Francis Inquiry – Key conclusions and links

Robert Francis QC has today published his findings after a 31-month public inquiry costing £13 million into why up to 1,200 patients died needlessly in Stafford between 2005 and 2009.

Links

Final report
Executive summary
BBC Live report
BBC Report
BMA responses

Francis said it would be ‘dangerous’ to blame ‘a single rogue healthcare professional’ for what went wrong. His 1,782-page report contains 290 recommendations.

The Telegraph reports as follows:

(Francis) said of the scandal: ‘This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety. Patients were let down by the Mid Staffordshire NHS Foundation Trust. There was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed, and fundamental rights to dignity were not respected.’

The evidence of more than 250 witnesses and more than a million pages of documentary evidence showed that elderly and vulnerable patients were left unwashed, unfed and without fluids, said Mr Francis. Some patients had to relieve themselves in their beds when they got no help to go to the bathroom, others were left in excrement-stained sheets and had to endure ‘filthy conditions’ onwards.

In a letter to the Health Secretary, Jeremy Hunt, accompanying the report, Mr Francis said hospitals must put patients first, ensure ‘openness, transparency and candour’ throughout the NHS when concerns are raised and ensure proper accountability for what staff do.

He said the scandal happened because board members and other leaders within the Trust ‘failed to appreciate the enormity of what was happening, and reacted too slowly, if at all’.
He says ‘routine neglect’ became the norm because of a culture of ‘fear, bullying and secrecy’.

The Trust had a culture of ‘self promotion rather than critical analysis’ and consultants ‘did not pursue management with any vigour’ about concerns they had and in many cases ‘kept their heads down’’

The Trust focused on finances rather than patient needs, he said, and ‘squabbling’ between local patient groups such as community health councils meant that “the public of Stafford were left with no effective voice...throughout the worst crisis any district general hospital in the NHS can ever have known’.

Francis’ full letter to the secretary of state is reproduced below:

Dear Secretary of State

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

As you know, I was appointed by your predecessor to chair a public inquiry under the Inquiries Act 2005 into the serious failings at the Mid Staffordshire NHS Foundation Trust. Under the Terms of Reference of the Inquiry, I now submit to you the final report.

Building on the report of the first inquiry, the story it tells is first and foremost of appalling suffering of many patients. This was primarily caused by a serious failure on the part of a provider Trust Board.

It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention. Above all, it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care.

The story would be bad enough if it ended there, but it did not. The NHS system includes many checks and balances which should have prevented serious systemic failure of this sort. There were and are a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies, all of whom might have been expected by patients and the public to detect and do something effective to remedy non-compliance with acceptable standards of care. For years that did not occur, and even after the start of the Healthcare Commission investigation, conducted because of the realisation that there was serious cause for concern, patients were, in my view, left at risk with inadequate intervention until after the completion of that investigation a year later. In short, a system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.

The report has identified numerous warning signs which cumulatively, or in some cases singly, could and should have alerted the system to the problems developing at the Trust. That they did not has a number of causes, among them:

•A culture focused on doing the system’s business – not that of the patients;
•An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern;
•Standards and methods of measuring compliance which did not focus on the effect of service on patients;
•Too great a degree of tolerance of poor standards and of risk to patients;
•A failure of communication between the many agencies to share their knowledge of concerns;
•Assumptions that monitoring, performance management or intervention was the responsibility of someone else;
•A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession;
•A failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level reorganisation.

I have made a great many recommendations, no single one of which is on its own the solution to the many concerns identified. The essential aims of what I have suggested are to:

•Foster a common culture shared by all in the service of putting the patient first;
•Develop a set of fundamental standards, easily understood and accepted by patients, the public and healthcare staff, the breach of which should not be tolerated;
•Provide professionally endorsed and evidence-based means of compliance with these fundamental standards which can be understood and adopted by the staff who have to provide the service;
•Ensure openness, transparency and candour throughout the system about matters of concern;
•Ensure that the relentless focus of the healthcare regulator is on policing compliance with these standards;
•Make all those who provide care for patients – individuals and organisations – properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service;
•Provide for a proper degree of accountability for senior managers and leaders to place all with responsibility for protecting the interests of patients on a level playing field;
•Enhance the recruitment, education, training and support of all the key contributors to the provision of healthcare, but in particular those in nursing and leadership positions, to integrate the essential shared values of the common culture into everything they do;
•Develop and share ever improving means of measuring and understanding the performance of individual professionals, teams, units and provider organisations for the patients, the public, and all other stakeholders in the system.

