IMPROVING THE MANAGEMENT AND OPERATIONS
OF THE NATIONAL BLOOD SERVICE
28. In his report, the Comptroller and Auditor General
outlined the progress made by the National Blood Service in reorganising
the service and restoring confidence after the management and
operational problems in the 1990s. He concluded that the Service
had improved the efficiency and effectiveness of its operations,
but needed to further improve working practices, the use of cost
and management information, and the performance measurement framework.[22]
29. We examined in particular:
- The action taken to restore confidence in the
Service;
- The quality of the Service's risk management
and contingency planning;
- The scope to use costing and other comparisons
to improve quality and efficiency.
The action taken to restore confidence in the
Service
30. In August 1997, the Secretary of State commissioned
a review of clinical concerns raised about proposals by the National
Blood Service to transfer processing and testing of blood from
Liverpool to Manchester. The Cash report, which also covered concerns
in other centres such as Oxford and East Anglia, led to the dismissal
of the Service's Chairman and Chief Executive. In announcing this,
the Secretary of State drew attention to a serious breakdown of
trust between the National Blood Authority and many local people
and clinicians in Liverpool. He concluded that the blood transfusion
service in Liverpool had been severely damaged, and that there
was a widespread loss of confidence in the Authority by clinicians,
hospital blood bank medical and laboratory staff, and the general
public.[23]
31. The National Blood Service told us that, following
the review, it had spent a lot of time in Liverpool and Merseyside
working with the staff and local health services. It was following
up commitments by the Secretary of State to upgrade the blood
centre in Liverpool, with a proposal for a new centre in Speke,
and had given a very strong signal that the Service was committed
to continuing the service based there. In Oxford, the Service
had also been working with local health services, and wanted in
particular to develop the research aspects. East Anglia was now
operating essentially as a specialist centre offering diagnostic
services, had a very strong research base with the local hospital
and university and seemed to be moving forward well.[24]
32. In addition, senior staff and the new Chairman
now spent a lot of their time out in the Service. The Service
had worked very hard to improve staff morale, and by creating
a national structure now had the ability to work on standards
and to focus expertise on a national basis.[25]
33. The Committee enquired about the terms on which
the Chairman and the Chief Executive were dismissed in 1997. The
National Blood Service told us that the Chairman had no contract,
and was dismissed without compensation. However, under the terms
of his contract the Chief Executive received six months pay of
£43,000, £65,000 compensation for breach of contract
and £124,000 in pension contributions. The Panel taking this
decision needed to work within the terms of reference of the Service
on disciplinary matters.[26]
The quality of the Service's risk management
and contingency planning
34. The Comptroller and Auditor General noted that
the National Blood Service takes a strategic approach to handling
stocks of blood components. The Service had improved its arrangements
for risk management and contingency planning, and these had worked
well during the road fuel crisis and in handling a shortage of
O negative blood.[27]
The Service confirmed that it had put a lot of work into getting
contingency plans to a very high standard, and would continue
to review them against any new potential threats that might occur.[28]
The scope to use costing and other comparisons
to improve quality and efficiency
35. So that the National Blood Service could further
improve its efficiency, the Comptroller and Auditor General made
a number of recommendations on improving working practices and
securing economies.[29]
We asked the new Chief Executive of the NHS about the progress
made. His first impression was that the Service had come a long
way since the crisis of the 1990s, but there was no room for complacency
and still a lot of detailed work to be done. He found the Comptroller
and Auditor General's report very helpful. He noted that since
1997 the Department had improved the arrangements for monitoring
the performance of the Service, including a very formal accountability
review, and had improved communication with the Service, for example
by the Chief Executive of the Service attending meetings of NHS
Chief Executives.[30]
36. The National Blood Service accepted the Comptroller
and Auditor General's conclusion that there were opportunities
to further improve efficiency. It aimed to secure best practice
by adopting a genuinely national structure, and to offer local
services within a national framework. The Service was conducting
major reviews of all its operational departments and over the
next few months would be moving the service towards those best
practices. The Service was also taking first steps towards a common
set of costings, although it would need a year's experience before
it could make meaningful cost comparisons between blood centres.[31]
37. One area where there were still some problems,
which made it more difficult to improve services to donors on
a consistent basis across the country, was in revised terms and
conditions for staff, changes in working practices and multi-skilling.
Negotiations were stalled.[32]
The Service explained that it was trying to move from 14 semi-autonomous
services, each with their own teams, local terms and conditions
and working practices. The Service had made progress in introducing
multi-skilling in some areas, for example the Midlands and the
South-West. Fifty per cent of their mobile teams were now fully
multi-skilled , and another 45 per cent were partly multi-skilled.
What the Service was trying to achieve in changing the terms and
conditions of staff was to protect their earnings, but to pay
them on a different basis. It was vital that the Service made
progress on working practices that met the needs of donors. It
recognised, however, that for some staff the changes sought were
far different from their traditional working practices, and the
Service had to take the staff with them.[33]
Conclusions
38. The conclusions of the Cash report, and the terms
in which the Secretary of State announced the dismissal in 1997
of the Chairman and Chief Executive, were highly critical of the
way the Service was managed. While we recognise the need for the
Service to operate within the terms of contract and its disciplinary
arrangements, we are astonished that the Chief Executive was able
to leave with a payoff of £108,000 and a £124,000 contribution
to his pension fund. This is not the first case where those responsible
for poor management have received significant payoffs. The Department
should review the NHS arrangements for taking disciplinary action
in such cases.
39. The National Blood Service has taken a number
of steps to rebuild confidence following the crisis that developed
in the 1990s. Four years on, however, it has still not concluded
a deal with staff on new pay, conditions and working practices
that will give donors the service they need. The Service should
pursue negotiations vigorously.
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