FAMILY doctor Harold Shipman may have been driven by an "addiction to killing" when he claimed the lives of at least 215 of his patients, the official inquiry into his crimes said yesterday.

A report by High Court judge Dame Janet Smith unveiled for the first time the shocking death toll of the GP who murdered patients over a 23-year period - making him Britain's most horrific serial killer, and one of the world's worst.

She said that in addition to the 171 women and 44 men who died at his hands from deadly injections, there was a "real suspicion" he had claimed the lives of 45 more.

Her interim report said there were "deeply disturbing" failures in the systems that should have safeguarded his patients.

The judge said that the trust placed in the 56-year-old GP by patients and their families had allowed him to carry on murdering.

"He betrayed their trust in a way and to an extent that I believe is unparalleled in history," she said.

Dame Janet said in her first report, compiled after a year of hearings at Manchester Town Hall, there was still no evidence of a motive.

His addiction to the painkiller pethidine in the 1970s probably led to addictive behaviour, she said, adding: "It is possible that he was addicted to killing."

As medical authorities and politicians called for a review of the measures that should have detected Shipman's killing spree, two communities were left in shock by the report.

Residents of Todmorden, West Yorkshire, where Shipman began his career in 1974 and was disgraced over forging prescriptions and abusing drugs, learned for the first time that the GP had killed there.

The report decided he murdered the first of his victims, 70-year-old cancer sufferer Eva Lyons, there in March 1975. There were also suspicions surrounding the deaths of a further six of his patients at the Abraham Ormerod Medical Centre.

Despite his drugs conviction, Shipman was given the chance to rebuild his career and moved to County Durham.

For 18 months, from 1976 to 1977, he worked at Bishop Auckland child health clinic as a non-prescribing clinical officer.

But according to a spokesman for County Durham and Tees Valley Health Authority, Shipman, who lived in Newton Aycliffe, was not in a position to prescribe drugs or sign death certificates during his time in the North-East.

His son, David, graduated from Newcastle University last week after gaining an engineering degree.

In 1977, Shipman became a GP in Hyde, Greater Manchester, where he claimed most of his victims. He was finally arrested in 1998.

Last night, residents of Hyde were still trying to take in the scale of his murderous spree.

Dame Janet's report highlighted the failings that let Shipman escape detection as he murdered patients, the youngest of them aged 41.

The majority of his victims were cremated and Dame Janet said the system of checks in place to protect the public against concealment that a person had been unlawfully killed "provided no safeguard at all".

Dame Janet said Phase Two of her inquiry in the autumn would examine what went wrong and how the system could be improved.

In addition to the 215 killings and the 45 suspicious deaths, there were a further 38 where there was too little evidence for her to reach a conclusion.

Speaking of Shipman's motive, Dame Janet said: "Only he can answer that question and at the moment it seems very unlikely he will."

Families of Shipman's victims were told by post of the individual decisions in the 48 hours before publication of the report.

Christopher Rudol, whose 82-year-old father Ernest was killed by Shipman in June 1995, said the finding had brought to an end three-and-a-half years of waiting and uncertainty.

"The wait has been horrendous. Every part of the investigation, you have to get out the records and the photographs and it brings it all back."

Dame Janet concluded in her report: "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."