In introducing the first report, I said that it should be patients – not numbers – which counted. That remains my view. The demands for financial control, corporate governance, commissioning and regulatory systems are understandable and in many cases necessary. But it is not the system itself which will ensure that the patient is put first day in and day out. Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows that this cannot be assumed to be happening.

The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms. I hope that the recommendations in this report can contribute to that end and put patients where they are entitled to be – the first and foremost consideration of the system and everyone who works in it.

Yours sincerely

Robert Francis QC
Inquiry Chairman

Cameron divides his party and supporters over Same Sex Marriage Bill – full party breakdown of votes

The Marriage (same Sex Couples) Bill passed its second reading in the House of Commons last night by a reported majority of 400-175.

The full debate can be read here.

The full list in Hansard of who voted for and against is here (scroll down) and you can find an alphabetical list here.

The Guardian blog gives a list of names by party here

The blog 'Liberal Conspiracy' (mouthpiece of the liberal elite) has published a 'list of shame' (ie. read 'roll of honour') of those who opposed the bill. C4M has a full list of all votes arranged alphabetically.

Only 127 Tory MPs supported it. Another 136 opposed it, and 40 MPs either voted both ways (actively abstaining) or did not vote. So in total he was supported by only 42% of his own MPs.

Liberal Democrats and Labour MPs largely supported it as expected.

The Bill now goes to committee stage then third reading in May and then to the Lords. It needs to get through the Lords to become law.

If it fails then David Cameron could still use the Parliament Act to force it into law despite Lords’ opposition.

YouGov polls on how party supporters feel on the issue are in the chart above.

Cameron is now in the position where he has the support of only a minority of his supporters and MPs. Things don’t look good for him.

The papers are almost unified this morning in their criticism of Cameron and the Daily Mail, Telegraph and Guardian are particularly strong on the self-inflicted nature of the wound.

Cameron was accused last night of needlessly splitting his party and prioritising an issue important to only a handful of voters. One poll suggests 70 per cent of voters now see the Tories as divided.

According to the Daily Mail the same YouGv poll cited above showed that just 7% of voters list gay marriage as one of the issues that most concern them – against 56% for the economy.

A Comres poll commissioned by the Coalition for Marriage asked voters whether ‘marriage should continue to be defined as a lifelong exclusive commitment between a man and a woman’. 53% were in favour and only 36% against.

Among the non-white voters Cameron is seeking to woo 65% favoured the traditional definition and only 25% didn’t.

So it appears that Cameron is in step with Lib Dem and Labour voters who will never vote Tory but out of favour with traditional Tory voters and minority groups. Not a shrewd move. Perhaps he would be better off in another party.

Colin Hart, of the Coalition for Marriage, which has opposed the legislation, said: ‘This result is a disaster for David Cameron. Despite a personal plea from the PM his MPs have overwhelmingly rejected gay marriage. Mr Cameron must think again.’

Last night was not the first time Mr Cameron has gone into the Commons division lobbies with a minority of his MPs over gay rights.

In 2007, on a free vote, he was among fewer than half of his party who supported gay adoption.

The previous biggest Tory split on a free vote was under Mr Duncan Smith in 2003, when the party split over reform of the House of Lords.

