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There was a ministerial commitment "to investigate allegations of problems of access to alpha interferon."

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A paper on Hepatitis C was prepared for a meeting of the NHS Executive stated: "The cost of treatment with alpha interferon (£2-5,000/patient) is already placing a considerable burden on purchasers and the pressure to prescribe Alpha Interferon widely is growing."

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The NHS Executive Board agreed that measures needed to be taken in the interests of public health, but reached no conclusion as to guidance or what should be funded.

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The paper on Hepatitis C discussed at a meeting of the NHS Executive Board on 13/14 June was provided to the CMO.

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The CMO and colleagues from the Department of Health had a meeting. The NHS Executive Board had not yet come to a firm view on funding of interferon treatment, and a cautious approach was necessary.

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There was an internal meeting at the Department of Health to discuss Hepatitis C and Alpha Interferon. There was thought to be "a strong case, on public health grounds, for at least developing clinical guidelines on the management of HCV, including the use of Alpha Interferon."

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Officials made the decision not to recommend issuing purchasing guidelines due to the likelihood the issue would have on health authorities.

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A final submission was sent to the office of the Parliamentary Under-Secretary of State for Health, John Horam, highlighting the increased expectations of Hepatitis C treatment, particularly for those infected through receiving blood transfusions and blood products, following the lookback exercise.

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It was recommended that the Department of Health did not issue any purchasing guidance as it may be read as giving "an implicit signal to purchasers about the priority to be attached to a particular condition or treatment" which purchasers would not welcome.

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The annex to a submission regarding Hepatitis C noted: "Ministers have given commitments to help, including investigating alleged problems of access to Alpha Interferon for [haemophiliacs]. So far the few cases identified have been readily resolved."

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John Horam noted that providing different treatment to people depending on how they were infected with Hepatitis C would be controversial.

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The Secretary of State suggested that "GPs should have a greater role in identifying, diagnosing, treating and referring HCV as appropriate, and that GP involvement should be secured..."

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Professor Sir Kenneth Calman noted that "The direction of policy seems then to have been set and did not change throughout 1997, including after the General Election of May 1997 and subsequent change of government."

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Professor Sir Kenneth Calman noted that the issues surrounding inability to access interferon treatment for Hepatitis C "were common across the NHS when new drugs or treatments emerged."

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Professor Sir Kenneth Calman stated: "The decision in early 1998 to provide central funds to make recombinant products more widely available was driven...by the understandable fear felt by haemophilia patients and their carers in the face of the unknown but theoretical risk of vCJD and against a background of infection with blood borne viruses."

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A policy submission was sent to the offices of the CMO and the Ministers of State, Tessa Jowell and Baroness Margaret Jay. It noted that some health authorities were refusing to fund alpha interferon due to its cost and belief it was of limited clinical effectiveness.

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The position of the Department of Health remained "Funding for treatment is a matter for the local health authority."

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Dr Rejman noted that "it appears that the Department of Health was encouraging the use of Interferon, where it was appropriate, but accepting that the final decision rested with the purchasers."

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Dr Rejman stated the current recombinant products contain albumin from human plasma. Manufacturers could not therefore claim it was safer from a viral point of view than plasma derived factor VIII.

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A working party of the Royal College of Physicians of Edinburgh produced a report on Hepatitis C and noted that there was no general agreement as to who should meet the drugs costs, general practitioner or hospital.

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