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Dr Jack Gillion, in his oral evidence to the Inquiry, noted that there was "virtually nothing" in the way of guidelines about the use of transfusion in the early 1980s.

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Dr Morris McClelland confirmed in his oral evidence that in Northern Ireland there was an Advisory Committee on Blood Safety

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The onus was on individual clinicians to keep themselves up to to date with the latest medical knowledge; this was characterised by Professor Philip Steer as a "reactive rather than proactive arrangement"

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In his oral evidence, Dr Wallis talked about how clinicians tended to read material relevant to their own area of medicine

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Dr Wallis told the Inquiry that all haematologists read the British Journal of Haematology, but only some would read Transfusion Medicine. His impression was that regional colleagues "were pretty good on picking up on guidelines that were published."

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In his oral evidence, Dr Wallis highlighted that the time when the clinician first developed a practice around the use of blood which became routine for them was an important factor in whether or not unnecessary use of blood was a feature of their clinical practice.

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In his oral evidence, Dr Wallis stated how surgeons were competitive and would be worried if they had excessive blood use compared to a colleague and so the use of feedback figures was an effective strategy for reducing blood use.

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In his oral evidence, Professor Melville stated that medical staff are required by the GMC to undergo annual appraisal which is linked to revalidation.

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Despite the fact that transfused blood in all parts of the UK is considered to be safe, witnesses had concerns about whether compliance with best practice standards could be better, and believe that it should be

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In his oral evidence to the Inquiry Professor Mark Bellamy stated that with regard to transfusion of red cells in his own area of clinical practice, it was "better not to transfuse to 'normal' blood count values but to adopt a lower target, a restrictive transfusion threshold".

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In his oral evidence to the Inquiry Professor Mark Bellamy stated that although there was a small working group of clinicians and SHOT staff, SHOT's steering group was drawn from a wide range of individuals from the Royal Colleges and professional bodies and it was independent of government.

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The annual reports of SHOT contained recommendations for transfusion safety.

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Professor Bellamy, the present SHOT Steering Group chair, described the extent to which recommended measures are implemented as well as the response rates to the surveys as "variable".

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In his oral evidence, Professor Neuberger stated that SHOT's recommendations were accepted and implemented for additional testing for Hepatitis B infections.

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Professor Bellamy in his oral evidence stated that he thought that mandating Trusts to have a designated person in place to report haemovigilance matters might be possible but that If such a post were not mandated, he feared that what would then be an optional position could be an early victim of cuts.

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Professor James Neuberger was "very much in favour" of legally mandating reporting, and said that having someone statutorily responsible would be a "very useful start."

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Dr Cave was concerned to encourage a system-wide culture for reporting events, and feared that having a single person appointed as responsible might take away from a sense of collective responsibility. Making reporting as easy as possible seemed to her to be a critical factor in making an impact

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The 1963 edition of "Notes on Transfusion" reiterated the statement that a transfusion should never be given without a definite indication, adding that this was in "the patient's interests" and due to unlimited blood supplies and an ever-growing demand for blood it must not be used unnecessarily.

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The 1963 edition of "Notes on Transfusion" highlighted that the use of blood transfusion to correct "moderate or slight degrees of anaemia" was "unjustifiable" where there were slower but safer methods available.

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The Advisory Committee on the Safety of Blood, Tissues and Organs' planned to set up a working group to agree principles for future lookback investigations.

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