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Bosnia and Herzegovina: Export Licence Application

The Minister for Europe (Mr. Denis MacShane): On 30 November 2004 the Government issued a licence for the export of training ammunition to the security department of the US embassy in Bosnia and Herzegovina. Training ammunition is non-lethal, allowing for practice shooting without risk of serious injury. In this case, the equipment was for training purposes in support of the day-to-day protection of embassy personnel.

An EU arms embargo has been in place against Bosnia and Herzegovina since 1996. The purpose of the embargo is to aid the establishment of peace and stability for the people of the region, taking into account the need to ensure the safety of international troops and civilian personnel deployed.

We fully support the EU embargo. However, in limited circumstances, we are prepared to make exemptions where denying an export would frustrate the purposes of the embargo. I am confident that granting an exemption to allow for the protection of diplomatic personnel is consistent with the embargo's aim of establishing peace and stability in Bosnia and Herzegovina.
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Continuing Care

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): Today I am commissioning the development of a national consistent approach to assessment for fully funded national health service continuing care and announce the publication of the independent report on continuing care entitled "Continuing Health Care: Review, Revision and Restitution".

I would like to acknowledge the work during 2003–04 carried out in bringing together more than 95 health authority criteria into the legally compliant 28 strategic health authority (SHA) criteria which exist today. Having achieved this objective and significantly improved arrangements for assessing new cases, and having made good progress with the retrospective review of cases where people have been wrongly denied funding in the past, it is now practical to move forward and improve the system further.

The Department will work with the SHAs to build on all the good work done so far. Learning from good practice, we will produce a national approach to continuing care to improve consistency and ease of understanding. We want to help to achieve these aims. This does not constitute a break from past practice. As I have said before all the current criteria are fair and legal. It will however make the process easier to understand for practitioners and patients alike.

Shipman Inquiry

The Secretary of State for Health (Dr. John Reid): The fifth report of the Shipman inquiry, "Safeguarding Patients: Lessons from the Past—Proposals for the Future", Cm 6394, was published today, together with the Government's response to the inquiry's fourth report, "The Regulation of Controlled Drugs in the Community", Cm 6249. This follows the publication of reports on the extent of Harold Shipman's criminal activities; on the 1998 investigation by the Greater Manchester police; and on death certification and the coroner system. The inquiry is now working on a supplementary report to the first of those reports and hopes to publish this final element of its work early in the new year.

The Government express their profound thanks to Dame Janet Smith and her team for the care and attention that has gone into the preparation of each of her reports. We also reiterate our sympathy to the relatives and friends of Shipman's victims and express our thanks to them for their valuable contribution to the inquiry's work.

The Inquiry's Fourth Report

The inquiry's fourth report, published on 14 July 2004, analyses the means by which Harold Shipman was able to obtain his lethal armoury of controlled drugs and finds weaknesses both in current systems of control and in the ways in which those controls were operated. The report recommends strengthening current arrangements
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in four main areas. First, it recommends a new integrated, multiprofessional inspectorate to inspect the management of controlled drugs in national health service primary care to replace the existing unco-ordinated arrangements for inspection. Secondly, it recommends restrictions on the right of general practitioners to prescribe controlled drugs in certain circumstances, for example prescribing for oneself or one's immediate family or prescribing beyond the requirements of one's normal clinical practice. Thirdly, it recommends auditing the prescribing of controlled drugs in primary care and the movement of supplies of controlled drugs in the community. Fourthly it recommends, better information to patients on the special legal status of the controlled drugs that are prescribed for them.

The Government fully accept the need to improve current arrangements for the management of controlled drugs, and to do so in a way that does not hinder patients from accessing the treatment they need. We fully accept the great majority of the inquiry's recommendations and for the remainder we propose to achieve the same recommended ends by alternative action. Dame Janet Smith has seen our proposals, and is pleased that we have accepted the principles underlying her report, and that we intend to follow up her recommendations with rigorous action.

We will also follow through the implications of the inquiry's recommendations for other health care settings, including hospital care, the private sector, and care homes. Our proposals are set out in "Safer Management of Controlled Drugs—The Government's Response to the Fourth Report of the Shipman Inquiry", Cm 6434, which is published today.

We will make it clear that responsibility for the proper management of controlled drugs is an integral part of the clinical governance responsibility of all NHS and private sector health care organisations. We will develop improved arrangements for the inspection of controlled drugs that strengthen, rather than detract from, this proper local responsibility.

We will ensure that prescribing of controlled drugs—which in future will include prescribing by health care professionals other than doctors and dentists—takes place in the context of a general framework of good prescribing practice backed by clinical governance frameworks and appropriate professional regulatory sanctions.

We will also capture information on all prescribing and requisitioning of controlled drugs, including private prescribing, and provide analyses of prescribing patterns by prescriber and by patient for those operating the local controls. Information systems will be set up that will enable a full audit trail for the movement of controlled drugs into the community.

We will also ensure that patients receive appropriate information about controlled drugs in the context of an informed discussion with the health professionals involved in their care, and against a background of information about the safe handling of prescription medicines more generally.

Finally, we will support all these actions through improved education and continuous professional development for healthcare professionals dealing with controlled drugs.
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The Inquiry's Fifth Report

In her fifth report, Dame Janet makes recommendations in the following areas: handling patients' complaints and whistleblowing concerns; the development of clinical governance in primary care; the availability of information about GPs; professional regulation of doctors and the role of the General Medical Council.

We have been working hard with the medical profession and others over the period since the conviction of Harold Shipman to strengthen the systems, rules and regulations that govern the medical profession and we are pleased that Dame Janet recognises the progress that has been made.

Dame Janet also welcomes the changes made to date in the NHS complaints procedure and in the increasing amount of information available about doctors' performance. She recognises the progress that has been made in developing systems for handling poor performance and aberrant conduct and the importance of continuing to develop clinical governance in primary care. Her recommendations build on all this work but also reflect her continuing concerns that, in some areas, there has been insufficient change to safeguard patients appropriately.

Dame Janet has made some very significant recommendations that would have a major impact on service delivery. We will need to study them carefully and discuss them with a wide range of stakeholders and interested parties. We also want to consider them alongside recommendations made in the recent inquiry reports into the activities of Clifford Ayling, Cm 6298, and Richard Neale, Cm 6315 both published on 9 September 2004.

Dame Janet has also made significant recommendations concerning the constitution and operation of the General Medical Council. We have recently made changes to the constitution of the General Medical Council to ensure a far greater voice for patient interests. We will consider carefully the recommendations Dame Janet makes for further reform, and the implications of her recommendations for other regulatory bodies in health and social care. Changes to the General Medical Council's disciplinary procedures have also recently been made and came into force only last month. We will consider carefully with the General Medical Council the recommendations in the report for further changes to these procedures.

The scale of Shipman's crimes was unprecedented and his activities were totally abhorrent. No sanctions will stop conduct like that of Shipman so our energies must be focused on prevention and early identification of problems. Standards of behaviour must be high and action against those who fail to maintain those standards must be timely, firm and fair.

In welcoming the inquiry's previous reports, my right hon. Friends the Home Secretary and the then Secretary of State for Health emphasised the need to learn lessons from the mistakes of the past. All of Dame Janet's reports have provided us with an expert and detailed analysis of where systems failed. We are determined to ensure that all reasonable measures are taken to provide the safeguards that are needed and that the public rightly expect.
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