Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  80. Yes but on the other hand—and I am not saying you personally, you were not there and you can legitimately, both of you, say that—when you get it wrong it seems to all common sense and sense of normal justice that the people who made it wrong should in some way do something to compensate their victims. Do you have any such plans in mind? Are you working on any such plans?
  (Mr Crisp) Not that I am aware of.

  81. Take then the human form of Mad Cow Disease which the Chairman has already referred to. Would the same approach apply there as a result if someone was to suffer from that as a result of a blood transfusion?
  (Mr Crisp) We would go through the same set of processes, looking at investigating the reasons, at understanding responsibility, taking the appropriate steps within the appropriate contractual arrangements.

  82. To stop it happening again?
  (Mr Crisp) To stop it happening again but, also, to investigate why it happened and if there was culpability there then to take action.

  83. Are you saying the differentiation in your mind is there was no culpability in the previous case?
  (Mr Crisp) Yes.

  84. Why is that?
  (Mr Crisp) There are different cases. On the HIV cases, there was in fact compensation paid, and I think I may have misled you a moment ago in implying that there was not, if that was the question you were asking. As far as Hepatitis C, we did not pay compensation. We introduced viral screening for Hepatitis C as soon as it was available. So what those two cases show is that we have actually taken judgments on the basis of the individual considerations that we were dealing with. Any future case you would approach in the same way.

  85. Yes. Finally, and this is my last question, it comes to you again, Mr Gorham—again not trying to trap you into anything, this is a nightmarish situation—with this disease, as you say your equipment is disposable anyhow but how far can you guarantee that the risk is now eliminated for people receiving blood that you supply in relation to Mad Cow Disease, the human form?
  (Mr Gorham) I think the scientific position at the moment is that the risk is unknown. We have taken all the measures that ministers and the Department have required us to. I think Mr Crisp alluded earlier to other measures that are now being considered and they will be subject to risk assessment. The science is developing. I think the most important thing for us to do is to make sure that we are fully up to date and ready to take any further steps that are necessary.

  86. That is all you can do, take all reasonable measures. Just to be reassured about it, how far are you sure that you are at the front line of examining systems of protection at an international level?
  (Mr Gorham) Our scientists are very heavily involved in international discussions and also linked in with the scientists in wider fields and the specialists in the spongiform encephalopathy field. We are making sure that we are as up to date as it is possible to be.

  Mr Williams: Thank you.


  87. Thank you, Mr Williams. One of the Committee Members wants me to put a question to you, Mr Crisp. Is Mr Gorham's contract drawn up in such a way that if he makes as much of a mess of things as his predecessor, will he get the same compensation? Not that he is going to, it is a theoretical question.
  (Mr Crisp) I am not immediately aware of the individual contracts. The same issue applies to Mr Gorham as to any other employee. This needs to be a fair process that is gone through if his services are found to be unsatisfactory. There are contractual requirements there, as elsewhere.

  Chairman: Thank you. Mr Alan Campbell.

Mr Campbell

  88. If I can start with a question Mr Williams asked you because out of interest I want to ask a supplementary. You said that private hospitals were charged on the same basis as NHS hospitals and that amounts effectively to a handling charge. To your knowledge do private hospitals charge their patients, or should we call them customers, on the same basis?
  (Mr Gorham) To the best of my knowledge they do, but that is not a matter for us.

  89. Has any investigation been done into the cost to patients of receiving blood which presumably was given by people who believed that they were giving it to the NHS?
  (Mr Gorham) I think you have got to put that in the context of the fact that we are the only organisation allowed to collect blood for transfusion in England and, therefore, they have no alternative source of supply.

  90. Yes, but there is an issue as to whether or not they could be making a profit there.
  (Mr Gorham) I have just got a note that says the contract is that they must charge it at a cost price, which I confess I was not aware of.[4]

  91. Again, I think this is to Mr Crisp and it follows on from Mr Williams. I listened very carefully to what you said about the risk from CJD and we all agree that it is very important that everything is done to ensure as much as possible is found out and the risks are minimised. Is the Department taking advice on whether or not it is legally culpable for what has happened in the past? Are there financial reserves put aside in case there is a challenge?
  (Mr Crisp) Where we have paid compensation specifically to haemophiliacs with HIV who contracted it through blood and there was a decision taken to pay compensation there, which is currently running at about £2.5 million a year, we take every example where that is appropriate and look at it on an appropriate basis. I am not aware that at this moment we have got any that we are looking at in this way.

