HC Deb 01 February 2000 vol 343 cc907-19 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 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.

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.

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.

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?

On the question of controlled drugs, would it not be possible in this high-tech age for pharmacists' registers to be monitored, and to check for any anomalies in doctors' prescribing? The role of the General Medical Council has been mentioned. Is it not essential that the GMC not only does a good job for patients, but is seen to do so? Might it not be in the interest of public confidence for the issue of a lay majority on the GMC to be considered again?

Finally, in regard to death certification, may I echo the suggestion of many that the requirements and, indeed, the payments of signatories be reviewed? Is it not also clear that we now need a coroners service that is sufficiently professional, and resourced adequately enough to be able to collect and monitor data effectively, and spot any irregularities early?

Mr. Milburn

I am grateful to the hon. Gentleman for his support. Let me begin with his last point. Part of the review by my right hon. Friend the Home Secretary will involve examining the role and functions of the coroners service, and deciding what measures are needed to strengthen it. There are important lessons here for both the coroners service and the registrars service. Given the amount of information that comes their way, both coroners and registrars should be in a position to take an overview of what is happening in a particular locality—of, for instance, the rate and type of deaths, and the cluster of mortality statistics. That did not happen in this case, and I think the inquiry should consider why it did not happen, not necessarily in order to penalise anyone but to learn some lessons, and to ensure that we get the arrangements right for the future.

As for Harold Shipman's past practice, I said in my statement that the chief medical officer would undertake an audit. It will be an audit of all Harold Shipman's past practice, and the deaths that occurred during his time as a GP over two and a half decades. I think that that is the right thing to do: I think that the public, and former patients of Harold Shipman, deserve that reassurance. The chief medical officer will appoint expert clinicians to lead the process, and we will try to ensure that the audit is undertaken and completed as quickly as possible.

The hon. Gentleman mentioned pharmacists and controlled drugs. That is a terribly difficult area, and it is perhaps now clear that some of the practices, processes and procedures need to be examined again. The problem arises when a GP collects a controlled drug from the pharmacist, says that he is going to prescribe it to a patient and does not do so, or prescribes only part of it. We need a system that can deal with such potential problems, without denying the flexibility that GPs sometimes need. They may need access to controlled drugs if, for example, there has been a road traffic accident.

We must try to get the balance absolutely right. I do not pretend for a moment that it will be easy, but it is right for us to examine the issues now. As I said in my statement, I think that the inquiry will want to look very closely at the role and conduct of the General Medical Council, how it is constituted and its structures, processes and procedures.

Mr. David Hinchliffe (Wakefield)

I welcome my right hon. Friend's statement. Those of us who know Lord Laming are well aware that he will do a thorough and sensitive job.

May I press my right hon. Friend on three key issues that I think should be included in the inquiry? He mentioned the role of the coroner. Will the inquiry examine the wider role of the coroners office in evaluating local trends in reported deaths? It seems astonishing that no one in the area where Shipman practised spotted what was going on. That is a key point, which we need to look at urgently.

Can we look not just at the role of the GMC, but at its wider relationships with other health bodies, which are crucial to understanding what went wrong in the 1970s? I remain to be convinced that the problems that occurred then could not reoccur. I support the comments by the hon. Member for North Devon (Mr. Harvey), the Liberal Democrat spokesman, on a lay majority on the GMC, which would bring increased public confidence.

As my right hon. Friend will probably be aware, in October, the Select Committee on Health produced a report of direct relevance to those issues. The Government have not responded to that yet. I hope that they will, bearing in mind some of the issues arising from the Shipman case.

As well as, obviously, addressing the issue of single-handed practices, will the inquiry look at the relevance of the independent contractor status of GPs, which has some direct connection to the issue of accountability and standards?

Mr. Milburn

I am grateful to my hon. Friend. I apologise for the delay in responding to the Select Committee's report. Clearly, we need to do that, and will respond in due course.

