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Shipman Inquiry

I join others in thanking the Minister for securing us this opportunity to debate the issues, not least because the way in which he introduced the debate has, apart from anything else, allowed us all to raise some of the issues in interventions, which has been helpful in exposing some of the issues for future resolution, and saved me from having to explain many of the things that I otherwise might have. I also share the Minister’s appreciation of the contributions that the hon. Members for Stalybridge and Hyde (James Purnell), for Denton and Reddish (Andrew Gwynne) and for Calder Valley (Chris McCafferty) have made in representing their constituents. As constituency Members of Parliament, we can barely comprehend the scale of the distress and grief that Harold Shipman’s evil caused. However, it must be of comfort to the families and the communities that those hon. Members represent that their Members of Parliament have been active in representing them and are here today, ensuring that the issue does not become unfinished business. I entirely accept the point that the Minister made. We must all learn from the past and ensure that they we do not allow the deficiencies of reform in the past to prevent us from taking the necessary steps today. I am therefore all the more grateful that Ministers tackled the question of controlled drugs in the Health Act 2006, in part 3, which we generally welcomed. There will be the question of what the role of the inspectorate of the Royal Pharmaceutical Society of Great Britain may be in helping to buttress accountable officers and how the two might interact with one another. We do not want any duplication between the two, so it will be helpful to consider that as time goes on, particularly as the RPSGB will, for professional regulatory reasons, be separated from the proposed general pharmaceutical council. That gives even greater confidence that the RPSGB will be a proper vehicle for exercising greater professional scrutiny. We debated the timetable for coroners reform, so it was a surprise, given the availability of draft legislation, that Ministers did not introduce legislation in this parliamentary Session. That was only a matter of surprise, however. It would be a matter of disappointment, which would be shared throughout the House, were Ministers not able to bring anything forward in the next Session. It is not that every issue is resolved, but with the consensus that exists, I cannot but feel that the coroners system is ready for reform. The basis of that reform must be a greater assurance that investigation of suspicious deaths will take place to uncover wrongdoing. Perhaps most important, we must ensure that the system is not so rigid, for reasons to do with historic legal structures, that it fails to be as sensitive and supportive as it should be to the relatives of those who have died. They must be assured that the issues will be fully investigated. I do not represent that part of our Front Bench that will be responsible for the structure of coroners reform, so now is not the moment for me to address it. However, I am sure that we shall want to consider carefully the relationship between medical examiners, in the context of the NHS, medical assessors—a recommendation of the Luce review—and coroners, and whether, if we do not take up that recommendation, medical examiners will in practice be able to give coroners the necessary support. I hope that they can. It must be right that consideration of the process of death certification and coroners reform should proceed alongside one another. I have seen that Ministers wish to embed medical examiners in primary care trusts. I think that that is the right thing to do, as it will put medical examiners in a position where they can link their role into performance management of primary care providers and commissioners. Although the Select Committee on Constitutional Affairs was worried about the risk of a conflict of interest, we do not need to go down the policy line too far with the Minister to recognise that, in terms of corporate and clinical governance, primary care trusts will at the very least separate their commissioning and provider functions. The role of a medical examiner in those circumstances forms part of that core PCT commissioning responsibility, so that whether providers are community-based providers or hospital-based providers, a medical examiner could clearly be independent and have no conflict of interest. I should like to talk for a few moments about the regulation of the medical profession. Let me put the matter in context. The Minister quite rightly said that the medical profession continued to command a very high level of confidence among the public. The system of regulation of the medical profession also continues to command confidence. However, when one considers the issues that we are dealing with and the responsibilities of the medical profession, the system of regulation and the level of confidence enjoyed must be exemplary. For example, if one says, as is true, that three quarters of the public are fairly or very confident in the system of regulation of the medical profession, we submit that that is good, but not good enough. If one in four patients do not feel confident that their complaint or their belief that something has been done wrong will be properly investigated, that is too many people. We need to minimise any lack of confidence in regulation of the medical profession. Although it is sometimes tempting to say that the enormity of what Harold Shipman did was so exceptional that one could not extrapolate from that lessons about regulation of the medical profession as a whole, the principle that we are dealing with is a risk-based system of regulation. One calculates risk by calculating the probability of an event and looking at the severity of its consequences. One has to contemplate only for a moment the enormity of what Harold Shipman did to understand that even a tiny probability of such an event occurring mean that one must, taking a risk-based view of proportionate regulation, have a very robust system of regulation in place. I subscribe to the view that we should have a risk-based system. Dame Janet Smith seemed, on my reading, to set out in a very competent and comprehensive way to examine what had happened and to expose how, if people had acted on the information that was available to the respective parts of the system in place, it would have been possible, in a better system, to identify wrongdoing and risk, and to deal with it. However, because Dame Janet considered many aspects of the regulation of the medical profession and identified deficiencies in it, she has made wide-ranging recommendations geared to the reform of the system as a whole. On any reading, those recommendations go beyond what is necessary to identify and deal with—I hope far more effectively—someone who is behaving even remotely in the way Harold Shipman behaved. To bring that back to specifics, she recommended that revalidation should be conducted not on the basis of concerns about somebody’s fitness to practise but on the basis of a positive effort to secure revalidation.