Health Bill

I should like to spend a few moments looking at Clause 17 in the round, not in any way in a spirit of hostility, but rather because it presents an opportunity to look at its provisions in the context of the recommendations in Dame Janet Smith’s report on the activities of Dr Shipman, which has given rise to much that is contained in this part of the Bill. Dame Janet made a number of extremely considered and sensible proposals. The first and most obvious one to mention was her recommendation to set up a national controlled drugs inspectorate. She envisaged it as comprising small, multidisciplinary inspection teams operating regionally, with a wide range of powers and responsibilities. The Government have decided not to adopt that recommendation and have instead opted to go for the system that we have just been debating: having accountable officers locally. I say immediately that I can see advantages to both approaches. The advantage of Dame Janet’s approach is that it would draw together under one roof a comprehensive set of professional skills which, together, would be capable of monitoring all aspects of controlled drugs and their handling—which, in the absence of close scrutiny, Dr Shipman was able to exploit. The advantage of the Government’s approach is to place the onus of responsibility on those who have charge of the controlled drugs day to day, a principle that has inherent merit. I am sure that the Minister will agree that those two approaches, whatever their merits, are very different. It would be very helpful to hear from her why the Government chose the route that they did and rejected Dame Janet’s model. What point have the Government reached on some of Dame Janet’s other recommendations? She felt strongly that the purchase of all stocks of controlled drugs for practices should follow a procedure that can be monitored. The procedure that she recommended was that the prescribing form used for controlled drugs should be sent to the Prescription Pricing Authority, for entry into its database, thereby enabling all purchases of controlled drugs by any doctor to be monitored. What conclusion has been reached on that? What is to happen about Dame Janet’s proposals on GPs who keep stocks of Schedule 2 controlled drugs? She recommended a standard operating procedure that would be mandatory and which the Healthcare Commission should be responsible for approving in respect of GPs in private practice. She also proposed that the commission would ensure compliance with that SOP. It would be helpful to hear from the Minister the current position on those matters. Dame Janet and the Government were in agreement on the need for adequate scrutiny of an individual’s clinical practice in the handling and dispensing of controlled drugs. The importance of having a proper audit trail is beyond argument. One aspect of that that we have not yet debated is what happens, or what should happen, to any controlled drugs that are redundant following the death of a person to whom they have been prescribed. It is not clear to me who the accountable officer is in such a situation and how anyone would be able to check what drugs were unused and in the house of the deceased person. Dame Janet covered that issue in her report. She recommended that every injectable Schedule 2 drug leaving the pharmacy should be entered on to a statutory patient drug record card. After the death of a patient, or when injectable drugs are no longer required by someone, the card should be completed and sent to the PCT to which the patient’s GP is contracted. The entry or entries on the card should then be matched to the patient’s records. Separately, Dame Janet specified that there should be a formal process for the removal of redundant controlled drugs from the home of a patient and their destruction. The proposed inspectorate would have had a role in that process, although not an exclusive role, as I understood it. She also floated the idea that all controlled drugs would become the property of the Crown on the death of the patient to whom they were prescribed. Perhaps the Minister will shed some light on where we are with those issues in her reply, because I am not clear whether and where they are covered in the Bill.