27 July 2022: Hunt - D

There were some quickfire questions from core participant followed by a cerebral dialogue between Mr Hunt and the Chair:

On the recognition that an Inquiry would likely result in more money needing to be paid, did they also recognise the possibility of wrongdoing being established; he said it was not necessarily so, but he thought there likely was wrongdoing, but either way there was an injustice.

On the possibility of accelerated access to treatment for infected people; he said it was seen as unethical due to an ethos of the NHS treating the patient most in need first. If infected people were pushed up the list that would result in others being deprioritised.

On the suggested threat of the DUP withdrawing their support for the Government of an Inquiry was not called at the time of the Diana Johnston debate; he said he didn’t know about that.

On avoiding the Government “marking its own homework” by setting up a separate body to order independent investigations; he said it was a very interesting idea. He had set up a health safety body to sit outside the health delivery systems. But he thinks the problem is more culturally-based. There  is too much covering up going on. The system should be more “self-correcting”, and they should be hungry to find out about problems so they can fix these for the future.

On that same openness relating to Government overall; he said it might start with open-ended relationship between a Minister and their officials and a strengthening of their ability to discuss and disagree without harming that relationship. He preferred officials using his first name, but some were uncomfortable with that. He also though transparency has a role, citing the early mistakes with the Covid pandemic and the better option of doing more listening to other voices including scientists from up and down the country. They need to move away from the blame culture.

On the £125million and if there were consequentials for the devolved administrations; he said he did not know, but thought the Barnett consequentials elements had already happened.

On the expected results of the Penrose Inquiry and there possibly needing to have been more preparation for higher financial costs resulting; he said he did not think there was any concrete basis to the expectations, but knew if there were financial increases for Scotland, the rest of the UK would be obliged to follow suit.

On the assumption that all money had to come from the DH and why that was; he said that is the way Government works. The Treasury view is that they give out the money and the Departments have to get in with it.

On the position of costs coming out of DH money, leaving an open invitation to accuse claimants of taking money away from current patients; he said he once said that and got a backlash, but that was the reality of his position.

On the reality being that Governments can find the money when they have to; he said it was too stark to say it like that. However, he recognised how during Covid £400billion was needed, but that added to the national debt. So yes, money can be found but there are consequences. But overall, the State had a responsibility for the consequences of infected blood, and it should have acted much sooner, saying “I think the totality of this was a failure by the British State.”

The Chair highlighted the size of this Inquiry compared to the others in the NHS and the witness recognised that. Many of the other investigations were not full Public Inquiries, but there were still potential financial consequences.

The Chair spoke about the desire for Government, the medical profession, etc. to learn from mistakes and to avoid a blame culture. Sir Brian suggested that “blame” was alright, so long as it was blame for not admitting that they had made a mistake. This pithy assertion produced a spontaneous round of applause. The witness accepted the proposition. He cited his introducing the Duty of Candour initiative following the Francis Report on Mid-Staffs but it only related to the organisation. There was resistance to making it apply to individual doctors and nurses, saying that it would best be done through their professional bodies, but he wonders if they should have gone further. The Chair said maybe “the price” should be higher for not being transparent. The witness said he tried to push forward the culture change after each Inquiry. He had started in Government being afraid of culture change because it was so “nebulous”. As an aside, the Chair noted how that might affect his Recommendations should he want to put something in about culture change (every other Inquiry seems to suggest the need for culture change, but it never happens). The witness thought we needed to move to “no-fault compensation”, including recognising the difference between ordinary human error, even if it leads to deaths, as opposed to acts of gross negligence. He does not think doctors know the line between ordinary human error and gross negligence, so they are nervous. He mentioned the view that in medicine you “do the greatest good for the greatest number of people, but there will be consequences for a few unlucky souls along the way”. He thought that was wrong and not consistent with NHS values. There was also the issue of it taking so long after being swept under the carpet. The Chair noted the importance of the intersection between candour and accountability. Sometimes it is the system that is the problem, not the individual. Who would be at fault if a doctor makes a mistake while working a very long shift, him/her, or the shift manager? The witness moved the discussion on to the process of “implementation” after a better way of doing things is discovered. Due to the massive amount of sent out material coming to doctors every day, passing round a leaflet about better practice would not be enough. This led to the element of audit and the value of that in such a system.

The Chair finally asked about Ministers and officials staying either short or long times in their posts, and the effects of that; particularly the results with respect to certain statements/lines being replicated so many times that everyone forgets the rationale for it. If there is a rush on, it is easier just to pick up something already in place and take out the relevant bit for convenience. That might work for the newer in post person, but the long-standing person might in their way of thinking seek to defend the line “to the hilt”, stopping the possibility of a necessary challenge when required.

The witness gave an example of the UK being ranked No 2 in its readiness for a pandemic a few years ago, which he was proud of (the US was ranked No 1). This certainly caused a flutter of response from those in attendance. That ranking was carried out by Johns Hopkins University, of all places. The UK thought they were on the ball with their pandemic preparations, but they were actually suffering from “groupthink”. When they checked back, “testing” was not mentioned once in all the paperwork. The Civil Service, academia, and other contributors are very consensual-minded places, and they don’t like to upset each other. Nobody likes a fly in the ointment, but sometimes you do need someone to challenge the thinking, and not just expect Ministers to do that. When a new Minister does seek to intervene, it may be their lack of subject knowledge means they can be easily bated off. They are generally not the experts.

The Chair asked why the UK was so successful at combating the risk of e-bola. The three African countries most affected were shared out between the big global players; the US, the UK, and France. They went to the source of the problem and fixed it there with medical expertise, the army, others who knew what they were doing. That was the key factor.

The witness did not have anything to add.

The Chair thanked the witness for his candour and reflective answers.

Well, that sure was refreshing.