NATIONAL COMMISSIONING GROUP (NCG) FOR BLOOD. Minutes of the NCG Meeting held on Friday 20 July 2012 at Department of Health:

Transcription

1 NATIONAL COMMISSIONING GROUP (NCG) FOR BLOOD Minutes of the NCG Meeting held on Friday 20 July 2012 at Department of Health: Room 107D Skipton House, 80 London Road, London SE1 6LH and Room 5C12, Quarry House, Quarry Hill, Leeds, LS2 7UE Present: DH Dr Rowena Jecock (Chair) Julie Robinson Teresa Allen Rob Bradburn Mick Burton Gerry Gogarty Dr Clive Ronaldson Dr Lorna Williamson Laura Abel Rob Coster NHS Jackie Atmore Dr Charles Baker Stephen Bassey Professor Mark Bellamy Rupert Eggington Blood Safety and Supply Policy Team ALB Finance (via video link) Assistant Director, Customer Services Finance Director Divisional Finance Director, Blood & Specialist Services Assistant Director, Business Development & Strategy Director of Patient Services Medical & Research Director Governance and Assurance Manager (minutes) National Commissioning Manager (observer) Divisional Finance Manager, Great Ormond Street Hospital for Children NHS Trust Consultant Anaesthetist University Hospital of North Staffordshire Blood Transfusion & Haematology Laboratory Manager, Royal Cornwall Hospitals Trust Professor of Critical Care and Anaesthesia, St James's University Hospital, Leeds (via video link) Finance Director, East Kent Hospitals 1 Welcome and apologies 1.1 Dr Jecock opened the meeting and welcomed attendees, in particular new member, Stephen Bassey, together with Laura Abel and Rob Coster from. She explained that Professor Bellamy would be joining the meeting via the video link at Leeds. 1.2 Apologies had been received from Dr Mark Cook, Dr Jacqueline Cornish, Kay Ellis, Dr Matthew Streetly and Prof. Adrian Newland. 1

2 1.3 The Chair noted the revised membership of the Group: Chris Calkin and Stephan Bates had retired, Dr Tim Littlewood and Robert Elshaw had stepped down and Stephen Bassey and Dr Matthew Streetly have joined the Group. 2 Minutes of the meeting held on 4 November 2011 NCG-B 2012 mins 2.1 The minutes of the previous meeting were agreed. 2.2 Action at The Chair noted that the action was outstanding. It was agreed that the minutes would be agreed off-line and published on the website in a timely manner. Action: DH DH to prepare the minutes for publication, in consultation with the NCG. 2.3 Action at 2.4 s information about price comparisons with other countries had been circulated with the minutes. confirmed that they were happy to clarify any points with members. continued that more information had been gathered and that an update paper would be presented to the November meeting. The Chair reminded the Group that this paper was currently confidential and not for wider circulation at this time. Action: to provide updated briefing on International Price Comparisons to the November meeting of the NCG. 2.4 Action at 4.6 DH had circulated SaBTO s position statement on CMV to members. 2.5 Action at 5.4 The Audit report about the pattern of use of cryoprecipitate had been circulated. SaBTO could not recommend the use of Fibrinogen for treatment that is was not licensed for. It was DH s understanding that the MHRA had spoken to the manufacturers to encourage them to apply for a wider licence but they had not done so at the present time. 3 Update from NCG Finance sub-group meeting on 21 June summarised the output from the meeting: a challenge that a flat pricing target is not ambitious versus the tariff reductions that the NHS is expected to deliver (and the 4% CIP included within) considers itself to be very aware of the pressures facing the NHS and that continuing to hold red cell prices following a real 12% reduction in prices (after inflation) since 2008/9 is recognition of this strong support for ITS with needing to do more to communicate benefits 2

3 should express its strategic intent regarding the growth in specialist services and the impact this should have in reducing prices should communicate more regarding the plans and benefits expected from Club 96 Overall support for the NCG process with recognition that was better attuned to the pressures on the NHS and more focused on productivity and efficiency than in the past. The Chair noted that it was too early to claim benefits from the Club 96 initiative, but that work would continue. She welcomed the support for the NCG and the sub-group s agreement that the process had improved. Action: to clarify and communicate the benefits of ITS. 3.2 It was agreed that although formal minutes were not required from the subgroup meeting, it would be helpful to have a briefing note following the meeting. Action: to produce briefing notes following future Finance sub-group meetings. 4 DH Update 4.1 Mechanism for setting the blood price The Chair explained that the commercial review of had recognised the efficiencies made by. She expected that a review of the NCG mechanism for setting the blood price would commence in the next few months. As part of the scoping process she invited input from customer representatives. A further update would be presented to the November NCG. Action: DH DH to update the NCG in November on the process for establishing a blood pricing mechanism. 4.2 SaBTO The following outputs from SaBTO were highlighted: SaBTO had not recommended an extension of the use of imported FFP to all adult patients (as well as children and certain adults). Evidence from the efficacy studies on prion filters was expected in the autumn and would be considered in December. There was unlikely to be an impact on blood prices in the near future. Double dose red cells for safety purposes was not recommended 3

