Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 160 - 179)



  160. Considering the level of the criticism expressed to you, what confidence can you give this Committee that in future should something like this occur we will not find ourselves in exactly the same position, where we end up paying out a very large amount of money for what in anybody's parlance would be gross incompetence?
  (Mr Crisp) I think the safeguard is that it should not come to that. You have much tighter performance and monitoring during the lead-up to any point at which you are going to get rid of your chief executive. The point was made earlier, that there was criticism of the Department of Health for not being sufficiently on top of the monitoring arrangement, by the time you have a catalogue of the size you have just described you have gone too far. We do have, as I mentioned earlier, a much clearer performance management arrangement with the Blood Service. They internally have a much clearer one with their board, having a business plan which relates performance directly to the objective. There are a series of mechanisms which should take that forward.

  161. I wish that would happen. Certainly in a well managed service that would happen. We all know that everyone faces the prospect that something untoward will occur. I think we need to learn from our experiences. Can I come on to a completely different subject, it is this issue about the risk of CJD from blood transfusion. I know a great deal has been done based on the precautionary principle. I was interested to see that the American Blood Transfusion Service has screened-out anyone who lived in the United Kingdom within certain years from providing blood in the United States. I wondered whether there was any consideration given as to whether there were high risk categories that may be screened, in terms of providing blood to certain age groups within the population and whether any consideration has been given to that?
  (Mr Gorham) There is work actively under way on that at the moment. The American position is very understandable from their point of view, they do not have an endemic threat and, therefore, it is very wise to ensure that they do not expose themselves. We have recently undertaken a survey to establish what proportion of our donors have previously been transfused. That is one particular additional safety measure that is worthy of consideration. Consideration has also been given by the MSBT and I think SEAC, the Spongiform Encephalopathy Advisory Committee, as to whether there are particular target groups, such as young children, to which we should apply additional measures. Clearly the Blood Service will respond to the outcome of those discussions and it will be a risk assessment.

  162. It is actively under consideration.
  (Mr Gorham) Is it a live issue as to whether that measure should be taken.

  163. Can I take you back to 5.4 and 5.5. It is in relation to the efficiency savings that the Service is expected to make. I take the point made by Mr Campbell earlier on in relation to increases in expenditure because of additional responsibility taken on by the Service. You were not able to meet that £10 million reduction. This is a Committee to scrutinise the effect of the expenditure of the resources given to you. Can you explain that to us and why it is you will not be able to meet those targets?
  (Mr Gorham) I cannot fully explain the circumstances in which the target was not reached because I simply was not there at the time. We certainly have continued to make significant cost improvements since that time. We have been particularly successful in reducing the cost of our major procurement, such as blood packs and test kits. We are heavily committed to keeping the cost of the Service down, particularly as we know it is highly likely there is going to be expensive things we have to do.

  164. Can I finally take you on to the issue of staff terms and conditions, which seem to be, if not a running sore, a continuing management difficulty. There is this whole process of trying to achieve multi-skilling. Can you tell us where you are at in relation to that and whether what you are suggesting entails any reduction in the terms and conditions of the staff involved?
  (Mr Gorham) Fifty per cent of our mobile teams are now fully multi-skilled, another 45 per cent are partly multi-skilled and about five per cent are still single-skilled. What we are trying to achieve in changing the terms and conditions of our staff is to protect their earnings, maintain their earnings but to pay them on a different basis. Effectively the present arrangements are far too geared to historical precedent and are not geared up to the sort of service we have all been discussing that we need to offer. That is why it is so important we do work through this and do get an agreement with the staff to have a set of payment arrangements and other conditions that award them appropriately and that, effectively, meets the needs of the donors in fact.

  165. Are you happy that you will get your final agreement with all of the staff within a reasonable period of time?
  (Mr Gorham) What I have to say is we are going to work at it until we get there.

Mr Griffiths

  166. You and your staff of 5,300 people do an invaluable job. As I understand it you accept 2.4 million donations and help with supplying blood for 800,000 operations. Your own CV is particularly impressive, a working life dedicated to health care. I can see from your CV you had to sort out a considerable mess in 1992 in the London Ambulance Service. In 1998 you were brought in to sort out the shambles in the National Blood Authority, are you a sort of company doctor, a firefighter?
  (Mr Gorham) If so only by accident. I think it is a question of having had particular experiences and being in particular places at particular times. I am a great fan of the NHS, I spent my whole career working for it and I am attracted by roles where one hopes one can ultimately make a significant contribution to important services. I did not set out to be that at all.

