To establish what Harold Shipman had done, a High Court judge had to examine 888 deaths one at a time. Dame Janet Smith sat for a year, read 3,500 witness statements, and in July 2002 delivered a six-volume report of some two thousand pages called Death Disguised. She found that Shipman had killed at least 215 of his patients. She found a real suspicion that he had killed 45 more, without evidence firm enough to say so. In 38 cases the material was too thin or too poor for her to form any view at all. In 394 she found compelling evidence that he had not been responsible. A jury had convicted him of fifteen.
The motive, Smith said plainly, would never be known: asked whether it would ever become clear, she answered that only he could say and that it seemed very unlikely he would. He refused psychiatric examination and maintained his innocence to the end. What her report set out instead was how a man could kill on that scale, inside a regulated profession, for twenty-three years, and be treated as reliable the entire time by the system that was supposed to watch him.
Harold Frederick Shipman was born on January 14, 1946, on the Bestwood council estate in Nottingham, the second of the four children of a truck driver, also Harold, and his wife, Vera; the family were devout Methodists. He won a place at grammar school, where he was a good student and an athlete. When he was seventeen and studying for his final exams, his mother was dying of lung cancer, and he would hurry home from school to sit with her. In the last stage of her illness the family doctor came to the house to inject her with morphine, and her son watched the pain go out of her. She died on June 21, 1963, at forty-two. He went on to medical school at the University of Leeds, met Primrose May Oxtoby, a farmer's daughter, at a bus stop, and married her on November 5, 1966, when she was seventeen and five months pregnant; they had four children. He graduated in 1970, worked at Pontefract General Infirmary, and in 1974 joined the Abraham Ormerod Medical Centre in Todmorden, a mill town in West Yorkshire, as a family doctor. His colleagues there found him able and liked; junior staff found him rude.
He was a family doctor in Hyde, in Greater Manchester, and he killed his patients in their own living rooms with injected diamorphine, usually in the afternoon. Then he wrote the death certificate himself, gave the cause as old age or heart disease, and discouraged post-mortem examination. That is the whole mechanism. A doctor in England and Wales could at that time certify a death he had caused, and the cremation form needed a second signature he could reliably obtain from a colleague who had no reason to look.
The victim profile is more mixed than the shorthand suggests. The 215 the Inquiry identified were 171 women and 44 men, ranging in age from 41 to 93. The concentration is what makes it visible in hindsight: five of them lived on the same street, and nine in the same sheltered housing complex.
His first was Eva Lyons, killed in March 1975 at Todmorden in West Yorkshire, the day before her seventy-first birthday, in his first year of practice. Within about a year he was caught forging prescriptions for pethidine, a morphine-like painkiller, for his own use. Magistrates fined him £600, he was sent to a psychiatric unit near York, and the General Medical Council issued him a warning but did not strike him off, so he was allowed to carry on practicing. He moved to Hyde. Seventy-one of the killings the Inquiry found were committed while he worked at the Donneybrook House group practice; the remaining 143 after he opened his own solo practice on Market Street in 1993, where nobody at all was watching him.
He was popular, and that protected him. Patients queued to register with him because he gave them time, made house calls, and remembered their families. He was known locally as Fred. When police began asking about the death rate among his elderly patients in 1998, Hyde closed ranks behind him. Smith's summary of that was the sharpest line in her report: the way in which Shipman could kill, face the relatives and walk away unsuspected would have been dismissed as fanciful if it had been described in a work of fiction.
He had in fact come within reach of being stopped. On March 24, 1998, Dr. Linda Reynolds, a family doctor at the Brooke Practice on the same street, took her concerns to John Pollard, the coroner for the South Manchester district. Her practice had been asked to countersign a striking number of Shipman's cremation forms, most of them for elderly women who had died at home, and a local undertaker, Deborah Massey of Frank Massey and Son, had noticed the same pattern. At the coroner's request Greater Manchester Police opened a confidential inquiry. It went to Detective Inspector David Smith, who gathered copy death certificates, had the medical records of some of the dead looked over by a doctor at the health authority who found nothing amiss, visited the crematorium, and never secured an autopsy. On April 17 the inquiry closed with a finding that there was no substance to the concerns. Dame Janet Smith later found that the two detectives in charge lacked the experience for the work and that a properly conducted investigation would have stopped him. In the weeks after it closed, he killed Winifred Mellor, Joan Melia and Kathleen Grundy.
Medicine did not catch him, and neither did the police. Greed did, and badly. He forged the will of Kathleen Grundy, an eighty-one-year-old former mayoress of Hyde who died on June 24, 1998, leaving her estate of nearly four hundred thousand pounds to himself, and typed it on his own machine so crudely that Smith later called detection inevitable. Grundy's daughter, Angela Woodruff, was a solicitor. She did not believe the document, and she went to the police. Her mother was exhumed and found to be full of morphine. Smith read the forgery another way as well: it is hard to resist the inference, she wrote, that Shipman was driven by a need to draw attention to himself and his crimes.
The other thing that undid him was a computer. He had gone back into his patients' medical records after killing them and written in the histories that would make the deaths look expected: anginas, declines, warnings given. He did not appear to know that the practice system time-stamped every edit, so the records showed him composing a patient's medical past in the hours after she died.
He was tried at Preston Crown Court. The prosecutor, Richard Henriques QC, put it to the jury that Shipman had been exercising the ultimate power of controlling life and death and had repeated it so often that he must have found the drama of taking life to his taste. On January 31, 2000 he was convicted of fifteen murders and of forging Kathleen Grundy's will, and given fifteen whole-life sentences.
On January 13, 2004, the day before his fifty-eighth birthday, he hanged himself in his cell at Wakefield prison with a ligature made from bed sheets. The timing was not accidental. Ministers had directed that 100 percent of Shipman's own benefits from the NHS pension scheme be forfeited, but no equivalent step had been taken over his wife's entitlement, and by dying before sixty he secured Primrose Shipman a lump sum and a continuing widow's pension. A probation officer had noted the previous April that Shipman was talking about suicide and had mentioned the pension. The officer judged that his bond with his wife made it unlikely, and he was not closely watched.
The Inquiry ran to six reports, and the later ones are the part with consequences. Death certification, cremation certificates, the coroner system in England and Wales, the monitoring of single-handed practices and the General Medical Council's own disciplinary conduct were all rewritten because of what Smith found. Before Smith reported, an audit by Richard Baker of the University of Leicester had already estimated 297 more deaths among Shipman's patients than his practice should have recorded. One study out of Dundee later made the uncomfortable point that even with the monitoring she recommended, it would take around thirty excess deaths to register a murderous trend in a single practice.
The figure usually attached to his name is 215, and it should be said precisely: that is a judge's finding after examining 888 deaths, not a conviction, and it makes him the most prolific serial killer in British history by a very long way. What a court established is fifteen. Both numbers are true, they are not the same kind of fact, and the 38 deaths Smith could reach no conclusion about will almost certainly stay open.