'It is possible that he was addicted to killing'

Shipman inquiry catalogues deadly spree that claimed 215 victims

Harold Shipman murdered 215 people driven by a morbid addiction to killing, an independent inquiry report concluded yesterday.

His victims included 171 women and 44 men over a period of 23 years and ranged from a 93-year-old spinster to a 41-year-old married man. They were despatched in nursing homes, sitting rooms, bedrooms and his own surgery, the independent inquiry chaired by Dame Janet Smith said. The killing spree, unparalleled in this country, began with a 70-year-old terminally ill patient at Todmorden, West Yorkshire, in March 1975, and ended when Shipman all but gave himself up by forging the will of a solicitor's mother, Kathleen Grundy, in November 1998. He had become more prolific every year.

Asked what prompted Shipman's 23-year murder spree, Dame Janet said there was evidence he had been addicted to the painkiller pethidine in the 1970s.

"I think it is likely that whatever it was that caused Shipman to become addicted to pethidine also led to other forms of addictive behaviour," she said. "It is possible he was addicted to killing."

The report was entitled Disguised as Death – a phrase selected from the judge's remarks as he sentenced Shipman to life imprisonment in January 2000 and which, Dame Janet said, summed up the way he capitalised on the trust of patients.

In Hyde, Greater Manchester, last night, relatives of those murdered were yet to find comfort in the report. Jane Gaskell, 42, whose mother and father were killed, said: "It's not possible to hate somebody as much as I hate him." Helen Blackwell, 50, Ms Gaskell's elder sister, added: "I resent him for devastating our family." Sheila Marshall, 43, of Hyde, whose two uncles were ruled as being killed by Shipman, said she was still seeking clarification on what motivated Shipman. "I feel betrayed and angry and confused as to why he has done it. I implore him to speak out."

Dame Janet's conclusions, which confirm Shipman as one of the world's deadliest serial killers, also show serious systems failures. In all but three of the murders, other GPs had countersigned a cremation certificate confirming the cause of death stated by Shipman. Shipman had also been able to gather controlled drugs which he used to kill – despite being the subject of criminal proceedings for drug use during which he admitted addiction, in 1975.

Subsequent phases of the inquiry will examine such flaws but the 2,000-page, six-volume report's most extraordinary passages detailed unknown realms of callousness.

He was not averse to asking for the possessions of patients he had just killed: in 1985 he asked for a patient's budgerigar so he could give it to his aunt (he was refused). In 1997, he asked a female victim's brother for her sewing machine. He was granted it, as well as another victim's antique bench.

His utter contempt for elderly patients was also demonstrated in the report's detailed psychological appraisal. Dame Janet said: "The way in which Shipman could kill, face the relatives, and walk away unsuspected would be dismissed as fanciful if described in a work of fiction. Although I have identified 215 victims of Shipman, the true number is far greater and cannot be counted. I include the thousands of relatives, friends or neighbours who have lost a loved one or friend before his or her time in circumstances which will leave their mark for ever."

Despite an investigation into the Todmorden deaths by West Yorkshire Police, Dame Janet was able to establish only one unlawful killing out of 19 cases there. In a further three she was undecided. She also decided a case involving a woman alleged to have been the only survivor of a Shipman attack did not constitute attempted murder. But Mrs (now Professor) Elaine Oswald, who collapsed after being fed opiate drugs may have been the victim of Shipman's desire to "involve her in some sexual activity", Dane Janet concluded. In that case, Shipman was guilty of occasing actual bodily harm, she said.

In all, the inquiry has examined 887 deaths, closing the files on 394 in which there is clearly no case to answer. Of the 493 examined in detail, 200 constitute unlawful killing, 45 provide a "real suspicion" of murder, 210 constitue death by natural causes and in 38 cases there is inadequate evidence to form a view. Shipman is to be sent a copy of the report in Frankland jail, Co Durham, where he is serving life for the murders of 15 patients.