24 January 2023: Closing Statements, Charlie Cory-Wright (NHS Blood and Transplant) - A

Charlie Cory-Wright KC acts for NHS Blood and Transplant (NHSBT). He has been a regular character attending the Inquiry in person, regularly and freely engaging with core participants and their representatives across the spectrum of interests.

 

The opening remarks outlined the format of the closing statement. Then it was time to thank the Inquiry team members for the way they have supported everyone, in particular, those of the infected and affected community. Mr Cory-Wright referred back to his opening statement, as delivered at the beginning of the Inquiry, which signalled the intent of those who he represents to support the Inquiry in achieving its objectives, including the potential to uncover truths which are uncomfortable to hear. There was also a note of agreement with others’ comments about recognising the difficulties people have faced. He specifically apologised for any detrimental role his clients may have played in these matters.

 

The six principles introduced by Mr Snowden were accepted as being in line with the NHS Blood and Transplant ethos. A special note was made which recognised the infected and affected who have allowed their experiences to be made public, despite the traumas it might have caused. It was necessary to raise these issues for the Inquiry to do its work. The previous position of his clients was to avoid highlighting individual cases, but that position has changed. Certain families and individuals were named as exemplary representatives of the life challenges and tragedies the collective of people have faced. The role of groups and campaigners was mentioned as being key to the achievement of the Inquiry. The whole process has produced a “collective endeavour” with a “generosity of spirit” to cooperate in the common task of getting to the truth and learning how to ensure such things never happen again.

 

The scrutiny of past events has rightly started with the experiences of those most impacted, but there may be other lenses through which to see the matters, he said. Most importantly, though, is the acknowledgement of the damage caused to people. NHSBT apologised unreservedly for anything its past bodies did which caused harm. It was mentioned that these are events from 50 to 30 years ago. This writer would contest that the historical emphasis is not the full picture by far. The original events may have happened then, but many of the actions of the State and its collaborators since then have compounded the harms considerably.

 

Mr Cory-Wright gave some time to recognising the social and scientific changes which have occurred since those former times when the matters of interest to the Inquiry initially happened. Even the manner in which people interacted were said to be considerably different, including how people communicate. For example, giving people a month to pay a bill which was sent by post, or respond to an enquiry was the norm. Whereas nowadays there is the potential for almost immediate responses. He did not want to over-emphasise these factors, but they ought to be considered, he said.

 

The cultural differences between then and now were illustrated by the difference in how ready people were to then to refer to matters of sex, and how different they are now. People just did not discuss sex-related matters nearly so openly as they currently. Attitudes about homosexuality forced people to avoid, deny, or attack those seen to be straying from the social norms. Prejudices were common and some topics were not for conversation among people in their normal engagements. This writer wondered where this line of argument was leading to, an explanation or an excuse.

 

The written submission details some of the relevant changes to thinking and practice over the decades by NHSBT and its previous forms. These were recommended for review by those interested in this aspect of operational arrangements.

 

A trigger warning was given about the comments to follow, since they were not meant to be a criticism of peoples’ evidence. The first such matter was the problems of “people being able to remember” (or not remember) the detail of incidents from decades ago. This issue was mentioned in the interests of fairness and the possibility of situations being recalled wrongly, while not suggesting that these were made in bad faith, he said. The second potentially triggering issue was that of “hindsight”. The right answer may be obvious in hindsight, but not at all obvious at the time when there were different attitudes, practices, norms, resources, knowledge, and the like, it was asserted.

 

On the written submissions, Mr Cory-Wright briefly reviewed the structure of the response for the benefit of those who had not read them.

 

The next major topic was that of certain historical facts and issues. The central role of the blood services is to provide blood and products from voluntary donors and to do it safely and efficiently. Rather than apologise for everything in the final submission, only one or two matters were mentioned in the closing statement. The first apology to be given an airing was for the continuation of collecting blood from prisoners and other risky settings.

 

The structure of the services began in a non-centralised way, rather there was a regional model. There were advantages to this, but also disadvantages, such as the lack of a hub to take a overview and share good practice and standards. There was also the fact that blood services did not have control over clinicians.

 

On the matter of donors, people coming to give blood was core to the successful operation of services. Concerns over blood supplies derived from a volunteer pool was always an issue. Occasional blood shortages were a common management issue. Mr Cory-Wright referred to several documents which illustrated the problems and the attempted solutions to addressing shortage issues. These included media campaigns, recruitment drives, postponing certain non-urgent surgery, and more. A side note was included about the fears among some people that efforts to grow the volunteer blood donor pool was mostly an attempt to commodify freely-given blood and turn it into a profitable opportunity, for example on the matter of “blood-handling fees”. This was stressed to be not the case. There had also been concerns related to the AIDS risks which was gradually being connected to blood and its uses. It was recognised that a dilemma existed on the potential for drops in donations due to perceived links with viruses, thus affecting “donor goodwill”, as opposed to the dangers to patients either of getting a virus from blood and so becoming less well, or of the inherent dangers of people not having access to blood and blood products when there could be life threatening incidents. These matters were not being highlighted as a way of diminishing the duty on blood services to provide adequate and safe supplies.

 

The issue of testing was the next sub-topic. Mr Cory-Wright recalled the various factors involved in introducing tests, with some of these appearing to be at odds with meeting patient needs and demands. There is a set of criteria which informs the decision to introduce a test. Some of these are judgements based on expertise rather than simple yes/no dichotomies. There are “positive predicted values” and “negative predictive values”. These can be affected by the unique features of any virus, such as how it is transmitted and the impacts of being infected. Decisions on introducing new tests were presented as complex due to the various steps involved and the factors. The final written submission was recommended as a more detailed source of information on this issue.

 

Specifically with regard to HCV testing, the NHSBT did not row back from its position that the blood services should have testing sooner, and an apology was extended to Dr Lloyd for the criticism which had been directed at him.