Shipman inquiry calls for tougher rules on drugs and prescriptions

The inquiry into the activities of serial killer Harold Shipman has called for greater restrictions on the prescribing of controlled drugs and an inspectorate to monitor how controlled drugs are stored and disposed of.

The recommendations are contained in the Fourth Report of the Shipman Inquiry, 'The regulation of controlled drugs in the community', which was published and laid before Parliament today.

Harold Shipman, Britain's most prolific serial killer, was jailed for life in 2000 for the murders of 15 people. He died in January after hanged himself in his cell.

In July 2002 a public inquiry set up following Shipman's conviction found that he was responsible for the deaths of 215 people – the oldest a 93-year-old woman and the youngest a 47-year-old man. However, Dame Janet Smith, the High Court judge who heads the inquiry, said that the circumstances surrounding the deaths of a further 45 patients in Shipman's care led her to believe that the total number of victims may be as high as 260.

Dame Janet Smith's report found that Harold Shipman was "addicted to murder", having abused his position of trust in the community to kill his patients, typically through a lethal injection of diamorphine. He enriched himself either by persuading patients to include him in the will, or by forging the necessary documents.

In today's report, Dame Janet noted that there had been "virtually no revision" of the legislation relating to controlled drugs since the early 1970s.

"The requirements relating to controlled drug prescriptions and record keeping are out of date," she added.

"Above all, any new legislation must be based upon the dual objectives of improving the regulation and monitoring of controlled drugs as well as enhancing patient safety and care."

Summarising the report's conclusions, Dame Janet said that the recommendations "could not be guaranteed to prevent a dishonest doctor or healthcare professional from obtaining an illicit supply of a controlled drug". She added: "However, they would make it more difficult for him/her to do so and would also make it more likely that such an activity, if repeated, would be detected. The increase in the likelihood of detection would, I believe, have a powerful deterrent effect."

The report called for:

• an integrated and multidisciplinary inspectorate should be set up to monitor and audit the prescription, storage, distribution and disposal of controlled drugs
• a number of restrictions (including the prospect of criminal prosecutions) on the prescribing of controlled drugs which would discourage or prevent health professionals from prescribing in circumstances in which "it could be considered to be unsafe or unwise for them to do so" – ie. prescribing for their own use or for that of their immediate families, prescribing outside the requirements of their normal clinical practice, prescribing by professionals convicted of controlled drugs offences
• and a series of measures to tighten up the handling and safekeeping of controlled drugs along each part of the supply chain from the supplier to the patient's home, and to provide a complete "audit trail" to account for the movement of controlled drugs at each stage, both in the NHS and in the private sector.

John Grenville, of the British Medical Association's GP prescribing sub-committee, broadly welcomed the proposals, adding: "With regards to the proposals to tighten up the supply chain from supplier to the patients, it is important that any new system strikes the right balance between monitoring the movement of controlled drugs and giving quality patient care.

"Opiate drugs are widely used to ease patient suffering - notably for terminal care of patients with cancer and other illnesses. Patients would be in very severe pain if doctors were unable to give adequate doses of opiates at the appropriate time."

Home Office Minister Caroline Flint said that the government would study the recommendations carefully and in consultation with existing inspectorates, patients, NHS, police organisations, and the healthcare professions.

The inquiry's final report on monitoring of medical practitioners, disciplinary systems, whistleblowing and complaints is now expected to be published later this year.

(gmcg)