Common questions about the Infected Blood Inquiry

You may have seen and be concerned about stories in the news related to the Public Inquiry into how infected blood/blood products were given to patients.

The Infected Blood Inquiry is about blood and blood products given to NHS patients, particularly in the 1970s, 80s and very early 90s along with the quality of care provided to those who contracted infections, described as “the infected” by the inquiry. The inquiry also looked at the impact on the families, carers and loved ones of those infected. This extended circle of people were described by the Inquiry as “the affected”.

The UK Government announced the establishment of the Inquiry in July 2017 and its final report is being published on 20 May 2024. Click here if you’d like to read more about the inquiry.

Donor and patient safety are at the core of everything we do at the Welsh Blood Service.

The events investigated by the infected blood inquiry related to the safety of recipients of blood. It also looked at how donors were recruited, as this affects the safety of recipients.

Donating blood is very safe if you are fit and pass the donor screening questionnaire and tests. Donating blood can save and improve the lives of patients.

Despite improving evidence of which patients benefit from transfusion and reduced demand for blood in the last 20 years it remains challenging to collect sufficient donations to meet the needs of patients. We need to collect approximately 350 donations every day.

The Welsh Blood Service strives to provide our donors and the patients they support with the best possible experience by delivering safe, high quality, modern and efficient laboratory, diagnostic and transplant services.

The risks of blood donation include bruising of the arm, fainting and very rarely an injury to other parts of the arm near the vein. Donors are screened prior to donating to minimise the risk to themselves, they are cared for by trained and experienced staff at donation sessions and 24/7 advice is available following donation if required.

We work closely with partners in the UK and internationally to monitor any emerging issues for the benefit of donors and patients and we are regularly inspected by independent regulators.

Donors are not at risk of contracting the infections described in the infected blood inquiry. The events in the 1970s, 80s and very early 90s related to the safety of recipients of blood, not risks to donors.

Sterile disposable equipment is used by trained and experienced staff at blood donation clinics.

Staff and donors are advised not to attend donation sessions if they feel unwell and hence the risk of catching a cold or other infectious disease at a donation session would be expected to be less than spending time in a communal area such as a shop or restaurant.

The risk of an infection being transmitted from a donor to a recipient of blood cannot be absolutely eliminated. The risk has been reduced considerably since the 1970s and 1980s.

Risk reduction starts by ensuring that transfusions are only given to patients who do not have a suitable alternative treatment and are likely to benefit from a transfusion.

All donors are extensively screened before every donation and anyone considered at risk of passing on an infection is asked to defer donating until it is safe for them to do so.

The skin is cleaned and the initial blood is diverted into a side pouch which means any residual bacteria on the skin despite cleaning do not enter the donation bag itself.

All blood donations are tested in the Welsh Blood Service’s laboratories before being sent to hospitals or used for other purposes, such as validation or quality assurance.

Blood services and blood safety have evolved considerably since 1970s.

The Welsh Blood Service provides life-saving and life-improving treatments from donated blood, stem cells, and a range of related diagnostic and therapeutic services for the people of Wales and beyond. Today, we are responsible for collecting, manufacturing and distributing up to 100,000 lifesaving blood components a year to Welsh hospitals to patients who rely on us.

The Welsh Blood Service (WBS) collects voluntary, non-remunerated whole blood and blood component donations from the general public and provides blood components along with advice and guidance regarding their appropriate use to Wales’ Health Boards.

Donations are processed and tested at the laboratories based in the Welsh Blood Service headquarters in Talbot Green, Llantrisant, before distribution to 18 customer hospitals throughout Wales. We have a Stock Holding Unit and staff base in Wrexham, north Wales and also have staff based in Bangor, north Wales and Dafen, west Wales.

The Welsh Blood Service laboratories include a laboratory that undertakes testing during pregnancy, and a reference centre for matching of blood for transfusion if a hospital laboratory cannot find matched blood for a specific patient.

We support the solid organ and stem cell transplant programmes that run out of Cardiff and Vale University Health Board and manage the Welsh Bone Marrow Donor Registry, which provides haematopoietic stem cell products from volunteer donors nationally and internationally. The Welsh Blood Service also provides the UK National External Quality Assurance Scheme for Histocompatibility and Immunogenetics (NEQAS) an international quality assessment service supporting the provision of compatible organ and bone marrow transplants.

The Welsh Blood Service is an operating division of Velindre University NHS Trust. Learn more about the work of Velindre University NHS Trust.

The Welsh Blood Service is regulated by more than one external agency. Services related to insurmountable testing and transfusion are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the UK Accreditation Service (UKAS). Transplant services are regulated by the Human Tissue Authority and UKAS.