My hon. Friends's first question was about the coroners service. The answer to that question is yes. On the GMC's constitution and the way in which the GMC relates to the broader national health service, I am sure that that will be a matter for the inquiry and that it will look carefully at the GMC's role. As the Government have always made clear, professional self-regulation is under test. There is broad agreement now that professional self-regulation has to be more accountable, more open and more modern. The inquiry will look at how that can best be achieved in the light of the Shipman case.

I broadly take the view that independent contractor status has served the NHS pretty well over the past five or so decades. It is important that there are alternatives for GPs, particularly newly qualifying younger GPs who sometimes might want not to go into a practice and become a partner, but opt for the salaried route. As a matter of policy, we have been determined to open that as an option, but it is important that GPs, as they come through, train and come into the NHS, have a real choice about their future career and about the employment structure that best suits them.

Sir Brian Mawhinney (North-West Cambridgeshire)

Does the Secretary of State accept that his decision to put in place an inquiry is entirely welcome and that his choice of Lord Laming, with whom I have worked, will command support and confidence among Members on both sides of the House? Will he accept the thanks to him from Members on both sides of the House for his differentiation between one evil man and the broad mass of GPs who serve their constituents and their patients with dedication, professionalism and care? Perhaps he would consider using existing communication mechanisms to draw to the individual attention of GPs throughout the country his supportive words, those of my hon. Friend the Member for Woodspring (Dr. Fox) and other right hon. and hon. Members.

Will the Secretary of State confirm that the inquiry will look at the role of the police relative to Dr. Shipman? What police force will conduct that part of the investigation on behalf of Lord Laming?

Mr. Milburn

I am grateful to the right hon. Gentleman. I am particularly grateful for his support for Lord Laming, with whom I know that he worked closely during his period at the Department of Health. I am sure that he is right to say that GPs will be looking at, and listening carefully to, the comments in the House today. Rightly, they will want to feel that their interests are being protected alongside those of the patients. Although it is sometimes tempting to differentiate between the interests of patients and those of GPs, I prefer to think that, if we can make some changes, that will benefit both GPs and patients. I am sure that his sentiment—that the overwhelming majority of family doctors will be as appalled as hon. Members are about the activities of one evil GP—is absolutely right.

We have to ensure that it does not happen again, and that, together, we—the Government, the other parties in the House and the medical profession—take the appropriate action and get on with it. In my view, the worst thing that could happen would be to pretend that it can be business as usual; it cannot. We cannot stick our heads in the sand or pretend that this awful set of events has not happened, because it has. We must take whatever action is necessary to ensure that it does not happen again.

We have not contemplated bringing in an outside police force, which is more properly an issue for my right hon. Friend the Home Secretary. However, alongside Lord Laming, expert assessors—one from a medical background and one from a legal background—will be charged with examining the role played by the various statutory agencies, including police, in the investigation of the Shipman case.

Mr. Kevin Barron (Rother Valley)

Will my right hon. Friend confirm that the public inquiry will examine not only the role of the General Medical Council in this dreadful affair, but its current responsibilities and whether there have to be any changes?

Mr. Milburn

Yes, the inquiry will. I am sure that the GMC itself will have heard, and I hope will respond positively to, the views that have been expressed today in the House, and I think that it will recognise that there are some important lessons to be learned about how it behaves in such situations. The Government stand ready to listen not only to the inquiry's recommendations, but to the views of the GMC on how its performance could be reshaped after the Shipman case.

Mr. Douglas Hogg (Sleaford and North Hykeham)

The right hon. Gentleman has spoken of the possibility of trying Dr. Shipman for other offences. Will he keep in mind the fact that, in view of everything that has been said in the past 24 hours, it will be very difficult to give him a fair trial?

Although it must be right to strip Dr. Shipman of his pension entitlements, will the right hon. Gentleman keep in mind the separate position of his wife? It must be fair to consider her separately.

It is obviously right to hold an inquiry, but will the right hon. Gentleman be cautious about scapegoating? The truth is that great evil, like great good, is not all that easy to recognise. Furthermore, a propensity to take drugs is not the same as a propensity to kill.

