Page last updated at 12:19 GMT, Thursday, 12 February 2009

Are patients safer after Shipman?

Ann Alexander
Presenter, Could Shipman Happen Again?, BBC Radio 4

Harold Shipman

"I spoke to Dr Shipman, I can't really remember what he said because I was so distressed, but he did imply that my mother had been ill, she'd been to see him the day before, he'd been to see her that day, and she had died after he left, and I was kind of comforted by that."

Angela Woodruff remembers the sudden death of her mother Kathleen Grundy in June 1998. A former mayoress of Hyde, near Manchester, she was just one of Harold Shipman's many victims.

Impossible to imagine now, at the time, Dr Shipman was a highly regarded and well-liked doctor. "My mother thought he was wonderful," says Angela Woodruff.

Paul Horrocks, editor of the Manchester Evening News, recalls his reporters being insulted and spat at by a community which could not believe that Dr Shipman could have harmed anybody.

'Fundamentally flawed'

It is now 10 years since the family doctor was charged with the murder of 15 of his patients.

In fact Shipman had used loopholes in the medical system to kill more than 215 of his patients, successfully avoiding detection for many years.

The health service is a remarkably inert tanker, and turning it around in any way is very difficult
Laurence Buckman, BMA

The subsequent four-year public inquiry, which was chaired by senior judge Dame Janet Smith, exposed many serious deficiencies and led to recommendations concerned with preventing another serial killer.

But it also identified a need for significant change in attitudes, in systems and in practice, to better protect patients.

The doctors' regulatory body, the General Medical Council (GMC) came in for savage criticism, described by Dame Janet Smith as "fundamentally flawed".

A decade after the deaths first came to light, has enough been done to put things right?

Finlay Scott, chief executive of the GMC, told the BBC: "We've driven through a fundamental programme of reform which has enabled us to deliver our statutory purpose, to protect, promote and maintain the health and safety of the public".

LISTEN TO THE PROGRAMME
He highlights "revalidation" - a kind of MOT for doctors - which will begin to be rolled out across the profession later this year.

This will, he believes, "produce positive assurance that licensed doctors are up-to-date and fit to practise".

But he acknowledges the limitations of the new system to stop another Shipman.

"It's seductive - and dangerously so - to imagine that revalidation is designed to deal with those extreme cases. It is not."

Deliberate harm

Aneez Esmail, professor of general practice at the University of Manchester, fears that the profession is not doing enough to ensure that the doctors of tomorrow - school children at the time of Shipman's arrest - understand the implications of what happened.

"I went to talk to the medical students in Liverpool last month [about Shipman]," he says.

"What really worried me was firstly how little people knew about him, and I find this incredible. Here is a doctor that should stand out as something we all have to know about… because this is what happened on our watch, our profession.

"I think there should be a compulsory module on what went wrong and why it went wrong, and what it means for us as doctors in the future," he added.

Dr Shipman under police questioning

While there has not been another scandal on the scale of Shipman, can we really be certain that enough is being done to protect patients from healthcare professionals who are intent upon causing deliberate harm?

Less than a year ago a nurse was convicted of murdering patients in his care at two hospitals in Leeds, while a care home worker was charged with a similar offence in January.

Delay

In the same month the government published the Coroners and Justice Bill. It should finally address weaknesses that the government admits have become increasingly evident over the last 20 years.

Justice minister Bridget Prentice told the BBC she believes "the possibility of something as horrific as Shipman will have very, very little chance of happening again".

And yet the much anticipated reform of the process for death certification has been left to secondary legislation. Defects in the current system helped Shipman's crimes remain undetected. And it is this reform which could make a very significant contribution to public health.

Bridget Prentice accepts that with hindsight it is "unfortunate" that this single issue was not separated out and introduced sooner.

Laurence Buckman is chair of the GP's Committee at the British Medical Association (BMA). He offers this explanation for the delay:

"The health service is a remarkably inert tanker, and turning it around in any way is very difficult, and unfortunately politics gets in the way too," he told the BBC.

"I think that has been quite challenging in getting everybody to see that improving standards of care for patients is something everybody should want to do, not that it is part of a Shipman related activity," he added.


Ann Alexander is a former solicitor who represented the families of a number of Harold Shipman's victims. She presents Could Shipman Happen Again? on BBC Radio 4 on Thursday 12 February at 2000 GMT.

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