Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 20 - 39)

MONDAY 29 JANUARY 2001

MR NIGEL CRISP AND MR MARTIN GORHAM

Mr Rendel

  20. Thank you, Chairman. May I apologise for having to be out of the room at the start, so I apologise if I ask any questions the Chairman has already asked you but I hope not. Can I start off by asking what can be done to improve the safety of the Service by trying to make sure that pathogens that we do not know about, or do not know are in the blood, dangerous pathogens, are eliminated in some way? There are a number of others you test for that you know about but there may be others that are coming out that in a few years' time we will suddenly realise are very dangerous but you have not yet got around to specifying.
  (Mr Crisp) I suppose our starting point is looking at where we take expert advice from, which is clearly the Microbiological Safety of Blood and Tissues for Transplantation Committee which is where we would be looking for people to be reviewing, I guess, the whole picture and taking a view as to what might be happening. I think that is probably what I would say. Is that answering your question though?

  21. That is where you will get advice from. What sort of advice are they giving you about how that sort of problem can be dealt with? We have seen cases in the past, have we not, where we simply have not realised that there are dangerous things around, whether Aids or whatever it is, and we have realised too late and by that time numbers of people have been infected as a result?
  (Mr Crisp) Right.

  22. What can we do to try to guard against that happening, even where we do not necessarily know yet the full details of what pathogens might be?
  (Mr Crisp) I think we get the early warning from them and we then need to pick it up both within the Blood Service but also in the discussions between the Department of Health and the NHS. I do not know if you can be more specific?
  (Mr Gorham) Yes. I think it is fair to say that the Blood Services are very much more aware of that risk now. The whole approach to safety recognises that possibility. Donor screening done very robustly probably is helpful, even in terms of unknown pathogens, it is probably helpful. Just maintaining the safety of our systems all the way through is helpful. I think the way in which risk assessments are being approached where people are thinking very seriously about the relative risks of pooling products against single donor products is important. The difficulty there is—and I am not a scientist so I am treading slightly into territory that I am quite cautious about—knowing whether by pooling something you are increasing the risk of spreading it or not. You could be diluting it I am told by my scientific colleagues.

  23. I understand that there is a company in my constituency which is interested in this business which is looking at methods of treating blood.
  (Mr Gorham) Yes.

  24. In ways which will hopefully eliminate even pathogens which are not specified yet.
  (Mr Gorham) You are talking in terms of viral inactivation?

  25. I do not know exactly the scientific detail, I am afraid.
  (Mr Gorham) Yes. There are techniques for treating some blood and some blood products and new techniques are currently being developed.

  26. Are you involved in getting that research done or are you just waiting for it to happen?
  (Mr Gorham) We are very actively interested in it and we stay in very close touch with the manufacturers and companies that are developing these techniques whilst trying to maintain proper commercial relationships. Clearly we are interested in anything that potentially can improve blood safety. I think the other thing that we have done as part of our national restructuring is to give a much stronger focus to our research and scientific community and to encourage them to work closely together; I think they are naturally inclined to. We have placed emphasis on the sort of networking that Mr Crisp was talking about in terms of making sure you are out in the broader scientific community. I think part of the answer to your question is trying to recognise potential threats at the earliest possible stage.

  27. Can I move on now to the question of donors because although I am married to one I shall risk annoying the medical fraternity by saying actually I think the donor is the important part of this. If you do not get the right donors and enough of them your whole business collapses. I think it is very, very important that we deal with donors in an appropriate way and some of the questions the Chairman has been putting to you about the appointment scheme, frankly, worry me a bit. Can you tell us what proportion of donors are currently given appointments?
  (Mr Gorham) We set ourselves a target for this year to try and get up to 20 per cent of our mobile sessions, the public sessions, that travel from place to place. Because of the difficulties we have had with the manual systems, which in some places have actually made the situation worse not better, we are not going to achieve that target, which is disappointing. But, on the other hand, if you pilot something and it is not working correctly, you do not just—

  28. What is the proportion of mobile sessions compared with the others?
  (Mr Gorham) I do not know that figure but it is certainly the majority of our donors.

