13 July 2022: Jecock - B

A Ministerial briefing written by the witness in March 2009 was in preparation for a meeting with Lord Archer. It also referred to the initiation of the Penrose Inquiry in Scotland. The briefing included the “Government Position” which was basically just the usual rubbished assertions like, “it was the best treatment available at the time”. However, reference was made to the actual Archer Report which obviously pre-dated the memo, and it specifically highlighted how wrong these still-being-made assertions were. Counsel sought to discover if the Archer findings were considered and potentially relevant to change the departmental line. “I honestly can’t remember,” said the witness, not surprisingly. (When witnesses say “honestly”, alarm bells go off.) On cryoprecipitate being an option, she said she, “Can’t remember,” again; again, not surprisingly. She admitted that it would be reasonable to expect the Archer Report to influence the Government position. On the assertion that the Government stuck to its lines despite new evidence being presented, the witness did not accept that (producing a muted laugh), but she strangely noted how some lines to take became embedded (she did not want to say “entrenched”), with the Chair suggesting “received wisdom”, and that was seen as fair. So, the double-speak is exposed. New evidence was not ignored, said the witness, but the received wisdom resisted change.

With respect to the Irish scheme as an Archer recommended response model, the witness stuck to the view that the failings acknowledged by the Irish health system did not apply in the UK (… go figure). In the meeting with Lord Archer, there was the assertion that any harms had to be specified as having been directly caused by infected blood. (That little nugget would come back to haunt us.) A commissioning note was discussed with the general point mentioned that the person carrying out the task having to remain within the listed issues, within reason. The Irish model was killed off before it got anywhere. There was never a serious attempt to work out the costs of an Irish-type model applied to the UK, but a very rough estimate was done which produced a scarily-high sum (certainly enough to scare off any Minister, no doubt). The “preferred” approach put to the Minister was to propose beefing-up The Eileen Trust, The Macfarlane Trust, and The Skipton Fund, including moving towards more regular kind of payments. Then the kicker, it was all in the of context of a tight financial environment where the Treasury was not supporting any new spending. (Ever has it been!) The financial calculations to arrive at a total cost of the proposed changes were done by the witnesses’ colleagues, not herself. Some discussion on how the numbers were derived highlighted the estimates and assumptions used to make projections.

The Minister wanted to be seen as making the most positive response to the Archer Report, while also having robust responses to the Recommendations the Government did not want to accept. During the process the issue was being escalated up the line for more senior officials to have a hand in. It seems like the numbers were being made up in an arbitrary way to balance “affordability” with the need to present the Government in the best light. There was no needs analysis carried out to ensure what was to be paid, matched what was needed. Presentation and reputation were more important than the actual State-harmed people. And that is the “state” of our democracy (… government for the people, by the privileged).

The differentials the proposals would produce between HIV and HCV scheme claimants were the subject of various internal conversations, but with the over-riding control factor still being what was affordable in a climate of fiscal constraints (yawn). This constant living under current financial tightness is like pretending you want to grow palm trees in every person’s garden in the UK, but due to the prevailing weather conditions at the time you say you want to do it, your actions would have to be a much lesser response than what you say you would do otherwise (and presumably until the UK weather changes permanently to a more tropical environment, as if).

The Government was continually being challenged, not least because campaigners were further emboldened by the Archer Report, yet the same old same old tropes were still being peddled. Again, the witness asserted that the Government would have been open to change the departmental line if new evidence became available. Is it ever a good idea to tell the teacher she is wrong?

Just as the (moderate) increases and other changes were about to be announced, the sitting Minister who was increasingly coming across is sympathetic to the case of infected people and their families, was changed. (When else have we seen examples of a more open-minded Minister being supplanted by a hawk? Think Mordaunt and Ellis, perhaps.)

An Expert Advisory Group was established to take forward the changes, involving the Chairs of the relevant Trusts and Schemes. There were lots of doctors, and Charles Gore. The role was to come up with an “evidence-base” to support any changes and set out the rationale for decisions. Given that they had a constrained budget already in mind, this was surely an exercise in fitting the square needs into pre-set rounded down amounts. Hearing some of the “expert” inputs, including how they minimise the impacts on Stage 1 Hepatitis sufferers, was painful. Sir Robert Francis had highlighted how a court claim would sometimes involve two experts – one for the plaintiffs and one the defendants – carrying out assessments that would then be argued over. Clearly, a lot of difference can result by the way experts are chosen, and who they are. Not a postcode lottery, but a preconceived mockery.

These people were “trying to steer a difficult line” said the witness, with many factors involved, and not just medical ones (such as problems with missing records). As the various categories of infected and affected people were reviewed, then matched alongside these expert opinions on what money each cohort should receive, it feels like a mind-numbing game (of Monopoly) and a futile exercise to justify minimal resource allocation (like moving the deckchairs on the Titanic).

The witness wanted to explain something before the lunch break. She mentioned that there was a huge amount of “missing” documentation (ie. not sent to the witness by the Inquiry), and she said she was happy to try to fill in any gaps. Counsel mentioned the need for selectivity due to the large number of documents and the need to fit the questions into a single day of oral evidence. And there is the cutting edge point between thoroughness and speed.