3 October 2022: Expert Group on Public Health and Administration - B

The second morning session began to concentrate on how civil servants are held to account. Members of the public cannot raise concerns directly with the Civil Service Commission. They may be more likely to use the Ombudsman’s route. The Commission is more internal-looking. Civil servants may be asked to do something which goes against their own values, or clearly breaks the relevant Code. In these cases, the civil servant can report the issue to a senior colleague, and if it is seen that nothing needs to be done, then they have to decide whether they want to remain in post or not. Civil servants have a key role in making sure Ministers do not break any Code, particularly senior officials. It is about “Speaking truth unto power”.

Counsel then shifted to a scenario where a Minister discovers that a predecessor had broken a Code (for example, by misleading Parliament). Then they should and likely will want to highlight that. If a civil servant discovers an error, for example in a line to take, then they should highlight that and work to correct it publicly. That might involve a statement to Parliament. It does not involve going back to change historical documents, but in recognising the error (deliberate or not) and making sure it is not perpetuated.

Lord Bichard noted that these Codes are being applied to human beings. The use of Codes should be acknowledged as including that element since they relate to relationships of trust and the like.

The next major document-based topic was the definition of “public health” (a 1988 report authored by Donald Aitchison). Public health was noted to be far wider than just about clean environments and epidemic disease control. It is also not just the concern of the Department of Health and Social Security (DHSS), as was. Public health covers all aspects of wellbeing and should be a concern for the media, voluntary sector, and industry.

Focus was then given to one of the more traditional roles for public health, that of control of communicable diseases. At the time the system was noted to be complicated and “baffling”. There had been a “dangerous decline” in disease control by the time, according to the report. It was noted how public health as related to disease control was historically a local issue. In 1974 there was an enormous reorganisation (a “big bang”). Health Authorities oversaw the establishment of a “proper officer” within local authorities, but the roles were still not too clear. The creation of the internal market fragmented the NHS by the creation of Trusts. Disease control was not clearly designated as a role, as were many other aspects which were falling between the cracks. Fragmentation and reorganisation of the NHS since the early 1980s has been a very disruptive reality ever since. Huge changes in the workforce, preoccupation with making savings, commissioning arrangements, non-clinical managers, and many other shifts have compounded the problems. Issues such as disease control were seen as not directly affecting the clinical outcomes of patients, so fundholders were reluctant to spend money on them. There needed to be a coordinated approach at local regional and national levels. There was also perhaps a sense of complacency due to the apparent successes of vaccinations. TB sanatoriums were no longer needed, rather the shift was towards lifestyle health impacts.

The report recognised how there would be new infections to be dealt with, especially in an increasingly global context. Surveillance is a critical part of disease control. Prior to the NHS there had been calls for an epidemiological service, but it was never taken up. There were pressures not just due to budgets, but there were competing tensions from other medical fields. One expert thought that if epidemiology had been highlighted earlier, the whole Inquiry would not have been necessary because the surveillance system would have picked up the problems. (With all due respect to the expertise on display, this writer begs to differ due to the other aspects of the Contaminated Blood “Scamdal”. It was surely not just a matter of an unfortunate failure to see the problem coming.)

Other quotes from the report under consideration (written by the person responsible for the service he is criticising) seems like a call for closing the door before any more horses bolted. It seemed to be calling for a national, centralised response (which would eventually be set up), yet at least one EG member continued to decry the loss of local capacity which resulted. Of special interest is the apparently lone voice of Dr Galbraith to address issues of infection and his calls coming out contemporaneously to the timing of the discussions arising from the report. However, by 2012 the political will was to decide to stand back rather than be interventionist. The current system (2022) was criticised as being opaque and undemocratic, yet its former sense of being world-leading is still pretended. For example, the drive to save by merging bodies does not account for the loss of expertise or the resulting confusion over where responsibilities lie when there are less people to take responsibility and less specialists to cover the different areas of concern.

This writer notes how interesting this evidence would be to those of a particular public administration bent, but there has still been no mention of cover-up or how the structures were not fit for purpose (perhaps by design, but that has not been said either).

One speaker seems to be a cheer-leader for Norman Galbraith. Without the resources required, it seemed he and his small team carried out the role of the national body which the Government had not felt able to fund yet were happy to let happen for free via the good doctor. Articles reminding those who should have been listening were being published in the worthy periodicals, but it would take a couple of epidemic-style diseases to get someone to put our money where their wallets were and set up a belated response.

On “notifiable diseases” (The Disease Notification System”). There are 33 current notifiable diseases listed for the UK including HBV and HCV. But in the UK, unlike in other countries, HIV and the four major STDs are not notifiable which may be an issue of stigma and prudishness. So, to save the blushes of some parts of society it was deemed reasonable to let particular pathogens spread under the radar. The disgraceful Contaminated Blood situation might be correctly viewed as a global shame on governments, but the Inquiry is demonstrating how it has been a particularly British scandal.