'Institutional defensiveness' failed victims of infected blood for decades (2024)

Health secretary ElunedMorgan apologies for blood scandal

Eluned Morgan MS, Cabinet Secretary for Health & Social Care has issued a statament this afternoon in the aftermath of the report. It reads:

"The Infected Blood Inquiry was set up to investigate the scandal of infected blood, blood products and tissues which were supplied by the NHS in the 1970s and 1980s and used as part of NHS treatment across the UK during that time. Tragically, thousands of people were infected with Hepatitis C and HIV as a result. Many people have died; others have suffered a lifetime of ill health.

Sir Brian Langstaff, chair of the inquiry began taking evidence in 2019 and has today published his final report and recommendations into this tragedy. The Inquiry Report | Infected Blood Inquiry

This was the worst treatment scandal in the NHS. While it pre-dates devolution, as the Cabinet Secretary for Health and Social Care in Wales, I want to apologise to all those who were infected and have been affected by this terrible tragedy.

I want to place on record my thanks to Sir Brian for his time and compassion shown during the inquiry. I also want to express my admiration for the strength shown by all those who gave evidence about their personal experiences and their families, many of whom campaigned for a public inquiry to take place for decades.

It is right that their voices have been heard and I hope that survivors and their families feel assured that the inquiry has taken account of their evidence and provided answers to their questions and concerns.

The Welsh Government provided access to our records as part of the inquiry and current and former officials and Ministers provided written and oral evidence as required.

We are today receiving a copy of Sir Brian’s report and recommendations, which we will consider carefully, and in detail. We remain committed to working on a four-nations basis to respond to the inquiry’s recommendations, with a view to achieving the best possible outcomes for beneficiaries and their families in Wales.

The debate in the Senedd on 7 May confirmed our position in relation to the UK Government’s proposal to set up an arm’s length body to provide the vehicle by which compensation could be paid. Welsh Government officials will work with the UK Government to ensure Welsh beneficiaries and their families are recompensed in keeping with the inquiry’s interim report on compensation.

Our Wales Infected Blood Support Scheme (WIBSS) continues to provide support for known beneficiaries and their families. For people who believe they may have been infected before 1992, we have worked with the Welsh Blood Service to help answer any queries they may have.

They can also access a home testing kit from the Public Health Wales website. I will provide further updates to the Senedd once we have had an opportunity to consider the inquiry’s recommendations."

Wales 'lacked curiosity' on health position

The report details how the Welsh Government's health position 'lacked curiosity' as to whether the position in other parts of the UK - namely England - was justified.

It reads: What has been said about the response of the government in England thus applies to Northern Ireland and Wales too, and needs no further comment here – save that there is the added criticism that health policy, insofar as it related to infected blood in both Northern Ireland and Wales, was determined with a lack of curiosity as to whether the English position was actually justified.

'It is right that more is done to support and compensate survivors'

Commenting on the report, Welsh Conservative Shadow Health Minister, Sam Rowlands MS said: "This tragedy, affecting thousands of victims and their families, was one of the greatest scandals in the history of the NHS.

“While this inquiry has shone a light on a dark time, it is right that more is done to support and compensate those survivors suffering with ill-health to this day."

Scandal 'could and should have been avoided'

In the report, Sir Langstaff says a "catalogue of failures" caused this to happen. "Lord Winston famously called these events 'the worst treatment disaster in the history of the NHS,'" he writes. "I have to report that it could largely, though not entirely, have been avoided. And I have to report that it should have been."

He adds: "I have also to report systemic, collective and individual failures to deal ethically, appropriately, and quickly, with the risk of infections being transmitted in blood, with the infections when the risk materialised, and with the consequences for thousands of families."

'Community finally has answers in black and white'

Following the release of the final report of the Infected Blood Inquiry today, Rachel Halford, CEO of The Hepatitis C Trust, said: “Today’s report represents six years of concerted effort by Sir Brian Langstaff and the Inquiry team to uncover the truth about the cause of the contaminated blood scandal.

“After decades of relentless campaigning, this community finally has answers in black and white. Systemic, collective and individual failings and cover-ups have led to one of the gravest disasters this country has ever seen.

“Among its shocking findings, the report has brought to light evidence that much more could have been done to prevent hepatitis C and HIV infections from blood and blood products, and to help those infected. But far beyond these failings, it makes clear that people - including many children - were deliberately given deadly viruses, treated as "objects for research".