The Welsh Blood Service is a national operational division of Velindre University NHS Trust. The Trust Board are responsible for the oversight of quality, safety and regulatory compliance in the organisation. The Board’s Quality Safety and Performance Committee considers these matters bi-monthly to provide assurance to the Trust Board. As part of this assurance, the results of regular donor satisfaction surveys are also reported to Trust Board and the Committee.

Internally, the Trust has a number of assurance systems, including a system of clinical governance, a Quality Management System (‘QMS’), an audit programme and risk management system. We also report voluntarily to a UK haemovigilance programme, the Serious Hazards of Transfusion (SHOT) – one of the most developed, and oldest haemovigilence systems in the world.

We also undertake Welsh benchmarking of prudent use of blood and blood products in supporting patients through the Blood Health National Oversight Group.

The Welsh Blood Service runs a 24-hour Consultant on call system across the country which can be accessed by any individuals in hospitals needing urgent (or other) clinical and/or laboratory advice relating to transfusion. Our Hospital Services departments are available to provide advice to hospital laboratories around the clock and will refer individuals or problems to the Consultants on call too, where appropriate.

We are frequently the first implementers of new measures aimed at assessing risk and providing assurance, such as FAIR (For Assessment of Individualised Risk).

The UK has some of the most internationally accessed guidelines in the world. UK guidance is also referenced in peer reviewed journals and applied in Wales.

Click here to find all the relevant information about donating blood in Wales.

We answer frequently asked questions, you can watch videos that help you visualise what happens at the clinic and much more.

Not everyone is able to give blood. To make sure the blood we give to patients is safe, we ask all donors to complete an extensive safety check questionnaire before every donation.

For safety reasons, we ask some donors never to donate, and some to wait a short while before coming back to donate. Find out more by clicking here.

For example, as a precautionary measure to reduce the risk of transmitting Variant Creutzfeldt Jakob Disease (vCJD), people who have received a blood transfusion since 1980 are not currently able to donate blood.

Blood is manufactured into specific components each with a specific storage requirement and shelf life:

• Red cells can last 35 days. They carry oxygen and are used to treat anaemia. A small number of donations of rare blood are stored frozen for up to 10 years, after testing, in case they are needed for complicated patients in the UK or internationally.
• Platelets can last 7 days and enable blood to clot swiftly at a bleeding site.
• Plasma and a blood component derived from it called cryoprecipitate can last 3 years. These components strengthen clots, thereby reducing bleeding.

We screen blood and blood components for various infections. Some screening procedures are applied to all donations, some only to new donors and some are ‘discretionary’ and used only when indicated by risk factors identified when health screening the donor, for example travel risks.

Before they give blood, donors are required to complete a health check – The Self -Administered Health History. This health check consists of a comprehensive questionnaire about medical history and lifestyle and enables us to assess whether it is safe for the donor to give blood but also that the donation is safe for recipients to receive.

Donors are asked to read our Before You Donate booklet so they understand the importance of accurately answering the health check questionnaire.

Donor and patient safety is at the heart of everything we do. The donations are also tested for infections to help ensure that each donation is as safe as possible to transfuse to patients.

We need to ensure the blood supply in Wales is safe. Each donation is tested to find out the donor’s blood group and compared against previous records if the donor has donated before.

Before they are released into the supply chain, all donations are routinely tested for hepatitis B, hepatitis C, hepatitis E, human immunodeficiency virus (HIV), syphilis and human T-lymphotropic virus (HTLV).

In some cases supplementary tests area also carried out before the blood is issued to hospitals.

The tests play a very important role in ensuring that we provide a safe blood supply to patients. We test donors for their blood type so we can select the matched blood for the patient. We also test for infections that can be passed from donor to patient via a blood transfusion.

If any blood donation tests positive for infection, it is not released and therefore cannot be issued to a patient. The donor is also contacted and given support and advice, as appropriate.

Click here to find out more about the tests we carry out on donated blood.

Donors are advised to report any illness they develop following donation. The information they provide is used to assess any potential risk of infection in their blood donation. Any blood components at risk are recalled and discarded to ensure a safe blood supply.

Blood donations are taken by our transport team directly to our blood testing and manufacturing centre in Talbot Green, Llantrisant. The sorting, recording, testing and storage of blood all takes place in our modern laboratory using the latest technology. Modern safety standards are very rigorous and follow strict guidelines.

Once all the testing is complete and passed, each pack of blood can be labelled and placed into controlled storage, ready to be sent to hospitals. Any blood donation that is reactive on testing for markers of infection is taken out of the supply chain and, if confirmed, the donor is contacted with advice and support.

The quality and efficiency of this service is very important to us, and we are regularly inspected by independent regulators to ensure we maintain our high standards.

