Two doctors who left a trail of damaged and abused women during careers that lasted decades were allowed to continue practising because of a culture of complacency, separate inquiries reported yesterday.

The scandals of the disgraced gynaecologist Richard Neale, who botched operations on women over more than a decade, and the GP Clifford Ayling, who was jailed for sexually abusing his patients over 30 years, have gone down in the annals of medical dishonour as among the worst in memory.

Both were doctors of the old school, overbearing, arrogant and dismissive, who systematically betrayed their patients' trust. But they were allowed to get away with unacceptable behaviour for so long because patients, colleagues and managers did not dare to challenge their authority.

Reports from the inquiries into the two doctors, announced in June 2001, were published by John Reid, the Health Secretary, yesterday.

Neale, a consultant in North Yorkshire, was struck off the medical register in 2000 after being found guilty of a series of blunders that left 14 women in pain, incontinent or unable to bear children.

Ayling, 72, a GP who worked in Folkestone, Kent, was jailed for four years in 2000 after being convicted of 13 counts of indecent assault on patients between 1991 and 1998.

A group of 31 women abused by Ayling accepted damages of £350,000 from the Kent and Medway Strategic Health Authority yesterday. The women, who will receive sums of up to £20,000 each, had sued the health authority which employed him.

The inquiry reports into the two doctors, which together run to 600 pages, make a series of recommendations, including a call for reform of the NHS complaints system to ensure that patients' voices are heard.

In her foreword to the Neale inquiry report, Judge Suzan Matthews, the chairman, says: "A sense of complacency undoubtedly contributed to what occurred. There is no room for complacency and there remains an urgent need for a root and branch change in attitudes and culture within the NHS."

The Ayling inquiry report, chaired by Dame Anna Pauffley, says that despite the "long history of continuing unease" about the GP's behaviour generated among his professional colleagues, it was ignored.

"They recast what they heard into explanations which they could find acceptable and in so doing deceived themselves and failed their patients," the report says.

Mr Reid said the Government would respond in detail to the reports after the inquiry into the GP serial killer Harold Shipman, which is also examining the NHS complaints system, publishes its final report later this year.

The Neale inquiry says that one of the most disturbing aspects of the case was that in 1984 Neale had been struck off the medical register in Canada, where he had emigrated in the late 1970s, after the deaths of two patients, but this failed to sound alarm bells in Britain.

Neale returned to the UK and got a job as a consultant at the Friarage Hospital at Northallerton in North Yorkshire, where he worked from 1985 to 1995. Despite knowing of his record in Canada, neither the General Medical Council in the UK nor his NHS employers, the Yorkshire Regional Health Authority, took action. He was able to continue operating, causing patients "unnecessary suffering and trauma", for more than a decade. Judge Matthews said this was the "most perplexing aspect" of the case in her 370-page report. "How such a situation can ever be acceptable or fair must now be considered with urgency," she said.

The GMC said in a statement yesterday that it "could not defend" its practice 15 years ago and had taken steps to see that it could not happen again.

Tighter monitoring of doctors' competence has been introduced since Neale was struck off, but the inquiry calls for better checks before doctors are recruited to identify concerns from past employment, and for security of tenure for consultants to be ended.

The inquiry into the Ayling case said there had been allegations of "disturbing" instances where his behaviour was "overtly sexual and broke the boundaries of the trust and integrity patients have the right to expect from their doctor" over many years.

His approach to patients was described as "over-familiar" where sensitive and intimate examinations were being carried out which "bordered on the unprofessional" and was distressing to both patient and observer.

The inquiry team found little published guidance on dealing with such "sexualised behaviour" and said there was an "urgent need" to address this to ensure that NHS trusts recognised and responded to such concerns.

It says all patients must be offered a chaperone for intimate examinations.

Mr Reid said changes in the National Health Service in recent years had addressed weaknesses identified in the inquiries, including improvements in the complaints procedures.

He said Neale "fell short" of the high standards patients had a right to expect which had caused them "unnecessary distress".

The abuse of patients by Ayling was "completely unacceptable" and patients should never be put in a position where doctors or other staff could "take advantage" of their trust.

THE GP...

Clifford Ayling relied on the authority vested in doctors to pursue his own sexual gratification with his patients. Most were too frightened and confused to question his behaviour. His colleagues were reluctant to believe rumours of unnecessary internal examinations and his readiness to make female patients strip.

The local medical committee in Folkestone, where he practised, was perceived by local GPs as a 'safe haven for troubling knowledge' to whom responsibility for further action could be entrusted. The inquiry report says this is 'inappropriate today'.

Ayling was finally brought to trial in 2000, almost 30 years after the first alleged indecent assault in 1971. He was jailed for four years and later struck off.

...AND THE GYNAECOLOGIST

During a 14-year period from the mid-1980s to the late 1990s, Richard Neale caused appalling suffering to scores of women from North Yorkshire to the Isle of Wight by carrying out operations that were beyond his competence in a negligent and reckless manner.

He misled patients about the risks, failed to inform GPs of complications and lied about his qualifications. He was finally struck off the medical register and banned from practising in 2000 after being found guilty of ruining the lives of 13 women.

The report describes him as an "old-fashioned consultant with personality and behavioural issues that raised eyebrows but which were tolerated and overlooked because no one challenged his clinical competence".

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