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Mr. Gerald Bermingham (St. Helens, South): Does my hon. Friend agree that the Director of Public Prosecutions has already said that there will be no prosecution in respect of the second batch because of the question of getting a fair trial? It seems logical that the DPP will reach the same conclusion about the 64 cases that Manchester police are now investigating.

Mr. Hutton: Hon. Members will understand that I do not want to pre-empt such decisions. There are on-going inquiries, for which the police are responsible, into the suspicious deaths of some of Dr. Shipman's patients. It would not be sensible to try to second-guess the decisions of appropriate prosecuting authorities.

Dr. Liam Fox (Woodspring): On a point of information, will the Minister tell us how far back the audit of Dr. Shipman's records goes?

Mr. Hutton: I understand that Professor Baker's review considered all the evidence from Dr. Shipman's practice from the beginning of his time as a GP. I believe that the clinical audit covers 20 years.

My right hon. Friend the Secretary of State announced the terms of reference and the chairman of the inquiry on 3 January. Subject to the House's agreement and that of another place, the terms of reference for the inquiry have been set out in the motion. First, after receiving the existing evidence and hearing such further evidence as necessary, the inquiry will consider the extent of Harold Shipman's unlawful activities.

Secondly, the inquiry will examine the actions of the statutory bodies, authorities, other organisations and responsible individuals concerned in the procedures and investigations that followed the deaths of those of Harold Shipman's patients who died in unlawful or suspicious circumstances. Thirdly, by reference to the case of Harold Shipman, it will inquire into the performance of the functions of those statutory bodies, authorities, other organisations and individuals with responsibility for monitoring primary care provision and the use of controlled drugs.

Finally, following those investigations, the inquiry will recommend what, if any, steps should be taken to protect patients in future, and report to the Home Secretary and to the Secretary of State for Health.

The inquiry will be chaired by Dame Janet Smith, who has been a High Court judge since 1992. She was presiding judge of the north-eastern circuit between 1995 and 1998, and a judge of the employment appeals tribunal since 1994. She is extremely well qualified for the job.

I would like to acknowledge the strong contribution made by my right hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) in getting an inquiry set up into these terrible crimes. He has been in regular contact with

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my right hon. Friend the Secretary of State for Health about the case and has, in particular, been tireless in his support for the relatives of the many victims of Harold Shipman. Unfortunately, my right hon. Friend cannot be here tonight as he is recovering from an illness that he developed at Christmas.

The House will know that the Government and the medical profession are already taking action to modernise regulatory structures and to deal with poor performance wherever it occurs. During the summer, we consulted fully on proposals that included regulating deputy and assistant doctors through health authority supplementary lists and regulating doctors within personal medical services by means of a separate list system. Those proposals also included requiring all doctors in general practice to declare any criminal convictions and any adverse General Medical Council findings. That work forms the basis of the proposals in the Health and Social Care Bill now before Parliament.

By setting up primary care groups and primary care trusts, which provide more locally focused management structures for general practice, we have restricted the opportunities for doctors to act inappropriately. In addition, the Health and Social Care Bill will introduce important new powers to strengthen the links between GPs, health authorities and primary care trusts. Underpinning those provisions will be greater information sharing, to support appraisal and mandatory clinical audit.

Personal medical services contracts agreed for the third-wave pilots from April 2001 will require doctors to participate in at least three clinical audit programmes each year, and to allow 30 hours for continued professional development per year per doctor. My officials in the Department of Health are in discussion with the British Medical Association about how to apply the same standards to all general practitioners.

From April this year, all GPs will be required to participate in annual appraisal. The purpose of the appraisal will be developmental, but it will also identify poor performance wherever it exists. That is important in order to protect patients. In August last year, we took powers to allow the GMC to impose interim suspensions on doctors when necessary, including in conduct, health and performance cases. Additionally, the minimum period of erasure from the medical register is now five years, ensuring that when a doctor is struck off, he should not expect to return except in the most exceptional circumstances. The GMC must also notify a doctor's employer if it is considering his fitness to practise.

In November, we took the necessary legal powers to set up the National Clinical Assessment Authority. The authority will become operational in the first half of this year and is at the centre of the Government's co-ordinated approach to better protection for patients and better support for doctors. It will provide a central point of contact for the NHS when concerns arise about a doctor's performance.