  29. 20 per cent of those. In terms of the overall proportion of donors, it is really quite a small proportion?
  (Mr Gorham) We have got all of our static clinics on appointments. We have got what we call the industrial sessions, sessions which go to firms, in two of the former zones fully on appointments and we will get the third former zone fully on appointments in the course of the next year. What we are doing is getting appointment systems in where we know we can run them reliably and we are working very hard to sort out how we can get appointment systems into the mobile sessions where it is most difficult and where it is appropriate. I would reiterate the point I made to the Chairman that some donors do not want appointments. If we are going to be responsive to what the donors want we actually need to offer them the choice of dropping in without an appointment as well as offering them the choice of an appointment.

  30. Presumably there is no reason why you should not say it is appointments in the morning and anyone can drop in any time in the afternoon? So you would have one session in terms of where the mobile space is but have it both ways.
  (Mr Gorham) There are a number of options, yes.

  31. You were saying that your present system for appointments was not very robust, you could not change appointments. What efforts are you making to get that corrected?
  (Mr Gorham) Basically it goes back to having the correct IT system behind it. For reasons which I think will be understandable to the Committee, the Service concentrated on getting its core IT systems right for controlling the laboratory systems because it was so crucial to blood safety. The NBS actually inherited, I think it was, 11 different systems which were totally incapable of communicating with each other, so in its early days it put an enormous amount of effort into getting that right and it then extended that system back into the donor area but still primarily to extend blood safety. What we are now doing is two things. The first thing is we actually have three donor databases at the moment, it was based on the three old zones. So the first thing we are doing is trying to get that so it is a single database and behind that we want to put the modern technology which gives us a proper appointment system. We want that system to be able to work with our national call centre so that when a donor phones the national call centre they can then be offered an appointment or they can change an appointment. So that is the strategy we are adopting.

  32. If you get a lot of people turning up, perhaps where you have not got an appointment system, then it is quite clear that some of them are going to have to wait a very long time. Do you have any system of warning them so perhaps they can go away and do some shopping or something?
  (Mr Gorham) Yes. We do meet and greet people and we do tell them.

  33. When was that introduced?
  (Mr Gorham) We have been doing that much more actively over the last year. I spend a lot of time visiting sessions and I have actually seen quite significant changes of practice and attitude over the time I have been visiting sessions. I am not going to claim it happens every single time but it certainly happens a lot more than it used to.

  34. I do not know if it is true of other Members but certainly it is true of me that I used to have a lot more complaints about this sort of thing than I have done in the past year, I have to say, so hopefully this sort of thing is getting a bit better. One of the complaints that I had pointed out that some people will come, in an area like mine, into the centre of Newbury where you have to park your car when you come from the outlying villages, and they park their car and they have no idea how long they are going to have to park their car for. Now I understand that in some parts of the NHS if you overrun on a car parking ticket you get reimbursed but not in the Blood Service, why is that the case?
  (Mr Gorham) I think we have found that too difficult to manage. I do not think that is a good answer. In some areas we have actually refunded people where clearly we have done something unacceptable. We need to adopt a standard policy. I think your area is classically an area where an appointment system probably is appropriate. I think we have to continue to work to get that right. We have to set ourselves standards. We have to be prepared both to apologise and act appropriately where we fail to meet the standards and try to make sure it does not happen again.

  35. When somebody goes to the blood donor service and for some reason you find out there is something in their background or whatever which needs a special test before you can be sure the blood is safe, they have visited a particular country or whatever, and they have that test at that time, how quickly would you expect to get a test back?
  (Mr Gorham) We expect to get the results back quite quickly.

  36. What does "quite quickly" mean? Normally the blood donor sessions are about six months apart, are they not? You would expect to get it back before then?
  (Mr Gorham) Depending on the test we would expect to get it back in time for them to be able to know whether or not they can come to the next session.

  37. What are the longest tests?
  (Mr Gorham) I cannot think of anything that would not fall into that category. Clearly the outcome of the test might be you cannot come.

  38. Sure. So you would expect to be able to tell everyone in good time and to write to them?
  (Mr Gorham) Yes.

  39. Do you know how many people are not being told? I had one constituent who certainly was not told.
  (Mr Gorham) I am aware of an incident where somebody was not told, or it appears that somebody was not told. We have got a weakness in our system at the moment in that we cannot track back on a proper audit trail precisely what has happened there. It is not a question of there being a risk to safety but that the test result gets attached properly. I am certainly aware of one incident where it looked like somebody had forgotten to tell the donor and unfortunately our IT system does not deliver a prompt on that. There is the potential for human error and we are dealing with large numbers of people.


 
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