4 4.3 All-Wales Blood Service Paper NCG-B was presented for information and noted. While work had yet to begin by Welsh colleagues, s working assumption was that existing (mostly fixed) costs would be spread over fewer units therefore increasing prices. Therefore would need to find ca 2m of additional cost savings if the price was to be maintained. It was assumed that this would impact from 2014/15. Professor Bellamy joined the meeting at this point. 4.4 Sponsorship of NBTC The Group was informed that Professor Sir Bruce Keogh had taken over sponsorship of the NBTC. It was not yet clear how NBTC would operate within the new NHS Commissioning Board structure (from April 2013). 5 Update from Patient Blood Management event on 18 June 5.1 highlighted the outcomes from the event. These included recognition of the good work done in hospitals with regard to the NBTC structure and earlier BBT initiatives. The broad agenda of BBT was noted. The approach of the PBM was to focus on the key issues raised by the clinical committee: Implement systems Use data better Provide/share examples of best practice Identify resource requirements 5.2 In response to questions from the Group, explained that the stock management pilots over the summer should clarify the impact on hospital processes and costs. added that, subject to learning form the pilots, it was anticipated that there should be a return on investment within two years for each implementation. 6 Progress report against Strategy presented the update, highlighting the following: 6.1 Blood have continued to maintain supply of red cells and platelets through the first 6 months of the year with no blood group falling below a three day stock alert level for three consecutive days. collected 87% of platelets via component donation (target 80%), and this was achieved against a continued upward trend in demand. Manufacturing productivity has risen by 69% and testing productivity by 65% since 2008/9, and puts in the top quartile for performance as measured by the European Blood Alliance benchmarking process. 4

5 Customer satisfaction remains high and is above target at 63% (i.e. % of customers marking as 9/10 or 10/10 for satisfaction). In 2011/12, donors scored overall service 69% (on the same top two box methodology). The figure for the month of March 2012 gave their highest score ever of 71%. continued to maintain good regulatory compliance during 2011/12. Only one major regulatory non-compliance was received. During 2011/12 a range of projects enhancing efficiency and capability were delivered including: implementation of an On-line Blood Ordering System (OBOS) for hospitals improved patient safety by introducing bacterial screening for platelet products and donor testing for West Nile Virus testing commencement of the development of the Integrated Transfusion Service (ITS) programme. ITS is a range of initiatives that have the potential to transform the way delivers services to and works with hospitals. This incorporates: 1. Integrated Stock Management: Working with hospitals to help them to calculate optimum stock levels and introduce systems for automatic stock replenishment. This will minimise wastage and make the supply chain more efficient. This will include up to three hospital pilots, the first of which will commence in late July Implementation of Sales and Operational Planning (S&OP) that will enable better visibility of supply chain performance and integrated planning across the end to end supply chain. 3. Transfusion Innovation: will develop their Red Cell Immunohaematology (RCI) function so that it meets the current and future needs of hospital transfusion services, and also work with hospitals to explore opportunities for greater integration of services. Looking forward, and in the short term, is also: proposing the closure of the testing activity in Colindale and consolidating it into Filton. The business case generates savings of ca 1m pa and will be submitted to the Board for a decision on 26th July. Making Patient Blood Management an important focus of its immediate work plans with particular attention on platelets completing activities, in conjunction with DH and London hospitals, in preparation for the Olympic Games. 5

6 6.2 Specialist Services Individual strategies are under development for each of the business units. Highlights of the plans include: development of an electronic reporting tool for diagnostics results, to be piloted in 2012/13. The opening of a 6th cord blood collection site. Implementation of EMDIS that allows the BBMR to integrate electronically with international registries. Managing a new national heart valve fulfilment system, together with the development of new products in Tissue Services. Ongoing work with the blood cancer charity Anthony Nolan and the other UK Health Services to implement the recommendations of the UK Stem Cell Strategic Forum. 6.3 Future Plans s Strategic Plan is focused on: Continuing to modernise the blood donation service so that continues to attract enough donors to meet the needs of NHS patients. Plans to integrate the management of hospital blood bank stocks and use this to facilitate better planning of the end-to-end blood supply chain from donor through to patient. Building on s unique skills and capabilities in tissues, stem cells, diagnostic services and apheresis based therapies to support the provision of life changing treatments to NHS patients. The new plan requires that takes a longer-term view, introduces more effective planning processes and provides more modern interfaces with both donors and the hospitals. As such, it is very different from the previous plan, which included a strong focus on consolidation and the removal of excess capacity in the blood supply chain. The new plan has much more emphasis on planning, process integration and improvement and the use of appropriate and modern IT systems to support these new capabilities. 7 Demand Planning Paper NCG-B presented its Demand Planning Paper. The key points were: Red cell demand at the end of 2011/12 was on plan with a year end out turn of 1.84m. 6

