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21 Jun 2007 : Column 521WH—continued

I thank the Minister for outlining the proposals which, I stress, are historic and wide ranging. He is correct that we would not have reached the stage that we are now at without huge political will. The proposals will set out for the first time a national framework for the work of coroners, who will become full-time professionals, with a chief coroner heading the service. The proposals will empower bereaved families by giving them, for the first time, a proper legal standing. They will have the right to
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a second opinion, and the ability to challenge coroners’ rulings. Those changes will be welcomed by families who have had a relative die a violent or sudden death, but especially by families who were patients of Harold Shipman, such as my constituents in Todmorden in the Calder Valley and, of course, many constituents of my hon. Friend the Member for Stalybridge and Hyde. We should never forget the extent of the tragedy, especially for the hundreds of families in Hyde and Tameside who lost loved ones.

The extent and magnitude of Harold Shipman’s crimes were such that they were hard to encompass, unless one was personally involved and touched by the tragedy. Of course, by killing himself and going to his grave, Harold Shipman robbed all those families of the one thing that he could have given them: the truth—the right to know what happened and perhaps to help to put an end to what for most of the people concerned is a continuing horror story. The Government can help by making sure that the lessons of what happened in the Harold Shipman case are learned. That case gives rise to today’s debate and is probably the case of the greatest magnitude, but there are other instances in which GPs and medical and health professionals have not only gone beyond the bounds of their duty, but have behaved in a wholly inappropriate way, in relation to the life and death of their patients. The reforms are definitely necessary.

I hope that the reforms will ensure that a tragedy like the Shipman case can never happen again. My hon. Friend has had regular contact with the bereaved families in his constituency, and he has told me that he never ceases to be impressed by their resilience and their commitment to ensuring that reforms are made. They have met Ministers several times and have helped to develop the new proposals. My own constituents in Todmorden believe that Dame Janet Smith has done a remarkable job in very difficult circumstances. Of course, in the case of my constituents the events happened at the beginning of Harold Shipman’s time in practice. It was very difficult for those families when the bodies were exhumed, because the deaths were so long ago that there was little if any medical evidence to be assessed. That did not make things any easier. Families in Hyde have always made their respect for Dame Janet and her team, and their commitment to the implementation of her findings, very clear. I want to express my own gratitude for the dedication that all Ministers concerned have shown to introducing good and relevant legislation, for the spirit in which the Government have approached all the reforms, and for today’s debate.

My biggest concern, which is central to the debate, is the proposed reform of the coroners system by the draft Coroners Bill, and the reform of the regulation of the medical profession initiated by the chief medical officer. It is widely known that Dame Janet has concerns about some of the proposals in the Bill, particularly the way in which death certificates are to be checked. I know that the Minister has examined the proposals carefully and that, as has already been said, it is intended that there will now be a single process for both cremation and burial certificates, operated through local primary care trusts. That is a very welcome development.

There has always been widespread concern among patients—certainly among my constituents in Todmorden— about the fact that Shipman could write any name he fancied on medical certificates and it would not make a
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scrap of difference; they would still be accepted, and not detected as fraudulent. I should be grateful if my hon. Friend assured me that the new system will deal with those concerns. In addition—I know that other hon. Members have already asked about this—will he try to clarify the time scale for the introduction of the reforms? I am particularly interested to know whether the reforms will be extraterritorial. Will the family of someone who has died abroad, perhaps in suspicious circumstances, be able to contribute to the coroner’s investigation or challenge the verdict? Will the Government implement the suggestion that a simple information leaflet should be provided to bereaved families, setting out their rights? When does my hon. Friend expect the draft Bill to be presented to Parliament?

Another key question, which I think all the families have asked, particularly in Todmorden, given that Harold Shipman practised there for a period before going to Hyde, is why the medical system could not identify him earlier. When he practised in Todmorden he was found to be abusing drugs. That was brought to light by an eagle-eyed medical practitioner who was his colleague. Shipman was subsequently investigated and suspended from the Todmorden medical practice, and convicted in the Halifax court of misuse of drugs and prescription fraud. However, he was then able to go down the road and carry on practising in Hyde, with no monitoring at all. In both Todmorden and Hyde, his prescription and death rates were off the Richter scale, but he was never detected.

