Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 140 - 159)



  140. In fact you have redeemed yourself, Case Study 3 shows that plans are now in being and the problems that you had towards the end of last year regarding the fuel shortage, your contingency plans, would have worked. Are you confident that any plans you have for the future would work as smoothly as that? Can you foresee any problems that might occur?
  (Mr Gorham) It would be a very brave man that would say that. I am confident that we have put a lot of work into getting our contingency plans up to a very high standard. I am confident that we will continue to review them against any new potential threats that might occur.

  141. Are you confidant that supplies of blood will continually get through to hospitals regardless?
  (Mr Gorham) We will do everything in our power to maintain that situation.

  142. Good. Going back to paragraph 2.15 and 2.16, we are told here that almost half the trusts that you supply experienced inaccurate deliveries in 1998. What action have you taken to ensure that when you receive an order it is actually interpreted?
  (Mr Gorham) I should just say, in part this is where we were supplying an alternative rather than precisely what the trust asked for. I think we have improved our ordering arrangements. The fact that we have adequate supplies means that we are much more often in the position and we would expect to be in the position where we can supply anything we are asked for. The way we manage our stock helps us with that. One of the old zones piloted a hospital liaison function, which was a much more customer-orientated relationship with the hospitals they served, we have now extended that into a national function. We are paying a lot of attention to getting relationships with hospitals right, that is both medical and other staff involved in that. It is a single Service.

  143. What you are saying is that mistakes will not happen again? Mistakes should not happen again. A mistake like that could be fatal.
  (Mr Gorham) That is the point I am trying to make. We did not supply components that were unsafe for patients. We were either not able to supply the amount that was asked for or precisely what was asked for at the time it was asked for or we offered an alternative. Our systems are very critical of what is going on, they identify every time we cannot provide precisely what we are asked for and precisely when we are asked for it.

  144. 2.16, again, although the record of delivery is pretty good, there is not a lot to complain about, you do get some instances where hospitals have found the need to complain. What are you doing to get rid of those complaints from hospitals and trusts?
  (Mr Gorham) I refer to the hospital liaison function, which is designed to make sure that we fully understand what hospitals are looking for from us. We are reviewing our delivery arrangements over the next 12 months to see if there are improvements we can make. We are continuing to work on that. Basically, we want to get as near to zero complaints as we can possibly reach.

  Mr Steinberg: What interested me was it says, "In the Northern Zone there were 15 complaints".

  Mr Love: That includes Durham.

Mr Steinberg

  145. That is what I was wondering. Fourteen of these were from the same centre. What were the complaints about?
  (Mr Gorham) It was actually at Liverpool. It was largely related to some specific problems we had over bank holiday cover, which we have now sorted out.

  146. Good. Can I come on to something which has not been covered at all, that is page 38, paragraph 5.7—I am possibly not the best person to bring this up. I was a little perturbed to read this particular paragraph. I understand the background of the position, but it seems to me that very little priority has been given to try and come to some sort of agreement with the work force, presumably the unions. It does seem to me to be a little bit complacent in the sort of response that is in the report. It says, "In 1997, the National Blood Service opened negotiations with staff to vary the national conditions, but proposals were rejected in March 1999." It took two years for them to reject the proposals. Then, "The Service intends to reopen negotiations". Nothing has happened in four years. In that particular time efficiency savings are not being met or being made, why is that?
  (Mr Gorham) I think this is, historically, probably the most difficult issue we face in some respects. I am sorry, I will have to fill in a bit of history to set this in context. Prior to the formation of the National Blood Authority there were 14 semi-autonomous services. Each ran their own donor team, essentially working to the individual blood centres. Although the core pay package was from a common base the variety of local terms and conditions around things like subsistence and actual hours of work, number of days worked, all of those sort of things, a lot of which were enshrined in contracts at some point, and certainly heavily enshrined into custom and practice, varied immensely.

  147. I have been told I do not have much time left. I do understand the situation.
  (Mr Gorham) From our point of view we are coming from a very difficult background.

  148. My point of view is it has taken you four years. I am all in favour of employees getting the best conditions possible, with my trade union background, as I suspect most of us are, but clearly there appears to be some intransigence on both sides. It has taken four years to negotiate. I would be very unhappy as an employer if it took four years to get some sort of deal. You have not started to get a deal yet! On the other hand, as an employee I would not be very happy that if there are going to be changes it would take four years to come up with some sort of solution. What are the sticking points?
  (Mr Gorham) The sticking point is that for some of the staff we are trying to seek changes which are so far different from their traditional working practices that they are reluctant to move in that direction. It is vital that we take the staff with us. These are the people who deal with the donors on a day-to-day basis. We do need to move forward. It is vital that we move forward on this. We have to move forward in a managed and controlled fashion. It is going to take time to sort out.

  149. Yes, it is, it is four years. On the other hand, you have, in the meantime, the Midlands and the South-West, and so on, and to a lesser extent they have come to some sort of agreement.
  (Mr Gorham) We have been able to make progress in a lot of areas. I think that is the right way to keep going.

  150. It may be the right way, but it is a very slow way. Gone are the days when tradesmen were single-skilled.
  (Mr Gorham) Half of our teams are multi-skilled. We are making progress behind that headline.