Blood safety standards for all UK blood services, including the Welsh Blood Service, are determined by the Joint Professional Advisory Committee for the UK Blood Transfusion and Tissue Transplantation Services (JPAC) based on requirements from the regulators and advice from other external groups such as the UK Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO).

The criteria to determine what risk an infectious disease poses to patient safety include:

• whether the infectious disease is known to (or could potentially) be transmitted by blood transfusion
• how common the disease is in our population
• how severely the infection can affect patients

We look at all the evidence and current research to work out the risk and how we should manage it. Sometimes risk factors change. When they do, we update our rules. The quality and efficiency of our testing is very important to us, and we are regularly inspected by independent regulators to ensure we maintain our high standards.

We can provide all the red blood cells, fresh frozen plasma, and platelets required by the NHS. The 4 UK nations have a mutual aid system where we usually supply the needs of patients from donors within the same UK nation but on occasion if it is in the best interests of the patient we may transfer blood between UK nations.

We do not import blood components from outside the UK though there is an international system for supplying blood for rare patients for whom there are only a small number of suitably matched packs in the world should it be required.

The NHS does import plasma derived medicines such as immunoglobulin. Plasma from UK donors has not been used to manufacture plasma derived medicines since 1999 as a precaution against any potential risk of variant CJD transmission. In 2020 the UK government allowed plasma from UK donors to again be used to manufacture Immunoglobulin as surveillance demonstrated a low risk in the UK.

Donations are not released unless all tests are negative.

Any blood donation that reacts in our initial tests is not used. Further tests are carried out to confirm whether the result indicates a true infection.

All donations are initially tested using a high throughput system, any donation that is reactive in these tests is removed from the blood supply and additional testing carried out to confirm whether the donor is positive for the reactive marker of infection.

If a donor is found to be positive for a screened infection, we notify the donor and carry out a post-donation discussion where we explain the results, ask about any risk factors and advise regarding any further treatment or follow-up required. There will also be communication with the donor’s GP if this is consented to. In most cases the donor will be suspended and a note made on their donor record so that they cannot donate – either permanently or within a set period of time, depending on the infection or other issue.

Positive tests for infection are most commonly found in new donors who have not donated before. Rarely a donor who has donated before with negative tests is found to be positive on return. Previous donations can be traced and recalled if this occurs.

The Welsh Blood Service has obligations to make notifications of specific infectious diseases to Public Health Wales. These are known as notifiable infections and include hepatitis B, C and E. Donors with notifiable infections will be reported to the local health protection team who will ensure that any public health actions for household and other contacts are carried out. We also have procedures for sharing information, where indicated, with other healthcare professionals such as GPs. Infections in donors are also reported by the four nations to the UK Health Security Agency (UKHSA) who monitor trends.

Any blood sample can give a reaction in laboratory screening tests, which on further testing proves to be non-specific. Non-specific reactivity can be found in all biological tests.

Whenever we obtain a reactive screen result we carry out additional testing to determine whether the reactivity is non-specific or true reactivity due to infection.

Non-specific reactivity is of absolutely no significance for the health of the donor, but unfortunately may affect the eligibility of some individuals to donate: if blood samples show such reactivity it may not be possible to use the blood. Even if you’ve given blood before without any issues, we can sometimes see unusual results in our tests. If this happens to you, you will be informed.

Click here to find data on the numbers of infected donations which are compiled annually in the Safe Supplied joint NHSBT/UKHSA Epidemiology report.

In the case of actual transmissions, these are reported to Serious Hazards Of Transfusion (SHOT) haemovigilance scheme, collated across the UK and detailed in the annual SHOT report.

Compared to other everyday risks, the likelihood of getting an infection from a blood transfusion is very low. Blood donations are screened for several infections which can be transmitted through blood, but it is not practical or possible to screen for all infections, therefore, there will always be a small risk associated with having a blood transfusion.

When you have a transfusion, your team in hospital will explain the risks to you as part of their consent process. Please ask them if you have questions relating to your care.

As set out above, donor selection criteria together with testing form the basis of blood safety. All blood donors are unpaid volunteers and the risk of an infected unit entering the UK blood supply continues to decrease. The current risk of an infectious donation entering the UK blood supply due to a recently acquired infection is now less than 1 in 1 million donations for hepatitis B, less than 1 in 20 million for HIV and hepatitis C.

Since 1996 the Serious Hazards of Transfusions heamovigilance scheme (SHOT) has been collecting and analysing anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the UK. Where risks and problems are identified, SHOT produces recommendations to improve patient safety. The recommendations are put into its annual report which is then circulated to all the relevant organisations including the four UK Blood Services, the Departments of Health in England, Wales, Scotland and Northern Ireland and all the relevant professional bodies as well as circulating it to all of the reporting hospitals.

In respect of transfusion-transmitted infections, SHOT is supported by the joint NHSBT/UKHSA Epidemiology Unit which monitors infections nationally.

