nhsbt annual review 2006-2007

2006/07Annual Review

Saving lives together

ContentsPage 3

NHS Blood and Transplant – Background

Pages 4-5

Chairman’s statement

Pages 6-7

NHS Blood and Transplant in 2006/07

Pages 8-11

NHSBT Service Strategy 2006-2010

Pages 12-13

Financial review

Pages 14-19

The National Blood Service in 2006/07

Pages 20-25

UK Transplant in 2006/07

Pages 26-27

Bio Products Laboratory in 2006/07

8-31

The Board of NHS Blood and Transplant

NHSBT Annual Review 2006/073

NHS Blood and Transplant (NHSBT)

was formed following the merger of

UK Transplant (UKT) and the National

Blood Authority (NBA) on 1st October

2005. It is a Special Health Authority

within the NHS and consists of three

operating divisions: National Blood

Service (NBS), UK Transplant (UKT)

and Bio Products Laboratory (BPL).

NHSBT’s role includes:

• encouraging people to donate

blood, organs and tissues;

• optimising the safety and supply of

blood, organs and tissues;

• providing plasma-derived products

to the NHS;

• helping to raise the quality,

effectiveness and clinical outcomes

of blood and transplant services;

• providing expert advice to other

NHS organisations, the Department

of Health, Ministers and devolved

administrations;

• providing appropriate advice and

support to health services in

other countries;

• commissioning and conducting

research and development;

• actively engaging in the

implementation of relevant EU

statutory frameworks and guidance;

• involvement in broader

international developments.

NHSBT’s Service Strategy for 2006-2010

aims to ensure that the organisation

continues to deliver high-quality

services and the best possible value to

patients and the NHS.

NHS Blood and Transplant – Background


NHS Blood and Transplant (NHSBT) is

responsible, above all else, for the safe

supply of blood and blood products in

England and North Wales and of

organs, tissues and plasma products

across the United Kingdom. Our

success must be measured against

our ability to meet this responsibility:

to work with the rest of the NHS to

save and improve the quality of

patients’ lives.

While we have both maintained the

quality of the services delivered to

donors, patients and hospitals and

stabilised the cost of blood over the

past year, it is clear that changes are

necessary – across the three divisions

(National Blood Service, UK Transplant

and Bio Products Laboratory) – in

order to ensure these services into

the future.

The past six years have seen a

consistent decline in the volume of

blood collected.

While this is the result of a number

of factors, including the introduction

of rigorous safety measures which

exclude a greater number of potential

donors, we clearly need to adapt the

way in which we collect blood to fit in

with changes in people’s lifestyles – in

terms of the times and places donors

can give blood. The key to this is

flexibility: enabling people, for

example, to make an appointment to

give blood should they want to do so,

while continuing to welcome those

who wish to donate spontaneously.

This flexibility applies equally to

our processing and testing services.

Much of our estate is in need of

modernisation, with escalating

maintenance costs affecting our

ability to run some of our sites in

a cost-effective manner. We also

need to ensure that all of our sites

have the necessary flexibility both to

undertake new procedures and to

meet increasingly rigorous safety

and quality regulations as these

are introduced.

The United Kingdom has one of the

lowest rates of organ donation

amongst developed countries, with

demand far outstripping the supply

of organs for transplantation. The

current waiting list consists of more

than 7,000 patients who urgently

need a transplant and is increasing by

almost 10% every year. In recognition

of the need to address this situation,

the Government set up the Organ

Donation Task Force to identify ways

to improve organ donation rates. This

task force, set up in December 2006

Chairman’s statement

5

and chaired by Elisabeth Buggins,

Chair of NHS West Midlands and

one of our Non-executive Directors,

is due to report shortly. The work

which NHSBT has done in parallel to

review all stages of organ donation

places us in good stead to work

with the rest of the NHS to take the

report’s recommendations forward,

once approved.

Although Bio Products Laboratories

continues to face fundamental

operating problems, improved sales

resulting in a 25.6% increase in

income over 2006/07 are a testimony

to the skills and hard work of staff.

Our service strategy, announced

in November 2006, set out our

major challenges and how we would

address these over the next five years.

In the intervening period and in light

of discussions with staff, hospitals,

professional bodies and other

stakeholders, the Board commissioned

a review of the National Blood Service

supply chain and specialist services.

This was done in order to ensure that

the solutions proposed are the right

ones to meet the challenges we face

and that we have the necessary

capability and capacity to deliver these

solutions successfully.

