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Dr. Liam Fox (Woodspring): I am grateful to the Secretary of State for his statement and for his courtesy in making it available to the Opposition in advance.
As a former general practitioner, and as a current member of the Royal College of General Practitioners, I feel nothing but horror and disgust at the actions of Harold Shipman. I find it incomprehensible that any doctor who had the trust of his patients could behave in such a way. I am sure that that view is shared not only by the public but by the entire medical profession.
I extend the sympathy of all Opposition Members to the families of the victims. They are the ones who have to live most immediately with the results of Harold Shipman's wickedness. However, as a GP, may I say that it was Harold Shipman who was found guilty, not the medical profession or general practitioners? We need to keep a sense of proportion in this debate, and I am grateful that the Secretary of State made such a well-balanced statement.
We welcome the public inquiry. I hope that the Secretary of State will be able to give an undertaking that its findings will be debated in the House as soon as the House returns from the summer recess.
I welcome the statements on pay and pension in relation to Harold Shipman, which I am sure those outside the House will regard as sensible. I agree that there are lessons for the General Medical Council. Immediate removal from the register in cases such as this is simply common sense. I agree that there should be better reporting of deaths in GPs' surgeries and better monitoring of the deaths of GPs' patients. However, we should not expect too much of such figures because there would have to be a great difference between a GP's figures and the norm to reveal a substantial discrepancy.
I welcome the review of the coroner's role in monitoring procedures after death. I agree that doctors from home and abroad should be required to declare criminal convictions and any actions taken by a regulatory body. Will that require primary legislation? How will that be policed? Policing will be the most difficult aspect of such a measure.
I want to make one or two constructive suggestions. Should not the principle of requiring doctors to disclose criminal convictions be extended? Surely health authorities and other employing authorities should have a legal duty to check references for doctors from the United Kingdom and abroad.
Any doctor can sign part 2 of a cremation form for a colleague. There should be better controls; for example, doctors should be specifically trained to sign a part 2. Doctors who will do that in future should at least take a course. Perhaps someone other than a GP who has specialist knowledge should sign part 2 of cremation forms to ensure increased public confidence in that process.
The Secretary of State mentioned controlled drugs. Surely it should be an offence not to hand back drugs that are taken from the relatives of a patient after death. It is
common for doctors to take them and throw them away, but we need to ensure that procedures are in place to maintain public confidence. Hoarding controlled drugs is not acceptable.
Questions must be asked about the future of single-handed practices. Many of us in the primary care system have not wanted to face up to that question previously. However dedicated the individual GPs, questions must be asked about single-handed practices' auditing and ability to provide modern health care. The Secretary of State would be supported by the Opposition in considering that matter constructively.
The Secretary of State said that our GPs, almost without exception, were hard working, honest and trustworthy. I am grateful for the fact that there has been no knee-jerk response about regulation, and that the responsibility for regulation will remain principally with the profession in line with the law.
The Secretary of State said that no system could prevent one evil individual from carrying out such acts as those of Harold Shipman. He asked whether they could have been stopped or foreseen. I am sure that the question that he, like the House, wants to ask is, "How can we ensure that it cannot happen again?"
Mr. Milburn:
I am extremely grateful to the hon. Gentleman for his support and his constructive comments. I agree about the need to try to retain a sense of balance. It is important to learn and apply the lessons as rapidly as possible. All hon. Members, in partnership with the medical profession, should make the necessary changes to protect patients and the best interests of the overwhelming majority of doctors, who are hard working, trustworthy and honest. Many of the changes that I have described will have the support, and command the confidence, of the medical profession.
The hon. Gentleman asked about a debate on the findings of the inquiry. That is a matter for the business managers, but I am amenable to discussing the issues when the inquiry has reported in the autumn. I expect it to report at the end of September; its findings will be made public.
