Examination of Witnesses (Questions 160
- 179)
MONDAY 29 JANUARY 2001
MR NIGEL
CRISP AND
MR MARTIN
GORHAM
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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