Examination of Witnesses (Questions 80
- 99)
MONDAY 29 JANUARY 2001
MR NIGEL
CRISP AND
MR MARTIN
GORHAM
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.
Chairman
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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