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National Blood Authority
3.32 pm
The Secretary of State for Health (Mr. Frank Dobson): I wish to make a statement on the National Blood Authority.
Last summer, I received representations from local Members of Parliament and local doctors against the transfer from Liverpool of bulk processing and testing of blood. That had been approved by the previous Government, and was planned to be completed by 19 September 1997.
Having looked into what was happening, I decided to appoint Professor John Cash, then president of the Royal College of Physicians of Edinburgh and former director of the Scottish National Blood Transfusion Service, to conduct an independent review of the proposed transfer. Professor Cash's review was welcomed by the chairman of the National Blood Authority, Sir Colin Walker.
On 9 September, Professor Cash submitted to me an urgent interim report confirming that there had been a serious breakdown of trust between the National Blood Authority and many local people and clinicians in Liverpool. He also advised that the rationale of the original decision to move the service from Liverpool remained unproven, but that the rundown of the Liverpool centre had gone so far that, for reasons of patient safety, it should go ahead. He recommended that an independent user group should be set up to monitor the service, and that a new leader be appointed for the Liverpool blood centre. I accepted those interim recommendations, while bitterly regretting that the original transfer decision had gone so far that it was unsafe to stop it.
Professor Cash submitted a draft final report, which was passed to the National Blood Authority for comment. Points made by the NBA were considered by Professor Cash before he submitted his final report to me. Today I am publishing his final report, which presents a damning indictment of the NBA's treatment of the Liverpool blood centre and the clinicians it serves.
Professor Cash concluded: that, over the past three years, the blood transfusion service based in Liverpool had been very severely damaged; that the position at the centre remained far from satisfactory; that it would continue to under-perform unless further action was taken; and that there was a serious crisis and widespread lossof confidence in the National Blood Authority by Merseyside and north Wales clinicians, hospital blood bank medical and laboratory scientific officers and the general public.
In the light of what he discovered in Liverpool, with my agreement Professor Cash extended his review to consider certain aspects of the general performance of the National Blood Authority. He concluded that many of the concerns that had emerged in Merseyside and north Wales were also evident in Oxford and East Anglia. A number of issues of wider concern about the overall management of the blood service applied across the country. All the evidence pointed to a conclusion that the NBA was failing to maintain appropriate operational connections with many of its management teams.
Professor Cash also concluded that the chairman of the board had often, perhaps perforce, been too close to the day-to-day operational aspects of the national blood
service, and on occasions appeared to have been misinformed or to have misunderstood briefing that he received. There appeared to be a disturbing isolation of NBA headquarters from operational realities. Instructions had been inappropriately researched and not subject to effective consultation.
Since 1995, the national blood service has been exposed to a central management structure and a command and control culture that seemed to have insufficient regard for the views of customers and staff, and the interface between patients and the service. Professor Cash also drew attention to shortcomings in the arrangements within the NHS Executive, the Department of Health and user groups for monitoring the performance of the blood service.
Having considered Professor Cash's report and other representations about the performance of the NBA, I called in Sir Colin Walker, the chairman of the National Blood Authority, to say that I was concerned about the overall performance of the authority, and that, as a general principle, I believed that those at the top of an organisation had to take responsibility for it. I explained that, in view of the extra difficulties that the blood service is likely to face, I was not confident, in the light of past performance, that it was in the interests of the NHS for him to remain as chairman of the NBA.
Discussions have subsequently taken place between my officials and solicitors acting on behalf of Sir Colin Walker. He has refused to resign, so today I have dismissed him. I have appointed in his place Mr. Mike Fogden, the chief executive of the Employment Service under the previous Government. Mr. Fogden's appointment was carried out with the agreement of Sir Len Peach, Commissioner for Public Appointments.
Professor Cash made a series of recommendations about the future of the blood service in Liverpool. While pointing out potential risks to patients, he does not rule out reversing all or some of the transfer of services to Manchester. He recommends that the performance be monitored closely, and the position reviewed after one year's operation.
Professor Cash strongly recommends that, in the meantime, an action plan should be developed by the blood service, the north-west region of the NHS and Liverpool university medical school to upgrade the services in the Liverpool centre by such possible measures as the establishment of a regional stem cell service and a regional tissue bank, arrangements for specialist registrar training in haematology and transfusion medicine, and reviewing the development of the zonal reagent unit.
Professor Cash said that the Liverpool centre should be upgraded physically; new management arrangements should be put in place; more effort should be put into attracting and retaining top-quality staff; better consultative services should be available for doctors in the area; and there should be a drive to recruit more donors. I accept all Professor Cash's recommendations.
I have already appointed a transition director, Professor Bellingham, who is working to ensure that confidencein the centre is rebuilt. I have also established an independent clinical user group. I said in September that I wanted to maintain and improve blood services for the people of Merseyside and north Wales, and that remains my goal.
The new chairman's first task will be to implement those recommendations and to consider urgently the broader changes that are clearly needed in the National Blood Authority.
During a major reorganisation of their work, the staff of the blood service have worked very hard and effectively to continue to deliver a secure service to the clinicians whom they supply with blood and blood products. They--and 2 million blood donors in England--have done us proud. Both donors and staff deserve a new and better lead from the top. Under this Government, they are going to get it.
Mr. Patrick Nicholls (Teignbridge):
I thank the Secretary of State for his courtesy in telephoning me earlier today to give me the outline of his statement, rather than delivering it within the usual time limits.
Does the Secretary of State agree that the most important aspect of his statement is a belief that the medical profession's and public's confidence in delivery of blood services should be restored? Will he take this opportunity to confirm that the original reforms were not driven merely by a desire to cut costs?
Is it not true that--with delivery of blood services increasing at about 4 per cent. per annum--proper delivery of services could have yielded savings, which were earmarked to go straight back into the national health service? Is it not a fact that the original reforms were underpinned by a belief that, if duplication and administration costs had been saved, an extra £10 million might have been available to plough back into delivering primary care services? The savings were never made.
Is it not implicit in the Secretary of State's statement that we are dealing not so much with a defect in the structure of the National Blood Authority, as currently constituted, as with a chronic defect in its management and leadership? The right hon. Gentleman himself mentioned operational connections and the management team. The defect must be in leadership and in the management team. If it was not such a defect, I have absolutely no doubt that the right hon. Gentleman would take action to deal with the real defect in service delivery--frankly, by going back to the drawing board, and starting all over again.
As I said, it is essential to restore the total confidence of the public and of the medical profession in the services provided by the NBA. Will the Secretary of State therefore reconsider two passages in his statement? First--referring to Professor Cash and his recommendations on the future of the blood service in Liverpool--the right hon. Gentleman said:
Implicit in the right hon. Gentleman's comments must be a belief that the basic structure is sound. If that is so, it must be entirely right for the practices of the new management--those of us who know Mike Fogden have great confidence in his ability to grip the situation--to be reviewed. If we are dealing with unsafe practices, they cannot possibly be left for a year.
"While pointing out potential risks to patients, he does not rule out reversing all or some of the transfer of services to Manchester. He recommends that the performance be monitored closely and the position reviewed after one year's operation."
Some paragraphs later, the Secretary of State went on:
"I also want to reassure the people of Merseyside today that the safety and supply of their blood services is now and will continue to be maintained."
Those two statements seem to be contradictory. If the Secretary of State believes that there are substantial grounds--or any grounds--for thinking that services are not properly run, effectively managed or somehow unsafe,
the entire matter will have to go straight back into the melting pot. If we are dealing with potentially unsafe practices, a year is far too long to wait for a review.
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