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It has been called the worst treatment disaster in the history of the NHS. But the scandal that resulted in 30,000 people in Britain being infected with contaminated blood, about 3,000 of whom have died, was much more than that. As an excoriating public inquiry report has now concluded, it was a failure of the British state, at multiple levels, over decades. It was calamity that could largely have been avoided. And it was made worse by a “subtle, pervasive and chilling” cover-up by the health service, civil service and government.

After decades of suffering, the tens of thousands affected have received some closure through the publication of Sir Brian Langstaff’s report, and an apology from Prime Minister Rishi Sunak on behalf of successive governments. Several further things, all complex, now need to happen. The government must launch a proper compensation scheme, having failed to do so even after Langstaff called for it in an interim report last year. The culture in the health service must change further to put patient safety above all else. Reforms recommended by Langstaff to end the culture of “defensiveness” in government departments must be implemented too.

Britain was among at least a dozen countries to suffer infections of HIV, hepatitis C and other viruses from contaminated blood through transfusions, or blood products used to treat conditions such as haemophilia from the 1970s to the early 1990s. Where it differs from most peer-group countries is in the time taken to offer accountability and proper recompense, and the lengths to which the system went to avoid this.

Sir Brian Langstaff, chair of the inquiry, meets affected families
Sir Brian Langstaff, chair of the inquiry, meets affected families. His report recommends reforms to end a culture of ‘defensiveness’ in government © Charlie Bibby/FT

Langstaff’s report found health officials failed to ensure rigorous selection of blood donors to exclude higher-risk donors such as prisoners, or to block products from the US and Austria made from high-risk donations. Patients were knowingly exposed to unacceptable risks. Sickeningly, doctors conducted research by using products on patients, including children, without gaining consent or informing them of the risks.

These failings were then compounded by “institutional defensiveness”. Ministers, advised by civil servants, repeatedly told infected patients, wrongly, that they had received the “best available treatment”, their infections were inadvertent and blood screening had been introduced as early as possible. Documents were lost or destroyed. Successive governments refused an inquiry.

Part of the reason is surely that the iconic, publicly funded NHS played a central role, opening the state to potentially huge compensation costs. As also witnessed with sub-postmasters wrongfully prosecuted by the Post Office, the UK establishment has an instinct to close ranks when accused of failures.

Other countries made efforts much earlier to address what went wrong and compensate victims. Canada, Ireland, Japan and Denmark took action by the early 1990s. Some also attempted to hold individuals, and blood products companies, to account. France in 1999 charged former premier Laurent Fabius and two ex-ministers with manslaughter in its tainted blood scandal, though only an ex-health minister was found guilty. In the US, facing lawsuits from haemophiliacs, several pharmaceutical companies paid settlements.

In Britain, some key individuals who might have been held responsible are now dead. Repeated delays in reducing risks and confronting mistakes have increased the toll of infections and deaths, and pushed the financial costs far higher. The government is now expected to set out a compensation scheme costing up to £10bn — enough to have a material impact on the public finances, affecting all of society. But the biggest price, by far, has been paid by the victims of this appalling episode.

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