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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: MS FRASER BUTLIN:ANSWER: A.
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QUESTION: I think that would be a fair reading of the document , sir . It's certainly a conclusion you could reach. It is clear , however, that there was an issue about donors who self- ex cluded from donating and wouldn't then become known to the blood services subsequent ly. Dr Hewitt has raised this ...
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QUESTION: A.ANSWER: SIR BRIAN LANGSTAFF:
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QUESTION: SIR BRIAN LANGSTAFF:ANSWER: MS FRASER BUTLIN:
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QUESTION: MS FRASER BUTLIN:ANSWER: SIR BRIAN LANGSTAFF:
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null
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QUESTION: And that was the worry ? "ANSWER: Yes. "
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QUESTION: Was the worry directed at economics or safety or a com bination of both? "ANSWER: For us , safety was paramount: we wished to 48 minimise exposure of patients to commercial concentrates . "
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QUESTION: Does the article bring that out? " ANSWER: Probably not as clearly as it could, although I should say we were writing against the background of the [ World Health Organisation ] recommendations of 1975. This is a very important document which I suggest you read." Then he sets out the WHO decla...
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QUESTION: What was the reaction from within the profession to that article? " ANSWER: I cannot honestly say. As far as I am aware -- virtually zero, at least outside the Scottish Health Service. "
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QUESTION: A voice in the wilderness? " ANSWER: Perhaps, but at that time there wasn't a satisfactory forum in which a corporate reaction could be generated." Then the question is put about self-sufficiency in Scotland : 10 November 2021 ...
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QUESTION: Insofar as you were not self sufficien t between 1975 and 1983, where were you buying your commercial factor VIII concentrate? " ANSWER: Yes, but this purchasing exercise was , as in England and Wales , the responsibility of local Health Authorities, [ Haemophiliac ] Centres, hospital pharmacists ,...
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QUESTION: Would you know where they bought from? "ANSWER: They would buy from the identical sources our friends in England and Wales -- primarily the [ USA ], because , to the best of my knowledge , this was the primary source in those days." Then you see a reference, sir , to the conversation with ...
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QUESTION: Can I read to you part of Graham Ross' s note arising out of your telephone conversation with him on 28 November 1989 and ask you to say whether or not it accurately reflects your views ... " Then the quote is: "Appointed Medical Director of [ SNBTS ] in 1979. At no time during the period he held that...
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QUESTION: A total lack of meaningful infrastructure? " ANSWER: Yes." Then if we just go over the page , a couple of final passages in this, the second paragraph down is a question about importing American concentrates and 58 what is said is this: " It has been said to us by a virologist that this ...
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QUESTION: And this risk had long been recognised? " ANSWER: Yes." So there Professor Cash's views recorded in 1990 , touching on both issues of risk and on matters of self-sufficiency in both Scotland and England. With apologies to everyone for depriving them of their tea and coffee for ten minutes, perhaps we ...
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null
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QUESTION: Thank you. When do you say they made their final decision as it were to go ahead? " ANSWER: July 1990 , subject to a pilot trial." Then , if we go over to page 53 , if we pick it up at 2610 , or 2609: "
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QUESTION: So when did you say a decision in principle was made ? " ANSWER: I said the decision in principle that we must test was November 1989." Then at 2615 , the judge says: " I have three dates on Dr Gunson's evidence : November 1989 , in principle; July 1990, go ahead subject to the pilot trial; N...
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QUESTION: Who phoned whom? " ANSWER: I think I phoned her. "
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QUESTION: And the gist of your discussion was? " ANSWER: It looks as though we are going to have a problem completing these tests by 1st July , perhaps we ought to consider a later date , and I suggested 1st September , to which she agreed, and sent a memo to Dr Metters, who was her chi...
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QUESTION: Let us assume that that body had arranged to meet immediately after this very important conference. Can we assume that, please? " ANSWER: Yes. "
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QUESTION: Let us also assume that before Rome we in this country had done what the French had done and had run some extensive pilots? 75 " ANSWER: Yes. May I say, France was really the only country that reported at Rome to have done that. "
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QUESTION: I understand that, but you were striving, as your statements of objectives make s plain , to maintain the high est standards and ensure the maximum safety. So I am imposing upon you your own standards , Dr Gunson. Let us assume first that the Committee had met immediately after this very...
