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Professor Dame Marcela Contreras described that the arrangements for the North London Blood Transfusion Centre to provide blood stopped, principally as a result of the introduction of the Consumer Protection Act 1987.

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Dr Contreras described that she provided same day whole blood because the alternatives were of greater risk.

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A witness described that she was not told of any risks of infection from the transfusions she received in 1985. In 1993 she was told that an unidentified virus was present in her blood. It was not until 2009 that her infection with Hepatitis C was identified.

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Dr Colin Hilton described the use of fresh warm blood as a "last resort... life saving measure." After using fresh warm blood once, he has since acknowledged in restrospect that this was "unwise".

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John Napier described that the preface to Dr Tony Napier's 1987 book on blood transfusion noted that "The recent and quite unexpected appearance of AIDS ... must serve to displace any feelings of complacency about the safety of transfusion that may have arisen".

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Dr Roger Moore described the change in attitudes towards blood transfusions following the advent of AIDS.

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Dr Roger Moore described the process of, and attitudes towards giving a 'top up' of a unit or two of blood to aid recovery.

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There was a move towards undertaking audits at individual hospitals and on a national scale. Audits were also undertaken at RTCs.

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Dr Angela Robinson described that in the 1990s if a regional health authority was not prepared to fund a recommendation made by SACTTI "it was then difficult to implement it".

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Dr Robinson emphasised that the blood service has always recognised that it has a role in advising and educating clinicians as to the risks of blood and blood products and as to appropriate use of blood and good transfusion practice. Blood components should only be used when strictly necessary and in the absence of alternatives.

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Dr George Galea described that he recalls teaching medical students about the risks of transfusions and that "the safest blood is the blood that's not given." He told students not to "go overboard" with using blood.

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The implementation of maximum surgical blood ordering schedules at the Aberdeen Royal Infirmary led to a reduction in the number of unnecessary whole blood transfusions as well as to a reduction in the number of transfusions per operation, which reduced the risk of adverse events associated with blood transfusions.

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Patients with leukaemia, lymphoma or multiple myeloma often required a significant number of transfusions, and often would not have survived without them.

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Patients with leukaemia were often transfused with whole blood or red cell concentrates, and platelet concentrates were given to control bleeding associated with thrombocytopenia or because platelet levels had dropped.

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The transfusion threshold fell over the years, as patients with lymphoma required fewer red cells and platelet transfusions. However, treatment with aggressive chemotherapy still involved transfusion, and patients with myeloma frequently required red cells but rarely platelets.

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In his written evidence to the Inquiry, Professor Goldstone noted that there had been an increasing tendency over the past 30 years to think twice about the administration of any blood product on grounds of risk.

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There were no digital versions of national transfusion guidance initially, and the British Committee for Standards in Haematology guidelines on platelets were rarely read by clinicians.

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In Wales, it was common amongst orthopaedic surgeons at the Morriston Hospital to transfuse two to three units when performing total knee replacements.

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Dr Thomas became a key proponent of the red cell salvage technique, which led to transfusions in total knee replacement surgery decreasing from 82% to 27% and then to 7%.

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A hospital transfusion practitioner at the Morriston Hospital devised a transfusion record chart to aid record keeping and enhancing traceability of transfused components. This was subsequently used across Wales.

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