Examination of Witnesses (Questions 140
- 159)
MONDAY 29 JANUARY 2001
MR NIGEL
CRISP AND
MR MARTIN
GORHAM
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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