12 May 2022: Pickles - A

The gathering of paps along at the Courts are still facilitating the wags in their successful attempts to steal the news. Grrrr.

In her career, Dr Pickles was soon involved in clinical pharmacology. It included working with “normal volunteer and experimental drug use”. I wonder if infected blood patients were considered to be either ‘normal’ or ‘volunteers’ in the research we were used in? Her public health expertise did not come from actually being trained in the subject. She later passed an exam as her way in. She started in the Medicines Division at the DH in 1982. She received no training when starting, although she knew a colleague who eventually received training two years after starting. Her first job was well within her expertise, so the lack of training was not such a big deal. Later roles in the DH were “well outside her comfort zone”, but she still received no training, rather she had to quickly learn “on the job”.

On having to answer questions from the Penrose Inquiry Dr Pickles said she “freaked out”. She had experience of the BSE Inquiry investigations, but knew nothing about the legal support available.

Her work on the safety of medicines would also cross over to the efficacy of treatments, on occasion. Dr Pickles noted how much work (mostly reading) was involved in the Committee on the Safety of Medicines (CSM) but there was not much time available to do that. The issues of both cost and need were not factors in the considerations of safety of medicines. The CSM members were isolated from their department colleagues due to the need for confidentiality; as specified in the Act. Dr Pickles was also a member of what became known as the AIDS Unit, but when she was transferred there, she admits she did not know much about the topic. Her mother, who was herself a medical expert, was appalled to discover her daughter would be senior to people the mother knew were subject experts.

The AIDS Unit became noted internationally as leading on the world stage on factors such as political responses to AIDS. Dr Pickles reported directly to the Chief Medical Officer (CMO). A key role was in providing information to the public as well as clinicians. There were a lot of unhelpful and even silly stories in the media at the time. Lots of guidance documents went to professional bodies. Dr Pickles was also involved in the Expert Advisory Group on AIDS (EAGA). This was a much more open-ended group in terms of membership and the way topics were discussed (prostitution, sex, drugs, etc.) Normally, Government committees were very structured and controlled in the way they operated and what they were allowed to deal with. EAGA was far less restricted. There was some element of confidentiality there, but not in the same way as the CSM.

Dr Pickles then moved on to Med SEB (?), which underwent name changes to even more impenetrable acronyms. She covered the job of Peter Lister as well as her own job because his role had not been filled when he left. This exposed her to covering work related to Regional Transfusion Centres. She supervised Dr Rejman when he came into post. Dr Pickles had become expert in AIDS by then, but not Non-A-Non-B. Her view was that it was not so serious an infection. It related mainly to IV drug users, and was curiously prevalent in Japan.

Just like Dr Pickles herself, it is noteworthy to randomly point out how she occasionally comes out with a big sigh, for no obvious reason. Strange.

“Organograms” were required to understand the structures of DH between its divisions, branches, etc. These were usefully used in the BSE Inquiry. Clearly, and like it’s public-facing organisation the NHS, the DH was and still is a big and complex beast. The DH was not a popular employment location among doctors, mainly due it not paying well enough. This was a systemic problem since it made it hard to recruit good people, and hard to get rid of bad ones. There was also always pressure to reduce the size of the Department. Some posts remained unfilled for long periods.

Surprisingly, “There are no management lines over GPs,” admited Dr Pickles. The CMO did not oversee inspection bodies in the way the Chief Vet did. The CMO could put out influential documents, for example on public health, and these would be expected to be followed by clinicians on the ground. CMO letters went to selective sets of doctors rather than all doctors like GPs. GPs had so much to keep on top of that it was not helpful to issue numerous letters to everyone as a matter of course. There was a great deal of dialogue between the professional medical bodies (the Royal Colleges and various Societies) and the CMO or the DCMO. Clinical management was not seen as a role for the CMO. Doctors might resent his interference, and CMO post-holders may have been out of direct medical practice for a long time. The information or guidance from professional bodies was more likely to be well received. This begins to touch on matters related to clinical independence. Medical Defence Union types of bodies were also involved in giving guidance on clinical practice, perhaps surprisingly some might think. Dr Pickles said there was a collective interest in helping to avoid patients being harmed wherever possible.

All this structural and management discussion seems to be leading to recognising there being a systemic failure of leadership and oversight in this country’s medical establishment and it various organs. For example, when there was not a recognised patient representative group, even that would pose a problem to the DH and its efforts to disseminate information, take a lead role, or coordinate a national response. This may be an issue of sufficient weight to require a specific recommendation in the Inquiry Chair’s final report.

Occasions and needs to link to “the Celtic Fringe” (Northern Ireland, Scotland, and Wales) varied over time. Scotland was the most independently active of these, in part due to factors such as different laws and specific concentrations of problems like illegal drug use. Dr Pickles could not remember too much about who she linked to from these fringes – laughingly noting how it was 40 years ago – until Counsel reminded her that some names were mentioned in the documents the Inquiry had sent out.