In the afternoon of 23rd June 2021 the Inquiry heard a Presentation by Inquiry Counsel concerning Treloars.
Inquiry Counsel referred to a number of documents which focussed on Dr. Aronstam’s view on treatment including the volume of products used.
The documents referenced the early use of concentrates (1960s) and supply shortages to the school and noting the use of concentrates for prophylactic treatment by the early 1970s.
Inquiry Counsel highlighted that there had been no policy in place on how to treat students with severe haemophilia and with what products.
Inquiry Counsel referred to the ‘convenience of administration’, noting that all students were given a variety of products. There was no limited exposure, all students were treated the same way. The doctors were allowed to pick and mix products. The suggestion of sticking to one product i.e. Hemofil was made but rejected.
Inquiry Counsel explained the approach taken by Treloars regarding the choice of products used and some doctors preferring to use NHS concentrates and highlighted that there was no attempt to stick with NHS concentrates.
The rise in use of concentrate was noted between the years 1973 to 1977 due to the rise in patients and a greater use of Factor VIII.
Inquiry Counsel referred to a number of documents exhibiting Dr. Aronstam’s views on treating students with certain types of bleeds and noting his recommendation to treat ‘vigorously’. However, his thesis contradicts this view and recommends effective low dosage treatment.
Inquiry Counsel referred to correspondence/documents from treating doctors of pupils who returned home for holidays etc, informing Treolars that the pupil had to be given lesser volume of treatment (Factor VIII) whilst at home.
Inquiry Counsel then turned to the mechanics of supply and referred to various documents concerning the difficulties of sourcing the supply of blood products for Treolars and the complications caused by the change in policy. Documents showed that there had been an insufficient supply for Treolars to treat as they would like and so they purchased commercial products. Documents showed an increase from the early 1970s through to 1974. In 1978 the Wessex Region was approached to supply Treolars to help with their ‘enthusiastic programme’.
Inquiry Counsel referred to documents concerning the supply and demand of products in the UK in the 1980 and how the annual usage had been underestimated. There were various reasons why usage had increased i.e. prophylaxis, home therapy etc. It was forecast that there was an escalating requirement.
Inquiry Counsel referred to the involvement of clinicians at Treloars with the UKHCDO and named the individuals involved and who had had input into Annual General Meetings and who had been privy to all information.