Mr. Milburn

I certainly agree with the right hon. and learned Gentleman on the issue of scapegoating. Obviously, there are questions to answer in the matter, and that is right and proper. The case has been an horrendous set of events and, with the great benefit of hindsight, it is crystal clear that something was going enormously wrong with Harold Shipman's practice. Ultimately, the agencies that are constituted in statute are accountable to the House, and it is right that they should account for how they performed and dealt with a set of very difficult and complex matters in Greater Manchester. That is part of the purpose of the inquiry.

I stress again, however, that I really do not want the inquiry simply to turn into an investigation of past events. We already have a public inquiry, we have had a lengthy and difficult court case and we have had a trial. It is right that the inquiry should investigate the failures that may well have occurred in the systems, but it should also look forward and make positive recommendations about how we can strengthen and change those systems for the future.

I have to bear in mind the issue of pension requirements and Harold Shipman's wife. I have a judicial role in pension forfeiture, and I shall perform my duties accordingly.

Ms Chris McCafferty (Calder Valley)

I commend my right hon. Friend on his statement and particularly welcome the inquiry. He will be aware that Harold Shipman practised medicine in Todmorden, in my constituency, for some years. It was thanks only to the efficient and effective checks and balances that his partners had in place that his drug misuse was discovered and that he was subsequently prosecuted.

Like many hon. Members, I am particularly concerned that the West Pennine health authority was not aware of Harold Shipman's convictions while he was a GP in Todmorden. I am sure that my right hon. Friend will agree that this case highlights the importance of robust systems to monitor not just the death rates of GPs, but the quality of care that they are giving to patients. Will my right hon. Friend place a statutory duty on the GMC to be proactive in informing health authorities of all relevant information that relates to medical personnel, and consider whether GPs should have salaried status within the NHS, and all the accountability that that brings?

The facts revealed by this case have caused grave concern to my constituents also. Although there are no immediate concerns or suggestions that Harold Shipman started his activities in Todmorden, some of my constituents have concerns about relatives who were his patients. Will my right hon. Friend urgently establish a helpline to help those who are concerned about those matters, to dispense and gather information and to help alleviate worries? That would be very welcome.

Mr. Milburn

I am extremely grateful to my hon. Friend, who makes an important point about the majority of GPs. In Todmorden and in Hyde, fellow GPs of Harold Shipman blew the whistle. We should not lose sight of that. A fellow GP in Hyde first raised suspicions about Dr. Shipman's practice and the excess levels of deaths among his largely elderly female patients. My hon. Friend is right to say that it was a fellow GP in her constituency who raised suspicions about the fact that Harold Shipman was forging prescription forms and had illegally obtained controlled drugs—in this case, pethidine. That is an important lesson to bear in mind as we consider the future of general practice and the role of individual GPs.

My hon. Friend is right to say that the crucial issue is not just better monitoring of mortality statistics, although that is needed. I was heartened to see the comments from Dr. John Chisholm, the chairman of the GPs' committee of the BMA. The BMA and the doctors themselves recognise that there must be greater accountability in terms of how GPs perform. That is a welcome recognition, and provides us with the basis to reach sensible agreements, to make progress and to ensure that we do not see a repetition of this sort of tragedy in future.

My hon. Friend referred to helplines. I will consider that issue. I know that, in Hyde, the health authority has worked closely with Victim Support, which has provided an absolutely sterling service to the relatives and friends of victims. They have that sort of help and support, and I will look into whether it is possible to extend that.

Mr. Peter Lilley (Hitchin and Harpenden)

Will the right hon. Gentleman confirm that the inquiry, the establishment of which I greatly welcome, will not be limited to the narrow question of trying to prevent a recurrence of this incredibly wicked but, one hopes, incredibly rare occurrence of a medical practitioner deliberately killing healthy patients, but will be able to look more broadly at what may be a greater risk—of death through the incompetence, carelessness and negligence of doctors, both in hospitals and in general practice— through improved monitoring of their performance and the success rates of their treatments, with possibly even the publication of data about those things?

