---

Shipman Inquiry

I understand; the hon. Gentleman slightly tempts me, but I shall not go too far along that line. The moment that the hon. Gentleman mentions Government targets, one has to embrace the thought that the medical profession will be able to deliver the kind of professional self-regulation that we are discussing in circumstances in which responsibility for the care of patients is exercised by clinicians on the basis of their professional judgment. The chief medical officer said in his conclusions to his document ““Good doctors, safer patients””, which was published last year:"““The quality and safety of the care received by patients is not yet central to the goals, culture and day-to-day activities of every organisation and every clinical team delivering care to NHS patients. Financial and activity targets often have a higher priority.””" That comes back to the point made by the hon. Member for Oxford, West and Abingdon. If we are looking for professional regulation, it has to be in a structure within which professionals understand that the structural framework and the organisational framework are entirely consistent with the care and priority that they give to the care of patients. The next sentence in the report from Sir Liam Donaldson stated:"““It is misguided to think that these considerations are mutually exclusive. In the best healthcare organisations in the world, the ‘business plan’ and the ‘quality plan’ are one and the same.””" To be fair to the chief medical officer, we know exactly what he is aiming at, and I hope that we would see it in policy terms. Professionals would not find a conflict between Government targets or the objectives of an organisation and their professional responsibility, because they all point in the same direction. That is what we are aiming for. I managed to raise most of the points that I wanted to make in my interventions. One was about the standard of proof in particular. It is right to proceed on the basis of a civil standard of proof, flexibly applied. The point that I made in my intervention was that flexibility must be carefully applied in determining the severity of penalties that might ensue from accusations. I hope that that will be understood in the medical profession. As the Minister rightly said, most doctors are worried about the standard of proof that would be applied to deprive them of their livelihood and bring them in to public disrepute. That sanction would be applied only where there was evidence to support the accusation beyond reasonable doubt. A range of penalties are available that do not have quite the same impact and do not require a ““beyond reasonable doubt”” standard of proof. That seems logical to me, but everything that I read suggests that we have not yet got that message across to the medical profession. We need to have that debate, even if it is in the few months before we discuss the legislation.