documents and I do not know whether the Legal Assessor is going to give us advice now about the weight or perhaps at a later stage, as I think he has suggested, so we will file it for the time being and take it up at the appropriate time.

MS SMITH: Sir, I see that it is 12.50. At the risk of being extremely unpopular – and I may say unjustifiably unpopular because it is not of my making – there is another matter which relates to further objections made by the defence to parts of a statement which do need to be sorted out today in order that there is no interruption of the witnesses next week. Whether or not we shall need an involvement from the Panel on that is entirely speculative and indeed I have no idea how long the defence will take in making that objection. I do not believe for a moment that it will take all afternoon but I am going to ask you to bear with me either with a late luncheon or after lunch. As I say, I am in the hands of the defence since they are the ones who are making the objections.

THE CHAIRMAN: I have absolutely no idea what you are talking about but I am sure that this will make some sense when we hear it at the end.

MR COONAN: May I be the lightening conductor for this. There are two relatively short matters that Ms Smith and I, I think myself principally, need to have a very short word about and it may well be that we can resolve this very speedily indeed, but I entirely agree with her that it is better that, whilst the Panel are here, in case there is a matter which requires resolution by you, it is best dealt with today rather than flowing into next week and disturbing the flow of events then. As I say, they are relatively minor matters and this morning we had to deal with more fundamental matters which were resolved by agreement and I, for my part, am confident that we can do the same. I do not think that it is going to take very long.

THE CHAIRMAN: Thank you very much, indeed. We will now adjourn. We will have lunch now and we will wait for you either to release us for the day or to reconvene here at whatever time you wish.

MR COONAN: It might be an idea if Panel members have other plans for this afternoon that, if you gave us ten minutes initially at least to have a preliminary discussion about where we stand, then we can get word to you and you can plan your day accordingly.

THE CHAIRMAN: I think that that will be very sensible indeed and thank you for that offer. We will go into our room and wait for a message. Hopefully that will be in the next ten minutes and, if not, then we will go for our lunch and wait to hear from you. Thank you for your offer of help.

(The Panel adjourned for a short while)

(The Panel adjourned until Monday 20 August 2007 at 9.30 a.m.)

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