  167. In your present job what was the single most effective action you took to restore confidence to the Service?
  (Mr Gorham) To tell the staff that they were doing a good job and thank them for doing it. Secondly, to try to address some of the issues that were concerning them. There are a whole variety of issues and some will take a long time to sort out, one has to be realistic about that. I think people only work well if they are able to take pride in what they are doing, they believe it is important and they are allowed to do it. I think more and more of our staff are feeling that.

  168. Apart from staff morale, which we all agree is the most important thing, what was the biggest problem that you faced?
  (Mr Gorham) I think the Service was trying to do a lot of things at once and was not entirely clear how they related together. It was not entirely clear about different things. We got some key people involved in too many things. There was a great danger of very important things not being completed well because we were giving staff too many jobs at once. I did put a lot of time and effort into trying to sort that out and I did actually delay some initiatives because of that, which is always disappointing in slowing things down. I would do this particularly with a service like the Blood Service, where the safety and continuity of the supply is critical. You do have to be prepared to take a conservative approach sometimes with safety in mind.

  169. More than two years on, what is the biggest problem you and the Service now face?
  (Mr Gorham) I think there are two actually, we have talked about both. We have talked about it a lot this afternoon, one is, you know, the unknowns around variant CJD and what impact that is going to have on our core process. Effectively over the last two and a half years we re-engineered our core process to introduce levcodepletion and to give ourselves the capability to do nucleic acid amplification acid testing. The second is sorting out this issue of providing a proper service to the donors. Those are the two big issues with us and we have to work very hard at them.

  170. The report says that seven hospitals have cancelled or deferred operations. When do you think we will be at the point where those cancellations and deferred operations can be avoided?
  (Mr Gorham) Those incidents took place in the winter of 1998-99. We have no incidents since then, certainly none reported to us. As long as we can continue our success in properly managing the blood supply, making sure there is an adequate blood supply we can avoid that. That is our highest priority.

  171. Case study 2, which is the O negative blood case study, indicates how valuable and useful that blood is. What steps do you take to increase the supply of O negative and the rarer blood types like A and B?
  (Mr Gorham) Basically it is a targeted marketing, if I can use that terminology. We produce a video specifically for new donors which explains to them how important their particular group is to us, not that other groups are not important. We have tailored our marketing activity, our letters, our leaflets, and so on, to be much more specific to particular groups. Really it is a case of concentrating on particular aspects on a much more tailored basis.

  172. Have you thought and do you ask beneficiaries to help you identify four members of the family?
  (Mr Gorham) That is a very important part of the way that we present our service to the donors. We hold donor award ceremonies and we always get a recipient to speak to the long serving donors, and that is always the highlight of the evening.

  173. People who benefit from the service who are in rare blood groups are encouraged to speak to their relatives of the same blood group?
  (Mr Gorham) Yes

  174. How is that done?
  (Mr Gorham) They usually come along and volunteer. Then we offer whatever support we can in any activity they want to take part in that helps us.

  175. What sort of response do you get? Do you have a notional figure or an actual figure?
  (Mr Gorham) It is very difficult to judge. At the moment because we have such a whole range of activities and a lot of them have been introduced relatively recently, it is quite difficult to judge the different impact of different activities.

  176. Right. You do not ask people?
  (Mr Gorham) We do survey them. I do not think we have a sufficiently built up body of information to give you a definitive answer at this stage.

  177. Those people with rare groups and in receipt of blood, what do they do, list relatives you can write to or do you have a mechanism, or are they just told, "I hope you can get your father, mother", whatever.
  (Mr Gorham) Their father or mother will not necessarily be in the same group.

  178. That is why I did not limit it to them.
  (Mr Gorham) In general we use them to support our activities aimed at the particular blood group. We would get them to take part in the video or we might quote their experience in a mailing.

  179. Can I be more specific, how do they know to ask uncle Robert to donate blood?
  (Mr Gorham) Unless they happen to know that he is the same blood group they would not know to ask.

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