Some of my previous blogs on Cameron and the gay marriage issue are listed here:

1. David Cameron, by his comments about homosexuality, demonstrates that he does not understand what true tolerance actually is

2. David Cameron has professed Christianity but fails Luther’s test of confession

3. David Cameron’s promotion of the gay rights agenda is based on a false presupposition

4. David Cameron owes the public an explanation as to why he thinks legalising same sex marriage is necessary

The full list of how party members voted is as follows: the numbers are slightly different from the reported numbers as some party members registered abstention votes by voting both ‘yes’ and ‘no’

YES - TOTAL: 397

Alliance Party: 1
Conservative: 127
Green: 1
Independent: 1
Labour: 217
Lib Dem: 45
Plaid Cymru: 3
Respect: 1
SDLP: 1

NO – TOTAL: 172

Conservative: 136
DUP: 8
Independent: 2
Labour: 22
LibDem: 4

DELIBERATE ABSTENTIONS (i.e. voted both ways): 5 (All Conservatives)

ABSENT/ABSTAINED: 67

Conservative: 35
Labour: 16
LibDem: 8
SDLP: 2
SNP: 6

Radio Four debate on ‘change therapies’ for unwanted same-sex attraction

This morning I took part in a short documentary on the Radio Four Sunday programme on ‘change therapies’ for those with unwanted feelings of same sex attraction.

The presenter was Ed Stourton (pictured).

‘Change therapy’ (more accurately SOCEs - sexual orientation change efforts) is aimed at altering the strength and direction of sexual feelings and is currently banned in the UK by counselling organisations such as the BACP and UKCP. ‘Change therapists’, however, continue to practise under auspices of professional counselling bodies in the US and Canada.

The UK ban is primarily on the basis of the argument that sexual orientation is biologically caused and fixed, that change is therefore impossible and that therapy aimed at change is harmful (I have previously critiqued this view here, here and here).

The Sunday Programme item was prompted by a debate earlier in the week in the Houses of Parliament where Professor Michael King of the Royal College of Psychiatrists and Gay Rights Activist Peter Tatchell took on Consultant Psychiatrist Joseph Berger and therapist Mike Davidson (See my previous reviews of the arguments Tatchell and King presented).

The Sunday Programme piece was reported by Trevor Barnes and featured six interviewees – Mike Davidson, Di Hodgson, Pamela Gawler-Wright , myself and two clients who had experienced change therapy. It was commendably well-balanced.

You can listen to the whole (8 minute) piece on I-Player here (starts at 30.50 and ends at 38.30).

The programme began by playing an interview of a man who had not found ‘change therapy’ helpful and ‘left very quickly’.

This was followed by the testimony of ‘Robert’, a 55 year-old man, now divorced, who had struggled for years with a promiscuous homosexual lifestyle. He explained how he had sought Christian therapy to help him to change:

‘I had been allowing myself to be labelled by an activity. In fact I realised I was in bondage to that addiction in my life. Through the help of counselling, through the help of my pastor, through the help of an accountability elder that I had within my church I came to understand that my identity is not in the things I did, for example in the act of homosexuality. My true identity is in Christ’

I argued that with some groups of people, as with Robert, counselling and other forms of therapy can be successful :

‘The evidence shows that some people will experience a change in the strength or direction of their sexual feelings either spontaneously or with therapy from a skilled therapist. People who experience a dissonance between their feelings and their values or desires will sometimes seek professional help and if they can harmonise their lifestyle choices with their values then they do feel better.’

Di Hodgson, chair of the Diversity, Equalities and Social Responsibility Committee of the UK Council for Psychotherapy (UKCP), questioned the very principles underlying the therapy:

‘I think there is very conflicting evidence. But in some ways, to me, that’s really not the right question to ask, if I may say, because whether or not something works doesn’t mean that it is ethical or in the public interest or the right thing to do for someone. So we have taken a view in a way which is regardless of the scientific findings. We still believe that it is unethical to seek to agree or to work towards changing someone’s sexual orientation through psychotherapy.’

I thought this was quite an extraordinary admission by someone speaking on behalf of an organisation that seeks to de-register therapists who practise ‘change therapy’ on the pretext that it does not work.

A psychotherapist, Pamela Gawler-Wright, was then interviewed. She claimed that she had personally met many people who had been harmed by ‘change therapy’.

