HL Deb 08 April 1998 vol 588 cc799-807

6.1 p.m.

The Minister of State, Department of Health (Baroness Jay of Paddington)

My Lords, with the leave of the House, I should like to repeat a Statement being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows: "Madam Speaker, I wish to make a statement on the National Blood Authority.

"Last summer I received representations from local MPs and local doctors against the transfer of bulk processing and testing of blood from Liverpool. This had been approved by the previous government. It was planned to complete the transfer by 19th 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 9th 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 all these 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. This 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; the position at the centre remained far from satisfactory and that it would continue to underperform unless further action is taken; there was a serious and widespread loss of 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, Professor Cash extended his review to consider certain aspects of the general performance of the National Blood Authority. He concluded: 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. The Chairman of the board had often, perhaps perforce, been too close to the day-to-day operational aspects of the NBS and on occasions appeared to have been either misinformed or misunderstood briefing he received. There appeared to be a disturbing degree of isolation of NBA headquarters from operational realities. Instructions had been inappropriately researched and not subject to effective consultation. The National Blood Service has been exposed, since 1995, to a central management structure and a command and control culture that seemed to have insufficient regard for the views of customers, staff and the interface between the patient and the service. Professor Cash also drew attention to shortcomings in the arrangements within the NHSA 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. I explained that in view of the extra difficulties which 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 in the chair 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 makes 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.

"He 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 Liverpool by such measures as considering 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. The centre should be upgraded physically, new management arrangements put in place, more effort put into attracting and retaining top quality staff, better consultative services for doctors in the area and a drive to recruit more donors.

"I 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 at a high level. I have already appointed a transition director, Professor Bellingham, who is working to ensure that confidence in the centre is built up again and he established an independent clinical user group. I said in September that I wanted to maintain and improve blood services for Merseyside and that remains my goal.

"I accept all Professors Cash's recommendations. The new chairman's first task will be to implement these recommendations, and consider urgently the broader changes which are clearly needed in the National Blood Authority. The staff of the blood service have worked very hard and effectively to continue to deliver a good service to the clinicians they supply with blood and blood products, during a major reorganisation of their work. They and the 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 will get it."

My Lords, that concludes the Statement.

6.10 p.m.

Earl Howe

My Lords, the House will be grateful to the Minister for repeating the Statement on this important matter. From these Benches we view with concern the criticisms of the National Blood Authority which have been voiced by Professor Cash. We accept the decision of the Secretary of State, which he no doubt took with regret, to dismiss the chairman of the authority and we very much welcome the choice of Mr. Mike Fogden as his replacement.

Does the Minister agree with me that the most important consideration in the Government's plan of action for the NBA is that the confidence of patients, of clinicians and of donors in the performance of the service on Merseyside and in North Wales must be restored as quickly as possible? If she does agree with that, will she, for the record, make it absolutely clear that, whatever the shortcomings of management in the north west and at national headquarters, the safety both of blood supplies and of patients is not in question?

The Statement cites a warning by Professor Cash of potential risks to patients and the possibility of reversing all or some of the transfer of services to Manchester. Again, can the Minister reassure the House that the potential risks referred to in that passage relate to the hypothetical situation of a policy reversal and that, as Professor Cash says explicitly in paragraph 4.4 of his review: The prospects that Merseyside and North Wales Hospitals will enjoy good supply services in the transition period are high". Taking this further, am I correct in concluding that in Professor Cash's opinion, by waiting a further year before reviewing the operation of the new structure in the north-west, there is no foreseeable danger that standards of safety or the security of blood supplies will deteriorate in the interim?

Running through the Statement, there is a mild undertone of criticism, suggested rather than explicit, of the decision taken by the last government to restructure the National Blood Service. Will the Minister dispel that impression, which I may be alone in having, and confirm the Government's support for the rationale of the restructuring which has taken place, particularly in the way that it has enabled the NBA to establish a more co-ordinated service across the country as a whole—a common IT system, better inventory control and a more secure system of clinical support to hospitals—and a range of other improvements to what was previously a disjointed and regionally focused system?

I was encouraged to see that, despite the concerns which he felt it his duty to express, Professor Cash has acknowledged with considerable warmth the achievement of the NBA in transforming itself into a better, more modern and more efficient service over the past two years. In the light of that, will the Minister confirm that what is now at issue is a series of failures at managerial level and failures of leadership within the NBA rather than any failure in structure, as indeed is directly implied by the Secretary of State's decision to dismiss the NBA's chairman? Were there now any concern on the part of the Secretary of State that the structure of the service was faulty, presumably that concern would have been acknowledged and addressed at ministerial level.

