Chapter 4: Healthcare organisations and individuals
Chief Medical Officer response
On 16 July 2002, Professor (by then Sir) Liam Donaldson wrote a note to Marcia Fry, a senior DH official, copied to Ministers’ offices and to Nigel Crisp, the DH Permanent Secretary and NHS Chief Executive. His note said that following the CHI investigation he had “concerns that there are some aspects of the case that are still unclear [and] I believe we should consider further investigation” (DOH000040, p2).
Sir Liam concluded:
“I am concerned that neither the CHI investigation, nor the public investigation, nor the health authority investigation has properly examined the deaths associated with Dr Barton’s practice or in relation to care of the team. I do not think that this can be left as it is, even though others appear to regard the NHS part of the investigation as concluded and are simply awaiting the GMC’s verdict.” (DOH000040, p5)
Sir Liam wrote to Marcia Fry again on 29 July, having met Professor Livesley, who “believes that the police did not investigate adequately and were wrong to drop their investigation". Sir Liam also stated:
“The CHI investigation did not look at individual cases … The GMC investigation may take a couple of years (on past experience) and they have not suspended the doctor concerned … Professor Livesley’s report which I have seen in confidence makes worrying reading but only deals with one case. He told me that there had been mention of other cases in which death had been hastened but he had not been asked to look any more widely … Locally there is a high degree of concern amongst a number of relatives.” (DOH000051, p3)
Observing that none of the previous approaches had audited the death rate or the nature of deaths systematically, the note proposed “an NHS investigation initially examining data to look for evidence of excess mortality or clusters of deaths”. Sir Liam proposed that he should commission for this role Professor Richard Baker, who had carried out a similar audit of deaths attributable to Harold Shipman. Recognising that this “would clearly raise the temperature locally and nationally”, Sir Liam said: “he is very sound and we cannot risk a poorly conducted methodology” (DOH000051, p4).
On 29 July, Simon Stevens, then Health Policy Adviser at 10 Downing Street, replied that it was hard to disagree with this suggestion. Mr Stevens went on to say that “it is very worrying if in Liam’s opinion the CHI investigation was inadequate, it would be helpful to have more detail on why this was, and what needs to be done in future” (DOH000340, p1).