John Horam
WS Questions - JE
2.16 - Did he ever ask what the basis was for the advice that there was “no fault nor negligence”?
Did it cross his mind that fault may lay beyond the “NHS” as framed in the line, for example DH, CSM, etc.
2.23 - 2.25 - Does this read to him as officials essentially resisting the wishes and decisions of the minister?
Should the departments “line” not be subject to change by Ministers responsible for said department?
Non-WS & Additional
What was his understanding of / involvement with (if any) UKHCDO?
“That was a long time ago—before blood products began to be heat-treated in 1985 to destroy viruses.”
Was he aware that some blood products, eg Albumin, were heat treated decades before this date?
Was he aware that some Factor VIII was heat treated in the late 1970s?
Would he accept given the above that this statement to the house was inaccurate?
“The people we are discussing today therefore received the best treatment available at the time.”
Is it correct that the basis upon which this statement is made, in relation to haemophiliacs, is that a) heat treatment didn’t exist until 1985 and b) HCV testing was introduced until 1991?
Did he think it was appropriate to make a blanket statement that thousands of individuals, infected at different times, even in different decades, by different products, given by different hospitals/doctors in different circumstances, were given the “the best treatment”? How could that be said?
“It has been suggested in this debate that there have been more than 50 deaths of haemophiliacs from liver disease so far. We have no reason to dispute that figure.”
Was he concerned that DH seemed to have no real grip on the actual figures?
Why was DH reliant on not contesting figures from MP’s as opposed to having their own substantiated figures? (They cannot rely on lookback as this didn’t include haemophiliacs).
“Some 50 per cent. of sufferers may progress to chronic hepatitis with varying degrees of good and ill health. Some 20 per cent. of infected patients may develop cirrhosis, a progressive destruction of the liver, which may take 20 to 30 years. Fortunately, the majority of those years will be trouble-free in terms of health.”
Wasn’t this painting a rather rosy (false) picture of reality? The reality being that, without treatment, progressive liver disease ultimately results in liver damage, failure, cancer, death.
“First, we do not accept—I disagree with my hon. Friend on this—that the NHS has been negligent.”...”there can be no question but that they received the best treatment available at the time.”
In the absence of any formal inquiry or investigations having taken place, on what basis could this be said?
“That treatment was essential for their survival. There was no alternative.”
On what basis could he say there was “no alternative”? Presumably he was talking about Factor concentrates?
By essential for survival, essentially he was saying that for every person with haemophilia, for every Factor concentrate treatment given, the only alternative was death?
Given all of the above, would he accept that much of the information provided to the house on this occasion was, at best, unknown, potentially misleading or at worst, simply untrue?
“It is important to remember that it is not always possible at the time treatment is given to fully appreciate the risk or to avoid suspected or known risks. In the case of each individual patient, a balance must be struck between the benefit to be gained versus any possible risk.”
So in his view, would he still agree now that:
Patients must be seen as individuals?
It is important to consider the risks and benefits or any treatment given?
That risk/benefit analysis should involve the patient on each occasion?
Did he have any basis on which to know that this had happened for all haemophiliacs infected with HCV?
“as a result of factor 8 concentrate and drugs—the life expectancy was very close to that of normal males.”
Would his views on the situation have changed had he known that the change in life expectancy was actually mostly down to the introduction of Cryo and not concentrate?
“All those benefits have come about as a result of the blood products which, simultaneously, have been the cause of the infection.”
Would he agree, in hindsight or otherwise, that those perceived advantages were relatively minor in comparison to the disadvantages which include , for example, dying from AIDS or liver failure?
Can he appreciate how talking up “benefits” such as keeping a product in a fridge, rather than a freezer, were offensive to people and their families who were dying… and the justification was that they could store something in a fridge?
“A figure of a total of 50 deaths from hepatitis C in patients with haemophilia has been suggested, and has been cited in the early-day motion to which I have referred.”
Again we see a rather flimsy reference to the numbers, does this again show DH didn’t really know the numbers? Wasn’t this a concern?
“it is important to keep a sense of proportion. I understand from the United Kingdom Haemophilia Directors that, of 126 haemophilia patients known to have died in 1993, 12 showed the cause of death as liver disease, of which hepatitis C may have been the cause. That is less than 10 per cent.”
Was that number really of any comfort at all given that at least 88 of the remaining 114 died from HIV/ADS and most would also have been infected with Hep C? [Source for 88: http://hansard.millbanksystems.com/written_answers/2003/dec/19/haemophilia#S6CV0416P2_20031219_CWA_1028]