"Over decades, instead of acting to protect people, the Government and the health system have sought to delay, defer, and hide the truth from the people they'd harmed.

"They must now take full responsibility. We urge the Government to stop its endless delays and to act. Already 3,000 people did not live to see this day, and time remains of the essence.

"The Government must now quickly and comprehensively respond. This response must accept their responsibility, and give concrete timelines for paying compensation to everyone affected. And it must commit to implementing all of the recommendations of this report transparently collaboratively with the communities whose lives have been so blighted by its actions, and to taking the lessons learned to ensure absolutely nothing like this can ever happen again.

“The report recommends that groups previously excluded from financial support - such as bereaved parents and children, people who contracted hepatitis B and the people who received infected blood transfusions after 1991 - are included in the compensation scheme. We urge the Government to clarify its plans for redress for these groups as soon as possible. After so many years of being shut out from support payments, these individuals have waited long enough to receive the recognition that their lived experiences are part of this horrific scandal.”

'Unacceptable level of complacency'

Explaining how the scandal happened, Sir Langstaff says in the report overview that "over many years blood was used unnecessarily, being wrongly seen by many clinicians to be little or no risk. There was an unacceptable level of complacency about the safety of blood."

He continues that this "unnecessary use, and overuse, of blood was particularly problematic in the treatment of pregnant and postpartum women and in the undertaking of non-emergency surgery."

He adds: "It took until 1998, and the creation of the Better Blood Transfusion initiative, for a UK-wide framework addressing best practice in transfusion to be established and a concerted effort to be made to reduce unnecessary blood transfusions. This, or something as effective, should have happened earlier and there is no good reason why it took so long for coordinated action to be taken."

'Responsibility for much lies with successive governments'

In the introductory summary of the report, Sir Langstaff notes "the scale of what happened is horrifying".

"The most accurate estimate is that more than 3,000 deaths are attributable to infected blood, blood products and tissue," he writes, adding: "The chapters that follow make clear who is responsible for each of these failings, though in general I can say that responsibility for much lies with successive governments, even though others may share some of it. It will be astonishing to anyone who reads this Report that these events could have happened in the UK. It may also be surprising that the questions why so many deaths and infections occurred have not had answers before now."

Report has been published

The report has now been published and can be read online here.

What are the symptoms of HIV and Hepatitis C?

Hepatitis C is a virus that can infect the liver. If it's left untreated it can cause potentially life-threatening damage to the liver over many years, according to the NHS website.

It doesn't have any noticeable symptoms until the liver has been signficantly damaged, so many people might not even realise they have it. But when symptoms do occur, they include:

• flu-like symptoms, such as muscle aches and a high temperature (fever)
• feeling tired all the time
• loss of appetite
• stomach ache
• feeling and being sick

These symptoms can be mistaken for something else and the only way to know for sure that you have Hepatitis C is to get tested.

Meanwhile HIV (human immunodeficiency virus) damages the cells in your immunse system, thereby weakening the body's ability to fight everyday illnesses.

The first symptoms of HIV - flu-like symptoms - normally occur in the weeks after infection. After this, symptoms might not be present for several years, until the immune sysem becomes severely damaged, the NHS website says.

Then symptoms can be:

• weight loss
• chronic diarrhoea
• night sweats
• skin problems
• recurrent infections
• serious life-threatening illnesses

ITV to make drama on scandal

Earlier this year, it was reported that ITV had been given the go-ahead to make a drama about the infected blood scandal following the success of the channel's series about Post Office workers fighting for justice. Mr Bates Vs The Post Office, which began airing in the New Year and stars British actor Toby Jones, pushed what has been called the largest miscarriage of justice in British legal history up the news agenda for weeks.

Campaigners have previously pushed for the infected blood scandal, where thousands died in what is widely recognised as the worst treatment disaster in the history of the NHS, to receive the same attention.

Read more here.

How many people in Wales were infected by contaminated blood?

More than 30,000 people across the UK were infected with HIV and Hepatitis C. This figure includes 400 people in Wales.

What time will the report be published?

The inquiry’s report is due to be published at 12.30pm today. Sir Brian Langstaff will share his findings at the Methodist hall in Westminster.

