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Shipman Inquiry

I echo the last remark of the hon. Member for South Cambridgeshire (Mr. Lansley). If we can create such a culture, we will have done something truly valuable for the country for many years to come. I am grateful for the way in which all hon. Members contributed to the debate. If we can continue our deliberations on these matters in the same vein, we will do politics, our parties and Parliament a service in trying to get the right settlement for the future. When my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) spoke about the effect on the borough of Tameside, it got me thinking. The borough does not want to be remembered for those terrible events—nor should it, because it is a fantastic part of Greater Manchester, which I represent, too. In some ways, I hope that my hon. Friend’s constituents and those of my hon. Friend the Member for Stalybridge and Hyde (James Purnell) will see some of the positive legacy of the improvements to Tameside general hospital that we hope to implement quite soon through the substantial redevelopment scheme under the private finance initiative. It is a matter of some coincidence that tomorrow I shall open a new practice in the fine borough of Tameside, near the constituency of my hon. Friend the Member of Stalybridge and Hyde—Dr. Kailash Chand’s practice at the Stamford House surgery. In many ways, what matters is not raking over the coals but bringing forward positive progress to the borough of Tameside that shows that the health service can take a stride forward and do something significantly better than before. That is the challenge that faces us all. I shall answer the questions that colleagues have asked, although I do not intend to speak for a long time, as we have had a full debate. My hon. Friend the Member for Calder Valley (Chris McCafferty) eloquently asked how it was possible for Shipman to continue his criminal activities for so long without being detected and how the system could not have been adequate to pick up the clues and warnings and protect patients. That is the key question that I have asked myself in considering the right response to the matter, and it was why I re-examined the issue of death certification when I was asked to do so. The hon. Gentleman is correct to say that the matter should sit within the clinical governance function of PCTs, so that information is used for commissioning and public health purposes, for general good governance in a locality and to detect any patterns of disease or illness. That would make it part of an integrated system, working with a reformed coroners system and system of professional medical regulation to do precisely what my hon. Friend said. That is a crucial piece in the jigsaw of creating systems that give us the satisfaction that we want. My hon. Friend asked whether we could create systems to ensure that such a thing never happens again. I am not sure whether we can ever be so arrogant as to say that any piece of legislation could do that, but we can work to close the cracks and limit as much as we can the weaknesses and the likelihood of it happening again. That is my objective in bringing forward our package of proposals. If the system is to work it is crucial that PCTs examine the whole range of indicators of clinical quality, including death rates, analyse information from death certificates and have an overview of complaints. They must use all that information to inform the strengthened system of scrutiny and accountability. My hon. Friend and others asked about the timetable for the implementation of the system. We propose to publish a consultation document on death certification shortly—that is not Department of Health-speak ““shortly””; it does mean shortly. The timetable for implementation is still to be determined, because it will be subject to legislation. One of the problems, and the reason why I referred to Dame Janet’s third chapter of the third report, is that there is legislation controlled by and relating to different bodies such as the Ministry of Justice and the Office for National Statistics, and the Home Office has a considerable interest in some of the issues that we are debating. The matter is complicated and subject to legislation, but it makes sense to consider a timetable for putting the reforms together. The earliest that we can hope for the coroner reforms to be fully implemented—the hon. Member for Oxford, West and Abingdon (Dr. Harris) asked me about that—is 2010. That is not unreasonable at this stage. I recognise the frustration that some people feel about the pace of progress, but I cannot make decisions on future legislative programmes. We need to ensure that the hon. Member for South Cambridgeshire’s frustration does not turn to disappointment, and we do not want momentum to be lost. My hon. Friend the Member for Calder Valley asked me about deaths abroad. When a death takes place overseas, the body is brought back to England and Wales and the coroner investigates the circumstances, as he would if the death took place in this country. That will remain the same. Families in those circumstances will get the same powers as others under the new Bill to challenge coroners’ decisions, although the death certification process is not the same. My hon. Friend the Member for Denton and Reddish raised important points about medical regulation and GMC affiliates. It is important to say how we envisage those affiliates working. I agree with the hon. Member for South Cambridgeshire that the system being developed is, in many ways, not punitive. As the chief medical officer made clear in his document, ““Good doctors, safer patients””, the idea is to create a supportive system whereby doctors exhibiting signs of difficulty, perhaps through alcohol or drug misuse, are supported, referred to bodies such as the National Clinical Assessment Service and offered