17 March 2003
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1 Monday, 17th March 2003
2 (11.00 am)
3 DAME JANET: This is the preliminary meeting for
4 Stages 3 and 4 of Phase 2 of the Inquiry. I would like to
5 begin by clarifying the representation and attendance this
6 morning so that I can identify everybody. There are many
7 familiar faces, but some less so.
8 First on my list I see John Hand for the Co-op
9 Pharmacy.
10 MR HAND: Morning, Madam.
11 DAME JANET: Thank you very much, Mr Hand. I will
12 be coming back to you a bit later about other matters.
13 Mr Lissack, not here; Mr Gilroy, yes;
14 Mr McDermott, yes; Mr Pittaway, yes; Beverly Lang, yes,
15 there you are; Market Street Practice staff.
16 Is that Miss or Mrs?
17 MISS OLDFIELD: Miss.
18 DAME JANET: Thank you very much, Miss Oldfield.
19 The National Pharmaceutical Association, Mr David
20 Reissner; Mrs Pope is here for the Greater Manchester
21 Police, I understand. Yes, there she is, good.
22 Mr Brandwood for the Royal Pharmaceutical Society of Great
23 Britain; Royal College of Nursing, Mr Ian Hargreaves.
24 MR HARGREAVES: Morning, Madam.
25 DAME JANET: Any other representatives here I have
1
1 not mentioned?
2 Let me begin by giving you a progress ... there is
3 somebody.
4 MR STEARS: Alan Stears from the Home Office Drugs
5 Inspectorate.
6 DAME JANET: Thank you.
7 As I was saying, I will give you a progress
8 update. The reports for Stages 1 and 2 of Phase 2 are in
9 preparation at the moment and we are hoping to deliver them
10 to the Secretaries of State in June with a view to
11 publication in July. I must stress that the date of
12 publication is not a matter for the Inquiry. It is a matter
13 for Government and I should add that it can only be done
14 during the time when the Houses of Parliament are in
15 session. If it has not been done by the end of -- I think
16 it is round about 19th July, it cannot then be done until
17 Parliament reconvenes in the autumn.
18 The proposed arrangements for the remainder of the
19 Inquiry are as follows: I think it is well known now that
20 Stage 3 will deal with controlled drugs and Stage 4 with the
21 monitoring of general practitioners.
22 I thought it might be helpful to representatives
23 if I set out in rather more detail than has been given in
24 the list of issues the scope that of each of the two
25 remaining stages.
2
1 In Stage 3 the Inquiry will consider the existing
2 statutory framework and the adequacy and shortcomings of the
3 existing procedures for prescribing, dispensing,
4 requisitioning by signed order, collecting, delivering,
5 storing, administering and disposing of controlled drugs in
6 the community. We will examine the individual cases in
7 which Shipman stole drugs from patients or obtained them by
8 fraud on the Prescriptions Pricing Authority.
9 In particular, we will examine the requirements of
10 the keeping of the reports by pharmacies, doctors and
11 nurses. We shall consider whether these are adequate and,
12 if not, how they should be improved so as to provide tighter
13 controls. We will look at the arrangements for the
14 inspection of records, how they work in practice and whether
15 they should be changed.
16 We will examine the underlying policy of the Home
17 Office and the procedures they adopt when exercising their
18 powers and duties under the Misuse of Drugs Act. In
19 particular we will consider the policy governing the
20 exercise of their power under Section 12 of that Act in
21 relation to doctors convicted of drugs offences. This will
22 be considered not only in relation to the way in which
23 Shipman was dealt with in 1976 but also the way in which
24 such similar cases have been handled at various times since
25 1976 and the way in which they are handled today.
3
1 We will examine the way in which doctors and
2 pharmacists are monitored by the police. We will consider
3 how such monitoring is organised, by whom it is carried out
4 and what training is given to the personnel involved. We
5 will consider the role of the Royal College of Pharmacists
6 of Great Britain in the monitoring and running of pharmacies
7 and we will consider the roles of the Prescription Pricing
8 Authority and the Department of Health in the supervision or
9 monitoring of the use of controlled drugs.