Looking specifically at the north-west and the decision to transfer bulk processing and testing to Manchester, it is noteworthy that Professor Cash says only that the rationale of that change remains unproven. For all the problems that have been exposed, problems which stern principally from staff shortages and a lack of investment in Liverpool, he does not condemn the underlying policy decision.

I believe that our National Blood Service is one of the best such services in the world. To the extent that public confidence in the NBA has suffered, as it clearly has, in the north-west, it is vital that the new management should take steps expeditiously to restore that confidence. We wish Mr. Fogden every success in steering through the necessary corrective measures during the transition period in conjunction with Professor Bellingham and in his stewardship of the NBA over the longer term.

6.14 p.m.

Lord Taverne

My Lords, I have only one question to ask the noble Baroness. As the reorganisation of 1995 seems to have been mainly driven by the desire to cut costs but seems to have led to a lower quality of service and a higher degree of costs, can she assure us that this new reorganisation, while recognising the importance of costs, will be mainly driven by the needs of service?

6.15 p.m.

Baroness Jay of Paddington

My Lords, I am grateful to both noble Lords who have spoken. I confirm the point made by the noble Earl, Lord Howe, that the Secretary of State acted with some regret today because he had, as I repeated in the Statement, invited the previous chairman of the NBA to resign a little while ago. That invitation had not been accepted and this was the only course of action left to him.

It is true that our blood service remains among the very best in the world. I can certainly confirm that we have confidence in the safety and efficacy of the blood supply in the north west and throughout the country. Our concern has been precisely as both noble Lords reflected in their comments; namely, the management and organisation of the authority since 1995.

I disagree slightly with the noble Lord, Lord Taverne. There has been progress in the past few years in the organisation. The present Government affirm that the national structure has the advantages to which the noble Earl referred; for example, in terms of the national IT system and a structure which is not entirely dependent on regional organisations. The problem is that there has been dislocation and great concern among those who work on the technical aspects of the delivery of the blood service that their skills have not been recognised. I suspect, without going into the details, that many of those criticisms have been about the methods of management and the actual organisation of what one might call the human resources policy within the blood service rather than about the structure itself.

I can confirm to the noble Lord, Lord Taverne, that quality of service is paramount in how we want to see the blood service develop from now on. The consistent position in all of our policies on developing the National Health Service has been to lay the emphasis on quality outcomes of service as well as successful financial outcomes. That is very much in our minds.

The noble Earl referred to the details of the organisation of the blood supply in the north-west and the review of the change made last autumn. It is of course not a year from now that that will be reviewed but a year from when that change was made—that is, in September—so there is not really quite so long to wait. One of the things that the new chairman will need to address expeditiously is the assessment that he will want to make with Professor Bellingham about what has happened in the past few months in Merseyside and North Wales and whether he is confident, particularly in consultation with the users' group that Professor Bellingham has established, that the service is of the quality that everyone there needs.

I would just re-emphasise that the Government agree with Professor Cash's report where it says that the National Blood Service has made significant and laudable progress in recent years. We have been concerned, which is why the Secretary of State felt compelled to take the decision that he did today. about particular aspects of the reorganisation, which started with concerns in the north-west and then, unfortunately, became much wider. However, we very much want to pay tribute to the work that has been done by those in the National Blood Service and to those donors who have provided the basic wherewithal for maintaining the very good service that we continue to have in this country.

6.19 p.m.

Lord Winston

My Lords, I have always been under the impression that our blood service is one of the best in the world when compared with many of the countries in the sophisticated parts of Europe and in the continent of North America. I am sure that is still so. Given the difficulty of getting blood products, can she say what current concerns are as regards getting blood from one region to another in the areas where there are sometimes acute shortages?

Baroness Jay of Paddington

My Lords, I wish that I could confirm to my noble friend that the concerns referred to in the Statement were isolated to the north-west and North Wales. Unfortunately, our concern, not about the structure per se but the organisation of the new structure and the way in which it has caused dislocation to the service to the people who would perhaps be distinguished medical colleagues of the noble Lord in other regions, has been part of the evidence which suggested that all was not well. Of course, the noble Lord is right that the overall production of blood is of a very high level and that the quality of the blood products provided is also of high quality. The specific concerns about the transport of blood products between the regions has been a subject of concern as regards the transfer of processing from Liverpool to Manchester. As I said in response to the noble Earl, we shall be asking Mr. Fogden to look at it and to assess the situation carefully.

There have been other suggestions, for example, that the Plymouth and Bristol centres should be merged. Partly because of those kinds of concerns about the transfer of blood products, the Government have asked the National Blood Authority not to proceed with that particular merger.