As seen with COVID, today scientists and doctors are much more aware of emerging infections and tests and vaccines are rapidly developed and implemented. Blood services collaborate internationally and learn from each other.

In the UK we can rapidly develop and implement policy changes. Furthermore, the Welsh Blood Service is managed and led across Wales, we are a national organisation with consistent policies and processes, we have coordinated communications with hospitals and consistent education programmes.

We have guidelines and advice from expert committees and bodies, such as the Blood Health National Oversight Group in Wales (BHNOG), the Joint Professional Advisory Committee for the UK Blood and Tissue Transplantation Services (JPAC) and the Safety of Blood Tissues and Organs (SaBTO) advisory committee for the UK Government’s Department of Health. These, in addition to the assurance mechanisms, such as audits, inspections and external reporting, check that processes are working as we think they are and provide us with external scrutiny of our work.

As a system, we have surveillance in place with both the UK Health Security Agency and SHOT, to horizon scan for emerging infections and to monitor infections in donors and patients. The governance of the system is therefore strong both within the Welsh Blood Service and with external oversight.

Click to read about receiving a blood transfusion.

It will take you to a leaflet developed jointly by the four national Blood Services. A blood transfusion may be given because of a shortage of red blood cells in the blood, either because the body is not making enough of them, or by loss of blood.

Intraoperative cell salvage is widely available. Any blood lost in surgery is recycled during the operation or shortly afterwards. If you are undergoing an operation where a transfusion may be likely you can ask about cell salvage. Donating blood in advance of an operation, known as Pre-deposit Autologous Donation (PAD), is not routinely available in the UK.

In rare cases of unusual antibody formation where compatible blood is not available, PAD may be considered, but it can only be carried out in premises specially licensed by the Medicines and Healthcare products Regulatory Agency (MHRA).

If you are interested in finding out more about blood transfusion:

Click to find information about transfusion on the Blood Health National Oversight Group pages.

Click here to read the Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee’s transfusion information for patients.

We understand that the publication of the Infected Blood Inquiry’s report and its findings may raise public concerns or may remind members of the public about blood transfusions they may have received in the past.

We want to reassure you that all blood donations collected in Wales will have been tested for:

• HIV from October 1985.
• Hepatitis C in Wales from September 1991.

Any blood testing positive for these infections will not have been available for transfusion.

If you are concerned about being infected following a blood transfusion before September 1991, you can access a free and confidential test for Hepatitis C and HIV from Public Health Wales here. The risk of having acquired an infection is very low.

Click here check the symptoms for Hepatitis C and HIV on the NHS Wales symptom checkers web pages.

Click here for further information from Public Health Wales about Hepatitis C.

The Wales Infected Blood Support Scheme (WIBSS) was established to provide support to people who have been infected with Hepatitis C and/or HIV as a result of NHS treatment with blood in Wales.

It aims to provide both a streamlined financial payment service, a Welfare Advice Service and a Psychology and Well-being service for Welsh beneficiaries and their families.

England, Northern Ireland, Scotland and Wales run their own individual registered schemes.

In Wales, anyone who was administered with infected transfusion in a Welsh hospital, regardless of current residence, can apply to be on the Wales Infected Blood Support Scheme.

To be registered on a scheme, you will have:

1. To complete an application form which you can find on the WIBSS website;
2. To have had the application endorsed by a medical professional;
3. To have demonstrated evidence of a transfusion delivered by the NHS in Wales prior to September 1991;
4. To provide evidence of Hepatitis C and / or HIV infection.

If you think you may be eligible to apply for support, please contact the team on 02921 500 900 or email wibss@wales.nhs.uk

Some residents in Wales may have been treated in healthcare settings in England. If you were treated in England you can apply to the England scheme.

Further information about the England Infected Blood Support Scheme and how to get in touch with the team here.

Click here to find out more about the Northern Ireland scheme.

Click here to find out more about the Scotland scheme.

The UK Government is establishing a single Infected Blood Compensation Scheme to oversee all relevant compensation claims for England, Northern Ireland, Scotland and Wales.

On 21 May, the UK Government updated information on the new Infected Blood Compensation Authority which is available via this link that will take you to a new website.

As the work to establish the single scheme progresses, the Wales Infected Blood Support Scheme will continue to manage the service and is there to support you. Please click here to follow the WIBSS website for further updates.

The Infected Blood Inquiry is also funding a confidential support service for anyone affected by treatment with infected blood or blood products. This is run by a team from the British Red Cross who have been working with the Inquiry since September 2018.

You can contact the confidential support service directly by calling 0800 458 9473 or 0203 417 0280 at these times:

· Monday between 11am and 1pm
· Wednesday between 7pm and 9pm
· Friday between 2pm and 4pm