Our plans for the next five years are

far-reaching; we will only be able to

deliver them with the continuing

commitment and dedication of our

staff. While recognising the extent

of the challenges ahead and their

impact on our staff, I am convinced

that our plans for the future are

pivotal to our ability to deliver

the first-class service to which we

all aspire.

Having overseen the first phase of

the development of NHSBT, with

the merger of the National Blood

Service and UK Transplant and the

delivery of savings required by the

Government’s Arm’s Length Body

Review, Martin Gorham stepped

down as Chief Executive in July 2007.

I would like to thank him for his

commitment in implementing changes

made to date and look forward to

working with our new Chief Executive,

Lynda Hamlyn, in meeting the

undoubted challenges ahead.

Bill Fullagar

ChairmanNHS Blood and Transplant

Our plans for the next five yearsare far-reaching; we will only beable to deliver them with thecontinuing commitment anddedication of our staff.

‘‘ ‘‘

A ‘Bafta’ for


7

NHSBT has achieved its immediate

goal of managing major change – the

merger of previously autonomous

service providers – while maintaining

and improving the quality of the

services delivered to patients. The

organisation has stabilised the rising

cost of providing blood to the NHS,

brought together a number of

corporate services and is on track to

exceed the targets set by the

Government’s Arms Length Body’s

Review. The task over the coming

years is to maintain this rate of

progress while ensuring quality and

continuity of supply.

Following the merger of the National

Blood Authority and UK Transplant

(UKT), progress has been made in

streamlining support services by

providing them on a group basis. The

merger has also enabled the provision

of additional management support

and other resources to UKT and Bio

Products Laboratory (BPL), as well as

support for the Organ Donation Task

Force (see page 21).

NHS Blood and Transplant in 2006/07

achievement in blood donation Bradford-born Steve Abbott has spentmost of his TV and film career workingwith members of the Monty Pythonteam. But the executive producer ofgems such as ‘A Fish Called Wanda’ andMichael Palin’s travel series says he ratesovercoming his fear of blood andreaching 75 donations up there withwinning a Bafta.

Steve gives blood three times a yearand received his emerald award in 2006.He presented the award to his mother,Lily, who introduced Steve to donatingand made over 60 donations herself.

Steve’s commitment is especiallyimpressive because he faints if he sees blood! He says that at a session, “I walk with my head in the air withoutreally looking at anything and when I’m on the bed I can’t watch. If I wasever to see a bag of blood I’d keel over immediately.”

He presented the award to hismother, Lily, who introducedSteve to donating and madeover 60 donations herself.

‘‘ ‘‘


NHSBT published its Service Strategy in

November 2006. This strategy focuses

on modernisation and investment to

ensure continued delivery of high

quality services to patients and the

NHS into the future.

National Blood Service (NBS)

The NBS is responding to its changing

operating environment by

modernising, consolidating and

investing in its operations to create a

service fit for the 21st century.

A number of factors – including the

fall in the number of blood donors

(20% in the last five years), an ageing

estate, with some facilities that are

inappropriate for modern processing

and testing requirements, over-

capacity within the system and rising

blood costs – has led to the need for

fundamental change.

The NBS will focus on four key areas:

• Improving blood collection

arrangements to attract blood

donors;

• Consolidating blood processing and

testing into fewer, more flexible

and modern buildings, whilst

maintaining the majority of the

existing network of local blood

banks, so that hospitals continue

to receive blood as and when

they need it;

• Reviewing the specialist services

provided by the NBS and how best

to provide these in the future;

• Ensuring greater efficiencies across

the service.

UK Transplant (UKT)

More than 7,000 people in the UK

need a transplant and this figure

continues to rise every year, despite

great efforts to increase donor

numbers. The UK organ donation

rates remain significantly below those

in some other major European

countries. There is, therefore, an

urgent need to review all stages of

organ donation to help increase the

number of donors.

Over the next year, UKT will work

with its NHS partners to:

• Increase the number of annual

organ transplants from 2,700

to 3,150;

• Increase the number of annual

corneal transplants from 2,500

to 3,000.

NHSBT Service Strategy 2006-2010

Bio Products Laboratory (BPL)

The environment in which BPL

operates has changed significantly

over the last few years, as

demonstrated, for example, by

the need to import plasma from the

USA as a precaution against variant

Creutzfeldt-Jakob disease (vCJD).

As a result, BPL has relied on direct

Government funding to maintain its

operations, diverting resources away

from other parts of the NHS.

Over the period of the service

strategy, BPL will move towards

financial viability by:

• Increasing sales revenue;

• Reducing operating costs;

• Increasing operating efficiencies;

• Business development already in

progress and the search for partners

to access international markets.