10 That is the proposed scope of Stage 3. If anybody
11 considers that we have missed out something that we ought to
12 have included, I would be grateful if they would let the
13 Inquiry know -- not now, but as soon as possible.
14 The timetable for Stage 3 is as follows: hearings
15 will begin on 19th May and will be completed in the week
16 beginning 30th June. As before, the usual pattern of
17 sitting will be Monday, Tuesday, Thursday and Friday but
18 that is not immutable and representatives must be prepared
19 to attend on any day of the working week.
20 The first document disk will be distributed today.
21 I remind everybody that the material is confidential until
22 it goes into the public domain, either by production at
23 a hearing or by posting on the Inquiry website.
24 Salmon Letters for Stage 3 have already been sent
25 out. I do not anticipate there will be any more, although
4
1 that possibility cannot be completely ruled out. I do
2 stress that Salmon Letters give notice of potential areas of
3 criticism. There has been no pre-judgment of any issue.
4 The arrangements for television and radio
5 broadcasting will be the same as before. That means that if
6 any witness has any objection to the possibility that their
7 evidence might be broadcast, they should make an application
8 to be excused from having their evidence filmed and issued
9 to the broadcasters. I would like to receive any such
10 applications before the hearings begin. I do not want to
11 have to disrupt hearings in order to deal with that.
12 The usual arrangements will prevail for the
13 calling and questioning of witnesses. For those who have
14 not appeared before, the arrangement is this: the Counsel
15 for the Inquiry calls all the witnesses save for those who
16 have received a Salmon Letter. If such a witness and their
17 representatives wish for the representative to call the
18 witness to make their initial statement of evidence, that is
19 permitted. Please inform Counsel to the Inquiry of any such
20 arrangement. I should have mentioned that Mr Melton QC will
21 be primarily in charge of Stage 3. Miss Swift will be in
22 charge of Stage 4.
23 The timetable and witness list is regrettably not
24 quite ready; there have been a number of last minute
25 changes. However, it will be available well before Easter.
5
1 Seminars will be held on the 11th and 12th of
2 September this year. The Inquiry does not propose to issue
3 a discussion paper. Proposals for change would be welcomed
4 by the Inquiry. Any person or body who wishes to submit
5 ideas of proposals should do so at any time from now but
6 should ensure that they reach the Inquiry by 14th July.
7 I will announce the arrangement in respect of
8 submissions at a later date. It is likely these will follow
9 the earlier practice whereby interested parties put in
10 written submissions and this is followed by an opportunity
11 for oral presentation.
12 I will now take any applications for
13 representation. I distinguish between representation and
14 funding. I will say a word about funding in a moment. It
15 may be there are one or two parties here today who have not
16 formally been granted representation; that is the right to
17 appear through a representative.
18 Please, will anybody who wishes to speak wait
19 until a microphone is close by or move to one if near at
20 hand.
21 Mr Reissner?
22 MR REISSNER: Madam Chairman, I make an
23 application for representation on behalf of the National
24 Pharmaceutical Association and its members.
25 DAME JANET: As you will see from the list of
6
1 issues I just read out, the scope of the Inquiry, we will be
2 looking into matters which are plainly of interest to the
3 body you represent and, yes, you may be represented.
4 MR REISSNER: Thank you very much.
5 DAME JANET: Is there anybody else?
6 Mr Hand?
7 MR HAND: I represent Co-op Healthcare who have
8 been afforded representation.
9 DAME JANET: Do you have a microphone there?
10 MR HAND: Yes.
11 I represent Co-op Healthcare Ltd who have been
12 accorded representational rights. I also represent Mayfair
13 Chemists Hyde Ltd, who have not. In view of the time
14 sequence, I wonder if Mayfair Chemists Hyde Ltd could be
15 afforded representational rights?