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QUESTION: We have looked at why they could not. It is questions of funding , good will , matters of that kind . They have most move d earlier. " ANSWER: Building , possibly . " MR JUSTICE BURTON : What do you mean ' if ', because you are the man who would know ? "
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QUESTION: Sticking with England and Wales , if at any rate that is the figure you have, about how many donors does that represent? " ANSWER: Something in the order or 1.5 to 1 .6 million. "
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QUESTION: Just one other general question : what is 132 the broad turnover in the donor population? How many donors do you lose a year? " ANSWER: From retirement , illness, donors moving from one venue to another , it is something in the order of 12 to 15 per cent per year. "
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QUESTION: People just getting busier and -- " ANSWER: And stopping , yes." Then if we go , please , to NHBT0000146, it is at page 95, this is Dr Gunson giving evidence on 24 October 2000 , and if we go to the bottom of that page , he is still being examined - in - chief , at this stage , by his cou...
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QUESTION: What you say in paragraph 20 is that the blood sup ply within the service was a constant source of concern and during the period with which we are [ go over the page ] concerned here , you spent several hours most days ensuring that blood supply met demand throughout the country. " Is that an exagg...
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QUESTION: Were you successful during that period? " ANSWER: During that period we were extremely successful. There was not , I do not think , one critical report in the press during the whole of the periods until 1993." Sir , then can we turn now to DHSC0002195_044 . This is a document -- I think this i...
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QUESTION: Dr Lloyd, can you see and hear me? ANSWER: I can. There is a slight delay in your voice but, yes, I can hear you clearly, thank you. 3
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QUESTION: I'm going to start by just getting an overview of y our medical career. You took up your first house offic er post in 1975; is that right? ANSWER: That's correct, yes.
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QUESTION: Then, between 1975 and 1979, you had various house officer and senior house officer posts with no particular emphasis on haematology or transfusion? ANSWER: That's correct.
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QUESTION: Then, in 1980, you had your first placement at the Northern Regional Transfusion Service from 1980 to 1981, as a locum registrar; is that right? ANSWER: That is correct, yes.
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QUESTION: What led you to that post? ANSWER: I was following what would be considered a traditio nal medical career, working my way up the ladder, I gue ss, and at that time working in neurology at Newcastle General Hospital, I felt that a career in what one might call the traditional medical format was not f or ...
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QUESTION: In the course of the year or so that you were there , 74 at that stage, you spent, I understand, some time i n each department of the Centre and you've explained you would review donor information and also you became involved in blood banking and component production and the introduction of automated b...
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QUESTION: Then from 1981 to 1983, you were a registrar in blo od transfusion and haematology and, as I understand it , that involved receiving training and experience in haematology, pathology and microbiology at the Free man Road Hospital; is that right? ANSWER: Yes, and some clinical biochemistry. So it was al...
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QUESTION: You also, during that period, had a secondment to P HL; is that correct? ANSWER: Yes, I went to the Public Health Laboratory Service , which had laboratories actually based in the same building as the Transfusion Service in Newcastle, a nd 75 that was mainly to look at virology.
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QUESTION: You also, during this period, had a further period of time at the Regional Transfusion Centre; is that correct? ANSWER: Yes, that's right. It was officially a rotation, s o I came back into the transfusion centre.
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QUESTION: Can you remember of that period '81 to '83, can you remember approximately when you were back in the transfusion centre, which year it was? ANSWER: It was likely at the end of that rotation, so proba bly 1983. I think I would have started off the rotatio n by going to the Freeman hospital, and then com...
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QUESTION: You tell us in your statement that your time at the haematology department at the Freeman Road Hospital provided insight into hospital blood banking, use o f blood products and clinical issues arising from transfusion. What kind of issues arising from transfusion do you recall encountering during that p...
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QUESTION: We'll come back to that at a later stage of your evidence, that issue. ANSWER: I'm sure.
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QUESTION: 1983 to 1987 you were then a senior registrar in transfusion and haematology, spending time in each of the three main teaching hospitals in Newcastle. So would that be Freeman Road, Newcastle General and t he Royal Victoria Infirmary? ANSWER: That's correct.
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QUESTION: You had a period at the Haemophilia Centre, the Newcastle Haemophilia Centre, at this time. Can yo u 7 remember which year that was? ANSWER: No, I can't now. It would have been at my -- towar ds the -- in the latter half of that period, b...
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QUESTION: How long, very roughly, were you at the Haemophilia Centre? ANSWER: Very roughly -- very hard to remember now -- probab ly four weeks. I doubt whether it would have been longer. There were so many other things to fit int o that period of time.
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QUESTION: And you had then also during this period of your wo rk, a further period at the Regional Transfusion Centre ? ANSWER: Sorry, you froze then but I think you were asking i f I had a further period at the transfusion centre?
