21 September 2022: Scottish Govt Decision Making 1970s to 1990s (Presentation) - A

The presentation was to cover Scottish Government decision making during the 1970s to the 1990s. It was backed up by a lengthy document, with an addendum to follow. A new statement by a Mr Davies was also due. The presentation did not cover blood supply issues since these was covered previously. The main body involved at the time was the Scottish Home and Health Department (SHHD). Some of the material covered was extracted from evidence presented at the Penrose Inquiry.

During the period, the Minister (Secretary of State for Scotland) at the Scotland Office was a Cabinet role, while the actual work was being directed by the SHHD. The hierarchical structure describing the most common arrangements over the period was reviewed, including the mix of civil servants and medical civil servants; such as the Chief Medical Officer (CMO) for Scotland and other medical professionals, including Dr Archibald McIntyre, Dr Albert Bell, Dr John Forrester, and Dr McDonald. There were weekly meetings of these medical advisers and monthly reports prepared to detail their activities. On the decision to refer any particular matter to a Minister, it was reviewed from previous evidence that there were no specific criteria, rather it was a matter of “judgement” at the time.

It was considered key to the maters at hand to understand the relationship between Westminster and Edinburgh. Basically, the main decisions were taken by the Department for Health and Social Security (DHSS) while everything else was decided by the SHHD. Previous evidence had indicated the routes of liaison between officials which operated as and when considered necessary. It had already been established that there were strains in relationships within Scotland, primarily due to the character of Prof Cash.

A Scottish “Dear Doctor” letter from 1968, when the CMO was Dr Brotherton, related to the requirement of seeing “jaundice” as notifiable. There would later be clarification of Hepatitis A and Hepatitis B. The screening of blood was generally not considered necessary, but after an outbreak at a renal unit, the need for screening became increasingly an issue. A Dr Wallace from Glasgow (based at Law Hospital) referred to issues with plasma pools and Hepatitis risks “going back 30 years” including the war years. He felt that even if screening only reduced incidences by 25% it would still be worth it due to the seriousness of Hepatitis. (That’s interesting to note.) It was recognised how different Scottish Regional Transfusion Centres (RTCs) were using different methods of screening. By 1973 there was general screening of donations, but the method was not yet standardised. Dr Wallace continued to be active in this area, including his own work for more effective screening methods. By 1975, via the Maycock Group, there was a more intensive discussion on the subject happening in Scotland, including the particular activities of Prof Cash and the aforementioned Dr Wallace. The issue of the costs involved were strongly linked to the discussions due to the financial constraints at the time. (Was there ever a time when there were not financial constraints?)

By 1976 there were clear differences emerging between Dr Wallace and the SHHD. It was noted that the sole supplier of the preferred screening test was Abbott Laboratories. (Where has this branch of Big Pharma appeared before in the Inquiry? Oh yes, US tainted blood and also the financial link to David Owen.)

For context, from a screening test involving almost 100,000 donations, there were 36 examples of Hep B surface antigens. Dr Wallace raised the risk of litigation if the more sensitive test was not used. Without it, he suggested that 7 of the 36 infected donations would not have been picked up, and so making the Department liable. Meanwhile, the SHHD were referring to the need to bear in mind the increased cost for what they called a “marginal” benefit in the pursuit of “perfection”. Reference was made to the long experience of Dr Wallace on the subject, and his assertion that HCB was “only the tip of the iceberg”, inferring there were other pathogens to come. His assessment had been that annually 96 donations would not be picked up if the less sensitive (and cheaper) tests were applied. There were suggestions by some in the SHHD that Dr Wallace’s mentioning of legal risks was a form of blackmail to suit the aim of securing funding for his work. The assessment was that there was a stand off between finance and test sensitivity standpoints.

It is noteworthy how keenly interested the Chair seems to be about these historical matters. On occasions he entered into brief conversations with Counsel, giving insights into his thinking and what he views as significant.

During the remaining of the 1970s the debates continued, with some concerns being raised about how long it was taking for the Maycock Advisory Group reports to be published after drafting, which meant that some of the content was out-of-date by the time it got to readers. By 1981, there were still concerns being discussed about potential legal implications, clinical judgement, and available funding.