Memorandum submitted by the NHS Executive
In addition, I would like to clarify the response
given to question 90 from Mr Campbell about whether the non-NHS
sector could be making a profit from blood supplied by the NBS.
As a condition of supply, non-NHS hospitals
are required not to make a profit on the material supplied. This
condition was part of the arrangements when charging was introduced
in 1 April 1984. Such a condition was a routine feature of contracts
governing the provision of the majority of blood supplied to the
non-NHS sector under the previous zonal contracts used by the
NBS. Inadvertently this clause was omitted from the standard national
contract introduced by the NBS from 1 April 1999. As soon as this
was realised NBS made arrangements to rectify this omission immediately.
However, there is no evidence to suggest that
non-NHS hospitals have every attempted to make profits on blood.
Immediate action would be taken on evidence of any breach of this
Finally, you asked Mr Gorham to explain why
he did not raise the issue concerning cross infection from a donor
with the human variant of BSE to haemophiliac recipients that
appeared in the news the following day. We are sorry if the Committee
feels there was any question of withholding information but this
is certainly not the case. The matter has, in fact, been in the
public domain since last December and received media attention
on several occasions since thenfor example, newspaper articles
in The Times (26 December and 29 January) and The Guardian
(19 January). Neither the NBS nor the Department is, of course,
responsible for the timing or content of media reports.
Although CJD was mentioned several times in
the course of the hearing, this was always in the context of current
or possible future action to reduce risk of transmission. This
particular story relates to a donor who gave blood before the
switch to US plasma and has since developed CJD. Had a relevant
question been asked it would certainly have been answered.
We understand that the Microbial Safety and
Tissues for Transplantation Committee plan to provide the Department
with its considered views on 19 April. If the Public Accounts
Committee has not published its report by that date, we will send
a further note at that time detailing the advice received.
NBA collects, processes and supplies blood in
North Wales through an arrangement made with the Welsh Blood Service.
The powers of the National Assembly for Wales
to call for witnesses and documents are in section 74 of the 1998
Act. The powers are limited to bodies specified in Schedules 4
and 5 of the Act. UK Ministers and their departments are not included
in those schedules, nor is the NBA and therefore cannot be required
The protocols surrounding invitations to civil
servants working for the UK Government to give evidence to a Committee
of a devolved legislature are contained in Devolution Guidance
Note 12, which is available from http://www.cabinet-office.gov.uk/constitution/devolution/guidance.
A copy of DGN 12 is attached.
The decision of the then Secretary of State
that it was not in the interests of the NHS for Sir Colin Walker
to remain as Chairman of the NBA was taken on the basis of his
judgement that Sir Colin had mismanaged organisational change
within the Blood Service. In his view, in doing so Sir Colin had
lost the confidence of the Service's medical and other staff,
donors and the public and had done considerable damage to the
reputation and good standing of the Service. There was never at
any time a question that action taken by Sir Colin had had a detrimental
effect on safety or caused risk to the public.
There is no necessary or direct relationship
between stock movements (Figure 11) and donor potential and collections,
and stock movements vary year on year. In 2000, for example, the
net flow into the London and South East Zone was only slightly
greater than into the Northern Zone. Historically in Midlands
and South West the donor potential and collection capability has
always exceeded local demand.
We have not seen the figures on which NAO base
their finding ie we do not know the extent to which Londoners
are disproportionately represented among recent donors. However,
London is also a disproportionately heavy consumer of blood because
of the preponderance of large acute hospitals.
The £1.9 million does not represent the
cost of clinical negligence settlements in 1998-99. The figure
is taken from the NBA's audited accounts for the year, which by
accounting convention have to include "provisions" for
any future payments which might arise from events happening in
that year. The bulk of the £1.9 million reported in 1998-99
was in respect of provisions, £1.7 million in respect of
a single on-going class action by people who claim to have been
infected with the Hepatitis C virus from contaminated blood received
in the early 1990s. 1998-99 was the first year in which the NBA
was advised by its lawyers that the likelihood of eventually having
to pay this sum had increased to over 50 per centthe point
at which, by the then current accounting convention, the provision
had to be shown in the accounts. In previous years the likelihood
of having to pay was deemed to be less than 50 per cent, so the
potential liability had previously been shown as a "contingent
The £1.7 million was represented by 56
cases at a payment of £14,000 net of the estimated cost of
settlement contribution from the centrally (Vote) funded Existing
Liabilities Scheme, of which all NHS bodies are members; and eight
cases at an estimated cost of £56,000 net of the ELS contribution.
A further £400,000 represented the anticipated legal costs
of defending the claims.
A further £77,000 was provisions in respect
of an outstanding claim from a patient who received a transfusion
of blood contaminated by bacteria.
Of the remainder, £130,000 does represent
actual in-year payments, mainly for small claims by donors for
bruising. In addition £28,000 was paid as the NBA's contribution
to the NHS Litigation Authorityadministered Clinical Negligence
Scheme for Trusts, ie the NHS's own risk pooling scheme for clinical
negligence events occurring after 31 March 1995.
1 See Annex A, p21-24. Back