16 DAME JANET: They traded as Battersbys; is that
17 right?
18 MR HAND: Yes.
19 DAME JANET: In Market Street?
20 MR HAND: Yes.
21 DAME JANET: Yes, and they were taken over by
22 Co-op Healthcare, so --
23 JOHN HAND: They were.
24 DAME JANET: -- so it is really predecessors in
25 title of your existing clients. You may represent them as
7
1 well.
2 MR HAND: Thank you very much.
3 DAME JANET: Mr Brandwood?
4 MR BRANDWOOD: I appear for the Royal
5 Pharmaceutical Society.
6 DAME JANET: You must plainly be represented.
7 MR BRANDWOOD: Thank you.
8 DAME JANET: Mr Stears, yes. I was, I must
9 confess, slightly surprised to see the Drugs Inspectorate
10 were here -- I am sorry, my fault, I should have waited
11 until you had your microphone -- in a separate capacity
12 apparently from the Home Office. Of course the Home Office
13 are entitled to representation.
14 Are you seeking separate representation for the
15 Drugs Inspectorate?
16 MR MACFARLANE: Madam, I am the Chief Inspector of
17 the Home Office Drugs Bank.
18 DAME JANET: Are you Mr MacFarlane?
19 MR MACFARLANE: My name is MacFarlane, Ma'am. If
20 I may, at the moment, say we do not know whether or not we
21 will be represented legally at the hearing, but either way,
22 of course, will be here to give evidence.
23 DAME JANET: Yes, I had rather assumed that you
24 would be represented as and when necessary by the Home
25 Office.
8
1 MR MACFARLANE: It is possible, Ma'am, that the
2 Home Office may engage counsel to represent us. That has
3 not been decided. It will be decided in the light of the
4 letter that was sent to us last week from the Inquiry
5 Secretary.
6 DAME JANET: Perhaps it would be better if you
7 clarify what your position is and what application you want
8 to make and make it in writing.
9 MR MACFARLANE: That is absolutely fine, thank you
10 very much, Ma'am.
11 DAME JANET: So far as funding is concerned,
12 I think it is understood now that I cannot grant funding;
13 all I can do is make recommendation to the Secretary of
14 State for Health. I know there is one application for
15 funding because I have received a written submission from
16 Mr Hand.
17 Mr Hand, are you content that that should be dealt
18 with in correspondence or do you wish to pursue it now?
19 MR HAND: No, I do not wish to pursue it now. I
20 had a very helpful conversation with Leading Counsel to the
21 Inquiry and I am content to stand on the written skeleton.
22 DAME JANET: Thank you very much.
23 Is there anybody else who wants to make funding
24 application in respect of Stage 3? Good.
25 Stage 4: again, for the same reason, I will give
9
1 an indication of the scope of the ground the Inquiry intends
2 to cover.
3 Dealing first with Primary Care Trusts, formerly
4 Health Authorities. The Inquiry will consider the powers of
5 a Primary Care Trust to monitor the performance of a general
6 practitioner working in its area with special reference to
7 what is required or permitted under the statutory framework.
8 We shall consider the adequacy of the powers available to
9 the West Pennine Health Authority and its predecessors in
10 the years 1977 to 1998 -- that is the period during which
11 Shipman was practising in Hyde -- to look out for or detect
12 an aberrant doctor.
13 In particular, we will consider the nature of the
14 information available to such bodies at the time of
15 appointment of a doctor and thereafter. We will examine the
16 efforts made by the West Pennine Health Authority and its
17 predecessors to monitor its GPs during that same period and
18 will compare those efforts with those being made by other
19 health authorities in other parts of the country.
20 We will consider the role of the medical and
21 pharmaceutical advisers. We shall examine any changes in
22 the powers available to Primary Care Trusts since 1998 and
23 the adequacy of the powers now available. We shall consider
24 whether more information is now available than was available
25 at the time when the West Pennine Health Authority was
10
1 responsible for Shipman.
