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Primary Care Trusts

12. Mrs. Diana Organ (Forest of Dean): What progress he is making with the development of primary care trusts. [106249]

The Minister of State, Department of Health (Mr. John Denham): Excellent progress has been made towards primary care trust development, with 68 primary care groups proposing to make applications to become

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63 primary care trusts this year. Of the 19 applying for an April 2000 start, 17 will become operational in April and the other two will start in October 2000.

Mrs. Organ: Does my hon. Friend agree that the introduction of primary care trusts and groups has led to increased effectiveness and efficiency in the use of NHS resources? However, in Gloucestershire several primary care groups that want to develop into trusts face funding problems due to Gloucestershire health authority's funding difficulties last year. What reassurances can my hon. Friend give to the primary care group in the Forest of Dean that it will receive sufficient funding in future to be effective, efficient and successful and to consider being developed into a primary care trust?

Mr. Denham: My hon. Friend is right about the advantages of primary care groups and trusts. From April, we shall devolve about £20 billion to those organisations, which is three times the amount devolved to front-line clinicians by the previous Government's fundholding plans. That will enable services to be developed more efficiently and effectively.

On the question of Gloucestershire, my hon. Friend will know that following last year's increase of 5.5 per cent. in the health authority allocation, this year's allocation has gone up by 6.31 per cent., which is a significant increase. However, it is for local people to determine the size and shape of primary care trusts, taking into account the views of all the people in the local health system. That means that the right balance must be struck locally between the need for an organisation that can stay in touch with the communities that it serves, and the need to keep management costs well under control to make sure that money is spent on patients, not bureaucracy.

Mr. Peter Lilley (Hitchin and Harpenden): Will the Minister confirm that the introduction of primary care groups has resulted in patients now having to go to the hospital selected for them by their primary care group? The last vestiges of patient choice have been abolished, and patients, with the agreement of their GP, are no longer allowed to be referred to another hospital with a shorter waiting time or with a better success rate for the operation concerned.

Mr. Denham: No. The right hon. Gentleman needs to pay a little more attention to what is happening in the national health service. Nothing that we have done removes clinicians' right to make the appropriate referral for a patient. Indeed, a legal change in their position would be required to remove that right.

The unplanned system introduced by the previous Government was bureaucratic, expensive, unfair and uneven, and we have got rid of it in the interests of patients, doctors and NHS resources, because it is better to make sure, through proper planning and commissioning of services, that patients can get the service that they want at the highest quality and at their closest local hospital. If we contrast our vision of making sure that services are of a high quality and provided as close to patients as possible, with the right hon. Gentleman's vision in which a few patients chase all over the country trying to get on the lists of a handful of doctors, we all know which one patients prefer.

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Hearing Impairment

14. Mr. Malcolm Savidge (Aberdeen, North): What plans he has to improve NHS services for people with a hearing impairment. [106251]

The Minister of State, Department of Health (Mr. John Hutton): We will start a project in England later this year to trial digital hearing aids for national health service patients. The project will form a key part of our plans to develop modern NHS hearing aid services.

Mr. Savidge: I welcome that reply as I am aware from my local health authority area of the urgent demand for

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hearing aids. I am certain that new technology can play a vital role in meeting that need. If the pilots are successful, do the Government intend to extend the availability of digital hearing aids throughout the NHS?

Mr. Hutton: I can certainly give my hon. Friend that assurance. There is no doubt that digital programmable hearing aids are successful--they work. We have to ensure that that technology is available to NHS patients who use audiology services in local trusts, and we intend to do so in a major development and major modernisation of hearing aid services. I am delighted that the Royal National Institute for Deaf People has given it such a warm welcome.

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Harold Shipman

3.30 pm

The Secretary of State for Health (Mr. Alan Milburn): With permission, Madam Speaker I wish to make a statement about the Harold Shipman case. Harold Shipman is the general practitioner from Hyde, Greater Manchester, who, the House will know, was found guilty yesterday at Preston Crown court on 15 charges of murder, and of forging the will of one of his patients. I understand that the Crown Prosecution Service is considering further charges. The police have investigated a total of 136 cases.

The whole House and, indeed, the whole country will have been shocked to hear the detail of those dreadful crimes. I am sure that all right hon. and hon. Members will want to join me in offering our deepest condolences to all the relatives and friends of the people who died at the hands of Harold Shipman. Those relatives and friends have endured the ordeal of a lengthy public trial with quiet dignity. Our sympathies today are with those families.

We now know that Harold Shipman murdered at least 15 women patients. They had placed their trust in him as their local GP. He abused his position of trust in a way that was callous, systematic and determined. As Mr. Justice Forbes, the judge presiding in the trial, said yesterday, he murdered each and every one of his victims by a calculating and cold blooded perversion of his medical skills. It is almost beyond belief that a doctor could act in this way.

The relationship between individual doctor and individual patient is built upon trust. The Shipman case must not be allowed to erode the bond that rightly exists between our first-class family doctors and the families whom they serve. GPs in this country, almost without exception, are hard working, honest and trustworthy. It is almost universally agreed that we have one of the finest family doctor services in the world. In my view, it is imperative that we protect that reputation, even as we learn the lessons of the Shipman case.

It is of course true that a determined criminal can defeat the best-regulated organisation in pursuit of his purpose, but we must be confident that we do indeed have the best systems for regulation and self-regulation firmly in place. There is no doubt that those systems have to be strengthened and changed. Not only did Harold Shipman manage to perpetrate those appalling crimes, but he managed to get away with them for years without being discovered.

