31 March 2022: Perry - C

The high level principle of "clinical independence/freedom", meant that doctors could only ever be encouraged, not forced, to use SNBTS derived products over commercial ones. For it's part, PFC had to ensure its products were attractive for  their own good clinical reasons as the product of choice in Scottish hospitals. There was the opportunity for state blood product providers to engage annually with Haemophilia clinicians to share knowledge of needs and how products could be made to better meet those needs.

Dr Perry knew about the emphasis at Yorkhill on the use of commercial concentrates, but not the reason for it. Things changed quickly when Dr Willoughby left Yorkhill and Dr Gibson took over. Prof Cash tried to know what treatements were being used, where and why, but it was not an enforceable reporting system. The UKHCDO probably knew more. By 1983/84 the use of commercial products was almost non-existent in Scotland, Dr Perry says. This corresponded with the achievement of self-sufficiency (as defined by Scotland). However, due to improved processing that resulted in a period of lower yields, there was a time in 1987 when there had to be a reversion to using some commercial products.

The pro rata system was, in part, to encourage suppliers to seek to maximise their plasma collection. Alternatively, there was also the issue of time expired blood use. "Waste not, want not" attitudes again, aka minimising loss of value of unused material.

The lack of processing capacity in England towards its achievement of greater self-sufficiency could have been supported by Scotland. However, Dr Perry did not know why Scotland was not used to support the English production. He called it a "fight" to get recognition for the PFC as a special case to overcome the the Whitley Council rules and achieve a special order to allow this variation. Dr Perry saw this as a failure of the SHHD and the CSA. The lack of the proposed shift pattern arrangement was a major factor in holding back the ability of PFC to maximise its production possibilities.

Northern Ireland suffered due to the pro rata system. They had to top up their supplies beyond what they got from the PFC, because their supplies of blood were insufficient for their actual needs.

Pool size decisions were revisited. It seemed to be a collective decision rather than being the responsibility of one senior person. Dr Perry is convinced of the safety increase from larger pool sizes, simply because the impact of not doing so would have constrained capacity and so require topping up with commercial products. There were also logistical considerations, such as storage capacity, production lines, cleaning between different processes, QC sampling, loss of raw material just from its journey through the production line, etc.

Any alternative arguments, such as one from a Dr Crawford, to increasing pool sizes was resisted for various cost and operational reasons.

The freeze-dried cryo option was pretty much ruled out by the time Dr Perry started at the PFC. He saw it as too different from what was being moved towards, which was a much larger-scale production facility. On at least one occasion the production at PFC was referred to as a "sausage machine".

The recognition of over-production in 1983, which would lead to product going out of date before use, was considered as a "criminal act" if it was wasted. The idea of a shortage in England while there was spare in Scotland seemed untenable if the only option was to destroy perfectly good factor concentrate (there are a lot of assumptions in that description) instead of distributing it to England and Wales. That south of the border distribution is what eventually happened after liaison between Prof Cash and Prof Lane. It took a bit of time to get going, and Dr Perry could only speculate as to the reasons for the delay. The potential supply to England might have been "over-optimistic". Is this an alternative way of describing what Dr Snape had termed Scottish "exaggeration". It seems strange how difficult it was to supply products from Scotland to England.

1984 saw the end of the pro rata scheme in preference for supplying local areas based on stock in hand.

On appointment to his Scottish post, Dr Perry did not have much knowledge of Hepatitis. There was no formal programme to pass on this information, but he quickly picked up a working understanding of, particularly, non-A-non-B. At the time the impression was given of it being a fairly mild disease that might be passed on by blood products.

There was a telling comment from Prof Cash during an informal lunchtime discussion with Dr Perry about how sustainable the argument was of the greater benefit of clotting factors (reducing the harm from bleeds), over the risks of viral infection from those same products. This argument is another of the common mitigation-seeking assertions from apologists for clinicians and Government to justify the continued use of products known to be infected. Prof Cash's doubt is noteworthy.