'It was a death sentence'

Leigh Sugar, another Welsh victim of the scandal, was given contaminated blood aged 14 and died when he was 44 in 2010. Leigh's mum Margaret Sugar previously told WalesOnline the family's ordeal was a “horror story”.

She said: “It’s a very sad, sad story. My son’s name was Leigh and he was born a mild haemophiliac. This didn’t affect him until he was about 14 years old.

“He led a normal life – he’d play sports and do all of the normal things. No-one would know that there was any problems.

“When he about 14 he fell off his horse and I took him to the hospital. The doctors said that they would have to give him quite a lot of [blood] but of course I didn’t know it was contaminated. I had no idea and neither did he. I took him in and he had that lethal injection. It was a death sentence.”

Ms Sugar said her son was injected with blood that gave him hepatitis C, a virus that can infect the liver. It was not until Leigh – who established the popular Tynant Garage in Beddau – was in his late 20s that he was diagnosed with the disease.

Ms Sugar described her son as an “ambitious” and “hard-working boy” who had his life ahead of him. She said: “He planned to have a future but he lost the battle when he was 44 years old.”

‘I was given contaminated blood when I was 18 months old and now I have cirrhosis’

Kirk Ellis from Caerphilly is another Welsh victim fo the scandal. When he was just 15-years-old, he was told he had Hepatitis C.

The year was 1996 and research into the liver-attacking virus was in its infancy. Kirk was given between one and 10 years to live.

“To this day I can see the look of complete and utter shock on my mothers face,” he previously told WalesOnline. “All that was going through my head was that I am going to die."

Like many victims, Kirk had haemophilia - a rare blood disorder that affects the body’s ability to clot. He was diagnosed at just 18-months-old and was given a treatment intended to make his life better.

A clotting agent called Factor VIII was introduced to help a haemophiliac's blood clot to prevent internal bleeding following injuries. Unbeknownst to his family, he been infected with Hepatitis C.

Having the virus for over 30 years took a serious toll on his health mentally and physically. Kirk was left with cirrhosis of the liver - scarring of the liver caused by his hepatitis.

Read more here.

Brothers from Cardiff died within months of each other

Brothers Gareth and Haydn Lewis from Cardiff were two other Welsh viticms of the scandal. They were born with the genetic disorder haemophilia which impairs the body's ability to make blood clots, a process needed to stop bleeding.

During the 1970s and 1980s haemophiliacs were given blood plasma which was the standard form of treatment for the condition. But some of it came from unregulated commercial companies in the US which paid needle-sharing drug users, prostitutes, and prisoners for donated blood.

Gareth and Haydn were both diagnosed with HIV in the 1980s after having the concentrated blood product Factor VIII from infected donors in the US.

The pair were also found to have hepatitis C years later and died within six months of one another in 2010.

Their sister Beverley Tumelty, who gave evidence to the inquiry, previously said she feels it is her duty to stand up for her older brothers now they no longer have a voice.

"It fills me with dread knowing that I have to be part of this inquiry but my older brothers always looked after me growing up so I feel it's my duty to speak about what happened to them," she said.

"While they were alive they campaigned so doggedly to help others in the same position as them. I am phenomenally proud of them."

'I've fought it hard'

Victims of the scandal in Wales previously told WalesOnline how their lives were changed forever after they and loved ones were injected with contaminated blood.

Antoni Olszewski, from Skewen in Swansea, was given contaminated blood after he was hit by a train in 1986.

Dad-of-four Mr Olszewski, 64, said: “I was coming home from work [in Port Talbot steel works] back in 1986 and I was crossing the railway as normal and I was run over by a train and it dragged me up the track.”

He was given the blood in the life-saving surgery afterwards – but didn’t find out he had been infected with the condition until 1998 when he went to give blood.

Mr Olszewski said that within three days of attempting to give blood doctors knocked on his door and told him he had chronic hepatitis C, a virus that can infect the liver.

Mr Olszewski said: “I have been ill – very, very ill – but I’ve fought it hard. I’ve had a good health service that have helped me all the way because they knew what they had done.

“Chronic hepatitis C normally attacks your liver but with me it attacked my immune system, too, similar to Aids.”

He added: “It’s about time it came out into the open. I had to walk around for all of these years with a timebomb.

“And mentally you don’t know when it’s going to go bang. It drove me nuts.”