Patient-centred care after Shipman

Abstract

Professor Baker (April 2004 JRSM1) believes that the Shipman case exposed a medical culture in need of radical reform. In laying blame on the medical profession he tends to ignore those who were primarily responsible for delay in detecting Shipman's murderous behaviour. We now know that Shipman was a criminal who at the same time was a registered medical practitioner. It was in the public domain that Shipman had a criminal record dating back to his time in practice in Todmorden, West Yorkshire. Following his disgrace and his rehabilitation, he applied to enter practice in Hyde, Cheshire. His new family practitioner committee failed to check whether he had had a previous criminal record. During Shipman's time in practice in Hyde, the family practitioner committee had medical advisors visiting practices, and part of the advisors' duties was to check doctors' drug registers. Pharmaceutical inspectors visited chemist outlets regularly and likewise examined drug registers. In both of Shipman's convictions, any failure in either the storage of drugs or the recording of drugs in drug registers had to be the responsibility of Government inspectors to enforce regulations available to them at the time or to detect irregularities in their system. What information was passed by all of those professional State-paid inspectors to alert the appropriate authorities with regard to Shipman's activities? Our coroners were not vigilant. Thus they failed in their duties. The police, though alerted, failed to investigate fully a complaint. Funeral directors also had a public duty. Government statistical analysts through their computerized information should have noticed an abnormal trend. Yet Professor Baker writes about systems that failed at the patient-doctor level and at the patient-professional level. It is true that there was and is a system failure in death certification. The medical profession, the Royal Colleges, the BMA and the General Medical Council collectively and separately over the years lobbied for changes in death certification. As a profession we recognized that technology has progressed and changes were needed in many areas. Government must accept that funding is a vital element so that our monitoring systems can be upgraded. Government had failed to provide Parliamentary time to support requests from the General Medical Council and the Royal Colleges for new statutory regulations. It was Government-paid officials who failed the people of Hyde. The statutory instruments that were available to them were not used.