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QUESTION: Yes. ANSWER: And that's correct, yes.
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QUESTION: And you did the second part of your MRCPath exam having done the first part earlier in the 1980s. ANSWER: Yes, yes.
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QUESTION: Then in 1987 you took up a post as a locum consulta nt 78 haematologist at the transfusion centre, and then June 1987 to October 1988 you were a consultant haematologist at the transfusion centre. ANSWER: Yes, that's right.
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QUESTION: What, in broad terms, did that role as a consultant haematologist entail? ANSWER: I had obviously -- sorry, I shouldn't say obviously . I had quite a number of -- I spent quite a lot of t ime with interactions with the individual haematologist s, particularly when products were requested. It was not u...
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QUESTION: And then November 1988 you became the director of t he Northern Regional Transfusion Service. I think you r title at that point -- ANSWER: Yes.
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QUESTION: -- was medical director and then later became chief executive? ANSWER: I think I was medical director and general manager. Excuse me. Sorry, this is a problem I have. I was director and general manager from the beginning. It was some years later that we ...[frozen screen]...
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QUESTION: Sorry, you froze then, Dr Lloyd, and we lost the last -- ANSWER: Sorry.
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QUESTION: No, no, not your fault at all. We lost the last bi t of your answer. ANSWER: Yes, I was medical director and general manager fro m the beginning, and then it was several years later that we reorganised a bit and I became just the chi ef executive. We also of course at that time, around that time, we...
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QUESTION: And when you took up the role as director in November 1988, your predecessor Dr Collins moved to the clinical haematologist role; is that right? ANSWER: That's correct, yes.
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QUESTION: I want to ask you next a little about the Centre, i ts facilities and its arrangements. I've just mention ed Dr Collins, that was Dr Anne Collins, and prior to her -- ANSWER: Yes.
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QUESTION: -- appointment, it was Dr Sheila Murray. Who was director; is that right? ANSWER: That's right. I met her on one occasion in 1980 ju st as the transfer from herself to Dr Anne Collins too k place.
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QUESTION: In broad terms, what was the geographical reach of the Northern Regional Transfusion Service? ANSWER: It had a very wide geographical area to cover, one of the largest in England and Wales, with some large areas of low-density population and a few very high ly dense pockets of population. So it covered...
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QUESTION: Now the centre which you first worked at in 1980 wa s based in the Institute of Pathology in Newcastle General Hospital, and I think had been since the 1950s. ANSWER: Yes.
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QUESTION: Can you describe to us the facilities there and how adequate or otherwise they were for their purpose. ANSWER: Yes, that building I believe was opened in 1956. O ne floor was dedicated to the transfusion service and that would have been at a time when there was very little in the way of processing blood...
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QUESTION: Again, I'm afraid we lost a few seconds then, 83 Dr Lloyd. You said it was, and then we missed a little and then you said, "the 1980s". ANSWER: Okay. I think it was -- yes, I said something like : it was pretty outdated, even by the standards of th e 1980s.
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QUESTION: An adjective a use in your statement to describe it , in fact, is "Dickensian"? ANSWER: Yes, sorry about that. Yes, it was in some ways. The thing that sort of struck me was that we would see blood grouping being performed and the results were transcribed by clerks sitting on high stools at woo den ben...
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QUESTION: I'm going to ask you to look at a document with me, Dr Lloyd, just so that I can pick up one point from it. Sully, can we have NHBT0101335_052. ANSWER: Sorry, can you say that number again?
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QUESTION: NHBT0101335_052, it should come up on your screen. ANSWER: I was trying to pull it up, but a little too fast f or me there.
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QUESTION: Have you got it, Sully? 84 ANSWER: No, say it again? 0101?
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QUESTION: Sorry, we're just having to reload it on to our system here, Dr Lloyd. NHBT0101335_052. ANSWER: 052. Is that going to come up for me?
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QUESTION: It should come up on the screen in front of you, Dr Lloyd. Can you see it now? It should be displa yed on the screen on which you're talking to me? ANSWER: Yes, it has. Okay. Right, I --
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QUESTION: It should now be in front of you. So it's a letter -- ANSWER: Yes --
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QUESTION: I'll read it. My screen is not working, although if everyone else's is, that's fine. I've got a hard copy. The paragraph towards the bottom of the page beginning: "Finally, the concept introduced" -- ANSWER: Yes, I have it.
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QUESTION: "-- that the Centre was designed and commissioned f or 200,000 donations per annum shows a lack of understanding of current blood transfusion practice ." This was the sentence I wanted to ask you about: "The original submissions for this building of a new Transfusion Centre was made in the 1960s, at wh ...
