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A follow-up note of the sixth meeting of the Advisory Committee on the Virological Safety of Blood which Dr Robert Perry sent to Professor Cash additionally noted that Hepatitis C testing was in place in Finland and Australia.

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A submission was sent to Baroness Hooper recommending that Hepatitis C antibody screening should be introduced as a public health measure.

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The submission on the Hepatitis C antibody screening test stated that it was unlikely routine screening could be introduced before 1 April 1991. The Minister was asked to agree that it should be introduced and that preparations should be made to introduce it "as soon as practicable."

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In his evidence to the Penrose Inquiry, Dr Perry said he thought that the composition of the Advisory Committee on the Virological Safety of Blood was unduly biased to virology and that "the public health perspective was not as dominant...as it possibly could have been." His observation was that "the best became an enemy of the good" and that the search was for "perfect outcomes rather than good outcomes that could meet a public health need."

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Professor Cash's evidence to the Penrose Inquiry was that Dr Gunson had told him at this time that funding issues in England were the source of the delay and that "this was a device to give the Department of Health more time, more space, to resolve these very difficult financial problems that they had."

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Professor Cash told the Penrose Inquiry that he and Dr Gunson had fallen out badly over the postponement of routine screening for anti-HCV but they "fell in again" and he subsequently wrote a letter to Dr Gunson stating that the start date in September 1991 had the Scottish National Blood Transfusion Service directors' fullest support

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Professor Cash told the Penrose Inquiry that he very much regretted having been so tough on Dr Lloyd in regard to his unilaterally introducing anti-HCV testing.

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Professor Cash wrote to Dr Ludlam at the Royal Infirmary Edinburgh saying: "We (SNBTS) hope to have restricted access to the Chiron (NANB) testing kits and I write to enquire whether you would be prepared to let us have serum samples from your haemophilia patients?"

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Professor Cash wrote to Dr William Whitrow (Inverness), Dr Stan Urbaniak (Aberdeen) and Dr Ewa Brookes (Dundee) tasking them to let him know of any sera they had which might be of interest for Chiron testing.

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Professor Cash wrote to Dr McIntyre at the Scottish Home and Health Department asking him to confirm his agreement that discussions between senior Scottish National Blood Transfusion Service managers and Ortho Ltd regarding use of their anti-HCV test should not take place until instructions were received from the Scottish Home and Health Department.

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Highlights from the fifth meeting of the Advisory Committee on the Virological Safety of Blood recorded "Agreed not to introduce test in advance of FDA approval but very compelling reasons to implement quickly following U.S. decision."

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The UK commenced routine anti-HCV screening using Ortho, Abbott and UBI ELISA tests with confirmatory testing using RIBA II tests in reference laboratories.

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Dr McIntyre, who attended the Advisory Committee on the Virological Safety of Blood meeting as an observer on behalf of the Scottish Home and Health Department, stated with regard to the date of introduction of testing that "Some wanted to start forthwith but the Chairman suggested that 1 April 1991 might be more realistic."

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Dr Diana Walford, in a memo to John Harley, said when describing non-A non-B Hepatitis: "This form of hepatitis can be rapidly fatal (particularly when acquired by patients with pre-existing liver disease) or can lead to progressive liver damage".

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The Cambridge regional transfusion centre officially started anti-HCV testing on the nationally coordinated date of 1 September 1991.

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In his written statement to the Inquiry, Dr Boulton explained that "'litigation' should be viewed as a sort of surrogacy for 'responsible practices'", which would involve balancing the need to secure clinical supplies of donor blood with patient welfare and the minimisation of risk, even using an imperfect testing method.

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Dr Boulton's view at the time of providing his statement to the Inquiry was that the UK Blood Transfusion Service should have introduced HCV screening in 1990 and this should have been fully funded.

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Funding did not appear to have presented a challenge to the Scottish National Blood Transfusion Service in relation to starting the anti-HCV screening tests.

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The view of David McIntosh of the Scottish National Blood Transfusion Service in his evidence to this Inquiry was that: "misplaced desire for Anglo-Scottish solidarity was the clear cause of the unnecessary delays in the universal implementation of HCV testing in Scotland."

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In his written evidence to the Inquiry, Professor Allain stated that the start of anti-HCV screening should have been on 1 August 1991 to ensure that labile blood products were already tested at the official starting date.

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