27 January 2023: Closing Statements, Philip Aldworth KC (Northern Ireland health agencies)

Philip Aldworth KC (and Mark Robinson) represents the Northern Ireland Blood Transfusion, the Northern Ireland Department of Health, and the Belfast Health and Social Care Trust. His closing statement was on behalf of the Trust, while Mr Robinson will speak for the other two clients. This was a geographical area of the UK where far less documentary evidence was available to the Inquiry, and relatively few oral witnesses had come forward.

 

Mr Aldworth firstly gave a background to the organisational development during the period of interest to the Inquiry. The variety of legacy organisation is “convoluted”.  Specifically, the Belfast Haemophilia Centre was located in the Belfast City Hospital. Children were treated in the Royal Hospital for Sick Children. The submission and statement only deals with a limited number of topics, mainly for context and clarification.

 

With permission, Mr Aldworth addressed the infected and affected core participants as he quoted from the final submission by way of a formal apology. The light shone by the Inquiry makes uncomfortable reading. The Trust recognised the harm, hurt, and distress caused. It was with deep regret to see how this all had happened. The Trust adopts the assertion that without qualification these things should never have happened. Saying, “We are sorry”, may be long overdue but it is sincere, he said. He also said the Trust does not want to pre-empt the Inquiry findings (… here we go again).

 

As a reflection of the evidence given to the Inquiry, Mr Aldworth recognised the commitment of the Trust to fully engage with the Inquiry. In relation to the Rule 9 statements of former staff, it was highlighted how elderly some of these people now were, and that the timescale involved were so long ago that it proved challenging (… here we go again). Deficiencies in recall are “not due to lack of effort or want of trying”. In saying this, there has been no desire to achieve “forensic advantage”, he said. The problem of “hindsight” was noted, and the jigsaw analogy was extended to include not just the problem of missing pieces, but also of not having a picture to work from. This writer then heard the jigsaw analogy extension becoming a justification for past decisions due to incomplete scientific knowledge available to clinicians.

 

Mr Aldworth moved to the historical issues related to the Belfast Centre, which were mainly contextual. The state of knowledge related to risk firstly concerned Hepatitis B (HBV). This virus was not common in NI in the 1970s. During this decade there was some awareness of Non-A, Non-B Hepatitis (NANB-Hep) and how it could be transmitted by blood and products. Liver function tests highlighted abnormal results, but patients remained generally well. NANB-Hep was considered to be benign, and Belfast was not alone in this thinking, he asserted. The gradual realisation of the seriousness of what became Hepatitis C (HCV) was slower due to the less modern communication systems available at the time. Mr Aldworth stated that the lack of full understanding was a contributing factor to what happened. There was “genuine uncertainty” among clinicians (… so the Precautionary Principle didn’t apply?) Another factor was the “well-intentioned albeit misguided desire” to avoid patient distress in relation to uncertain risks. This may have indicated questions over past practice and “paternalism”.

 

On HIV-AIDS, reference was made to the US situation and the outputs from the UKHCDO and the UK Government at the time related to risk etc. The lack of evidence of risk statements were recalled, and “the immense benefits of therapy” assertion. There were efforts to protect children, based on issued guidance. Dr Mayne was name-checked (… where is she now?) The relatively high number of patients with inhibitors was a factor, as indicated by the amount of porcine factor products used. Proportionately fewer patients seroconverted to HIV (25% in NI compared to 59% across the UK). NI was able to be self-sufficient in cryoprecipitate production, but factor concentrates were not locally available. These had to be sourced externally, relying on the “goodwill” of England and Scotland. The demand also meant the need to obtain commercial products. Dr Mayne had tried to keep any particular patient to one product, but this became impossible to sustain. Among other consequences, there was a significant rise in the use of Scottish products on a pro-rata basis arising from NI derived blood which was fractionated at the PFC.

 

The issue of death certificates was seen as particularly resonant for NI. Avoiding listing HIV or AIDS on death certificates was standard. This was to help avoid scandal within communities due to the stigma at the time of HIV-AIDS, especially given the close-knit communities there. It was not done deliberately to conceal information.

 

In relation to patient records, efforts were expended to discover these, but there was the matter of destruction policies in place by the legacy organisations. It was specifically asserted by Mr Aldworth that there was no evidence of deliberate or wrongful destruction or altering of patient records.

