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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