The Natioal Blood Service REPORT BY THE COMPTROLLER AND AUDITOR GENERAL HC 6 Sessio 2000-2001: 20 December 2000 LONDON: The Statioery Office 0.00 Ordered by the House of Commos to be prited o 18 December 2000
executive summary I this chapter Backgroud 1 Overall coclusios 3 Recommedatios 4 Backgroud 1 The Natioal Blood Authority - a special health authority of the NHS - rus the Natioal Blood Service ad is resposible for the collectio ad distributio of blood compoets i Eglad ad North Wales. The availability of blood is essetial to the NHS, ad may people owe their lives to trasfusios that were made possible by volutary doatios of blood. 2 Sice its creatio i 1993, the Natioal Blood Service has bee reorgaisig to effect the chage from a regioal to a atioal service, ad aspects of this process led to some cocers amog users ad employees. I August 1997, the Secretary of State commissioed a review of the cliical cocers raised about the Service's proposals to trasfer processig ad testig of blood from Liverpool to Machester. The report led to the dismissal of the Service's chairma ad chief executive. The Natioal Blood Service completed its trasitio to a atioal orgaisatio i April 2000. The Natioal Blood Service Was set up i 1993, ad i 1994 took over the services previously ru by idividual regioal health authorities. Is resposible for collectig, processig ad testig blood compoets ad distributig them to hospitals. The Service operates: 15 blood cetres (util April 2000 orgaised ito three zoes); The Iteratioal Blood Group Referece Laboratory; ad The Bio Products Laboratory Some 5,300 people are employed by the Natioal Blood Service. I 1998-99 it: Collected 2.4 millio volutary blood doatios from 1.9 millio people; Supplied blood for aroud 800,000 trasfusios; ad Spet 241 millio 1executive summary
3 The emergece of variat Creutzfeldt-Jakob disease has led the govermet to make two chages to the way the Service operates: It exteded the use of leucodepletio - the removal of white cells - for all blood destied for trasfusio, by 31 October 1999, to reduce the theoretical risk to recipiets of doated blood of huma to huma trasmissio of the disease. The Service reports that leucodepletio results i a oe per cet loss of doatios, ad costs 60 millio a year. It required the Bio Products Laboratory, which had used British plasma to maufacture blood products, to obtai all its plasma from o-uk sources. This has lost the Service icome of aroud 25 millio a year that it received for supplyig plasma to the laboratory. From 1999-2000, the Service has recovered that loss through prices for blood compoets charged to hospitals. Miisters have yet to decide o the future role of the Bio Products Laboratory. 4 We focused o how well the Natioal Blood Service performed ad the actio it was takig to improve its efficiecy ad effectiveess. We excluded the Bio Products Laboratory from our examiatio because of the cosideratio curretly beig give to its future. We obtaied most of the evidece for our fidigs by udertakig a cesus of blood bak heads at NHS hospitals; coductig iterviews ad examiig documets at the Natioal Blood Service ad the NHS Executive; ad commissioig a survey of the public to determie attitudes towards blood doatio. Also, i examiig safety issues, we placed reliace o the ispectio ad licesig work of the Medicies Cotrol Agecy. Overall Coclusios 5 The Natioal Blood Service has take a log time to complete the trasitio to its atioal role, although there are clear sigs that it is ow doig so. Sice its establishmet, it has had to cope with the emergece of variat Creutzfeldt Jakob disease. 6 Resposes to our cesus ad curret data o collectio of blood from doors ad delivery to hospitals idicate that the Service is performig as well as, ad i may areas better tha, it was before its establishmet as a atioal service. There were restrictios i the supply of blood to hospitals i 1998-99, ad the Service acted promptly to avoid ay repetitio i 1999-2000. There are also effective measures i place to esure that blood is safe for trasfusio. Users were broadly satisfied with the service provided ad the resposiveess of the orgaisatio. 7 Iformatio provided by the Natioal Blood Service idicates that, betwee 1995-96 ad 1998-99, the Service cut its costs by some 5.4 per cet i real terms. The Natioal Blood Service's curret performace idicators have, however, a umber of weakesses that prevet them from formig a complete ad appropriate basis for accoutability to the NHS Executive, or for the directio ad maagemet of the Service's busiess. There is scope for improvig or developig performace idicators for overall efficiecy ad for other areas of its work, such as meetig hospital demad, wastage, safety ad promotio of the optimal use of blood i hospitals. 3executive summary