 

The next topic was related to the current arrangements for patient care. There have been significant changes, particularly over the past 10 years. The Trust wanted to highlight what had already been improved before the Inquiry reported (… sounds like pre-empting). Mention was made of psychological support, with a commitment to sustain that beyond the Inquiry. There have also been efforts to “reach out” to patients, especially those who do not attend the Centre so frequently. A satellite clinic has been established. “Good communication” has been put at the centre of patient care, he said. Learning already recognised had arisen from the Inquiry which is about the key issue of seeing patient care as a partnership between the patient and the clinician, and he cited Nicola Leahey’s statement.

 

There then followed some concluding remarks from Mr Aldworth. They were mainly a commitment to continue to engage with the Inquiry after it ends through the application of its recommendations. This commitment was made to the Inquiry and to patients.

 

The Chair asked a single question for clarification from the final submission document where there may have been a word missing. He then commented on the matter of death certificates and how they did not mention viral infections, with this not being a case of deliberately hiding facts. The Chair said that that was exactly what was happening but wanted to be sure it was understood that the deliberate non-inclusion was not to cover up what clinicians may have done, but to protect people from any social consequences. It was something which shouldn’t have been done, but was done for a good reason. Mr Aldworth accepted this analysis.

 

The platform was then handed over to Mr Robinson in relation to the Blood Transfusion Service. He began with an apology, unreservedly, for its part in the terrible hurt and loss people experienced. He referred back to the 2018 opening statement which noted the tragedies and life-changing impacts due to contaminated blood. He spoke of the “burning agony of loss and suffering across many, many years”. He acknowledged the courage, fortitude, dignity and decorum of the infected and affected. The Inquiry had been welcomed as a way of discovering the truth about what happened. Mr Robinson mentioned the significant resources invested in responding to the requests made by the Inquiry. It remain their unambiguous aim to continue to assist in any way possible. It was asserted that the desire to fully engage was in part to demonstrate transparency and accountability.

 

Mr Robinson then gave a brief overview of the establishment and functions of the Blood Transfusion Service. He covered the basic blood collection and processing functions as well as the structural issues of management and accountability. He wanted to make it very clear that there were no nefarious links with the pharmaceutical companies. He also mentioned the current protocols for ensuring the safety of blood in NI. These include the bodies and processes which had been described by Mr Cory-Wright.

 

Reference was made to the key time period when these matters were happening as occurring in an era of considerable civil unrest in NI. These are seen as unique factors within this jurisdiction and as having some impact on what was happening in relation to the contaminated blood situation.

 

In his conclusion, Mr Robinson referred back to his client’s efforts to fully discharge its duties related to the Inquiry. He also reviewed the apologetic response of recognising “the unimaginable pain and suffering” people experienced.

 

The Chair sought clarity on the submissions related to “ensuring safety”. He gave a hypothetical scenario. The response was that the current systems would cope with the incident as suggested. Sir Brian homed in on the critical factor of the speed with which a response would emerge related to a potentially new viral threat, and he cleverly guided the conversation to the example of a response which would include discontinuing the use of a treatment which appeared to carry a risk. Mr Robinson summarised by saying that given the weight of evidence heard by the Inquiry, if there were a new transmissible virus risk, “there would be a very quick reaction”.

 

Mr Aldworth returned to the lectern. He had a short statement to read out on behalf of the Department of Health in Northern Ireland. It was given in the context of there being no functioning executive, including there being no Minister in place in the Department of Health. For these reasons it was considered inappropriate to include in its final submissions any conclusions the Chair should reach. The statement referred back to the opening of the Inquiry in 2018 where it was acknowledged there were tragedies and life-changing impacts arising from contaminated blood use. The Department is sorry that this suffering was caused. The infected and affected were recognised for their contributions to the Inquiry. He recalled the commitment of the Department to fully cooperate with the Inquiry and stated that they had done so. Financial parity was mentioned as a previous commitment. The description by former Minister Robin Swann of the contaminated blood situation being a “tragedy” was re-stated, as was his commitment to provide the support required. The Department is ready to respond to the Inquiry report.

 

Finally, Mr Aldworth returned to the infected and affected, expressing his client’s recognition of the dignity, resolve, and courage shown. They have been deeply moved by the evidence. He concluded by thanking the Inquiry team for their exemplary assistance and spirit of cooperation. It has been a model of good professional relations.

 

The Chair returned the thanks.