How does the Minister think the new system will ensure that that cannot happen again? Does he have confidence that we are now reforming the system overall? Are all the pieces of the jigsaw falling into place? Joined-up thinking and the interconnectedness of the reforms are important considerations, which, as the Minister pointed out, have caused some delays in implementation—and he is right that the reforms need to stand the test of time. I expect he understands the frustration of Members of Parliament whose constituents have been affected by Harold Shipman, and of the general public, who feel great anxiety about whether they will be protected in the future. Only a very small minority of medical practitioners abuse their powers, and the vast majority of GPs and health professionals are in that business because they want to help people, but the affair has left a very bad taste in many people’s mouths, as well as a lot of fear. The general public are anxious for the reforms to be implemented. Given all that I have said, and given our understanding of the need for interconnectedness, joined-up thinking and transparency, and the fact that it is important to get the reforms right for the 21st century, perhaps the Minister will tell us when he expects the reforms to be fully and finally implemented.

3.30 pm

Andrew Gwynne (Denton and Reddish) (Lab): It is a privilege to follow my hon. Friend the Member for Calder Valley (Chris McCafferty). She and the Minister for Pensions Reform, my hon. Friend the Member for Stalybridge and Hyde (James Purnell), have been at the forefront of the campaign for justice for Dr. Harold Shipman’s victims. I echo all of the views that she expressed.


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As one of the three Members of Parliament for the metropolitan borough of Tameside, I am grateful to be allowed to contribute briefly to the debate. I know that my hon. Friend the Member for Stalybridge and Hyde would have liked to contribute as well, because the Shipman tragedy so directly affected his constituency, as it did mine, to a much smaller extent, but, as has been explained, he is not able to take part due to ministerial protocol.

I welcome the Minister’s thoughtful comments, the details in the various reports before us and the work of the Select Committee on Constitutional Affairs. We should never forget the extent of the tragedy, in which hundreds of families in Tameside lost their loved ones. The extent of Dr. Shipman’s crimes are such that it is hard for anyone who was not involved or from the affected communities to understand just how deep the wounds are and, in some cases, will be for some time. Despite that, the communities of Tameside, particularly the town of Hyde and the parts of Denton that were covered by Dr. Shipman’s surgery, have not let him win. The borough has pulled together to make sure that we are defined not by that tragedy, but by our successes. Tameside officially has the best council in the north-west of England, and the area is growing rapidly and becoming increasingly prosperous as a result of massive inward investment. We should focus on those positives in Hyde, Denton and Tameside.

I strongly agree with my hon. Friend the Member for Calder Valley that by ending his life, Harold Shipman took the one thing that he could and should have given the affected families: access to the truth and the full story, and information about the full implications of his actions. What the Government can do, however, is ensure that such a situation can never happen again. I was reassured, as, I am sure, were my hon. Friends, by the Minister’s positive and forward-looking opening remarks.

I know that my hon. Friend for Stalybridge and Hyde has had regular contact with the families, and that they have met Ministers several times. The Minister of State, Ministry of Justice, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), and the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Wythenshawe and Sale, East (Paul Goggins), both visited Tameside in their official capacities to discuss the proposals while—this is the important point—they were being developed.

The families in Tameside welcomed the inquiry of Lady Justice Janet Smith and her team, and they are as committed as we all are to ensuring that the Government implement the inquiry’s findings. The onus is on us to ensure that that happens, so I welcome the spirit in which the Government have approached this issue and I reiterate that the Minister’s remarks were very positive. It is also positive that we have been allowed to air our views on this matter again in the debate.

Reform of the coroners system and the need for tighter regulation of the medical profession are central issues. In its inquiry, the Select Committee thoroughly examined many issues regarding the reform of the coroners system, and its report and findings are to be welcomed, taken alongside what the Government have been doing. However, I wish to raise a small number of issues with the Minister, which follow my hon. Friend’s comments almost directly.


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The first issue that I want to address is death certification. The Select Committee report rightly highlighted concerns about death certification and the Government’s approach to it. Lady Justice Janet Smith also highlighted a number of concerns about the proposals for changes to the coroners system, particularly how death certificates will be checked and monitored. The Minister has considered the proposals, and he told us that a single process will be operated through local primary care trusts. I hope that that means that there will be a single process for both cremation and burial certificates.