Recommedatios 8 Buildig o the improvemets brought about sice the creatio of the Natioal Blood Service, particularly i supply ad safety, we idetified a umber of areas where the Service could make further chages. Our detailed coclusios are set out o pages 14, 24, 30 ad 36 our recommedatios are at paragraphs 9 to 14. O meetig hospitals' demads for blood, medical advice ad support 9 Hospitals eed medical support ad advice o trasfusio matters so that they ca put ito practice measures developed to reduce trasmissio error ad use blood more effectively. We recommed that the Service icreases further the umber of hospitals it ivolves i cliical audits to wide awareess of good practice. 10 Because the results of scietific ad medical research projects have ot routiely bee widely dissemiated, there is a risk that hospitals will ot be aware of fidigs that could improve patiet care, ad that full beefit will ot be derived from those projects. We therefore recommed that the Service uses more active ways of dissemiatig iformatio, for example through postgraduate lectures, or by publishig results o its website, to eable the fidigs to reach a wider audiece. 11 The Service employs a umber of mechaisms that aim to secure resposiveess to users. But users' complaits are ot subject to the same cetral moitorig ad cotrol as are those from doors. Without such maagemet, there is a risk that users' complaits may ot be give the priority they merit ad that remedial actio may be delayed. To esure that the Natioal Blood Service takes speedy ad appropriate actio i dealig with users' complaits, we recommed that the Service sets targets for respodig to them; ad moitors performace agaist those targets ad the actio take to deal with the cause of the complaits. O ecouragig people to give blood 4executive summary 12 The Service curretly collects sufficiet blood to meet hospital demad. But, uless it cotiues to recruit ad retai a substatial body of regular doors, there is a risk that collectios may declie. Our survey of public attitudes to doatio highlighted groups likely to doate ad approaches that might cotiue to attract ew doors. But retaiig doors is a cosiderable challege. Some factors that put doors off, such as the fear of eedles, are largely outside the Service's cotrol, although it ca ifluece other factors, such as the time it takes to give blood. We recommed that, to keep the umber of doors lapsig to a miimum, the Service (i) addresses further the factors that ihibit doatio, for example by reducig the time it takes to doate blood; ad (ii) sets more demadig door care performace targets, for example for the proportio of doors waitig loger tha 30 miutes before registratio ad screeig.
O maagig efficiecy ad performace 13 The Natioal Blood Service has improved the efficiecy of its operatios. To improve further, ad keep blood prices charged to the NHS to a miimum, the Service eeds to: examie ad harmoise best workig practices across its operatios i order to esure that it is able to operate at cosistet levels of efficiecy apply its improved procuremet practice to cover all the classes of goods ad services it uses to secure further ecoomies; ad make fuller use of its uit cost iformatio ad of ew or improved approaches by (i) comparig uit costs across the Service, ad ivestigatig differeces to idetify good practice; ad (ii) comparig its performace with that of other blood suppliers - i the other home coutries ad elsewhere - ad with other orgaisatios egaged i similar collectio, testig, or distributio activities i the public ad private sector. 14 Uless the Service has relevat performace idicators, it will lack the iformatio it eeds to idetify ad deal with aspects of its activities that require attetio. The Service's seior maagemet recogise the importace of good performace idicators, ad set up a workig group that idetified idicators relatig to door care. However, other activities ad aspects of the Service are ot at preset represeted i the performace idicators; ad there is a lack of measures of efficiecy that would provide the Board, maagers, the NHS Executive ad users with the iformatio they eed. We recommed that the Service udertakes a comprehesive review to establish which performace measures (icludig measures of efficiecy) would provide useful idicators of success or warigs of failure for the purposes of maagemet ad accoutability. This should lead to it adoptig high level idicators, with targets, supported by idicators ad targets tailored to local eeds ad circumstaces. 15 The Natioal Blood Service welcomes the broad thrust of these recommedatios, ad plas to ecompass them i the desig ad implemetatio of the ew maagemet structures ad systems, which is curretly takig place. 5executive summary