On figures and mortality statistics, the Shipman case has thrown into sharp relief the fact that our method of collecting, using and monitoring figures is susceptible to allowing a callous, evil and cunning individual to slip through the net. We must address that rapidly; we are in discussions with the ONS. It is not true to claim that the figures that were available in Hyde, and probably to the West Pennine health authority, were not susceptible to interpretation. Clearly, the mortality rate among Harold Shipman's patients was higher than average; it was excessive among his elderly women patients.
As to ensuring that criminal convictions and professional censures are made available to employers and health authorities, we have the basis of that in the criminal records bureau, which was established under the Police Act 1997. We shall consult the medical profession about how we can use that to achieve what we want to achieve. Controlled drugs and the training of doctors are both very important issues. Reform of the system for registering death and signing off burial and cremation certificates is long overdue. That is now crystal clear, but it is properly a matter for my right hon. Friend the Home Secretary and the review that he has established, which will report as
quickly as possible. It, in turn, will be fed into the inquiry. If the inquiry decides to make further recommendations, so be it. We shall look on them favourably.
Finally, the hon. Gentleman referred to the future of single-handed practices. Like him, I think that that is an extremely difficult issue. There are about 3,000 single-handed GPs in this country and an awful lot of small practices--often in inner-city or isolated rural communities--provide a valuable service to tens of thousands of patients. Those patients, in my view, have the right to expect precisely the highest standards of care and no difference between the standards of care provided by a single-handed GP or a GP in a large practice. We must ensure in future that there are proper methods to enforce those standards, wherever a GP practises, and effective monitoring of them, too.
Mr. Tom Pendry (Stalybridge and Hyde):
Will the Secretary of State accept from me that his statement goes a long way to give comfort to my constituents in Hyde and, in particular, to those whose lives have been shattered by the actions of that evil man? The whole House will join my right hon. Friend in expressing our sincere condolences to those who have been affected by a doctor whom they trusted, but who betrayed their trust. Does he agree that the bond between doctor and patient is very precious? I hope that the inquiry that he is setting up will go some way to restore that particular bond and the faith that we have in that relationship.
I am pleased that my right hon. Friend said that my constituents who have been affected by the case will have access to the inquiry. I believe that that will be well received in my constituency. He covered some of these points, but I hope that his inquiry will acknowledge the need to change the monitoring of death certificates and recommend tighter control of the dispensing and collecting of drugs by GPs; the introduction of new procedures to suspend and, if necessary, dismiss GPs; the placing of any criminal records of GPs in the hands of the health authorities; and the monitoring of registered deaths. Anything short of that will not satisfy my constituents or, I believe, the nation.
Mr. Milburn:
I am extremely grateful to my hon. Friend, who has been very active in his support for the relatives of the victims of Harold Shipman. He has also been in regular touch with me about the case. I can confirm that the inquiry will be accessible to the relatives and friends of the victims, which is appropriate and right. We have to find the best way of achieving that access and of ensuring that change happens, as we all want and, I believe, as the relatives want. They want at least a tad of good to come from all this. We must make sure that the inquiry is open and accessible, and yet can get on with its job and report as quickly as possible. He referred to the suspension of GPs. As he is aware, we do not have such powers. I think that many will conclude that perhaps we should have them in the future.
Mr. Nick Harvey (North Devon):
I, too, express shock and horror at these dreadful crimes, and echo the sympathy already extended to the families--and, indeed, to the many other families of former patients of Harold Shipman who are now wondering anxiously whether the deaths of those patients were also suspicious.
I welcome the statement, and thank the Secretary of State for giving notice of it. I also welcome his announcement of an inquiry, and of the Home Secretary's review of death certification procedures. Is it not the case that some of the welcome appraisal measures mentioned by the Secretary of State will identify incompetent doctors, but will not necessarily show up evil doctors?
Let me take up a point that has already been made. The requirement that a doctor should disclose convictions or professional censures is all very well, but what if the doctor does not do that? Would it not be better for the system to be the other way round, and for health authorities to be required to perform full checks and searches before appointments are made; and would it not be better for the checks and searches to be extra thorough in the case of those who are to practise as single-handed general practitioners?
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