10 November 2022: Roberts - B

Questions from core participants:

On the benefits of not receiving a blood transfusion but tranexamic acid instead; he said there was a long list of reasons to avoid blood transfusions and a subsequent witness was ideally placed to go over these.

On the concept of seeing tranexamic acid as a generic drug with a coating; he said in surgery it would not be given as a pill.

On the possibility of tranexamic acid not being used as a possible issue to raise under the duty of candour; he said he did not feel qualified to answer.

On why compliance with guidelines on using tranexamic acid is so low; he said it was because nobody had tried very hard to make it happen.

On what could be done to increase compliance; he said there were many things including awareness-raising, and particularly by closing the audit loop of reporting what was and was not done.

The Chair pursued the question of audit loop. The witness said the awareness-raising had to happen simultaneously. He saw the NHS as having the responsibility to set up systems. He suggested the trauma audit network as an example route for getting a loop working on the issue, which could then lead to league tables.

The witness said he wanted to say sorry to victims for what happened to them. He hoped there would be learning because it was so awful. He pointed out that the next pandemic virus could be blood borne and so the NHS really needs to improve clinical care when there is a crisis.

The Chair thanked the witness for his justified enthusiasm and the encouragement he gave.

In other contexts, the evidence of Prof Roberts could have been seen as a campaigning cry from the wilderness. A cheap and effective medical treatment which could make a major difference to the health outcomes for people who might otherwise be seen as requiring a blood transfusion, and one which could bring significant savings to healthcare providers, was being (deliberately) ignored for the very reasons that it was cheap and effective. The so-called conspiracy theorists (a derogatory label invented by US security agencies) will see stark parallels between tranexamic acid and another cheap medicine which was asserted by some as an effective option in Covid-19 treatment. That possibly repurposable drug was not just ignored but was mischaracterised and minimised by the vested interests who had profit-driven aims to turn a global crisis into a mega money cow. One of those interests even got a mention in the earlier evidence. Like the evidence from a few months ago about the UK-developed cleansing regimen that was not taken up by the NHS even though it would ensure metal surfaces in hospital theatres did not carry CJD and the like, the tranexamic acid uses to replace many blood transfusion uses, have also so far fallen on deaf ears.