Mr. Milburn

I think that the right hon. Gentleman is aware that we will publish mortality statistics for the first time. It is a contentious issue, as he will recall from his time in office when the previous Government published the statistics in Scotland. We have extended that to England and I believe that that is the right thing to do. The issue is complex but, in the final analysis, the patient has the right to know. The patient is the recipient of what is a public service. The public pay for it and use it, and it is right and proper that the public should know what level and standard of service they are receiving. We may even need to go further than we have in the publication of such information.

As to the scope of the inquiry, it is right and proper that it should concentrate on the implications of the Shipman case. I have no doubt that it will have wider repercussions that will be considered by the inquiry team and reflected in its recommendations.

Dr. Howard Stoate (Dartford)

As a GP, I have been horrified and appalled by the havoc wreaked by that callous and brutal murderer. Patients and doctors will welcome my right hon. Friend's statement, especially his affirmation that trust is the cornerstone of the doctor-patient consultation. Without that trust, it would be difficult for doctors to do their work. I would hate to see a knee-jerk reaction to what has happened, and I welcome the long-term inquiry that he mentioned and the fact that he will consider carefully and calmly any recommendations, especially on death certification and the availability of controlled drugs. As my right hon. Friend is aware, without drugs such as morphine, doctors would not be able to save as many lives as they do. Will he ensure that the report is considered carefully when it is published and that we do not rush into any premature decisions that might do more harm than good?

Mr. Milburn

My hon. Friend is right. We have tried to strike a balance today by taking action where appropriate and where there is an obvious gap in the processing systems. I hope that we have got the balance right. At the same time, I wish to empower the inquiry to examine the structures more broadly and to consider the specific lessons that can be learned. I have no doubt, given the chairmanship of Lord Laming, that the inquiry will undertake its proceedings carefully and sensitively, especially given the feelings of the relatives of the deceased. When it produces its recommendations, the Government will need some time to consider the implications and we will then report back to the House.

Dr. Julian Lewis (New Forest, East)

I congratulate the Secretary of State on the contents of his statement and on the sensitivity with which he delivered it and has answered questions. Does he agree that the peculiarity of this case, even compared with the cases of other serial murderers, is that there was no obvious financial, or apparent sexual, motivation for the crimes committed? Is it not to the credit of the police that, as soon as a financial motivation was drawn to their attention, they managed to investigate the case so thoroughly and unravel it so comprehensively? While I endorse what has been said about the need to discover who has made mistakes in the past, does the Secretary of State agree that, on the surface at least, the police—once alerted—appear to have done a first-rate job?

Mr. Milburn

I am grateful to the hon. Gentleman for his support. He will be aware that in the judge's summing up yesterday in Preston he praised the performance of the local police in what was a difficult and lengthy investigation. Credit is of course due to the police, as it is to the relatives of the victims. In particular, I pay tribute—it is difficult to find the words to do so—to the daughter of Mrs. Grundy because, without her intervention and early investigation, I fear that Harold Shipman would have continued his killing ways.

Mr. Andrew F. Bennett (Denton and Reddish)

I echo the expressions of condolence to the families and friends of all those murdered, and I offer the sympathy of the House to all those in Tameside who are uncertain about what happened to their relatives or friends. I wish to press my right hon. Friend to consider carefully the appointment that he will shortly make to the chairmanship of the West Pennine health authority. Will he try to ensure that, through that appointment, he gives new direction to the health authority to try to restore confidence to all those people in Tameside and Oldham who use its services? Will he try to make sure that that new appointment gives a new direction to the health authority that will help to restore confidence to all those people in Tameside and Oldham who use its services?

Mr. Milburn

We will give proper and due consideration to that appointment when it comes up. Inevitably, the health authority is in the spotlight at the moment, and it has acted to suspend its GP adviser. The health authority has produced its own internal report, which we at the Department of Health have received and which the authority published at its press conference last night. However, it is also appropriate that the inquiry considers the role and conduct of the authority, alongside that of the other statutory agencies, such as the police, the coroners service, the registrars service, and others.