§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)My right honourable friend the Secretary of State for Health has made the following Written Ministerial Statement today.
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.
64WSThe 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 in current systems of control and in the ways in which those controls were operated. The report recommends strengthening current arrangements in four main areas: first, a new integrated, multi-professional inspectorate to inspect the management of controlled drugs in National Health Service primary care to replace the existing unco-ordinated arrangements for inspection; secondly, 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, auditing the prescribing of controlled drugs in primary care and the movement of supplies of controlled drugs in the community; and fourthly, 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 arrangements for the management of controlled drugs and to do so in a way that does not hinder patients from accessing the treatment that 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 healthcare 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 healthcare organisations. We will develop improved arrangements for the inspection of controlled drugs that strengthen rather than detract from that proper local responsibility.
We will ensure that the prescribing of controlled drugs, which in future will include prescribing by healthcare 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 65WS 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 those actions through improved education and continuous professional development for healthcare professionals dealing with controlled drugs.
In her fifth report, Dame Janet makes recommendations in the following areas: handling patients' complaints and whistle-blowing concerns; the development of clinical governance in primary care; the availability of information about GPs; and 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 that 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.
She 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.
66WSIn welcoming the inquiry's previous reports, my right honourable friends the Home Secretary (Mr David Blunkett) and the then Secretary of State for Health (Mr Milburn) 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.