Mike Davidson, a therapist who has been suspended by the UKCP for practising ‘change therapy’, conceded that it is not for everyone but argued that clients should not be banned from seeking it:

‘Any therapy in the wrong hands is potentially damaging but therapy that overrides a person’s right to choose the pathway that suits them and is consistent with their own values is damaging. So I’m not arguing that everybody should change, or that everybody can change, but I think people need to have the right to explore the possibility if that is what they want.’

He went on to argue that much of the objection to ‘change therapy’ is not actually evidence-based but rather ideology-driven.

‘I think one of the reasons that there is such a reaction to this is that it is perceived to be a threat to the idea that homosexuality is innate and therefore unchangeable. Anything that comes along that demonstrates that actually the reverse is true, that in some cases it can be changed - and certainly homosexual feelings can be reduced and sometimes eliminated - is a threat to that ideological position.’

‘Robert’ later gave more of his testimony:

‘Through Christian counselling I now have a true understanding of my identity. My identity is not based on an activity. It’s based actually on a relationship with Jesus Christ . It’s that knowledge that is the source of my liberation. It’s that knowledge that is the source of my freedom. Is it wrong for a Christian counsellor to help me find that?’

Pamela Gawler-Wright responded by outlining her concerns that ‘change therapists’ start from a belief that homosexuality is wrong, is caused by unhappiness, and causes unhappiness. She objected to what she saw as the underlying ideology and ethical framework.

I concluded by arguing for a more even-handed approach:

‘People already can have ‘gay affirmative therapy’ which affirms their feelings and helps them to harmonise their lifestyle choices with those feelings. So we think there should be a level playing field and that people who would like to harmonise their lifestyle choices with their values should be able to have professional help for that as well.’

The programme, perhaps for the first time, gave an opportunity for those of us who support appropriate ‘change therapy’ to give our side of the argument. It also brought out clearly the point that objections to change therapy seem to be based much more on ideological grounds than on evidence.

I have previously on this site critiqued the arguments that have been used to discredit ‘change therapy’ (see links above) and would recommend to anyone wanting to know more detail about the evidence to read the booklet ‘Unwanted Same Sex Attraction’ which is available on the CMF website.

Some ‘change therapies’ are harmful and some ‘therapists’ are not properly trained but I cannot see why people seeking this kind of help should not in a free society have access to professional accredited therapists who are in sympathy with their values.

Change therapists are free to practise in the US and Canada under the auspices of their professional bodies but not in the UK. This seems to be primarily because those people who oppose ‘change therapy’, on seemingly ideological as much as evidence-based grounds, have managed to get into positions of power in the UK organisations that accredit therapists and put these bans in place (more on this here).

My hope is that this Radio Four documentary will be one small step towards that beginning to change.

Survival of twins born at 23 weeks and new Inquiry into abortion for disability reopen debate on abortion upper limits

When twins Mackenzie and Cameron Glover were born 17 weeks prematurely on 17 June last year, they were so tiny that their mother said they could ‘fit inside a pint glass’.

Now, after a lengthy battle for life against the most astonishing odds, the boys, born at just 23 weeks and three days gestation, have become one of the most premature sets of twins ever to survive in the UK.

Their mother Pam says her miraculous boys fill her with wonder – but she is left angry and mystified that the law continues to permit the abortion of babies older than her sons were at birth.

Pam said: ‘For us now, the idea that it’s possible to abort a child up to 24 weeks – older than Cameron and Mackenzie were – just doesn’t bear thinking about.’

The story, reported in the Daily Mail this week, has reopened the debate about abortion time limits.

It comes just as Fiona Bruce MP launches a parliamentary inquiry into abortion for disability which will examine the law, professional guidance and information and support given to parents.

Disabled babies can be aborted right up until the time of birth and in 2011, according to Department of Health statistics, 146 were aborted after 24 weeks.

In all 2,307 abortions were carried out in 2011 under Abortion Act 1967 Ground E, for disability. This included more than 500 abortions for babies with Down’s Syndrome although the real number may well be twice as high.

