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Dr Metters wrote to Dr Gunson, suggesting that the next ACVSB meeting should be brought forward and solely devoted to the question of whether routine anti-HCV screening of blood donations should commence, as "events are now moving fast."

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Peter Savage wrote to inform Dr Gunson that Ortho was shortly to commence clinical trials of a second-generation ELISA test, with improved sensitivity and specificity, and a second-generation RIBA test incorporating additional antigen bands.

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Dr Follett in Glasgow produced a full report of the Ortho and Abbott test kit trial.

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Dr Wagstaff wrote to Dr Gunson discussing the earliest date anti-HCV screening could commence.

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Dr Lloyd wrote to colleagues saying that Dr Gunson was looking for all red blood cells available for issue to be Hepatitis C negative by 30 June 1991, which would mean starting testing some weeks in advance.

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A letter from Dr Contreras to Dr Gunson expressed reluctance to start screening due to financial issues.

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Mr Macleod of the NHS Procurement Directorate wrote to Dr Gunson that the Department of Health had agreed that "there should be a 'second-round' comparative evaluation of Hepatitis C kits at the Newcastle, North London and Glasgow Regional Transfusion Centres with confirmatory testing to be carried out at the University College and Middlesex Hospital School of Medicine", to be completed by the end of April 1991.

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Professor Cash wrote to Dr Gunson that the recent development (ie the additional pilot stage) leading to a start date in September 1991, "has the SNBTS Directors' fullest support."

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The NBTS National Management Committee meeting noted that the ACTTD had received conflicting advice on the range of available confirmatory tests available. Dr Gunson offered to prepare a policy paper for the Committee after the next meeting of the ACVSB, by which time the evaluation of second-generation tests might have been completed.

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Dr Arthur Codd, consultant virologist at the PHLS in Newcastle stated "I understand that you will soon be screening blood donors for hepatitis C in advance of other transfusion centres" and inquired as to his proposed start date.

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The finalised version of a draft circular on changes to blood handling charges circulated to recipients in the Department of Health referred to a likely date of 1 September 1991 to commence HCV screening rather than the 1 July date which had previously been communicated.

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Dr Gunson wrote to Dr Contreras, stating that it was difficult to go against the advice of the virologists who were advising PCR as a confirmatory test, but now that they were having doubts, it was right that these were challenged and sensible conclusions arrived at.

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Dr Contreras wrote to Dr Lloyd stating that "a national approach might well have prompted the Department of Health to provide appropriate funding for testing."

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Dr Mortimer sent Dr Rejman a copy of minutes from an ad hoc meeting at which virologists drew up recommendations to transfusion services for confirmatory HIV testing.

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Dr Gunson wrote to all RTC directors reaffirming the 1 September 1991 start date but announcing that Dr Lloyd's "premature introduction of the test" could be used to extend the evaluation trial.

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Dr Lloyd responded to a "very colourful" letter from Professor Cash, stating his personal belief that starting HCV testing to the original schedule was the correct decision "even if it appears unpalatable to some".

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Mr Canavan wrote to Mike Malone-Lee: "As for HCV testing, I don't think anyone was under any illusions but that it was marginal in terms of cost benefit. But this is true of other NHS interventions. However the litigation factor, the introduction of testing elsewhere in Europe and the prospect of EC harmonisation of licensing requirements for blood products stacked up in favour of testing."

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Dr Mortimer suggested a confirmatory testing pilot during September and October 1991, which was accepted by the RTC directors.

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A draft letter from Dr Mortimer to all RTC directors in England and Wales identified the problems with confirmatory procedures to follow routine anti-HCV screening.

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Dr Gunson wrote to Dr Mortimer asking that Dr Mortimer consider several requests concerning anti-HCV testing.

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