NHS employers and health authorities will be able to refer a doctor to the NCAA if concerns about his or her performance cannot be resolved locally. The authority will carry out rapid objective assessments and make recommendations to NHS hospitals and health authorities so that they can take appropriate action. That could involve further training, support, or, if problems were intractable, dismissal or referral to the GMC.

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The Home Secretary is overseeing a review of the procedures involved in the certification of deaths and the authorisation of burials and cremation. The Office for National Statistics, the Department of Health and the Welsh Assembly are all involved in this work. The results of the review will be fed into the inquiry.

Right hon. and hon. Members may be interested to know that the location of the inquiry will be in central Manchester. We have secured newly refurbished offices next to Piccadilly railway station for the use of the chair and secretariat, and Manchester town hall will be used for the witness hearings. The inquiry will also set up a closed circuit television link to Hyde town hall, so that the witness hearings can be televised there on large TV monitors. That should enable the people of Hyde to keep in touch with the proceedings, should they wish to do so, without having to travel into central Manchester.

We owe it to the families and friends of those murdered by Harold Shipman to implement whatever steps are necessary to prevent a repetition of such terrible crimes. Shipman broke the trust of his patients in the most appalling way. However, he should not be allowed to break the trust that exists between family doctors and their patients. The measures that I have described today are intended to strengthen that bond of trust. They express the Government's determination to apply the lessons of the Shipman case to ensure that patients in future have the full and proper protection that they deserve.

6.55 pm

Dr. Liam Fox (Woodspring): I am grateful to the Minister for coming to the House and for giving his comments. However, as the Secretary of State gave the original statement to the House, and as it was his decision that resulted in the High Court review and the U-turn by the Government, it would have been only proper for him to come to the House himself to give the explanation of subsequent events. I say that with no disrespect to the Minister.

Even after a lapse of time, the immense wickedness of Harold Shipman is still hard to imagine. The tabloid terms that we have seen so often, such as "multiple killer" and "serial killer", still understate the full horror of what has happened. The way in which Harold Shipman abused his professional trust and the bond that he had with his patients is particularly vile and difficult to understand. That trust was given by patients who literally, and mistakenly, put their lives in his hands. The anguish of the relatives is difficult for any hon. Members to imagine. As a doctor, I cannot conceive of a bond built on trust being abused in such an unspeakable manner.

We must also remember, however, that it was Harold Shipman who was found guilty, and not the medical profession. I am grateful for the tone of the Minister's comments because, in cases of this kind, the specific is extrapolated to the general far too often. We must remember that the vast majority of our doctors are dedicated and hard-working, and we need to protect their reputation when considering any aspects of the case relating to Harold Shipman. All we ask is that all possible measures be put in place to prevent such a case from happening again.

The Minister detailed the terms of reference for the inquiry. The extent of the crimes is, as he said, still in doubt. It is unknown exactly how many victims of this

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man there were, or over how long a period the crimes took place. I imagine that that will be extremely difficult to ascertain from the medical records, and that much work will need to be done. That process will be very time consuming, and any chance of a short inquiry will, therefore, be remote.

There will be much supposition and doubt about Harold Shipman's previous clinical practice, which is why there is a need for full disclosure in the case, not only to maintain public confidence but to give all due comfort to the relatives of his victims. Questions as to who might have known what was going on or who might have been able to stop the events early before more patients became victims will be crucial for the inquiry.

The inquiry must also examine the role that the statutory authorities should play, the role that they did play, and the role of any responsible individuals who should have known what to look for, or who may have seen but not wanted to know, the pattern that was emerging. We need to know what all this will mean for future practice. We need to know the implications of peer review and audit, not least in the case of single-handed practitioners. How will we ensure that those who practise on their own will be audited by their peers in a way that ensures that all the same safeguards are applied to them as are applied to those in group practices?

I am sure that all hon. Members would acknowledge the sterling work carried out by the many single-handed doctors in this country, and we do not seek to denigrate what they do. However, we must ensure that, although they work individually on a contractual basis, they do not work in isolation on a clinical basis. That is one of the most important questions for the inquiry to consider.

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