7 Red cell demand is fairly stable and expects to see little change during the current financial year when demand is expected to be 1.83m. At this stage the forecast for 2013/14 is showing a continued stable position. Platelet demand which rose steeply in the first few months of last year was 265,000 against a forecast of 268,000. In the final quarter of the year the NBTC and workplan included a number of initiatives to reduce inappropriate use and hence reduce the demand increase where possible. The platelet forecast for 2012/13 is 280,000 and the early forecast for 2014/15 is 291,000. Frozen demand increased last year to against a forecast activity of 379,000 if cryoprecipitate was included (275,000 without cryo demand). anticipate total frozen demand will be 395,000 during 2012/13 and could be as high as 400,000 in 2013/ The Group asked for more information on the breakdown of cryoprecipitate provision, to include: Use of cryoprecipitate in shock/trauma packs are major trauma centres higher users than other users? Use of double doses. Initiatives to reduce platelet use. Action: to provide breakdown/analysis of cryoprecipitate provision. 8 Review of the commissioning plan for 2012/13 and early intentions for 2013/14 NCG-B presented the update covering the following: With regard to 2011/12, a total refund of 13.4m was provided in November Year-end actual demand for products and services imply that the refund should have been lower at 12.9m but this was managed within s overall financial position. With regard to 2012/13, the key variation from plan again relates to the level of product demand. A potential rebate of 8.8m is forecast at this point, which is driven by platelet demand (currently trending c4.5% above NCG plan), cryoprecipitate demand (where there has been no material adverse impact on demand from use of the licensed fibrinogen product), plus a refund of the balance on the Red Cell Demand Reduction Reserve. 7

8 The intention of the outline plan for 2013/14 is an increase in the aggregate cost for blood components and specialist services by 0.6%, an increase of 1.9m including inflation (see Table 1), which is predominantly attributable to product and service demand changes. The plan includes delivery of a cost improvement plan of 8.2m, representing efficiency savings of c2.4%. The 2012/17 Strategic Plan target of maintaining the red cell price at or below 123 is deemed achievable at this point, but is dependant on both assumptions in relation to hospital demand and there being no further material blood safety interventions. has not envisaged any material increases in the national prices of the specialist service portfolio. However, in RCI, has seen a significant increase in out of hours referrals from hospitals, possibly as a result of de-skilling within hospital transfusion laboratories. In response to this, will undertake a short consultation/review with the intention that a new out of hours tariff is introduced for agreement in the final price list to be agreed at the November meeting. The Group welcomed this proposal on the basis that it was a sensible approach to driving appropriate behaviours within hospital laboratories. Action: to undertake a rapid review looking at the structures and requirements of hospital laboratories and the subsequent effect on resource requirements and pricing structures. 9 Contracts NCG-B proposed a non contentious contract amendment. This was accepted by the NCG. 10 AOB 10.1 noted that there was an embargo on details of the ITS pilot until the end of July Olympic Planning noted that the stock target that morning was close to plan and that all other activities were close to completion (FFP and skin). The Chair congratulated on this achievement. 8

9 ANNEX A National Commissioning Group for Blood Actions from meeting held on 20 July 2012 Minute reference Agreed Action Responsibility Completion/Review 2.2 DH to prepare the minutes for publication, in consultation with the NCG. 2.3 to provide update paper on International Price Comparisons to the November meeting of the NCG. 3.1 to clarify and communicate the benefits of ITS. 3.2 to produce briefing note following the Finance sub-group meeting. 4.1 DH to update the NCG in November on the process for establishing a blood pricing mechanism. 7.2 to provide breakdown/analysis of cryoprecipitate provision 8 to undertake a rapid review looking at the structures and requirements of hospital laboratories and the subsequent effect on resource requirements and pricing structures. DH DH To be done. Being presented at the November meeting. Ongoing. to provide update at the November meeting. Circulated in the papers for the November meeting. Agenda item at the November meeting Circulated in the papers for the November meeting. Agenda item at the November meeting. 9