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

As a quick finishing-off note to the morning, it was noted how the lack of notification of HIV required a more voluntary process to meet the ends of public health.

The issue of death certificates was briefly reviewed. It is an opinion by the certifying doctor, with some guidelines to inform what is recorded. There have been cultural and interpersonal justifications for what is or is not recorded on a death certificate. For example, it was common not to record a suicide as a suicide “for obvious reasons” (like what?) Counsel mentioned the issues of people infected with viruses not having the actual reason listed, such as AIDS.

A recent document related to Covid-19 stated that public health stood at the crossroads of politics and science. In relation to disease control and risk, it is a political decision about when to impose restrictions or not. (So, for contaminated blood someone had to decide to treat with a certain product, to decide to not inform of there being a risk, to test without consent, to not reveal test results, and so it goes on. It’s political.)

The Chair asked about the public health response to a disease spreading in a foreign country which could get to the UK. Various hypothetical responses were presented as part of a surveillance scenario including the need to look out for reported cases and the application of preparatory exercises to try to plan responses before they happen in reality. The discussion could not avoid landing squarely in the realm of the recent Covid-19 situation as a reference point for EG members. It again seemed to rely heavily on political decision-making since it was never just a matter of a scientific exercise with an obvious single right answer.

This led to a topical move to the issues around the “Precautionary Principle”. It emerged in the 1970s as a response to environmental concerns. Put very (too) simply, it is about avoiding harm even if the evidence is only indicative or theoretical, rather than robust. The impact of the risk happening (“a catastrophic risk”) justifies being pre-emptively cautious against potentially harmful action. For contaminated blood, it would have included reverting to cryoprecipitate until a safe factor treatment was ready (as opposed to them being rushed out to initiate the flow of profits). There is also the issue of communicating the risk to patients. Counsel was able to distil the topic down to a simple common sense approach (“it’s not rocket science”) involving talking to people and being honest.

The concept of the precautionary principle was not strongly attached to blood policy in the era of HIV/AIDS in the early 1980s, but soon became a policy imperative. It became a matter of “safety first”, but it hadn’t started out that way. There was a small divergence on the matter of risk involving two examples; eating bacon and driving cars. At what point does the risk of getting cancer from eating bacon justify banning bacon. Involving the public at least allows people to make their own decisions about risk, as they do with alcohol, tobacco, and most foodstuffs. So, who decides where the participation trigger line is, and who decides everything else before that is reached? It’s political.

The discussion was pulled back to infected blood by a reminder of the risks from blood borne viruses being known since the 1940s, and as a specific issue being included in Government documents in the early 1950s. One member was concerned about the wisdom of assuming that having a public consultation on any particular health risk would result in the best outcome. (This may be true in some contexts, but it was said like a true senior civil servant.)

There was a spontaneous collective shift to the different ways science disciplines see evidence. A case in point was the intervention of one panel member who went down the route of saying how there are hundreds of viruses, and it may not be until some time in the future that any one of these will turn out to be deleterious to health. There seems to be a too nice assumption that nobody in a medical or public service role would ever do anything wrong, so it was simply a case of “they did their best given the scientific knowledge at the time” (yeah, right).

The next topic was about a strategically placed “systems steward” in the context of devolved nations. The discussion started with reference to the EG report, but after an intervention from the Chair, the conversation wandered off to became all about how to do government, how to get an idea funded by the Treasury, how a policy is initiated or changed, and more “interesting” sub-sub-topics for geeky aficionados of administration. For those without a life it involved the ROAMEF cycle and the Treasury Green Book, however the requested explanation of these did not explain them (to the understanding of this writer, at least). There was an admission that the hardest part of Government to standardise and set up within a framework was that of policy development. It was illustrated by the next explanation which sought to distinguish between the “system” of doing policy and the “process” of doing policy. (The afternoon break could not come soon enough.) Then it was mentioned that the majority of legislation is never actually implemented, and even less is subject to scrutiny. It was amazing (ok, not amazing, but mildly noteworthy) that more and more these “revelations” demonstrate how ineffective the UK version of democracy is (oh yeah, the Mother of Parliaments).