2 We will look at the various methods by which
3 primary care trusts might monitor a GP, including
4 a single-handed practitioner, such as by appraisal or
5 inspection of medical reports or by examining mortality
6 statistics.
7 We shall discuss the feasibility of obtaining and
8 using information relating to a doctor's convictions, any
9 complaints about him or her and any findings of negligence
10 or breach of duty. We shall consider the operation of
11 disciplinary processes with particular reference to the
12 receipt and handling of complaints or expressions of concern
13 submitted by one doctor about another.
14 Turning now to the powers and functions of the
15 General Medical Council, the Inquiry will consider the
16 statutory framework governing the powers and functions of
17 the GMC. It will consider the organisational structure with
18 particular reference to the disciplinary or fitness to
19 practice functions. The Inquiry has particular interest in
20 the way in which the GMC deals with doctors who have
21 committed drugs offences. The way in which Shipman was
22 dealt with in 1976 will be compared with the ways in which
23 cases of a similar nature have been dealt with in the years
24 since 1976, and are dealt with today. Insofar as the GMC
25 imposes restrictions and conditions of supervision on an
11
1 offending doctor.
2 We will examine the nature and extent of such
3 measures. The Inquiry is particularly concerned to
4 establish whether the approach adopted by the GMC to such
5 cases, especially those where the offending has involved
6 significant dishonesty within a professional context,
7 provides adequate protection for patients.
8 The Inquiry will examine how doctors in other
9 countries are disciplined for drug-related offences and will
10 consider how other health professionals are disciplined in
11 this country.
12 We will also consider how the GMC responds to
13 complaints about professional misconduct and expressions of
14 concern about possible errors or incompetence. We will
15 examine the procedures followed, including the sifting of
16 cases prior to referral to the Professional Conduct
17 Committee.
18 We will inquire into the extent to which
19 information about complaints and their outcome and other
20 material relevant to the competence of the doctors, such as
21 findings of negligence and breach of duty, have ever been or
22 are now disclosed to those with a legitimate interests such
23 as employers.
24 The Inquiry will consider the GMC's detailed
25 proposals for revalidation and, in particular, would wish to
12
1 know how and to what extent adverse information such as
2 complaints and their outcome and allegations or findings of
3 the negligence and breach of duty will be considered during
4 the revalidation process.
5 In respect of all these issues, the Inquiry will
6 consider whether changes should be recommended.
7 Turning now to complaints and expressions of
8 concern by one doctor in respect of another. I have already
9 mentioned that that will be a matter of interest in respect
10 of Primary Care Trusts but the Inquiry will also consider
11 the duty of a doctor to raise concerns about misconduct and
12 mistakes of another doctor and what methods are open to a
13 doctor whose methods raise such concerns. These will
14 include the possibility of making a report to the GMC and
15 the Local Hospital Trust or Primary Care Trust.
16 We shall consider whether the profession's
17 perception of its duty in this regard has changed in recent
18 years. These issues will be considered particularly in
19 connection with the duty of the consultants at Tameside
20 General Hospital to raise concerns about Shipman's treatment
21 of Mrs Renate Overton in 1994.
22 Turning to whistle-blowing, the Inquiry will
23 examine the problems of whistle-blowing in both the
24 professional and private context. In particular we will
25 examine why those who came to suspect Shipman were unable or
13
1 unwilling to make their concerns known. We will consider
2 what conditions should be created to foster a willingness to
3 report genuine concerns.
4 It will be appreciated from what I have said that
5 there will be some areas of overlap of issues between Stages
6 3 and 4; for example, in Stage 4 our consideration of the
7 ability of a Primary Care Trust or a Health Authority to
8 monitor a GP will include the feasibility of monitoring
9 usage of controlled drugs.
10 There will also be some witnesses who have
11 evidence to give, which is relevant to both stages. The
12 intention is such witnesses will only be called once in
13 Stage 3 and will be asked about those topics of their
14 evidence which are germane to Stage 4 on the same occasion.
