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Lord Peyton of Yeovil: My Lords, far be it from me to say anything except "thank you". I have always regarded it as total rashness for anybody moving a Motion of this kind to reply at the end. I have no intention of doing so. I am grateful to all those who took part. I beg leave to withdraw the Motion.
The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, with the leave of the House, I should like to repeat a Statement being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:
"Last summer I received representations from local MPs and local doctors against the transfer of bulk processing and testing of blood from Liverpool. This had been approved by the previous government. It was planned to complete the transfer by 19th September 1997. Having looked into what was happening, I decided to appoint Professor John Cash, then President of the Royal College of Physicians of Edinburgh and former Director of the Scottish National Blood Transfusion Service, to conduct an
"On 9th September Professor Cash submitted to me an urgent interim report confirming that there had been a serious breakdown of trust between the National Blood Authority and many local people and clinicians in Liverpool. He also advised that the rationale of the original decision to move the service from Liverpool remained unproven but that the rundown of the Liverpool centre had gone so far that for reasons of patient safety it should go ahead. He recommended that an independent user group should be set up to monitor the service and that a new leader be appointed for the Liverpool Blood Centre. I accepted all these interim recommendations while bitterly regretting that the original transfer decision had gone so far that it was unsafe to stop it.
"Professor Cash submitted a draft final report which was passed to the National Blood Authority for comment. Points made by the NBA were considered by Professor Cash before he submitted his final report to me. Today I am publishing his final report. This presents a damning indictment of the NBA's treatment of the Liverpool Blood Centre and the clinicians it serves.
"Professor Cash concluded that: over the past three years the Blood Transfusion Service based in Liverpool had been very severely damaged; the position at the centre remained far from satisfactory and that it would continue to underperform unless further action is taken; there was a serious and widespread loss of confidence in the National Blood Authority by Merseyside and North Wales clinicians, hospital blood bank medical and laboratory scientific officers and the general public.
"In the light of what he discovered in Liverpool, Professor Cash extended his review to consider certain aspects of the general performance of the National Blood Authority. He concluded: many of the concerns that had emerged in Merseyside and North Wales were also evident in Oxford and East Anglia. A number of issues of wider concern about the overall management of the blood service applied across the country. All the evidence pointed to a conclusion that the NBA was failing to maintain appropriate operational connections with many of its management teams. The Chairman of the board had often, perhaps perforce, been too close to the day-to-day operational aspects of the NBS and on occasions appeared to have been either misinformed or misunderstood briefing he received. There appeared to be a disturbing degree of isolation of NBA headquarters from operational realities. Instructions had been inappropriately researched and not subject to effective consultation. The National Blood Service has been exposed, since 1995, to a central management structure and a command and control culture that seemed to have insufficient regard for the views of customers, staff and the interface between the patient and the service. Professor Cash also drew attention to shortcomings
"Having considered Professor Cash's report and other representations about the performance of the NBA, I called in Sir Colin Walker, the Chairman of the National Blood Authority, to say that I was concerned about the overall performance of the authority, and that, as a general principle, I believed that those at the top of an organisation had to take responsibility. I explained that in view of the extra difficulties which the blood service is likely to face, I was not confident, in the light of past performance, that it was in the interests of the NHS for him to remain in the chair of the NBA.
"Discussions have subsequently taken place between my officials and solicitors acting on behalf of Sir Colin Walker. He has refused to resign. So today I have dismissed him. I have appointed in his place, Mr. Mike Fogden, the Chief Executive of the Employment Service under the previous government. Mr. Fogden's appointment was carried out with the agreement of Sir Len Peach, Commissioner for Public Appointments.
"Professor Cash makes a series of recommendations about the future of the blood service in Liverpool. While pointing out potential risks to patients, he does not rule out reversing all or some of the transfer of services to Manchester. He recommends that the performance be monitored closely and the position reviewed after one year's operation.
"He strongly recommends that in the meantime an action plan should be developed by the blood service, the north west region of the NHS and Liverpool University Medical School to upgrade the services in Liverpool by such measures as considering the establishment of a regional stem cell service and a regional tissue bank, arrangements for specialist registrar training in haematology and transfusion medicine and reviewing the development of the zonal reagent unit. The centre should be upgraded physically, new management arrangements put in place, more effort put into attracting and retaining top quality staff, better consultative services for doctors in the area and a drive to recruit more donors.
"I want to reassure the people of Merseyside today that the safety and supply of their blood services is now and will continue to be maintained at a high level. I have already appointed a transition director, Professor Bellingham, who is working to ensure that confidence in the centre is built up again and he established an independent clinical user group. I said in September that I wanted to maintain and improve blood services for Merseyside and that remains my goal.