Abortion industry leader Ann Furedi of BPAS has reacted strongly against the consultation saying that abortion should be a women’s choice.

However she has already come in for sharp criticism from Saving Downs, a charity advocating for children with Down’s syndrome, which has welcomed the inquiry saying that it is ‘exactly what the disability community needs: the removal of discriminatory laws against the disabled’.

Last year Health Minister Jeremy Hunt said that he personally favoured a lowering of the upper limit for aborting non-disabled babies to 12 weeks.

He is not alone. 13 of the current 16 Tory MPs in cabinet actually voted for a lowering of the limit in 2008 when the issue was last debated – including 7 for 20 weeks, 2 for 16 weeks and 3 for 12 weeks.

There are currently 16 countries in Europe which have upper limits of 10-12 weeks and that Britain has one of the highest upper limits and highest abortion rates in Europe.

Public and parliamentary opinion is changing on abortion for three main reasons – 4D ultrasounds, debates about fetal sentience and premature babies like the Olivers surviving below 24 weeks in neonatal units.

All this is increasing awareness about the ‘humanity of the pre-born baby’ and heightening concerns about abortion.

Ultimately societies will be judged by the way they treat the most vulnerable, and there is no one more vulnerable, more innocent and killed in greater numbers than a preborn baby.

Last year I was one of nine signatories to a letter to the Telegraph describing the practice of aborting babies for disability as a form of ‘eugenics’ and arguing that the present law is deeply hypocritical and discriminatory.

This consultation will be an opportunity for disabled people and their advocates to speak out against this practice and possibly bring some much needed reform.

Warning sounded to UK as Oregon assisted suicide deaths hit record high

Lord Falconer has just announced that he is about to introduce a new bill into the House of Lords to legalise assisted suicide along the lines of the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

Members of the House of Lords should note that statistics released just last month (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high.

Falconer’s bill, however, only requires a twelve month life expectancy and so is thereby even more liberal than Oregon’s.

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years.

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in the Netherlands and Switzerland, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an underestimate as they are based on physicians' self-reporting.

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain.

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300. With Falconer’s more liberal interpretation of what constitutes ‘terminally ill’ the numbers here would be expected to be higher still.

Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

We should learn from the Oregon experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland and the Netherlands. Legalisation leads to normalisation.

Currently only two US states, Oregon and Washington, have legalised assisted suicide, each on the basis of a referendum.

By contrast whenever a bill has been brought before a US state parliament it has been defeated. This has happened over 120 times in the last 20 years.

Thirty-four states prohibit assisted suicide outright. Massachusetts and six other states have banned it through legal precedent.

It is often argued by the pro-euthanasia lobby that opposition to the legalisation of assisted suicide is largely faith-based. But this is not true.

In Massachusetts, a left leaning Democrat state which rejected assisted suicide in a referendum last year, the opposition of doctors and disabled people has been very significant indeed.

This is because one of the most powerful arguments against it is public safety – any change in the law will put pressure on vulnerable people to end their lives and no law can be adequately safeguarded against abuse.

I have previously blogged about the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide.

Also deeply concerning are reports of depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers.

The lessons are clear. Let’s not go there.

Lord Falconer announces yet another bill on assisted suicide

Lord Falconer (pictured) announced this week(£) that he would launch another bill to legalise assisted suicide this May in the House of Lords.

It is likely that Falconer has opted again for the Lords rather than the Commons, despite past heavy defeats there, because an opinion poll last September showed that more than seven out of ten MPs would not support a change in the law.

In line with the recommendations of his sham ‘Commission on Assisted Dying’ Falconer will push for doctors being given the power to help mentally competent adults with less than one year to live to kill themselves. As in the Abortion Act just two doctors' signatures will be required.

Given the vast range of different agendas that exist in the pro-euthanasia lobby, it is virtually certain that groups will push for incremental extension once the principle of assisted suicide is established.