help and support to get their careers back on track. The revalidation process will contribute to that. GMC affiliates will have a key role in placing recorded concerns on file so that there is a record of things brought to their attention. Even if they are not felt worthy of being taken to the GMC, they should nevertheless be recorded as concerns. That will build the more detailed system that my hon. Friend was looking for. We will close the regulatory gap between the GMC, which is at the end of a long process in many cases, and examples of practice that give rise to concern at a local level. I hope that he appreciates that. I wish briefly to touch on an issue that we have not mentioned. As well as the reform of the death certification system, the Government are considering adding to the draft Coroners Bill a provision recommended by the Constitutional Affairs Committee to place a statutory duty on doctors to report to coroners particular types of deaths, such as those that are in unnatural circumstances or are violent and fit certain characteristics. We will set out our proposals on that in a consultation paper, which is currently being considered in draft form. The hon. Member for Oxford, West and Abingdon referred to that and I hope that he will be reassured. On death certification, I was pleased to hear the hon. Member for South Cambridgeshire say that having the medical examiner within the PCT was the right thing to do and that he did not feel it should give rise to concerns about conflicts of interest. However, that is a legitimate point to consider. It is important to say that if we create a unified system of death certification it will apply to burials as well as cremations. At the moment the charging structure falls heavily on people whose relatives are cremated, and any new system will have to create a unified charging structure. It is important that that is done carefully and sensitively when the details are considered. The role of the medical examiner receives a lot of criticism, but it will be hugely strengthened by Connecting for Health and the national programme for IT. An examiner sitting at a PCT will be able to call up the necessary documentation, have immediate access to records and speak to family members if it is deemed necessary. It will be an easy, streamlined process. The system has the potential to be neither costly nor bureaucratic and will do the job that Dame Janet envisaged for the coroners service. The hon. Member for Oxford, West and Abingdon spoke about doctors’ lower tolerance towards poor practice and the importance of their not being hounded. They are important points and the two need to be balanced. He often talks about Government targets as though they were inherently antithetical to good patient care. I hope he understands that our targets are about the generality of the population getting access to basic standards of care. It is not enough for the system just to deal with the patient before it. Obviously, any health care system must consider how it is meeting the needs of everybody, not just those who come into the system because it is their turn in the queue. I wish sometimes that he would temper his description of targets. They are designed to improve the system for everybody, not to work against the interests of patient care. I believe that the hon. Member for South Cambridgeshire made that very point. I would not want doctors to be hounded as a result of the new system. It is crucial that professionals who express concerns about a colleague are protected, and I assure hon. Members that that is very much part of our thinking. We had a useful debate on the standard of proof, and I suspect that we will return to the subject another time. Again, I was pleased to have the support of the hon. Member for South Cambridgeshire. Perhaps there is a need for better communication with the medical profession so that people fully understand what is being proposed and so that liberties are not taken with the serious issue of people’s livelihoods, but Lady Justice Smith and the chief medical officer both firmly concluded that what has been proposed is the right thing to do. In my view, too, it is the right thing to do, and the Bill will include the proposal. On the composition of the General Medical Council, I believe that the hon. Member for Oxford, West and Abingdon said that he supported the proposal for parity between lay and professional representation. He is nodding, so I am pleased. Personally, I preferred a lay majority—I will be open about that. I felt that that would be right, but, in discussion with the medical profession and the GMC, I accepted that parity was a fair compromise and that it enshrined the two interests that have to be balanced. In many ways, it perfectly embodies the balance that has to be struck between the public interest on the one hand and the professional interest on the other. That is what we are seeking to do. The hon. Gentleman also raised concerns about people being elected to bodies and asked why the Government were moving away from that. There is a clear conflict between representation and regulation in the public interest. The responsibility of anyone serving on a regulatory body in the health care sector is to uphold the public interest and to improve patient safety. I do not doubt for a moment that that is not uppermost in the mind of the vast majority of people—in fact, all the people—who are elected to serve on regulatory bodies. Nevertheless, the impression is created that the first priority is to the constituency of people who put the person on to the regulatory body. Indeed, in many ways it is why we are asking the Royal Pharmaceutical Society to make changes to its structure, too. That body in itself combines a representational role on behalf of the industry as well as a regulatory role, and my view is that the roles are not compatible if we want a transparent and fair system.