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QUESTION: -- the service moved in 1985 to a new purpose-built centre but do we understand from this that it was a purpose-built centre based upon designs and think ing 86 from decades previously? ANSWER: No, that's not quite the case. I think in this document and this paragraph, what I'm saying is the Regional ...
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QUESTION: We can take that down, thank you. Do you have any knowledge of why, it apparently having been identified in the 1960s, that there was a need for a purpose-built proper centre, why it to ok until the mid-1980s for that to be realised? ANSWER: No, I have no idea. The only thing that comes to m ind is one...
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QUESTION: If I can ask you next to look at -- and again it should, I hope, come up on the screen in front of you -- TYWE0000052_005. ANSWER: I'll get that up for you. No, sorry it's not comin g up on mine -- 88
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QUESTION: Don't worry, it should, I hope, come up on ours shortly. ANSWER: -- and it hasn't come up on the screen yet.
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QUESTION: Our document system is struggling today. TYWE -- ANSWER: Yeah, I did -- yeah.
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QUESTION: Dr Collins's letters. ANSWER: -- one of these poorly legible.
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QUESTION: Yes, it is. I'll read out the relevant passages. So it's from Dr Collins, it's dated 3 October 1986. ANSWER: Yes.
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QUESTION: So, by this time, the service has moved into the ne w centre. It's addressed to Dr Donaldson -- ANSWER: Yes.
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QUESTION: -- the Regional Medical Officer at the Northern Regional Health Authority, and I'm just going to re ad out the first four paragraphs. "Dear Liam "Your letter of 24th June requested a comprehensive survey of modern Blood Transfusion medicine, as well as complex information not readil y available from o...
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QUESTION: Then if we look at a report which may, I think, hav e been the report produced that's referred to in this letter. It's NHBT0101 -- ANSWER: I can tell you, NHBT -- (overspeaking) --
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QUESTION: -- 332_045. ANSWER: 332 -- that is the one, you're correct.
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QUESTION: Good. So hopefully it will come up on the screen again in the not too distant future. Yes, NHBT0101332_045. Thank you. So we can see there a page which has various sections set out. If we go over the page, we can s ee section 1 is "Major products and services provided by the Northern Regional Transf...
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QUESTION: Then if we go to the next page, I wanted to ask you about this next section. So headed "Whole Blood": "This region has a relatively high demand for whole blood. There are many periods during the yea r when whole blood is not available in the quantities requested, despite some whole blood being returned ...
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QUESTION: Just picking up -- ANSWER: I hope that answers your question.
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QUESTION: Absolutely. Just picking up your reference to the document from Anne Collins, CBLA0001800, please, Sully. This is a report by Dr Gunson. If we go to the second page -- if we just go a little closer, pleas e, Sully, into the table. ANSWER: I know the document.
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QUESTION: So we've got the reference there: Northern Regional Transfusion Centre: "1984-5 "- Does not expect to separate more plasma than 1983/4. Cannot obtain finance for SAG(M)." And then "1985": 95 "Has been unable to initiate discussions on plasma supply with RHANSWER: Could not in any case increase sup...
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QUESTION: So that would suggest -- ANSWER: I'd say that -- if I might say, there is another document where Dr Collins specifically mentions the problem of erratic supply of optimal additive, or SAG-M, so there is another document, and I'm sorry I can't remember it, but I have seen it. So yes, there's more than ...
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QUESTION: And then if we pull up CBLA0002392. ANSWER: Oh, yes.
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QUESTION: And if we could go to page 165, please, Sully. This is a document you drew attention to in a recent addendum to your statement, Dr Lloyd. So we've got table 11: "Number of units of red cell products made in 1985/86." Then if we look at the regions on the left-hand side, as I understand it region B is t...
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QUESTION: Well, that's useful to know, thank you, Dr Lloyd. And we can see there highlighted for us on the screen the relevant figures, which show, if we look at the figure under the heading "SAG(M)" a very -- ANSWER: Compared to most of the other centres.
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QUESTION: Exactly, a very modest use compared to the other centres. ANSWER: You know, it's not only a modest use, it is -- emphasises the fact that you couldn't provide this product on a regular basis. If you only make 2,000 in a year, you can't offer it as an alternative to whole blood.
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QUESTION: And if we go two pages further on, please, Sully, t o page 167. This is the second table you referred into your addendum statement, Dr Lloyd. Table 13. I think t his is -- region B is still the Northern Region in this table, and we can see there the percentage -- ANSWER: Yes, a little group.