On the 23rd March 2021, the Inquiry heard evidence from Nicholas Fish, Administrator at the Skipton Fund (SF) during 2006-2018 and Assistant to the Chief Executive of the Macfarlane Trust and the Caxton Foundation.
Mr. Fish explained he had initially joined the Skipton Fund as a temp and a few months later, had then taken over from Keith Foster as Scheme Administrator. He explained his responsibilities and his involvement in meetings as Scheme Administrator with the Department of Health (DoH) in providing statistics and forecasts for scheme payments.
Inquiry Counsel questioned Mr. Fish on the drafting the Agency Agreement and the influence SF had concerning any recommendations or changes to the document. He explained the DoH did not want or encourage input from the SF in relation to this document. He explained that often the DoH would make changes to the document but the SF would not be aware of these changes until possibly the day before, which would then cause chaos the next day with the SF receiving hundreds of e-mails and telephone calls from beneficiaries concerning the changes in policy.
Inquiry Council asked Mr. Fish how applicants could find out about the payment scheme and any proposed changes. He said this was mainly dealt with by the DoH as the SF was not allowed to advertise. The DoH wrote to hospitals/centres/doctors etc advising of the scheme. The SF would however advise of any changes on their website.
Inquiry Counsel asked Mr. Fish about the major changes in 2011 and how the SF notified beneficiaries including those with non-bleeding disorders and those who had died without a formal diagnosis. He said the MFT helped to pass on information through its beneficiaries, and the SF wrote and telephoned all the beneficiaries and doctors on their records and from then on wrote to beneficiaries if further changes were made.
Mr Fish was asked by Inquiry Counsel about the implications concerning the fraud committed by Keith Foster. He explained that Mr. Foster had fraudulently completed Skipton Fund applications and received payments. He explained how the DoH had subsequently revised the application process and this resulted in applicants and their doctors having to sign a declaration to prove the information they provided was truthful and correct and provide the applicant’s medical records to the SF Mr. Foster embezzled £400,000 in total from the SF but £267,321.91 was recovered. Mr. Fish confirmed the issue had not affected the payments to SF beneficiaries.
Inquiry Counsel asked to Mr Fish to explain the mechanics of the application and assessment process for Stage 1 payments post 2011. He said it was a system that he had inherited and to his knowledge, a system that the DoH was satisfied with.
Inquiry Counsel asked Mr Fish to also explain how applicants were able to appeal against a refusal decision. He explained they would send appellants a letter which contained a leaflet with recommendations on how to obtain their medical records and any other required information. He agreed with Inquiry Counsel that this process placed appellants in financial difficulty and those experiencing debilitating side effects from treatment at a clear disadvantage in having to provide this evidence, as there would often be fees incurred to obtain the required information. Mr Fish explained cases where applicants either could not or did not produce their medical records before 2012/13 would have been rejected.
Many decisions were overturned by the Appeals Panel once additional medical information was submitted and a more informed decision could be made on each case by the Directors.
Mr. Fish spoke of the reasons why some applications would not succeed such as those from women given anti D immunoglobulin during pregnancy/childbirth as this route was not considered a source of hepatitis C. He spoke of the assumption of intravenous drug abuse being the most probable route of infection rather than transfusion when assessing cases and obtaining genotype information when assessing third party transmission cases. He said natural clearers were excluded.
Mr. Fish was asked about the qualifying criteria for Stage 2 payments. He explained in detail the application process and assessment. How they relied on proof of cirrhosis, liver function tests, blood test results, fibroscans etc and how they investigated other reasons for applicants’ high fibroscan scores.
Mr Fish spoke about bereavement payments and the provision of evidence to support applications.
Mr. Fish referred to occasions where beneficiaries were being interviewed and investigated by the DoH. He explained of his involvement in writing a letter to the DoH asking that SF beneficiaries be excluded from investigation.
Mr. Fish also gave a brief outline of his role and responsibilities whilst working for the Macfarlane Trust and Caxton Fund.
For a full transcript of the evidence of Nicholas Fish please visit https://www.infectedbloodinquiry.org.uk/evidence where you can read the transcript or watch the evidence via YouTube video.