At a preliminary hearing which took place on 31 March 2009, I advised that I would take forward the work of the Inquiry in two phases. The first phase, which culminates with the publication of this Preliminary Report, has involved a period of intensive research of medical and scientific literature and gathering of factual evidence. Over 80,000 documents have been read and analysed by the Inquiry team. Over one hundred statements have been taken by members of the team from patients and relatives.
I am grateful to the patients and relatives who have come forward to provide statements to the Inquiry. These have been reflected in Chapter 4 of the report. It will be necessary to explore with interested parties the extent to which Chapter 4 is accepted as accurate, and can be treated as a reliable basis for findings in fact, thereby limiting the need for further evidence, written or oral, from these witnesses.
I am grateful also to Professor Oliver James, medical assessor to the Inquiry, for his guidance throughout the process, and to the specialists who assisted me and the Inquiry team by meeting us to provide the benefit of their expertise in their particular areas of interest. Professor Brian Gazzard, Chelsea and Westminster Hospital; Professor Edward Tuddenham, University College, London; Professor Andrew Lever, Addenbrooke’s Hospital, Cambridge; Professor Howard Thomas, Imperial College, London; Professor Jean-Pierre Allain, Cambridge University, and Professor Brian Colvin, Queen Mary University of London, made invaluable contributions to our understanding of the diseases and related matters and in that way provided guidance on the approach that has been adopted to the investigation. The Inquiry team also visited the Newcastle Haemophilia Centre where we were introduced to the systems and practices currently applied in a substantial modern regional centre, and given an illustrated talk on the complications of severe haemophilia in untreated individuals.
With the exception of Professor James, none of the experts has been asked to comment on the Preliminary Report. Responsibility for the representation of medical and scientific developments, so far as reflected in this report, is mine alone.
More generally, it is important to emphasise that I have not reached any conclusions on matters of fact or on recommendations that might be made. In this report I have set out, so far as reasonably practicable, the evidential background to the topics identified in or implied in the terms of reference, in order to provide a basis on which to move forward to examine areas of controversy at the public hearings. That has involved a process of selection based on the study of the material available, and for that, I accept responsibility.
As a result of the work undertaken to prepare the Preliminary Report, a draft list of topics for further exploration has been developed. The list is in a schedule to chapter 1 of the report. These are the topics which I consider should be examined during the public hearings in the light of the work done to date. But other topics may be suggested, either additional to the list or as modifications to it. I am anxious to hear from anyone who has such suggestions to make. I will consider any views expressed and, if I think it appropriate to do so, will amend the list appropriately. I will publish a revised list in due course.
In the run up to the hearings, which I anticipate will commence at the beginning of 2011, statements will be sought from clinicians and others, using the Preliminary Report as a reference document. I hope that this approach will help focus investigations and avoid spending time unnecessarily on irrelevant or uncontroversial matters.
Investigations into the five specified death cases are in hand. It is my intention to examine the circumstances relating to these cases early in the public hearing phase of the Inquiry.
At the conclusion of the hearings, I will set out my findings and any appropriate recommendations in a final report. I cannot predict how long that will take at this stage.
Interested parties are invited to send their comments and suggestions relating to the draft list of topics to the Secretary to the Inquiry on or before 31 October 2010. Contact details are set out in Appendix 5.
The Right Honourable Lord Penrose