  92. Thank you. Mr Gorham, as a starting point for the next questions I am going to ask you to, I want to refer to what the Secretary of State said in his statement of April 1998 in which a number of issues were raised specifically. I do not think that we should perhaps have too much concern for the Chief Executive who has gone with his 200,000 plus golden handshake, but what I am interested in is what has happened as a response to that situation the Secretary of State set out in his statement. He specifically mentioned the problems of Merseyside and North Wales, but he went on to say that similar concerns were expressed over the situation in Oxford and East Anglia. I just wonder if you can tell us what has been done specifically in terms of action in those areas to restore public confidence?
  (Mr Gorham) In Liverpool and Merseyside we have spent a lot of time working with the staff up there and working with the local health services. Certainly part of the problem was a break down in confidence between the Blood Service and the local health service. We have followed up on the commitments that the Secretary of State gave to upgrade the blood centre in Liverpool and, in fact, when we did that work we found that the cost of upgrading the centre and the benefit we would get out of it, because the building had got so many difficulties, was not worth doing. What we are doing is making a proposal to replace it on a site in Speke and that case, subject to authority approval next month, will be submitted to the Department. We have give a very strong signal to both our staff and to the local health services, the local population, that we are committed to continuing the service based there. In Oxford, we have been working with the local health services and our staff locally. We are particularly wanting to develop the research aspects of Oxford, which is entirely appropriate. The centre is actually on the John Radcliffe site. We have attracted some staff with strong research interests. Again, because of the John Radcliffe's own redevelopments, we are in discussion with them as to whether the blood centre should stay precisely where it is at the moment or it should be elsewhere within the Radcliffe development. We are now working very closely with the trust and they are very interested in the research activities we are involved in. East Anglia is essentially now operating as a specialist centre offering specialist diagnostic services both locally and to other parts of the country and, again, has a very strong research base with the local hospital and the university and that seems to be moving forward well. It links in very well with the other centres in supporting them with very strong science.

  93. The Secretary of State went on to list a number of very specific and very serious findings. One was that there had been, in his view, a failure of management and that the NBA's headquarters was, in his words, "detached from operational reality", which is extremely worrying. What was done specifically to address that issue?
  (Mr Gorham) The restructuring of the Service that has been carried through since I joined has really changed the relationship between the headquarters and the rest of the Service and, in fact, has actually physically dispersed the headquarters because not all of the national directors are based there now. All the senior staff spend a lot of their time out in the Service and, where appropriate, working with hospitals. I think the structure actually has the operational bucks stopping with the directors and we feel very connected with the Service. I do not think I in any way feel disconnected from the Service now.

  94. Something else that was said was that the Chairman of the Board at that time had either been "misinformed" or had "misunderstood" at the briefings that he was given. I understand that he is no longer there but did that problem disappear with the then Chairman of the Board and has something been done specifically to address that issue?
  (Mr Gorham) I think the current Chairman is extremely well informed. He, again, spends time out in the Service himself, he is not just a Watford fixture, he makes an enormous effort to keep himself fully briefed. I find that very helpful in working with him. He is particularly active in the donor area, which seems very appropriate for the Chairman. No, I do not think there is any question of that at all.

  95. I think the next question is for Mr Crisp which follows on. There were criticisms of the Department of Health for monitoring the performance of the Blood Service. What has been done specifically to tighten up on that?
  (Mr Crisp) Right. I think there are two things there. We now actually have a very formal review system, a very formal accountability review, which covers the whole range of issues which have been raised in terms of performance and in terms of the business plan. A new business plan was developed, a new strategic direction and a whole set of new pieces of material against which we were able to monitor were brought into effect. I think something which it will be worth mentioning here at this point is that there has been an intention on the part of the Blood Service, and of the NHS to get closer together, to work much more closely together. So, for example, Mr Gorham has been attending meetings of Chief Executives and so on within the NHS. There is not only a better formal mechanism for holding to account, there is better informal communication and I think a better culture of the Blood Service being part of the big picture rather than something, to use Mr Gorham's expression, that simply operates in Watford.

  96. Mr Gorham, page 28, paragraph 3.13 and figure 9 shows that there has been a rising number of complaints but as a proportion of the number of donors it has been falling in the late 1990s. Are there any more recent figures you can give the Committee or are they the latest?
  (Mr Gorham) I have some figures for the end of September last year. We had received 3,168 complaints, which is a ratio of one to 442. I am pleased to say we have significantly improved our performance on acknowledgement, we are up to 94 per cent. We have held our performance on clearing answers at 80 per cent, and clearly that is a figure I now want to see improved.

  97. Am I right in thinking the ratio of complaints to donors had actually gone up at the beginning of last year? Did you say it was one to 442?
  (Mr Gorham) Yes, so we are back to the level shown in 1998-99 rather than the level where it had peaked in 1999-2000.

  98. Should we read anything into that?
  (Mr Gorham) I think there were two reasons potentially why we had a particularly high level of donor complaint in 1999-2000. I think when we ran the initial television campaigns certainly we experienced very significant waiting times at some of our sessions and donors quite rightly complained about that. I think that actually spun off into some attitude problems with the teams as well, they were under a lot of pressures. I think we have gone some way to handling both those situations better. We are actually trying to make the complaints system more receptive to donors. I would actually expect to see it more likely to go up than come down because we are going to make it easier for donors to complain because it is an important source of feedback on the Service.

  99. When will you meet the 20 day deadline for dealing with complaints?
  (Mr Gorham) I honestly do not know yet. I will be discussing—

4   Note: See Evidence, Appendix 2, page 19 (PAC 2000-01/157). Back

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