"I accept all Professors Cash's recommendations. The new chairman's first task will be to implement these recommendations, and consider urgently the broader changes which are clearly needed in the National Blood Authority. The staff of the blood
Earl Howe: My Lords, the House will be grateful to the Minister for repeating the Statement on this important matter. From these Benches we view with concern the criticisms of the National Blood Authority which have been voiced by Professor Cash. We accept the decision of the Secretary of State, which he no doubt took with regret, to dismiss the chairman of the authority and we very much welcome the choice of Mr. Mike Fogden as his replacement.
Does the Minister agree with me that the most important consideration in the Government's plan of action for the NBA is that the confidence of patients, of clinicians and of donors in the performance of the service on Merseyside and in North Wales must be restored as quickly as possible? If she does agree with that, will she, for the record, make it absolutely clear that, whatever the shortcomings of management in the north west and at national headquarters, the safety both of blood supplies and of patients is not in question?
The Statement cites a warning by Professor Cash of potential risks to patients and the possibility of reversing all or some of the transfer of services to Manchester. Again, can the Minister reassure the House that the potential risks referred to in that passage relate to the hypothetical situation of a policy reversal and that, as Professor Cash says explicitly in paragraph 4.4 of his review:
Running through the Statement, there is a mild undertone of criticism, suggested rather than explicit, of the decision taken by the last government to restructure the National Blood Service. Will the Minister dispel that impression, which I may be alone in having, and confirm the Government's support for the rationale of the restructuring which has taken place, particularly in the way that it has enabled the NBA to establish a more co-ordinated service across the country as a whole--a common IT system, better inventory control and a more secure system of clinical support to hospitals--and a range of other improvements to what was previously a disjointed and regionally focused system?
Looking specifically at the north-west and the decision to transfer bulk processing and testing to Manchester, it is noteworthy that Professor Cash says only that the rationale of that change remains unproven. For all the problems that have been exposed, problems which stem principally from staff shortages and a lack of investment in Liverpool, he does not condemn the underlying policy decision.
I believe that our National Blood Service is one of the best such services in the world. To the extent that public confidence in the NBA has suffered, as it clearly has, in the north-west, it is vital that the new management should take steps expeditiously to restore that confidence. We wish Mr. Fogden every success in steering through the necessary corrective measures during the transition period in conjunction with Professor Bellingham and in his stewardship of the NBA over the longer term.
Lord Taverne: My Lords, I have only one question to ask the noble Baroness. As the reorganisation of 1995 seems to have been mainly driven by the desire to cut costs but seems to have led to a lower quality of service and a higher degree of costs, can she assure us that this new reorganisation, while recognising the importance of costs, will be mainly driven by the needs of service?
Baroness Jay of Paddington: My Lords, I am grateful to both noble Lords who have spoken. I confirm the point made by the noble Earl, Lord Howe, that the Secretary of State acted with some regret today because he had, as I repeated in the Statement, invited the previous chairman of the NBA to resign a little while ago. That invitation had not been accepted and this was the only course of action left to him.
It is true that our blood service remains among the very best in the world. I can certainly confirm that we have confidence in the safety and efficacy of the blood supply in the north west and throughout the country. Our concern has been precisely as both noble Lords reflected in their comments; namely, the management and organisation of the authority since 1995.
I disagree slightly with the noble Lord, Lord Taverne. There has been progress in the past few years in the organisation. The present Government affirm that the national structure has the advantages to which the noble Earl referred; for example, in terms of the national IT system and a structure which is not entirely
I can confirm to the noble Lord, Lord Taverne, that quality of service is paramount in how we want to see the blood service develop from now on. The consistent position in all of our policies on developing the National Health Service has been to lay the emphasis on quality outcomes of service as well as successful financial outcomes. That is very much in our minds.
The noble Earl referred to the details of the organisation of the blood supply in the north-west and the review of the change made last autumn. It is of course not a year from now that that will be reviewed but a year from when that change was made--that is, in September--so there is not really quite so long to wait. One of the things that the new chairman will need to address expeditiously is the assessment that he will want to make with Professor Bellingham about what has happened in the past few months in Merseyside and North Wales and whether he is confident, particularly in consultation with the users' group that Professor Bellingham has established, that the service is of the quality that everyone there needs.
I would just re-emphasise that the Government agree with Professor Cash's report where it says that the National Blood Service has made significant and laudable progress in recent years. We have been concerned, which is why the Secretary of State felt compelled to take the decision that he did today, about particular aspects of the reorganisation, which started with concerns in the north-west and then, unfortunately, became much wider. However, we very much want to pay tribute to the work that has been done by those in the National Blood Service and to those donors who have provided the basic wherewithal for maintaining the very good service that we continue to have in this country.
Lord Winston: My Lords, I have always been under the impression that our blood service is one of the best in the world when compared with many of the countries in the sophisticated parts of Europe and in the continent of North America. I am sure that is still so. Given the difficulty of getting blood products, can she say what current concerns are as regards getting blood from one region to another in the areas where there are sometimes acute shortages?
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