Lord Randall of St. Budeaux

My Lords, does my noble friend agree that the Secretary of State was compelled to take strong action on this matter because of the appalling failure in some of the fundamentals of the service; for example, as regards the actual deliveries of blood to consultants and other clinicians, the number of donors and missing targets significantly? Will she confirm whether the structure we have and which has been seen to have failed was related to the cuts which ensued at the time that the new structure was planned and we had the shift from the national transfusion service, because there was a significant reduction in staff levels and financing? It is important that we know whether those cuts did impact on the operation of the organisation as well as the structure.

Baroness Jay of Paddington

My Lords, I am grateful to my noble friend. The points he touches on are precisely about the lack of confidence, particularly among donors, which occurred very destructively in the Merseyside region. We were particularly alarmed when we looked at some of the figures concerning the decrease in the number of donors, who simply felt no confidence in the local service.

As regards the broader point that my noble friend makes, it is true that there was widespread rationalisation which led to disinvestment, particularly in members of staff. One of the concerns that we had when we looked in detail at the run-down of the Liverpool service, which led my right honourable friend to decide last September to confirm the move to Manchester, was precisely because there were so few skilled staff left in the Liverpool area so that it was impossible to maintain a satisfactory blood supply. One needs to be careful about judging with hindsight whether the decisions to restructure the service, which had some of the advantages I mentioned in earlier answers to questions on the Statement, were the same as those which led to the removal of skilled staff from important posts. It is not absolutely clear that that was so. But what is true is that in certain crucial areas the reduction in the numbers of skilled staff led precisely to a lack of confidence, which my noble friend rightly describes as being the issue which caused my right honourable friend to act today.

Lord Graham of Edmonton

My Lords, the House will be appalled and distressed at the sad and dismal tale of mismanagement at the top of the National Blood Service. But will my noble friend take this opportunity to reinforce, and pay tribute to, those at the sharp end of what is a vital part of the National Health Service? I refer to those who work hard in the clinics of our hospitals and in mobile units. Will the Minister accept that the prompt and decisive action taken by the Secretary of State is much appreciated? The problem concerns not only Liverpool, because reference was made in the Statement to East Anglia and Oxford. The Minister was frank enough to indicate that there may be other areas, too.

There are those in the House who may be aware that I recently suffered a thrombosis, in part due to a long air flight for which I was badly prepared. The Minister may care to give some thought to how air travellers can be better prepared, and better prepare themselves, for long air journeys, and even consider which department has that responsibility. Will she accept from me that in Whipps Cross Hospital anti-coagulant clinic I received, and will continue to receive, excellent service, in contrast to the miserable service at the top of the National Blood Service?

Baroness Jay of Paddington

My Lords, I am grateful to my noble friend. I am delighted at the care he received at Whipps Cross Hospital. I am particularly delighted that it has been successful in bringing him back so rapidly to your Lordships' House.

Perhaps I might repeat the final paragraph of the Statement, which I believe confirms what my noble friend asked: The staff of the Blood Service have worked very hard and effectively to continue to deliver a good service to the clinicians they supply with blood and blood products, during a major reorganisation of their work. They and the 2 million blood donors in England have done us proud". I believe that sums up the Government's attitude to those who work within the service and those who donate blood. It is one of the most extraordinary signs of the general sense of public service that we have in our local communities that so many people give blood. Some of us may remember that famous book of some 20 years ago called The Gift Relationship in which the whole area of public welfare was described in terms of the blood service and the way in which people volunteered their donations. That is the fundamental aspect on which we wish to congratulate people who participate.

I hear my noble friend's comments about the problems of long-distance air travel. Perhaps that is something I should discuss with my noble friend Lady Hayman.

Lord Monkswell

My Lords, perhaps I might also thank my noble friend for repeating the Statement. Over the past few years we have seen a major change taking place within the blood transfusion service which we now see publicly recognised as being intensely traumatic. Can my noble friend confirm that almost from the inception of these changes the trade unions representing the professional staff involved, and in particular my own union, MSF, have identified problems that were experienced by the professionals involved and have sought to ensure that the changes taking place were mitigated to prevent the difficulties that we now see portrayed before us? Can she also confirm that we must learn a lesson from the experiences over the past few years with this service; namely, that a dictatorial, centralised management style is no way in which to run a public service? It may be that private industry, going through similar major changes, might learn lessons in the way in which the public service should be organised and run and changes instituted by taking much greater account of the workers involved, particularly the points put forward by the organised trade unions.

Baroness Jay of Paddington

My Lords, I am happy to acknowledge the constructive role that the MSF union has played in trying to maintain skills and the morale of local workforces in the blood service and in drawing to wider attention some of the problems which they experienced as workers in local blood services. I suspect that one of the problems about the way in which the management was organised was, as my noble friend suggests, that there was not adequate consultation about some of the moves and changes which affected people's lives as well as their working arrangements and that that caused the lack of confidence to which I have referred several times this afternoon.

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