Patients have always been concerned that Dr. Shipman could have written almost anything on certificates—that he could have written “Donald Duck” or “Mickey Mouse” and it would have gone almost unchecked. That is a real worry for the families concerned. Will the Minister reassure us that the changes to the system that he proposes will address that worry, because people are very concerned that some of those practices went unnoticed for so long? He has assured us that a Bill will be introduced when there is parliamentary time. I understand the pressures that exist and that he might not be able to give firm commitments, but it is important, certainly for the families involved, that there is some degree of certainty about when the changes will be introduced. I understand that he cannot give absolute time scales, because of the programming of future legislation, but what are the general time scales in which we can expect some of the measures to be introduced?

The families also made a key point about medical regulation. I agree with my hon. Friend the Member for Calder Valley that the system should have flagged up what Dr. Shipman was doing a long time before it did. Of course, hindsight is a wonderful thing, but we know that he had a record of drug use and that he had been investigated and suspended in his previous post in her constituency. His death and prescription rates were considerably higher than they should have been, and should therefore have been detected, but they were not, so there are those issues to address. How will the system work differently to ensure that something similar could not happen? That is an important point.

On a more general level, the Select Committee emphasised the importance of medical regulation and scrutiny. Is the Minister confident that we are reforming the overall system, particularly in relation to medical regulation? That is crucial and is at the root of the problem.

Finally, it is worth recognising that the draft Coroners Bill was the first to be scrutinised in Westminster by families with recent experience of the inquest system. That is why it is so crucial that we get things right and why the Select Committee was absolutely right to highlight further areas in which work is required. The Minister has gone some way towards clarifying the Government’s intentions. Getting things right will not erase the pain brought about by Dr. Shipman’s activities, but it will make it more difficult for a similar episode to occur. That will offer some comfort and a sense of positive closure to the families concerned. I thank the Minister for his positive and thoughtful approach so far, and I am sure that my hon. Friend the Member for Stalybridge and Hyde and the communities that we represent look forward to hearing his response.

Mr. Mike Hancock (in the Chair): I apologise for not addressing Dr. Harris correctly earlier. I failed to
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realise either that I had made that mistake or the sensitive nature of that failure to him personally.

3.38 pm

Dr. Evan Harris (Oxford, West and Abingdon) (LD): I was shocked that you had even made a mistake, Mr. Hancock, such is your reputation for accuracy. I certainly did not take it personally. I hope that you do not mind me not taking it personally if you misaddress me, because I know that you are a perfectionist in all matters.

The Liberal Democrats welcome the debate and the opportunity to discuss these issues with the Minister in this sort of atmosphere. Several statements on the subject have been made in the House, but there is a limited scope for inquiry with statements. It has been extremely helpful to have a clear exposition of the background and the proposals from the Minister, and to hear from the hon. Members for Calder Valley (Chris McCafferty) and for Denton and Reddish (Andrew Gwynne). They spoke very well and with clarity and sensitivity on behalf of their constituents, and they showed how much they have thought about this matter as a result of the representations made to them and because of their need to represent their constituents. They have added value to the debate and to the discussion of the matter in this House. I understand that everyone involved could speak for a long time, so I was grateful to hear them summarise the remaining questions that they have for the Minister and the points that they wanted to make.

Given that there is an opportunity for a direct exchange, it would not be appropriate for me to comment in detail on what the hon. Members for Calder Valley and for Denton and Reddish said. I merely say that, for the most part, I agreed with their points and the importance that they attached to some of them. I want to raise a couple of points in response on which I do not completely share their perspective. I hope that they will allow me the opportunity to do so, even though I recognise the importance, relevance and accuracy of almost everything that they said.

I should like to put on the record my condolences to the families of the victims of Harold Shipman, the biggest mass murderer in British history. It is appropriate to say that now, because the pain never goes. I imagine that every day, relatives of those whose lives were lost are reminded of what happened, the fact that people are no longer with us and that the manner of the deaths was evil, rather than natural, although many of the victims were in old age. I cannot imagine what it must feel like, particularly given the media coverage that followed and the references to that man.

I am a doctor. I qualified in 1991, but have not practised direct clinical medicine since 1994 and have only been called on to use my medical training on an occasional basis since. I am still on the medical register, so I ought to declare an interest in that I am potentially liable to be referred to the General Medical Council and to be subject to its revalidation procedures, if they ever happen—I hope that they do as soon as possible. I fully anticipate not being able to take part in those because of my lack of recent clinical practice and, at an appropriate point, expect to come off the register.