15 The Inquiry recognises that parties interested
16 only in Stage 4 may wish to attend on occasions during
17 Stage 3. Primarily it will be the responsibility of those
18 parties to follow the Stage 3 proceedings and to see when
19 a witness in whom they are interested is going to be called,
20 however counsel and the Inquiry staff will do their best to
21 issue advance warnings and give assistance in that regard.
22 Arrangements: the Stage 4 hearings will start on
23 14th July and will run initially until 31st July. That is
24 a Thursday. We will be sitting each day of that week; no
25 break on the Wednesday. The Stage 4 hearings will reassume
14
1 on 15th September. There will be a Council meeting in this
2 Chamber on Wednesday 8th October, so there will be no
3 hearing on either 8th or 9th October. We hope -- and I
4 stress the word hope -- to take a break, if not for a
5 holiday, at least for further preparation during the week
6 commencing 3rd November; in effect, a sort of half term.
7 At the moment, because the programme timetable has
8 not be finalised, that cannot be promised and I would not
9 like anybody to book a holiday on the strength of this
10 indication. The position will be clarified as soon as
11 possible.
12 Apart from that week, hearings will continue until
13 the week beginning 15th December. Whether we will need all
14 that week or only part of it I cannot at present say.
15 The first disk of evidence will be distributed by
16 the end of April. Salmon Letters should go out in early
17 June. I think I can assure everybody it is highly unlikely
18 there will be any Salmon Letter relating to evidence which
19 will be heard before the summer break.
20 The witness timetable is not yet available, as I
21 have indicated, but it will be announced as soon as possible
22 and I will announce the arrangements for submissions nearer
23 the time.
24 Proposals for change will be considered at
25 seminars to be held in January next year; these will follow
15
1 the pattern of the earlier seminars, save there will not
2 have been a discussion paper. I anticipate an agenda will
3 be circulated. The Inquiry will welcome proposals for
4 change from any interested personal body. These can be
5 submitted at any time from now. I shall impose a cut-off
6 date in due course.
7 Is there any additional application for
8 representation or funding? Do you want to make an
9 application now or do you want to wait to see what happened
10 happens with the Salmon Letters?
11 MISS OLDFIELD: I would ask that the application
12 is made now subject to your approval, Ma'am. I also
13 represent the Market Street staff and we have been informed
14 they are going to be closely concerned with the
15 whistle-blowing section.
16 They have already been interviewed and I suspect
17 will continue to be interviewed and I would ask that you
18 recommend funding to be continued to Stage 4.
19 DAME JANET: The difficulty about that,
20 Miss Oldfield, is they have received representation up to
21 now but not on the basis of attendance every day at the
22 hearing. That is alright, is it not? I considered during
23 Phase 1, in fact, there were particular considerations
24 applying to your clients which made it desirable that they
25 should have legal advice at that stage and that is the
16
1 purpose for which funding was granted then and I think also
2 it maybe that those instructing you assisted in the
3 preparation of statements and, of course, the Inquiry funds
4 that.
5 At the moment, I cannot say on what basis it would
6 be appropriate to grant funding for your clients and I am
7 afraid I must ask you to wait until the position is clearer
8 before I can give it proper consideration. However, the
9 Inquiry does have your clients in mind and, as you know,
10 Mr Palin is always available for advice if necessary.
11 MISS OLDFIELD: I am grateful.
12 DAME JANET: That is all I wanted to say.
13 Miss Swift, have you anything to add?
14 MISS SWIFT: No, Madam Chairman.
15 DAME JANET: Or Mr Melton?
16 MR MELTON: No, Madam Chairman.
17 DAME JANET: Does any representative have any
18 other observation they want to make?
19 In which case I shall bid you goodbye until
20 19th May.
21 (11.35)
22 (Hearing adjourned until Monday, 19th May, 2003)
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