This week will mark a decade since the death of Harold Shipman. He remains the only British doctor to be found guilty of murdering his patients. The legacy of his actions is still being felt today and will no doubt still be felt for many years to come. He singlehandedly changed the British legal standing on healthcare and medicine. A trial lasting two years found that he had been responsible for deaths of up to 250 patients, although the true figure will never be known.
He administered lethal doses of diamorphine to his patients before falsifying their medical records to give a more convincing picture of ill health. He had operated as a sole practitioner having opened his own surgery in 1993. With no partners to witness his activity, he was able to continue unchallenged before a local GP and a local undertaker became concerned at the high number of cremation requests being made by him. The police initially failed to send in the best people to investigate. Thus, three more lost their lives before the police eventually realised the enormity of what was going on.
While Shipman remains the only British doctor to be found guilty of murdering his patients, it does not follow that he has been the only one. He was caught. Other cases had been brought to court before Shipman but he was the first to be successfully prosecuted. The regulation which now dogs many health professionals in the UK is in no small measure down to Shipman. Given the seriousness of his actions, there could have been no other action.
Above all, Harold Shipman more than any other person has made us question the way we should practice and regulate medicine. That can only be a good thing because he could only have practiced in the way he did under a flawed system. The challenge was to identify and rectify the flaws. One of the flaws identified was the failure of local doctors to be aware or suspicious of his actions. The recent Francis Report in to the failings at Stafford Hospital recommended a duty of candour and the banning of gagging clauses. While candour was called for, only time will tell if it will be delivered. The gagging orders remain. There were other recommendations of course but for brevity, I'm just sticking to these two.
The gagging orders exist to ensure that employees don't speak out when they see or hear practices which they find disturbing. In 2013, it was reported that more than £2 million had been spent on over fifty such gagging orders. Given this information, it's difficult to see how far we've come since Stafford - never mind Shipman! The point is that life will always throw up the odd bad apple. The challenge is whether we want to deal with it or ignore the elephant in the room. These staff subjected to gagging orders are stuck between the devil and the deep blue sea. Divulge the information and they lose a lot of money. Obey the gagging order and the malpractice continues. Purists might argue that an altruist wouldn't give a fig for the money and would just divulge the information. As we all know, life is seldom that straightforward and it is all too easy to criticise them. It is though entirely justifiable to criticise those who enforce these gagging orders as this is wrong whichever way we look at it.
Such a system is hardly conducive to candour so I would suggest that the gagging orders need to be outlawed before we can reasonably expect the recommendations of Lord Francis to be adopted fully. As for Shipman, he got the ball rolling but I fear it still has some way to go ten years after his death.
Tomorrow will mark thirteen years since the guilty verdict was delivered to the carers of Victoria Climbie and we heard the usual promises from social services that this must never happen again. On Armistice Day 2008, two brothers were convicted of the murder of baby P. We can recommend all the improvements to care we like, but it seems that enforcing them remains the biggest challenge.
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