  Mr Steinberg: I hope, for the sake of the Service, it is done a bit quicker than another four years.

Mr Love

  151. Good afternoon, can I refer you to page 27, which are the summarised results of the NAO's survey of attitudes. I note that you have not carried out a survey since 1989. I wonder if in the light of the difficulties that you face, both keeping and finding donors, whether this is something you should have been looking at during that long period?
  (Mr Gorham) We undertake a lot of survey work. Most of the survey work we do is very targeted. I think it was very helpful, from our point of view, that the NAO did this survey at this time. It was the right time to do this sort of survey.

  152. Do you think you should have done it beforehand? Did you have to wait for the NAO?
  (Mr Gorham) We did not have to wait for the NAO. Most of the survey confirmed our findings. There are a couple of new insights which are very helpful.

  153. Let me look at the four insights at the foot of the page, and in particular, the fact that, "A third of non-donors said they would definitely not give blood", for a variety of reasons and, "22 per cent of non-donors feared giving blood, with 20 per cent fearing needles". Is that something that you are aware of and have you attempted to address those particular fears?
  (Mr Gorham) Yes, we are aware of it. It has been further confirmed in some other research work that we have done, which we call the stakeholder survey. One interesting finding from that, which very much relates to this, is that our donors have said to us, "Do not emphasise the medical aspects of the Service, it is actually the things around altruism and the act of donation we want to talk about". Getting that information from two sources is a very powerful message to us about the way we present what we do to the public. In any sort of scientifically, medically based service there is a temptation to present the medicine. What the donors are saying, very clearly, is "Do not do that".

  154. Since you mention the word "altruism", has any consideration been given in the last few years to the issue of whether some form of incentive would assist the process of bringing more donors forward?
  (Mr Gorham) This survey said that only one per cent of the population said that they would find such an incentive helpful. That confirms our view that the losses that we might suffer through incentives, other than, you know, the very full thanks we should offer people, the valuing we should do and the awards that we make at certain points in their donor career would be entirely out of proportion.

  155. I would assume that that is because of the high public esteem there is for the National Health Service. Can I ask you, in relation to the fact that this blood is also provided to the commercialised sector, whether you think those public attitudes would change if they were aware that the blood was given on the basis you indicated earlier on?
  (Mr Gorham) The point we made is that we have to provide blood to the non-public sector, because they have no other source of supply. We supply it at the same charge that we supply it to the NHS. They are required by contract not to add anything to that cost.

  156. I understand that you are subject to contract on this matter. Let me ask you a question that occurred to me, I know that it is not always the case, but in most cases when the commercialised sector is providing services to the National Health Service I would assume they do that on a commercial or a quasi commercial basis. Why is it that we do exactly the same, a mirror image, when we provide a service to them?
  (Mr Gorham) There are two reasons for this. We have asked our donors what they think about this and most of them say they do not mind. Secondly we then trap ourselves into issues as to whether we are making profit ourselves out of a donated product. I think we see that as a very slippery slope to start on.

  157. Let me move on. When you were encouraged to talk about the issue of appointments you evaded that. I am well aware of the complaints that the National Health Service and doctors, in particular, make about the numbers of people who do not turn up for appointments and do not, of course, inform the doctor at the time, ruining their particular morning session. Does that play a role? Do you think that would lead to a reduction in the amount of blood that was given?
  (Mr Gorham) Potentially, yes. I think the attendance rate on appointments, where we have them established, is pretty good. There is some failure rate and some of that failure rate is without notice. I think what we have to do in developing effective appointment systems is manage that. We have to get a clear assessment of what rate we expect to turn up and build that into the system. I think experience is, the more reliable your appointment system is the more likely people are to turn up or tell you they are not going to turn up.

  158. You might find some disagreement from consultants in my local hospital who complain to me about the difficulties they face. Can I move on, Mr Crisp, I was very interested about a reply you gave earlier on in relation to the sacking of the previous chief executive. You said that his performance was considered to be unsatisfactory. Like Mr Campbell I read the speech of the Secretary of State when he came to the House. The fact that he came to the House and the fact that he spoke about this issue, which was of prime public concern, frankly, in my view, should have given the chief executive some pause for thought. What he actually said should have given him some pause for thought: A serious breakdown of trust; the Blood Transfusion Service in Liverpool has been severely damaged; a serious loss of confidence of the general public; a disturbing degree of isolation of NBA headquarters. Finally, as if that is not enough, insufficient regard for the views of customers, staff and the interface between the patient and the Service. Do you think that is unsatisfactory or was that, in fact, a sackable offence?
  (Mr Crisp) The view that was taken by the panel at the time was that it was cause for terminating the contract.

  159. It is the basis on which the contract was terminated. Frankly, I would assume that the chief executive on reading that would have tendered his resignation at the time. Assuming that he did not do that, do you think there was any cause for that panel to consider gross misconduct as being a more appropriate response to the criticism levied in the Secretary of State's report to the House?
  (Mr Crisp) My understanding is that that panel needed to work within the terms of reference of the National Blood Service, its own terms of reference for disciplinary matters. That is what happened and that is how it was handled.

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