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Mr. Hogg: Does my hon. Friend agree that the best way to try to determine the extent of Dr. Shipman's crimes is to ascertain that from him? He has little reason not to make a full disclosure because he is not to be further prosecuted. Does my hon. Friend also agree that one way forward might be for the inquiry--and, indeed, the prosecution authorities--to give an undertaking that Shipman will not be further prosecuted and to try to get him, on the back of such an undertaking, to make full disclosure?

Dr. Fox: We have already had the assurance that there will be no further prosecution should further evidence be found. Although I should like to think that such co-operation would be valid in the investigation, I must say to my right hon. and learned Friend that I would not necessarily regard someone who has murdered many of his patients as being of suitable character to be a witness. I would not want to place too much reliance on such a person, which is why we must hold an external inquiry--a full audit of all Shipman's records. All possible means must be used to try to ascertain the truth. Talking to Harold Shipman may be a useful pointer, but I am sure that my right hon. and learned Friend agrees that we should in no way rely on that to get to the bottom of what may be an extraordinarily widespread and sordid series of events.

We need to know how revalidation and the Government's annual appraisal proposals--and, indeed, subsequent reform of the General Medical Council--

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might affect these and subsequent cases. Such issues must be considered not individually, but as part of a whole. We must ensure that action is taken quickly and decisively at all levels in respect of early warning, early action and firm final action, not only to deal comprehensively with such cases but to ensure that those who are not guilty are cleared as quickly as possible and able to continue their careers.

Mr. Winnick: To return to the point made by the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg), if it emerged that Shipman was responsible for other deaths for which he had not been charged and convicted, how would those left behind feel? Shipman might have murdered their loved ones, but no action would be taken in court. Surely they would feel that the person in question had got away with such crimes. There is a point at issue here; perhaps the hon. Gentleman will address it.

Dr. Fox: I sympathise with that point, but it has already been made clear by the relevant authorities that there will be no further prosecutions. That is a matter not for the House but for the independent prosecuting authorities, although I acknowledge the hon. Gentleman's reflection of how the relatives would feel.

We must work out how the Government's proposed National Clinical Assessment Authority would affect subsequent cases. Indeed, there has been confusion over statements from Downing street and the Department of Health as to whether the NCAA would guard against such cases. My view is that the Minister put the case rather better than No. 10 that such a measure would not have stopped a Harold Shipman-type case. It is being put in place to ensure that those who practise incompetently rather than criminally are discovered more quickly. The Opposition welcome supplementary lists, which are long overdue, as they will bring the regulation of part-timers and locums into line with that which full-time doctors must undergo.

As for the impact on primary care as set out in the terms of reference, there is an interesting point in respect of the disclosure of previous offences. Of course it must be right that people should have to disclose their disciplinary conduct record, but it must also be sensible to include a double lock under which an employing authority has a duty to check the disciplinary background of anyone it was to take into its employ to ensure that there was no blemish. Simply asking for self-disclosure from those with a disciplinary blemish on their record is not sufficient and the public will want a stronger mechanism. We must also ensure that should such a mechanism be put in place, we have sufficient law to police it as that would greatly underpin public confidence in such cases.

We must consider how controlled drugs are used and, in particular, what happens when patients die with controlled drugs in their homes. How should such drugs be disposed of and what are the rights and duties of doctors? All those points require clarification and I hope that the inquiry will consider them in detail. Many of us with experience of such matters well understand the problems that doctors face and the pressures on relatives in terms of removing medicines and clearing up a house. That can cause great distress, so the clearer the regulations, the better the situation is likely to be for all involved.

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We look forward to the inquiry closely considering the coroners service. Many questions have been raised about its role in the Shipman case. Why was the pattern missed if it was so widespread and occurred over such a long period? What record-keeping mechanism would expose such a pattern? What review mechanisms were in place? What new review mechanisms are needed? Is the coroners service suitably regulated? If so, how is it to be policed? All those are important questions, but perhaps something even more important needs to be done.

A general practitioner who is not the doctor of the patient in question is called to sign part 2 of a cremation certificate for a colleague. The patient's own doctor cannot sign. I know from experience that certificates can often be signed in haste, perhaps to help relatives at a distressing time or to expedite funeral arrangements. The chances of missing a pattern increase when signing such certificates is spread among a number of doctors, so there must be a strong argument for a single person in a district to have the job of signing part 2.

If one person had the specific job of checking medical records and signing part 2, it would become evident to that individual if a pattern was emerging among doctors in the area, and the pattern would be easier to detect. Whatever the results of the inquiry, I hope that the Government will consider such a legislative move, which represents a simple way of putting in place a safeguard that does not currently exist. Although it is all too easy for such patterns to be missed for many of the right reasons, they can also be missed for many of the wrong reasons.

We welcome a public inquiry. The scale of the crimes makes holding an inquiry in private unthinkable, and I know that that is the view of the relatives of the Shipman victims. The Secretary of State initially said:

That was clearly not enough. The families and relatives of the victims must be able to raise the issues that are important to them, as my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) said in his interventions.

Setting up large television screens is a long way from the Government's original plans. The families of the Shipman victims, a substantial element of our national newspapers and the national media and I gave written evidence, forcing the Government into a U-turn. There will be a public inquiry, but that is not what the Government wanted. I am grateful to the Minister for his explanation, but, in all justice, the Secretary of State should have had the courage to come to the House to explain why he did not want a public inquiry and why the High Court forced him into this action. Through the House, he should give an explanation to the relatives of the victims of Harold Shipman.

7.9 pm

Ms Chris McCafferty (Calder Valley): At the risk of sounding patronising, I thank my right hon. Friend the Secretary of State for having the wisdom and the stature to recognise that his original decision was not correct. As someone who has campaigned to ensure that Harold Shipman's time as a general practitioner in Todmorden in my constituency of Calder Valley is considered as part of any inquiry or investigation, I have always been open

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about my view that the only way to establish the truth is to hold a full, open public inquiry considering all the aspects of the Shipman case. We owe it to the many unknown and suspected victims of Shipman, and their families, to do all we can to ensure that we uncover the truth about his activities, and to establish safeguards to ensure that such things never happen again.

Will my right hon. Friend the Secretary of State ensure that time scales and procedures governing submissions of evidence are widely publicised in Todmorden, where suspicious deaths are being investigated by West Yorkshire police? My constituents are very grateful to my right hon. Friend for ensuring that Todmorden was included in Professor Baker's clinical audit, for looking carefully at the professor's conclusions about Shipman's activities during his time as a GP in Todmorden, and for being mature enough to change his mind and propose a full and open public inquiry.

I welcome the motion, and hope that all Members will support it.

7.11 pm

Dr. Peter Brand (Isle of Wight): Being a doctor can be an extremely lonely occupation at times. Medicine is not clear-cut; there are many grey areas. It is not surprising that some doctors, especially those in single-handed general practice--and, indeed, single- specialty hospital doctors--can find it extraordinarily difficult. It is well known that many doctors in such circumstances tend to move in two directions: they lose their confidence and take to alcohol or drugs; or they think they are infallible and start to behave strangely.

Shipman did not just behave strangely; he behaved wickedly, and quite exceptionally. I certainly hope that it is exceptional for someone to be as murderous as that. I also hope, however, that the inquiry will consider some of the wider issues that may cause people to behave as Shipman behaved, and to take account of some of the risks carried by all of us when we fail to support professionals whom we imbue with a great deal of responsibility.

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