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Shipman Inquiry Finds a Better 1998 Police Investigation Would Probably Have Saved His Last Three Victims

Dame Janet Smith's reports faulted the Greater Manchester Police inquiry that cleared Shipman in April 1998 and found death certification had failed to detect his killings.

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Illustration of a stack of bound inquiry reports and papers on a table in an empty hearing room with blue chairs. Not an actual scene from the case.

In the spring of 1998 a doctor warned that Harold Shipman's patients were dying in suspicious numbers, and the police found nothing. On July 14, 2003, the Shipman Inquiry concluded that a properly run investigation would probably have saved his last three victims.

The inquiry's chair, Dame Janet Smith, a High Court judge, published two reports that day. The Second Report examined the investigation that began after Dr. Linda Reynolds, a family doctor whose practice was across the street from Shipman's practice in Hyde, told the local coroner, John Pollard, on March 24, 1998, of her concerns about how many of Shipman's patients were dying and how. At the coroner's request, Greater Manchester Police carried out a confidential inquiry, led by Detective Inspector David Smith under Chief Superintendent David Sykes. On April 17 the inspector concluded there was nothing in the concerns.

Shipman then killed three more patients before his arrest: Winifred Mellor, who died on May 11, 1998, Joan Melia, on June 12, and Kathleen Grundy, on June 24. Dame Janet found that Sykes should have assigned a suitably experienced detective and failed to recognize that the inspector was out of his depth. "Although I cannot be certain of this, I think that, if the police and the Coroner had moved with reasonable expedition, the lives of Shipman's last three victims would probably have been saved," she wrote.

The Third Report turned to the systems meant to catch a killing doctor. Death and cremation certification and the coroner system, intended to protect the public against concealed homicide, had failed to do so, it found. Dame Janet recommended splitting coroners' work between medical coroners and judicial coroners, both independent office-holders.

The Third Report described Shipman's killing as spanning 24 years, while the inquiry's chair had spoken in July 2002 of a spree that went unchecked for 23 years.

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