---

Shipman Inquiry

I am grateful for the Minister’s explanation. I want to reinforce my point about the motivation for the Minister’s proposed changes, many of which we support. The fact is that public trust of doctors is still high, so it is important not to have the wrong motive. It is better to make policies to protect patients and to improve the practice of medicine, rather than to require doctors to restore a loss of public confidence, because the latter would mean that we, as parliamentarians and legislators, were passing our responsibilities on to the media, who create—sometimes rightly, sometimes wrongly—concerns and worries, and we would be legislating on the basis of opinion polls, which is something that is notoriously difficult. I am reassured by much of what the Minister said: there is good evidence that each proposal will improve the safety of patients and reduce the risk of something like Shipman ever happening again, and the measure is not, even in part, an exercise to restore an alleged loss of trust in the medical profession. If it were, we might overreact or react wrongly, and that would not be of service to the public or the profession. I want to put on record my admiration for Dame Janet Smith’s work in her detailed reports. She went a long way in the scope of her recommendations, which show a huge amount of work and application. She has made sure that public policy-makers are not in a position to forget the views that she expressed. That is laudable, but as parliamentarians we must ensure that we do not—we all risk doing this, and I may have done so myself—simply make up our minds on the basis of the thinking of the person who ran the inquiry, whether it is the Alder Hey or Bristol inquiry. We have a responsibility to look at the generalities, perhaps even more so than individuals appointed to do a particular job. They are experts, and we should value their views and recommendations, but we should not abrogate or delegate our responsibilities to them. The hon. Member for Calder Valley said that the general public are keen to see the reforms implemented. I would agree if she meant that they are keen for reforms to be implemented to ensure that the risk is reduced, but I am not entirely sure that the public are aware of the details of the specific reforms. I agree that there is an appetite to ensure that lessons are learned and that processes are put in place. I want to reinforce a point I made earlier, because the Minister misunderstood it. I did not complain about his use of the term, ““Shipman Bill””, which he immediately corrected and explained; I understand entirely his correction. However, if the Government propose something in legislation and refer to the Shipman case, we should be careful to avoid a situation in which people who have serious concerns about the legislation are regarded as unsympathetic or as having failed to learn the lessons. There is a genuine difference of opinion. During the passage of the Human Tissue Bill after the Alder Hey case, one sometimes formed the impression that if one really cared about what happened at Alder Hey hospital, one had to show it by backing measures that were quite restrictive. That situation was not right, and it may have been counter-productive in the end. I do not want to dwell on the question of the coroner system, because we debated it in the Chamber some time ago. My right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith), who chairs the Select Committee on Constitutional Affairs, expressed his concerns very well, and other people, including the Minister, have commented on the need to make more progress. I accept that the Minister cannot give a clearer timetable, but there are serious concerns about the support for coroners’ offices, not least in my county of Oxfordshire, which has had to deal with a number of cases, and about the need to ensure a uniform and professional standard for the coroner system. I support the Government’s proposals for death certification, and I want them to be introduced. The medical profession rightly drew attention to the inadequacies of the death certification system years ago. I remember when I was a junior doctor being invited by the bereavement office to sign the cremation form for a patient whom I had not seen recently, although I was the treating doctor, and effectively signing off the judged cause of death in the medical notes, which then went to a part 2 completion. In retrospect, neither my colleagues nor I took the situation seriously. As it was one of the few things for which one received a separate fee, it was laughably known as ““ash cash””. In retrospect, it was a disrespectful way of treating the whole exercise, but black humour is fashionable in the medical profession. The main problem was that it was done without any confidence that either signing doctor would pick up any foul play or negligence. If that applies to cremation forms, where there is a higher level of foul play or negligence, the same should apply to death certificates. There are concerns, as featured in a recent television programme, that it is still difficult for the patient’s relatives to challenge the cause of death on the death certificate, so we must ensure that the process becomes a learning experience for the health profession, and indeed, patients. We must learn lessons, too, about patients who have died from natural causes, as the sad decline in hospital post mortems is deeply damaging to the education and training of current and future health professionals. We have failed to ensure that death certificates are as accurate as possible, if for no other purpose than audit. The Minister rightly said that clues were missed during the Shipman case, and that information was not adequately combined during the Ayling case. We need a more coherent system of complaint gathering. I find it difficult to blame the GMC for the Shipman case, because it dealt with his drug use in the usual way, which was not to deprive someone of their livelihood indefinitely in the case of drug dependency, but to seek to manage it. If a mass murderer has previously encountered the prison and court systems, it does not mean that the court system is negligent in failing to spot continuing homicides. There is no doubt that the system of medical checks and audit failed Shipman’s victims, and there is no good reason for failing to identify a better audit trail on the use of controlled drugs and the GPs’ death rates. When I say ““no good reason””, I accept that the health service has other priorities, but we must ensure that we protect health service auditing. There are so many targets, emergencies and patient needs that sometimes things like auditing, which do not attract bespoke research money, are the poor relation. It is critical to improve medical practice, as well as to pick up on poor practice. We must ensure that in any procedure that makes complaints easier, we avoid the problem of racial bias, which, for reasons that are not clearly known, sometimes occurs in complaints against doctors. We must ensure that doctors who are the subject of complaints are treated fairly, as I have said. On the issue of complaints metrics, the Minister rightly said that it is important that patients and the public can complain about doctors. However, I am worried that if hospitals or other employers—not individual doctors—are measured on the basis of the number of complaints, we will create perverse incentives. There is a strong argument that, all things being equal, units against which there are more recorded complaints are probably doing a better job by allowing complaints to be made, but one could take a view of the quality of care based only on the number of valid complaints. I should be grateful if the Minister assured me that performance monitoring will not mark hospitals, NHS units or PCTs down on the number of complaints. If anything, a significant number of complaints may represent the good practice of enabling complaints to be made. Without complaints, we would miss a real opportunity. The Government are right to tackle controlled drugs as they propose. I strongly support their approach, but the Minister knows that patients can be poisoned, and that doctors can poison their patients deliberately or inadvertently, with all sorts of drugs, not just controlled drugs. The lessons that we have learned in controlled drugs cases must apply to other drugs, too, because doctors’ prescribing practice is an area in which there is a great deal of room for improvement. The question is about best care, not just about criminal liability. I have a couple of questions about regulation, which the BMA, too, has raised. It would like to know the details of the timetable and the national advisory group on professional regulation, which has supposedly been set up to advise the Department and the devolved Administrations on the detailed implementation of the proposals. Does the Minister believe that the proposals for doctors to appeal against adverse findings by the regulator in the new system will be adequate and accessible without too great a legal cost? Another concern is that the appeal process is expensive, and when we are dealing with the health service and the needs of its employees, it is money that might otherwise be spent on health care. We need a system that is not just thorough but efficient. I welcome the Government’s general approach. My concerns about the proposed speed and extent of coroner reform, and the proposed medical regulation, should not be taken as a general criticism either of their approach or, in particular, the Minister’s openness and his ability to engage with the professions, the public and the Opposition on these matters. I look forward to his response.