Members of Parliament and members of the public will want to be reassured about whether these awful events could have been foreseen and avoided, whether the early signs could have been detected sooner, and whether action to halt Harold Shipman could have been taken earlier. It is to answer those and other questions in a careful and considered way that I intend to establish an independent inquiry into the issues raised by the murder of patients by Harold Shipman.

I am establishing the inquiry using the powers that I have as Secretary of State as defined in section 2 of the National Health Service Act 1977, and with the support of my right hon. Friend the Home Secretary. The inquiry will be comprehensive and inclusive. The victims' relatives in particular will be able to present their views

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and experiences to the inquiry. The report of the inquiry will be made public. I am publishing the terms of reference for the inquiry today; a copy has been placed in the Library of the House. Given the issues of confidence raised by the Shipman case, the inquiry must act thoroughly and speedily. It will report in the autumn. It will be chaired by Lord Laming of Tewin, the former chief inspector of social services.

The inquiry's primary purpose will be to make recommendations on how best patients can be safeguarded in future. It will look at the role played by all the agencies involved in the Shipman case, including the coroner, the registrar, the police and health services. It will examine all relevant issues, including the measures needed to safeguard against the risks of isolated professional medical practice, GPs' access to controlled drugs and the role of the NHS tribunal.

We have received and noted the West Pennine health authority's internal report on the Shipman case. Last night, the health authority announced the suspension of its GP adviser. The health authority report will no doubt be considered by the inquiry but, equally, the inquiry will also be charged with properly scrutinising the role and conduct of the authority itself.

It will also be important that the General Medical Council's involvement in Harold Shipman's case is examined by the inquiry, that lessons are learned and that recommendations for reform are made. The GMC must genuinely exist to protect patients. It must be truly accountable and it must be guided at all times by the welfare and safety of patients.

The House will know that the Government and the medical profession are already taking action to modernise regulatory structures and to deal with poor performance wherever it occurs in medicine. The GMC is developing proposals for assessment and revalidation of all doctors' licences to practise at five-yearly intervals. To strengthen and underpin this, in November last year, the chief medical officer produced recommendations in his report, "Supporting Doctors, Protecting Patients", to identify and deal with the small minority of doctors whose performance or behaviour gives cause for concern.

The report proposes that there should be annual appraisal of all doctors, including family doctors. Until now, there has been no such system. It proposes that health authorities should have the power to suspend GPs when the circumstances indicate that patients may be at risk. They do not have that power at present. Finally, it proposes that participation of GPs in external clinical audit should in future be mandatory. It is not mandatory at present. The detail of the proposals is still being consulted on. We need to press ahead as quickly as possible with them.

In parallel, the Government intend that the system of clinical governance should apply to all doctors. It will promote high standards of care and introduce accountability in a way that has not existed in the past. Isolation in which an individual doctor's pattern of practice is hidden from view will become a thing of the past. The new system will in turn be monitored by the new independent Commission for Health Improvement.

Our proposals will provide safeguards against the rare doctor who poses a grave and immediate threat to patients' safety. In the process, they will improve GPs' accountability without preventing them from getting on with the job of treating, and caring for, their patients.

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To reinforce the steps that are already in train and those that the inquiry may recommend, I believe that there are certain immediate actions that the Government need to take in the light of the Shipman trial.

First, the way in which the NHS tribunal works means that the health service would continue to pay Harold Shipman for about another month following his convictions for murder. That is inconceivable. I am acting urgently to make sure that it does not happen. Similarly, the powers that I have as Secretary of State allow me to remove pension entitlements from those recipients who have seriously damaged public confidence in the NHS. I am today giving notice that I am considering removing Harold Shipman's pension entitlements.

Secondly, despite his convictions for murder, Harold Shipman today is still a registered doctor with the General Medical Council. The public will now expect the GMC to give its most urgent attention to removing Harold Shipman from the register of medical practitioners.

Thirdly, there is at present nothing to require a family doctor to disclose a past criminal conviction or a previous professional censure to prospective partners or to a health authority. In the 1970s, Harold Shipman had a conviction for obtaining and misusing a controlled drug. He had a record with the General Medical Council, yet that did not lead anyone to monitor him more closely than any other doctor. That, too, will now change.

I can tell the House that we shall be requiring doctors to disclose criminal convictions and action taken against them by a professional regulatory body, whether in the UK or abroad, before they can be appointed to medical lists.

Fourthly, we intend to make it compulsory for GPs to report deaths in their surgeries and other serious incidents to health authorities. At the same time, we are working with the Office for National Statistics to find new and better ways of monitoring deaths of GPs' patients.

Fifthly, I have asked the chief medical officer to commission and oversee a clinical audit of Harold Shipman's past practice. The audit will examine the pattern of deaths, certified causes of deaths, prescribing of restricted drugs, and the relevant medical records. Any concerns highlighted by the audit will be drawn to the attention of the relevant authorities.

Finally, my right hon. Friend the Home Secretary is setting up an urgent review to consider how to improve death certification and make more effective the checks undertaken before cremation and burial. The review will also consider whether there should be a role for coroners in monitoring the proper procedures after death. The consideration and findings of this review will, of course, be made available to the inquiry that I announced today.

We owe it to the relatives and friends of those murdered by Harold Shipman to identify and implement whatever steps are necessary to prevent a repetition of the terrible events witnessed in Hyde. Harold Shipman was a determined serial killer. He preyed on some of the most vulnerable members of our society. He broke the trust of his patients in the most dreadful way imaginable. Having betrayed the trust of his own patients, Harold Shipman should not be allowed to break the trust that exists between family doctors and their patients.

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The action that I have outlined today is intended to strengthen that bond of trust. It expresses the Government's determination to apply the lessons of the Shipman case to ensure that patients have the protection that they deserve.

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