26 July 2022: Keel - C

Prof Keel was asked about the “Better Blood Transfusion” conference which included the aim for a “new up-front partnership” between blood services and the public. Counsel asked about the degree of impact and implementation of this approach in Scotland, but Prof Keel thought it better to answer a different question by talking about a report she co-authored with Brian McClelland; which was possibly mildly relevant. After re-statement of the question, it became clear that there had been some response, including a new leaflet being produced. A Programme Manager was appointed with a team of 18 nurses to cover the country, and a Steering Group was set up, all to seek to implement better use of blood across the NHS. That’s some pretty well-qualified people just to hand out a leaflet. As a matter of perception, Prof Keel stated her view that it was thought blood was a safe treatment for patients, as illustrated  by the previously common practice of “topping-up” a surgery patient as a matter of course or resolving a problem with anaemia with a transfusion. However, the witness confirmed how there were risks associated blood use, much more than generally thought. Why was this lack of knowledge so? What about standardised training for medical professionals?

The questions shifted to vCJD. The witness agreed with the view of Prof Ian Kennedy not to tell people if they had been exposed to an implicated batch of blood or blood product in case it worried them unnecessarily, given that there was no confirmatory diagnostic test and no treatment. How thoroughly paternalistic. Was this the type of thinking which caused people not to be told immediately of a Hepatitis infection? Counsel asked about the “precautionary” approach, and she said she would have supported this. (Is she just saying that because it is the right things to say? Does she actually believe it?) Prof Keel said she thought the Precautionary Principle should be followed, but with a nuance for blood products. Aaaah, what a neat and convenient little qualification Ms Keel. You are being precautionary about being precautionary. Who would have thought you were capable of being so subversive?

The impacts on people of receiving a vCJD warning letter were rehearsed and the witness said she was very aware of the issues, and these needed to be “managed”. She concentrated on the issue of surgery sterilisation processes, which she said added to the operational “burden” on the NHS of dealing with these patients. So, we were just a burden. No reference that the NHS caused it in the first place. What about the burden on us of having a letter with legal responsibility public health implications?

Asked about the issue of a Public Inquiry and when to hold one or not, the witness said it would have required new evidence to justify holding an Inquiry so that it could uncover the necessary evidence to learn from. She did not realise the circularity of her position related to the purpose of an Inquiry to uncover the evidence, which by her criteria “logic” meant the new evidence which would be needed to initiate uncovering the new evidence could never actually be reached.

Counsel asked if there was ever any consideration of the need for an Inquiry due to the numbers of people who had been harmed. The witness said she did not think the issues around contaminated blood were of a sufficient enough scale to justify an Inquiry. Yes folks, Prof Keel actually said that the scale had not been enough to require the establishment of the biggest Inquiry ever, anywhere in the world, on “the worst treatment disaster in the history of the NHS”. Yes Prof Keel, that Inquiry. Wake up and smell the faeces.

The questioning directly from the Inquiry concluded with a short course of mixed topics. One of these was paternalism and the patient/doctor relationship. She described openness as a “trend”. She had nothing useful to say about the raised concern of the same department of Government who was accused of doing something wrong, having the control of whether or not to hold an Inquiry. On the matter of retaining papers, it led to a discussion of the Prof Cash papers and the view of the witness that Cash liked to be “mysterious” in how he controlled access to paperwork. In relation to the Penrose Inquiry Report and its one Recommendation, she was involved just before leaving her post. Counsel asked if there had ever been an investigation into the needs of infected and affected people in Scotland. She was not sure but thought there might have been a needs assessment on a more general level (ie. not specific to infected blood patients, so the answer was either a) I should know but I don’t, or b) I should have done but I didn’t. Her team did engage with the insurance industry on issues relating to the difficulties of getting insurance, but clearly it never came to much because nobody knew it had happened.

Finally, Prof Keel was asked to reflect on whether there was any part of the treatment of infected and affected people by the Scottish authorities that should have been done differently. While re-stating the harms, the witness got herself caught up again on the idea of not making a special case for infected blood patients, and she stuck to the line that it was right at the time to resist making payments to the group of people involved. So, basically she could not think there was anything she did wrong or could have done better. Nothing, zero, zilch, nada, diddly-squat, not a sausage, nowt.