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An NHS funded national audit relating to two blood transfusion protocols demonstrated a considerable variation in the performance of standard blood transfusion procedures, and described the level of shortfall in practice as "alarming".

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A survey of 98% of NHS Trusts in England found that 27% of Trusts were not using tranexamic acid for trauma patients, and 30% were not using tranexamic acid for surgical patients.

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Dr Elizabeth Mayne stated she did not put HIV on the death certificate: "This question highlights a very difficult and thorny problem which affected all doctors in managing HIV deaths."

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Sir Donald Acheson gave evidence to to the Social Services Committee of the House of Commons. He referred to an arrangement whereby cause of death can be added in a
confidential way to a death certificate.

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Dr Peter Jones confirmed that each individual death involving HIV/AIDS was referred to the Coroner's Officer.

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Guy Dewdney explained how the delays caused by inquests was upsetting. His father died as a result of being given contaminated blood. There was a delay in the burial due to the coronial process.

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Sarah Gough recorded that when her father died of AIDS, they were visited by the coroner's officer that day: "because there was concern about what to put on my father's death certificate."

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A witness described how she was told by a doctor that "it was in my best interest not to record" her husband's HIV status on his death certificate.

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A witness described how Dr Christopher Ludlam took her mother aside when their father died and "explained that he wasn't going to put HIV as the cause of death on my father's death certificate. Dr [Ludlam] said that in his opinion my father would not have wanted it listed as the cause of his death. Instead...I think it states he had a brain haemorrhage."

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A woman was advised to have bronchopneumonia recorded on her husband's death certificate: "The Doctor advised me that this was the best course of action as if AIDS was on the certificate we wouldn't find anyone to bury him and that a cremation would be our only option (which is not what my husband wanted)."

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One woman promised her husband, infected with HIV and Hepatitis C from blood products, "that if he died the word 'HIV' would not be on his death certificate" because he was "extremely worried about people finding out that he had HIV."

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One woman stated that: "There was an inquest into [my husband's] death, which I did not want to be a part of because I couldn't face going through it all so soon after his death and I worried about the press finding out his HIV status."

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One woman described her father's death certificate recording heart failure as the cause of death because "This was at a time when no-one put HIV/AIDS or any related illnesses on death certificates if at all possible for sensitive reasons..."

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A woman stated that when she got home from the Inquest into her husband's death: "there were people from the press surrounding my house. I locked my door and wouldn't answer any questions but they continued to bang on my door and the back wall of the house."

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Mary Grindley said after her husband John's death: "I don't think John would have been too worried about what they wrote but my first thought was for my son. I told them I didn't want HIV or AIDS on the death certificate".

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Deborah James whose brother's death was recorded as solely due to Hodgkin's disease, stated: "Upon Glyn's passing medical staff told my Mother and Father that if they consented to the cause of death being Hodgkin's and not hepatitis C (HCV) then the family could avoid a post mortem."

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One person whose father was infected with Hepatitis C and HIV stated: "We made sure when my father died that his death certificate did not mention HIV or hepatitis C. It just says liver failure and states the symptoms of death rather than the cause to stave off any stigma attached to the hepatitis C infection."

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For Steve Dymond's widow, Su Gorman, it was a matter of considerable importance that the coroner recorded the medical cause of Steve's death as "1c Hepatitis C Infection Acquired from a contaminated blood product" on the record of the inquest.

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The coroner explored the circumstances of Steve Dymond's death and reached a conclusion that: "As a result of the infection with hepatitis C he suffered a variety of mental and physical symptoms which impacted on his university education, his career, his marriage and his ability to have children."

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One person noted of their father that: "The cause of his death was recorded as pneumocystis pneumonia. I am angry that this was recorded on his death certificate, and that there was no reference to HIV or contaminated blood products. At the time, the doctors suggested they were protecting me by not recording HIV, when I think they were protecting themselves."

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