A draft bill was published by Falconer last year and made the subject of a private consultation run by Dignity in Dying (the former Voluntary Euthanasia Society). But many individuals and organisations chose to ignore the consultation due to its perceived bias and although it closed last autumn no ‘report’ has ever been published.

There has been surprisingly little media coverage about Falconer’s latest announcement, but I see that DID have launched a ‘campaign’ on their website to support it.

There have been three failed attempts to legalise assisted suicide in Britain in the last six years, in 2006, 2009 and 2010, all of which have failed due to concerns about public safety.

The so-called ‘safeguards’ which Falconer is now proposing are similar to those in the Joffe Bill which was rejected by 148 votes to 100 at second reading in 2006. Falconer had an amendment legalising assisted suicide defeated by 194-141 in 2009. Margo Macdonald's Scottish bill was defeated by an overwhelming majority of 85-16 in 2010.

Alarming reports of incremental extension in jurisdictions which have legalised assisted suicide or euthanasia, like Belgium, the Netherlands, Switzerland and the US state of Oregon, along with worries about the effect the recession is having on vulnerable people and healthcare provision have intensified concerns that any change in the law would put added pressure on elderly, sick and disabled people to end their lives.

Official medical bodies and disability groups remain firmly opposed to a change in the law.

I expect the bill to get short shrift but peers will need to be reminded about the strong arguments against legalisation.

Professor Michael King applies double standard to evidence on homosexual change therapies

A woman who is happily married with children falls in love with another woman but is desperate to keep her marriage together. Should she be able to accept professional help to deal with her unwanted feelings of same sex attraction?

A bisexual man wants to marry his girlfriend but is worried that his residual feelings of erotic attraction to other men might jeopardise the relationship. Should he be able to seek professional help?

Currently in Britain the answer is ‘no’ but these questions were at the very heart of a fascinating debate that took place in the House of Commons this week under the title ‘Sexual reorientation therapy: Freedom to change?’

The event was subtitled ‘Should people be able to change their sexual orientation?’ and was billed as being ‘a debate about the legitimacy and freedom to offer sexual reorientation when many professional bodies are banning such therapies’.

‘Change therapy’ is psychotherapy or cognitive therapy aimed helping people who wish to change the strength or direction of their sexual desires. These therapies are more correctly termed SOCEs (sexual orientation change efforts).

When a person’s sexual desires and values don’t match up they might seek professional help either to help them overcome guilt so that they can participate freely in same sex behaviour (gay affirmative therapy) or alternatively to deal with feelings of same sex attraction so that they can abstain (change therapy). But only the first kind of therapy is currently approved by professional bodies. Is this fair and justified? We were about to find out.

Dr Michael Davidson of CORE Issues (who is about to undergo a disciplinary procedure for using change therapy) and Canadian psychiatrist Dr Joseph Berger (who uses it regularly) were supporting change therapy.

Psychiatrist Professor Michael King (who is its most vehement UK critic) and gay rights campaigner Peter Tatchell were against it.

Although members of the mainstream press were present the debate has so far been reported only by Christian Concern, Pink News and Gay Star News.

Tatchell and King essentially argued that homosexual orientation was biologically caused and fixed, that change was impossible and that change therapies were damaging and unethical.

I have already blogged about Peter Tatchell’s inconsistent views on the causes of homosexuality and now turn my attention to Michael King.

Michael King (pictured) is professor of psychiatry at University College London (UCL) and is head of the UCL mental health sciences unit which specialises in ‘psychiatric epidemiology, molecular genetics, health services research and randomised trials of complex treatments in primary and secondary health care’.

He also chairs the Royal College of Psychiatrists' Gay, Lesbian and Bisexual Special Interest Group which has advised the College on its Social Inclusion Report and its submission to the Church of England Listening Exercise on Human Sexuality. King was lead author of this latter submission. His website www.treatmentshomosexuality.org.uk was set up in 2008 as a discussion forum but appears to have attracted little interest.

King’s views have been extraordinarily influential and his submission to the Church of England is widely quoted.

