Is the NHS to blame for the UK’s slow response to the infected blood scandal?

In all the soul-searching and breast-beating that has followed the publication of Brian Langstaff’s exemplary report, one aspect of the infected blood scandal has received relatively little consideration.

Practically every other country where haemophiliacs and hospital patients received contaminated plasma in the 1970s and 1980s got to grips with the problem sooner and more comprehensively than did the UK.

Among them are the United States, several continental European countries, and Ireland, all of which stopped using contaminated blood products before the UK did. They started and completed their inquiries long before the UK and in some countries – notably Canada and France – a few heads actually rolled, including politicians, doctors, and pharmaceutical company representatives.

These countries also agreed standardised compensation systems, whether in the form of regular benefits, or lump-sum awards. All while successive UK governments were dithering about what, if anything, to do.

It is all very well for the current prime minister to say that the findings of the infected blood inquiry should “shake our nation to its core”, but the only people whose cores may be quivering very slightly at the levels of cynicism, incompetence and yes, immorality laid bare by Langstaff’s inquiry are likely to be in the corridors of power.

Through two botched military interventions, in Iraq and Libya, via the Hillsborough disaster, to the fire at Grenfell Tower, the chaotic withdrawal from Afghanistan, to the breath-taking miscarriages of justice at the Post Office that are now being aired at another inquiry, people have become inured to the inadequacies of our state.

Against this background, the infected blood scandal is just more of the same, but bigger, and disgracefully left over from yesteryear.

It is worth considering whether there is something particular to the UK, beyond a general reluctance to hold well-paid public servants and professionals to account, that explains why the UK was so slow to respond in practically every way, to the point where an all-embracing compensation scheme was only announced this week - half a century on.

And I suggest that there is, and it’s called the NHS. The majority of the countries that did a better job of curtailing the scandal and providing redress for the deaths and damage caused by infected blood had public health systems that are, first, based on insurance, and second, for the most part distinct from the state.

Now, I can hear the furious ripostes already. There is the standard objection that insurance systems are socially divisive and favour those who can pay, leaving poorer and sicker people with an inferior service, if any service at all.

Another would be that while our system may have been slow to react, it is benevolent in that it excludes no one from treatment and leaves no one with bankrupting medical bills. Just imagine what might have been the fate of those poisoned by contaminated blood in a system that was not, like the NHS, free at the point of use.

But this brings me to the central point of my argument, because what evidence is there that those who received contaminated blood in countries with insurance-based health systems fared any worse than they did in the UK? In many countries there were a lot fewer of them, because imports of infected supplies were stopped earlier, the survivors were mostly told what had happened, and they were better off than their UK counterparts, thanks to agreed benefits or compensation payments.

Insurance systems generally get a bad name in this country, because the comparisons are most often with the US, where the system can indeed exacerbate social divisions, and where medical expenses remain one of the most common causes of bankruptcy.

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European insurance systems however are, by and large, different in that they provide a safety net for all, while tailoring premiums to income and allowing choices and gradations of provision. No one is bankrupted by medical expenses and the contributory principle fosters a degree of personal responsibility and engagement.

These systems also generate more money for health, as the wealthier are required to pay more and can top up provision some more. In the UK that “extra” money goes into the quite separate private health sector, not into provision for all.

The big distinction between these insurance systems and the NHS is not just the element of choice. It is the multiplicity of providers that are, to a degree, in competition and function on a commercial or charitable basis. This may help to explain why the incidence of blood infection and the greater urgency in addressing it was speedier and more efficient than it was in the UK. It quickly affected the bottom line of providers, and in specific groups, such as those who had received transfusions, in a way that it did not in the monopoly behemoth that is the NHS.

There were some British doctors who suspected a problem with plasma and steered their patients away from imported blood products. But those who exercised that discretion were few and far between. And the scale, it appears, was a reason why UK governments stalled on setting up an inquiry and arranging compensation.

The institutional distance between government and health services in those countries with insurance-based systems is another reason why they may have acted sooner. A scandal in the health service has a direct political effect on government, with reputational consequences that both are keen to avoid.

The NHS may now have a separate management structure but as the past year of strikes has shown, it is still widely perceived as an arm of government, with accountability not altogether clear and diluted again by the blurred lines between ministers and civil servants.

There is much greater clarity in insurance-based systems about who is responsible for what, whether it is a question of money or clinical standards or, indeed, the regulation of blood products. The NHS is at once a monopoly provider of care, and in some purchasing and treatment decisions a free-for-all.

With the eulogies from the Covid pandemic but a faint memory and public regard for the NHS as low as it has ever been, the infected blood scandal could offer the impetus for change that is so badly needed.

In considering what direction that change might take, a look at how European insurance-based systems dealt with their respective contaminated blood scandals and then how they coped with the Covid pandemic – mostly no worse than the UK and in some countries better – could be a worthwhile place to start.