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I am also a member of the BMA’s medical ethics committee, and attend the BMA annual representative meeting as a member from the Oxford division. I do so mainly to discuss medical ethics matters. I shall refer to some of the BMA’s concerns, although I do not agree with them all. In the case of those to which I do refer, I shall be asking questions on the BMA’s behalf, and I shall indicate where my party—not me personally—agrees that there are relevant questions to answer.

A couple of premises need to be stated and some myths need to be abolished. I am interested to know the Minister’s view on a couple of important themes that run through what I am about to say. Does he accept the principle that doctors are more likely to be tougher on the underperformance, poor performance or criminal behaviour of other doctors than patients and the public? A strong argument can be made that doctors attach such significance to their responsibilities and greatly recognise the privilege that they have in practising medicine with the consent of their patients—they are able to do things to patients that people would not be able to do without the qualification—that they have a much lower level of tolerance for medical misfeasance and malpractice than the average member of the public. That is my experience. When dealing with my casework, I get visibly angry in my surgeries when I hear of allegations that appear to have some substance of poor practice or, especially, of attempts by management—this usually involves them but it can include some doctors—to cover up or unreasonably seek to excuse the behaviour of their close colleagues and other colleagues.

My general point is that the profession has a huge vested interest in having zero tolerance for doctors who behave in bad faith in a way that damages patients and, in doing so, damages the reputation of the profession. I invite the Minister to agree with that view, because it goes to the question of whether general professional self-regulation, rather than doctors judging doctors whom they know, is in any way weaker than the alternative that the Government appear to be proposing of Government regulation. They also have vested interests.

Andy Burnham: It is important that I say that I do not agree with the point that Government regulation is being proposed. We are proposing to maintain the system of professional self-regulation. It is as a result of the counsel of the regulators that we are proposing parity between the professional and lay interests. The hon. Gentleman will know that that is very different from the panels that hear fitness-to-practise inquiries. The GMC proposed bringing forward the parity proposal, which is as good as we can get in terms of a system of independent self-regulation where we enshrine and are clear about the public interest.

Dr. Harris: I accept what the Minister says. There is a debate to be had about terminology and I did not mean to caricature the Government’s position, but the feeling exists that the alternative to professional self-regulation is some form of regulation by those appointed. One can have an independent appointments system, but there is no doubt that if a number of council members are elected by their profession to uphold its integrity and proper functioning, that will, by degree, represent
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greater professional self-regulation than a system of appointed medical members combined with an equal number of appointed lay members.

I hope that the Minister will accept that there has been a change or, at least, that a change has been proposed, in terms of moving away from professional self-regulation. When the measures come forward in statute, we will take a view on whether we think that the case has been made. A case needs to be made, because there is a danger that non-members of the medical profession may well take a more lenient view—in my experience, that argument can be made. If anything, we must ensure that there is less of a willingness to believe that the doctor is right. In the doctor-patient relationship, too much respect is sometimes shown by the patient for the doctor. The relationship needs to be more one of equals.

I was grateful that the Minister responded to my first point. My second general concern is the most important one regarding regulation and the health profession. Even with the best audit trails and the most empowered patients in the world, episodes of poor or impaired practice, malfeasance or malpractice are much more likely to be identified by doctors themselves or their close colleagues. I am sure that the best way of getting the most reports of poor or bad practice by doctors is by relying on people on the inside who can see what is going on and are prepared to report it.

Therefore, a test of any new regulatory proposals is whether doctors will be prepared to report their colleagues. If doctors do not think that their colleagues will get a fair hearing or if they think that their colleagues will be abused in the media, as they have been, with little protection and no ability to answer back on the basis of patient confidentiality or legal process, that will be a huge deterrent to people reporting their colleagues.

The treatment of doctors such as Professor Southall and Roy Meadow by the media, which continue to report the Meadow case as if he had been struck off or found guilty of serious professional misconduct, is extremely damaging not just to the individual concerned, but to doctors. Doctors say that if this is the way the GMC behaves, by getting it so wrong, as the appeal found, or if this is the way that the media behaves, by, in the case of Professor Meadow, hounding and decrying a man who has made a significant contribution to child protection, there will be a diminution in the ability to pick up real cases of poor practice, because doctors will not report themselves or their colleagues. It is a difficult problem, and I want the Minister to accept that it is real. Individual doctors—not the profession generally—must know that they not only have a duty to report, but that it must be unabridged in any way by a fear of lack of due process.

It is appropriate to speak about the standard of proof. Recommendation 81 of the Shipman inquiry’s fifth report states:


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