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Shipman Inquiry

I take the point made by the hon. Member for Oxford, West and Abingdon. It was, perhaps, inadvisable of me to suggest that that label could be applied to the Bill. I was seeking to make a point about the breadth and depth of the reports from Dame Janet Smith’s inquiry and that we are also dealing with the recommendations of other inquiries relating to very serious professional misconduct. I simply wanted to say that it is desirable, in my view, to introduce a package of legislation at the same time, so that the matters could be considered in the round, because that would be helpful for all concerned. The hon. Member for South Cambridgeshire mentioned the private grief of Departments. That may be the case, but he should read the third chapter of Dame Janet Smith’s third report, to which I referred, because colleagues of his who are still in this place were engaged very deeply in the relevant matters. I am not making a party political point, by the way. It is simply that there is a salutary lesson in that chapter for Governments generally about how such matters can be resolved. They ran aground in the 1980s for precisely the reasons that are set out. I hope that when we finally put the proposals before the House, we do not allow that to happen again. The Government’s action programme for strengthening the safeguards on controlled drugs was published in December 2004, and action is nearing completion. The fourth report of the Shipman inquiry considered how Shipman could have amassed such a lethal armoury of diamorphine, and the recommendations are intended to deal with that very point. I shall set out the key elements of the programme which have been introduced. First, the new governance arrangements introduced in the Health Act 2006 build on existing NHS clinical governance processes by requiring all health organisations to appoint an ““accountable officer”” with specific responsibility for controlled drugs to share information and to collaborate in action needed to protect the public. The second key element is restrictions on prescribing controlled drugs, placing on all health care professionals a clear requirement to prescribe only within their professional competence. The third element is strengthening the audit trail for controlled drugs, for instance by capturing information on the private prescribing of controlled drugs and developing and implementing an audit trail for controlled drugs requisitioned for internal use by GP practices. The fourth element is improving information for patients on the therapeutic uses and special status of controlled drugs. Fifthly, we are working closely with professional bodies to improve the education of health professionals in the appropriate use of controlled drugs and in the special precautions needed. On the issues raised by the Shipman inquiry’s fifth report and the reports of the Ayling, Neale and Kerr and Haslam inquiries, the crucial first step is the initial identification of causes for concern. In Shipman’s case, despite the ingenuity with which he attempted to cover his tracks, potential clues were missed. In the case of Clifford Ayling, that was compounded by the failure of different NHS organisations to combine the information that each held. Health care organisations need to work with information of two types. The first is routine indicators of clinical processes and outcomes, which, taken together, give a broad view of the clinical performance of clinical teams and individual clinicians. The second is information derived from complaints from patients and carers and from concerns raised by other professionals or organisations. Clearly, information of that type needs to be used sensitively and with appropriate safeguards to ensure that the reputations of health care professionals are not unfairly impugned. The Government will work with professional, NHS and patient organisations to develop further the use of routine quality indicators and to agree guidance on the appropriate use of softer forms of intelligence, in particular on the safeguards that should apply to the sharing of such information between organisations. Complaints and concerns are potentially a vital source of information that may indicate poor professional performance or abuse. However, patients, carers and professional colleagues need clear signposting so that they know where to register their concerns. They may need support and help in articulating concerns, and reassurance that they will be taken seriously. In particular, they will want reassurance from those responsible, including senior managers, that action will be taken to ensure that there will be no recurrence of the incidents that caused concerns and that organisations take on board the concerns as part of their ongoing service improvement. This week, the Government launched a consultation proposing comprehensive reform of the complaints system for health and social care. Key features relevant to the debate are proposals for a right for patients with complaints against a GP to go directly to the PCT, rather than to the practice itself; closer collaboration between organisations receiving complaints to ensure that complaints are speedily routed, where necessary, to the most appropriate body; developing good practice on keeping complainants informed about the progress of their complaint; placing a responsibility on PCTs to maintain an overview of complaints against GPs; and working with the NHS to build capacity and skills for investigating more serious allegations. I have always believed that the NHS needs to adopt a more open culture in handling complaints from the public. Too often in the past, the tendency has been to allow the shutters to come down and to push complainants towards the legal process. There needs to be a learning culture at the very bottom of the NHS so that complaints are received and acted on. In the vast majority of cases, patients’ motivation in bringing complaints, including to Members of Parliament, is to prevent what happened to them from happening to somebody else; it is not to seek financial redress or to take the NHS to the cleaners. It is important that the NHS understands that and works with it. Where local information indicates a potential issue over professional performance, health organisations have a responsibility to take whatever action is needed to protect patients and, where possible, support and help the professional to get their career back on track. Experience shows that intervening early—before problems have become ingrained—is far more likely to be effective, and that is a major theme of the White Paper on professional regulation, ““Trust, Assurance and Safety””, which we published in February. In recent years, the Department has agreed new arrangements with the professions to clarify and strengthen such processes in primary and secondary care. The new arrangements incorporate important safeguards, including the separation of the investigation of concerns from the formal decision-making process. Despite those reforms, the Shipman inquiry considered that primary care trusts did not have adequate powers to protect patients in the case of poor performance by GPs. The Government agree and will this year carry out a review of the operation of the performers list system, relating it to the proposals for reform of professional regulation, to which I will now turn. The Shipman inquiry’s fifth report was critical of many aspects of the regulation of the medical profession, particularly the lack of clear standards for judging fitness to practise, the lack of demonstrable independence in the adjudication of the most serious fitness-to-practise cases and the way in which earlier proposals for the revalidation of doctors had been implemented. Given the radical and, in places, controversial nature of the inquiry’s recommendations on those points, the Government decided in early 2005 to set up a review of medical regulation under the chief medical officer and a separate review of non-medical regulation under the then NHS director of human resources, Andrew Foster. Those reviews reported in July 2006, and, following a period of consultation, our final proposals were published in the White Paper on professional regulation, which I mentioned. Our proposals include inviting the professional regulatory bodies and specialist organisations such as the royal medical colleges to develop clear standards to determine whether health professionals remain fit to practise. We also propose improving co-ordination between local NHS employers and national regulators—in the case of doctors, through a network of General Medical Council affiliates. That system was proposed by the chief medical officer to close what he termed the regulatory gap—a situation in which a professional’s behaviour may be causing local people concern, but there is insufficient evidence to take a complaint all the way to the national regulator.