The British Association for Counselling & Psychotherapy (BACP) makes reference to it in its September 2012 statement of ethical practice and, according to the Guardian, has written to its 30,000 members saying that it is unethical for them to attempt to ‘convert’ gay people to being heterosexual.

The UK Council for Psychotherapy (UKCP), representing training organisations and over 7,500 individual therapists, has welcomed the BACP’s stance and in fact issued a similar statement in 2011.

The Pan American Health Organisation (PAHO) - a regional branch of the WHO - released a similar statement in May 2012 claiming that ‘therapies’ to change sexual orientation ‘lack medical justification and represent a serious threat to the health and well-being of affected people’.

King’s argument at the debate went as follows:

He first asked if homosexuality was a condition that needed treatment and said that it had been removed from the Diagnostic Screening Manual of mental health conditions (DSM III) in 1973 ending ‘millennia of prejudice, stigma and oppression’.

He then said that we did not know the cause of homosexuality (contrary to Tatchell’s ‘new’ view) but that it ‘had nothing to do with a person’s relationship to their father’.

He added that there was no evidence, in terms of randomised controlled trials, showing that change therapies worked and that all published studies purporting to show their effectiveness fell below this ‘gold standard’.

He concluded, on the basis of his first three points, that the use of change therapies was unethical.

He then turned to the question of whether those offering change therapy should be free to practise, and argued that all the relevant professional organisations (RCPsych, BACP and UKCP) had issued warnings about change therapies and did not accept them.

Finally he asked whether patients should be free to seek change therapy and said that this question was being raised in the context of a homophobic culture. People who wanted to reduce same sex desire should be able to pursue this but ‘did not need to rush to psychotherapists to do it’.

So in summary he argued that change therapies were ineffective, harmful, unethical and should not be allowed.

I was unable to get a question in to King during the plenary (I had used my one allowed question on Tatchell earlier!) so I asked King afterwards if there were randomised controlled trials which showed that change therapies were harmful or that showed gay affirmative therapies were effective.

He said there were not, but that there were cases studies and series of cases showing this.

I reminded him that there were also cases studies and series of cases showing that some change therapies were helpful for some people. He did not deny this (see CMF’s publication ‘Unwanted same Sex Attraction').

I then asked if he was applying a double standard by approving ‘gay affirmative’ therapies on the basis of case studies alone but barring change therapies (for which there were also supportive case studies) on the different basis that there were no randomised controlled trials supporting them.

He seemed unable to answer this question.

I then asked him if he was being less than fully transparent in his presentation of the evidence and less than even-handed in suggesting that change therapies should be banned whilst gay affirmative therapies supported. Again there was no real answer.

I then said to King that I actually agreed with him that some ‘change therapies’ were harmful and that some ‘therapists’ were not properly trained but that I could not see why people, like those whose case histories I outlined above, should not in a free society have access to professional accredited therapists who were in sympathy with their values.

I still fail to understand why change therapists are free to practise in the US and Canada under the auspices of their professional bodies but not in the UK. It seems to be primarily because of the actions of people like King.

Oh and one other thing. I was interested to listen in on King’s heated exchange with another questioner after the debate. Here he was turning from science to theology.

He said he was a ‘Christian’ and had been in a monogamous gay partnership for 30 years. He added that ‘Jesus said nothing about homosexuality’ and asked why God would have any objection to permanent monogamous gay partnerships. He said that he went to a ‘wonderfully inclusive church’ in Bayswater which welcomed him and that evangelical Christians were obsessed with sex.

I wondered if King's passionately held convictions about Christianity and his own life-style choices had had any influence on his reading and presentation of the evidence and why he had not declared any of these personal interests in his scientific writings on therapies for unwanted same sex attraction.

I also wondered why he and others were so determined to drive anyone offering change therapy from the public square.

Later that day I attended a fascinating talk which went through King’s submission to the Church of England in some detail arguing that he had misinterpreted and misrepresented the scientific papers he had quoted. King had been personally invited to attend this presentation but had opted not to.

I will return to that paper in more detail later.