Professor Collins qualified in 1986 and he took his first Haematology post at the Royal London Hospital. He also worked at the Royal Free Hospital and the Great Ormond street Hospital before joining University Hospital of Wales in Cardiff as consultant haematologist in 1996, where he was Director of the Haemophilia Centre. When he became Director, Professor Collins became a member of UKHCDO. He was part of a number of working parties and Vice-Chair from 2016-2020.
Professor Collins said he took up his post in Cardiff four years after Professor Bloom passed away. In those four years there had not been a stable consultant until he arrived. Professor Collins spoke about the facilities of the Cardiff Centre. He said when he arrived at Cardiff, the facilities were relatively poor. He told the Inquiry a new centre was built in 2000 with better facilities, where the centre remains now. Professor Collins said the Cardiff Centre is the Comprehensive Centre for Mid and South Wales and that other centres rely on Cardiff for advice. He also noted patients can be registered at the Cardiff Centre as well as another Centre such as Swansea or Abergavenny.
He said for purchasing products he relied on the Welsh Blood Service. All products were heat treated when he started practicing so he considered all products to be safe. But, he would prefer to use recombinant products. On discussion of what products individual patients would use, Professor Collins said he would have discussions with patients. If there was a shortage of a product or budget concern, he would discuss changing products with patients. However, if a patient did not want to change they would not have to. When obtaining informed consent from patients about treatment, suchs as to parents before their child was born, he would give information about risks and benefits of products. He would give information regarding the risk of pathogenic transmission. He would discuss the past problems of HIV and hepatitis, in the context of reassuring patients that the products used now are safe from these risks. Such discussions would be recorded in patient notes and a letter to their GP would be copied to the patients.
When asked about testing patients for infections, Professor Collins said all patients were tested for HIV and hepatitis by the time he arrived at Cardiff and all knowledge he has about how this was managed comes from the patients. Testing of partners of those infected with HIV did continue to take place after his arrival, but Dr Dasani, who was an expert in the management of HIV took the lead in this process. Professor Collins also discussed a paper he participated in of a follow up of patients with Intermediate Factor VIII concentrate BPL 8Y by Dr Dasani. Professor Collins clarified this was seen as a service evaluation not a clinical study so patients would not be aware of the article. Dr Collins said patients should have consented to the tests of their stored samples for this study and this would have fallen to Dr Dasani or Dr Brown. Professor Collins said a research study changes treatment, so requires informed consent, whereas service evaluations generally do not.
He also spoke to the Inquiry about the National Haemophilia Database Research Register by UKHCDO, which holds various information about patients. It is used for patient care and research. A process was started of seeking individual consent of patients for the research purposes, but after a few years, this order was superseded by an NHS Health Research Authority Advisory Group. Professor Collins said he thought the informed consent process was practical, and he could have obtained consent from 90-95% of patients.
Professor Collins explained that he did not have knowledge about how treatment was managed by Professor Bloom. He has heard from patients that there were not full discussions of different types of treatment or all potential risks of treatment. For HIV treatment, Dr Dasani was considered a HIV expert. After Dr Dasani retired, the haematology team had to be supported more by the Blood Borne Virus Clinic as they were not specialists in HIV. Professor Collins also described the problems the Cardiff Centre had due to a lack of hepatology expertise in Cardiff, with patients having to be referred to England for certain problems. Professor Collins said he regards this as a gap in service as they were not able to provide optimal care. This gap was approached to be solved in 2011, when an administrative review made a key finding that the Haemophilia Centre in Cardiff needed a consultant hepatologist to monitor patients, although it took until 2016 for this to occur.
The Inquiry made the point that patients from Cardiff had noted gaps in their medical records from when they were under Professor Bloom. Professor Collins said he hadn’t noticed key documents missing, but he had noticed all HIV results were filed together separately from the notes. He said he would have noticed any systematic issues in notes. When asked more about Professor Bloom, he said he never spoke personally to Professor Bloom. When he joined the Centre he inherited various files from Professor Bloom including treatment protocols, various letters about use of different concentrates and reports to solicitors of individuals who had contracted HIV. Professor Collins said his understanding was that everything he had was sent to the Inquiry. Professor Collins was asked if he thought Professor Bloom had more files at his home. He said he did not know, although he heard on a radio programme that this might have been the case.
Professor Collins also spoke about how it was decided to rename the Cardiff Centre so that it was not named after Professor Bloom. He said that Haemophilia Wales had told him they did not want it renamed or the bust removed until after the Inquiry results. However, this view was later changed and the day that Haemophilia Wales asked for the bust to be removed, it was taken down.
Professor Collins was questioned about links to Pharmaceutical companies. He said that donations from three companies helped them build the new centre in 2000. This was needed as they were required to find the funding for the centre. These companies involved represented the three brands of recombinant Factor VIII, therefore neither had more influence than the other. He noted as there is now a National Tender on products to use, it removes influence on prescribing from certain companies. Professor Collins said companies want to influence the prescription of their products, but he does not not think he has been influenced as decisions are dictated by the national contract. He said when he inherited files from Professor Bloom, he did not personally come across anything regarding Bloom’s contact with Pharmaceutical companies. He noted that there is a potential risk there would be influence from companies as clinicians do have some freedom to prescribe, but this is an issue that affects many areas of healthcare and public life.
Professor Collins spoke about the importance of the Inquiry and how members of his junior staff had attended hearings in Cardiff to hear testimony. He viewed it to be important that younger staff knew and understood what had happened. Although the events happened in the 1970’s and 1980’s, Professor Collins noted people are still living with the events to this day.