29 June 2022: Horam - A

Lord John Horam was a bit of a political chameleon. He started as a Labour MP, then he jumped to the SDP, then the Conservatives. There can’t be many of them to the pound. He had various roles in Government, with the focus being on his time as Parliamentary Under Secretary of State for Health between 1995-1997. He had 31 areas of responsibility, a lot of which was in working on getting bills through Parliament. He led on challenging issues such as the PFI Initiative (while also trying to keep up with his 30 other topics). The Chair had to intervene to ask the witness to speak more slowly. Visually (at least) and by coincidence, there is a Philip Dolan resemblance at play (in this writers’ view).

The witness commented on the turnover of Ministers and Junior Ministers. He felt that it took about 18 months before you could really get to grips with the brief, and three years to be properly effective. Of course, that rarely happens, so Counsel extracted the inevitable acknowledgement of Ministers having to rely heavily on advisers. Breakfast meetings were held by Stephen Dorrell, occasionally attended by Gyles Brandreth as the Parliamentary Private Secretary (PPS). These meetings were not minuted (surprise, surprise).

Counsel confirmed with the witness the prevailing policy position of the Government against no-fault compensation for victims of viral Hepatitis C from infected blood products. During his first few days in the post, the Haemophilia Society had published a report on the impacts of HCV. The line was stressed to remain opposed to any special payments, while anticipating media attention and Parliamentary Questions. This issue was a focus of his work, but was not altogether new to him since he had received representations from a constituent whose son had been infected, and there was also someone he knew. The impacts on these two people had been recognisably very difficult. The Haemophilia Society report was picked apart by officials with a view to rebutting any efforts to pressure the Government into making payments, including undermining the veracity of the research methodology and sample size. Counsel asked if the DH ever commissioned its own research, but apparently not. So, the line was stuck to that those patients had received “the best” available treatment at the time. The internal communications did recognise the HCV (non-A-non-B) side effect since the 1970s. Other internal briefings listed the significant health detriments resulting from viral Hepatitis. There is no doubt they knew the considerable and various impacts people were facing, but the Government clung to the line there was no negligence or liability.

When he read the report, and from what he had learned from the two specific cases, it reinforced in him the need to accept the plight of infected people and their families; including the health challenges, the financial consequences, and the social and psychological problems which are caused. Active MPs on this matter who were raising questions at the time included Mr  John Marshall (representing Hendon?) and Mr George Mudie (representing a Leeds constituency). Further documents describe (or even dismiss) the Treasury’s resistance to setting a precedent as being simply an “administrative” matter. It also highlighted the particular interest being shown in the issue by the Prime Minister.

The arguments citing the benefits of factor concentrates were fed to the witness to inform his speeches, discussions, and answers to questions. When asked if the alternative of Cryoprecipitate was ever mentioned to him, he gave an affirmative “No.” He did also not recall having been advise of the sourcing of blood from the US but said the sourcing from prisons was common knowledge. In a debate, the idea of concentrating on those who had developed cirrhosis of the liver for targeted support was mooted. It appears that the witness was affected by the issues and they caused him to say he would look at the matter “afresh”. Counsel suggested this was a deviation from the policy line. However, the day after the debate, a letter was replied to which seemed to revert back to the official position. The witness had mentioned in his statement that the letter would have been drafted by a civil servant, before what he had said in Parliament, but sent out afterwards. His thought was to soften the line, while others such as the Treasury, expressed critical concerns about Lord Horam’s public statements being more concessionary. The witness had not seen the letter from the Treasury, and while he was not surprised by its contents since it was the job of the Treasury to protect public finances, he was concerned to see it and would have expected his officials to bring this to his attention at the time. For example, Lord Horam wanted to insert the words “at present” to any statement which said no plans were being made to provide support. It appears from some of the related correspondence how some officials wanted to see him brought back into line. They noted the “sympathy” for victims having greater sway with Lord Horam, and with “cost coming second”. Counsel referenced previous witnesses and a similar aim to put people “back in the box”.

This witness is coming across as one of the relatively few good guys who operated within the walls of Government. He seems to have been open to a more humane response to infected people and their families. He even commissioned work to look at alternative options for providing some kind of financial support. More documents were displayed which had only come to the attention of the witness when they were sent to him by the Inquiry. These illustrated an acceptance of the inevitability of having to change the official position, the role of public pressure, the automatic resistance of the Treasury, and possibly the need to have the Prime Minister override the financial concerns. Despite the witness trying to be an apologist for the way Government worked (if that is the right word), the impression is left that financial considerations and the power of the Treasury almost always trump any other considerations. Counsel led the witness to recognise that the approach of waiting until the Government was forced to act would inevitably have led to more people dying in dire circumstances in the interim. The witness agreed.