Request

1. The outcome letter states that my application [redacted] was assessed by the medical assessors. For my specific application and outcome letter, what are the qualifications of each of the assessors involved in this decision, and, in particular, I wish to understand what hands-on surgical experience they each have?

2. In making a 'balance of probability' decision, what information (data, statistics) do the assessors have available regarding probabilities of the use of blood products in medical procedures in the specific period of 1979 and 1986?

3. Their reply states “research into the rate of transfusion for total abdominal hysterectomy is approximately 5% of cases, and for a simple mastectomy approximately 1.8% of cases”. I wish to know which research this is based on – a specific research reference and research publication date for each of these statistics please?

Response

Question 1

Hands-on surgical experience

It is not a requirement for a medical assessor to have surgical experience. Therefore, we do not hold information on whether our assessors have such experience.

Qualifications

All the Qualifications and experience of the Assessors are detailed below.

Cambridge University - King's College Hospital, London BA Cambridge Double First-Class Part I - Natural science tripos 1 & 2 First Class Part II - Pathology MBChB (Distinctions in pathology, therapeutics and medicine) Member of the Royal College of Physicians (UK) MD Cambridge Fellowship of the Royal College of Physicians (England) Chairperson of various UK and International committees giving guidance on HIV and hepatitis C related matters Professor in HIV medicine, with sub-specialism in HIV viral hepatitis co-infection. Bachelor of Arts (Cantab.) Ma MBBS frcp professor of medicine (London)
Master of Arts (Cantab.) Fellowship of the Royal College of Physicians (England) Consultant Physician in HIV/GUM

The following explains what the above abbreviations stand for:

BA – Bachelor of Arts Cantab. – abbreviation for Cambridge FRCP – Fellow of the Royal College of Physicians GUM – Genitourinary Medicine HIV – Human Immunodeficiency Virus MBBS – Bachelor of Medicine, Bachelor of Surgery MD – Doctor of Medicine

Question 2

The following is used to reach the “balance of probability”:

1. The evidence submitted to the NHSBSA by the applicant or their representative
2. Further information provided to the NHSBSA by the medical practitioner relied on by the applicant. The medical advisor will use their clinical judgment to determine how this relates to the initial information provided by the applicant or their representative.
3. Any other appropriate source of evidence based on the Medical Assessor’s clinical judgment

Each application will be initially assessed by an appropriately qualified medical professional, who will use their clinical judgment of all the information provided (outlined in points 1-3 above) to reach a decision.

If an applicant or their representative is not satisfied with the decision they can appeal to a separate appeal panel. This panel is made up of different medical advisors to those that were involved in the original decision. They go through the same process as the original panel.

The process followed in assessing the application is explained below.

Each application will be separately and independently reviewed by all three medical advisors. They will weigh the balance of probability using their clinical judgment rather than any statistical tool. Their review findings will then be discussed with each other and a medical lawyer to reach a final decision. The NHSBSA play no part in determining how that decision is reached.

For more information on how a claimant can appeal the outcome of a claim then they should follow the process outlined at the below web link:

https://www.nhsbsa.nhs.uk/who-can-join-scheme-and-how-apply/how-appeal-eibss-application-decision

Question 3

The rate of transfusion for total abdominal hysterectomy is approximately 5%: (Ng Aust N Z J Obstet Gynaecol. 1997 Nov;37(4):452-7)

For simple mastectomy approximately 1.8%: (Malik et al Ann R Coll Surg Engl. 2008 Sep; 90(6): 472–473)

The study by Al-Benna et al 2008 gives a figure of 8% but in a much smaller population than the study cited above. The study by Agrawal showed a blood transfusion rate of 3%, hence the risk of blood transfusion is low and there is no evidence of receipt of blood transfusion on this occasion.

Please note that this request and our response is published on our Freedom of Information disclosure log at:

https://opendata.nhsbsa.net/dataset/foi-01544