Strategy review

Given the changing environment in

which we work, the strategy will be

reviewed and updated on a regular

basis. A review of the National Blood

Service (NBS) supply chain and

specialist services was commissioned

by the NHSBT Board in July 2007,

reporting in January 2008. Discussions

about the proposals set out in the

strategy with stakeholders, such as

staff, staff representatives, hospitals

and relevant professional bodies, are

integral to this review.

Management

The changes set out in the service

strategy are far-reaching and complex.

The organisation must have

the necessary management capacity

and capability to deliver our

change programme. We will also put

rigorous programme management

arrangements in place both to ensure

a disciplined, consistent approach to

change management and to identify

and address potential issues in the

implementation of this change.

Workforce

Throughout a period of very

significant organisational change it

is, clearly, essential to maintain the

commitment and motivation of

our staff.

Managing complex change, while

ensuring that the organisation

continues to provide the services upon

which patients rely, requires effective

planning. We recognise the impact of

change on our staff and must provide

the necessary support throughout this

period. Staff and their representatives

will be consulted regularly about

changes which affect them.

9

The NBS is responding toits changing operatingenvironment by modernising,consolidating and investingin its operations to create a service fit for the 21st century.

‘‘‘‘

Work is under way on the overall

employee relations framework to

support future workforce change.

An outline workforce plan has also

been developed and is currently

being refined.

By the end of 2007/08 we will ensure

that the organisation has the

management systems in place to:

• Support and deliver the workforce

change outlined in the NHSBT

service strategy;

• Maintain and improve operational

HR services;

• Promote the training and

development of our staff;

• Engage staff and stakeholders in

the changes proposed;

• Respond to the diversity within our

workforce and our donors;

• Ensure effective, responsive internal

and external communications to

support the NHSBT service strategy.

A survey of NHSBT staff, carried out in

early 2007, sought to gauge views

about the provision of better care for

donors, patients and their families and

improvements to the working lives of

our staff.

The organisation scored well on the

following:

• work-life balance;

• learning, education and development;

• occupational health and safety

Staff were less positive on:

• appraisals/personal development

reviews;

• job roles.

The key findings of the survey have

been compared with the results of

the recent Improving Working Lives

Practice Plus assessment to develop a

joint action plan to address the main

findings and outcomes from both

which were broadly similar.

Staff focus groups will continue to

monitor staff perceptions on a regular

basis. A further staff survey will be

conducted in 2008, and thereafter, on

an annual basis.

nice people who’veLesley Champion joined the then newlyformed Reading team as a donor carerin 1993. As a regular blood donor she’s no stranger to blood donationsessions. Volunteering for the Red Cross in her teens, she also helped withrefreshments at her local sessions.Lesley has really enjoyed working aspart of the Reading team: the majorityof staff joined at the same time andthey all trained together, which shefeels has made them very close. Beforejoining the NBS Lesley worked as anaromatherapist and masseuse. Sheenjoys the interaction with donors,describing them as “nice people who’ve taken time out to help others”. Ensuring they’re comfortable and treated well gives her great satisfaction.


‘‘

taken time out to help others

11

‘‘


NHSBT’s first full year set of accounts

reported an Income and Expenditure

surplus of £0.5m for the period

from 1 April 2006 to 31 March 2007.

Overall net expenditure (excluding

Department of Health funding) was

reported as £33m. The surplus was

primarily due to an increase in sales by

Bio Products Laboratory (BPL).

The organisation recovers its costs

primarily by charging NHS Trusts and

other organisations for the supply of

blood components, tissues and other

services. Funding is received direct

from the Department of Health to

support a range of activities including

tissue and organ transplantation. The

costs reflect the operating costs of the

organisation, as volunteers freely

donate all blood and tissues collected.

BPL competes in the open market.

Where our income came from

Capital funding was received from

the Department of Health in order to

purchase and replace fixed assets. The

appropriate levels of capital charges in

the form of interest and depreciation

are included with the Income and

Expenditure Account.

Financial review

English NHS bodies80%

Otherincome

12%Department

of Health8%

How we spent the money

The organisation’s highest area of

expenditure is staff, the majority of

whom are employed directly in the

collection, testing and distribution of

our products and in maintaining our

donor databases for blood and

transplants. Consumable supplies

include the raw materials required to

process the blood and platelets into

the products transfused by hospitals.

Net current assets have decreased

from £63m to £56m. This relates to

a net reduction in stocks, debtors

and creditors. Total net assets have

increased from £337m to £356m. This

reflects an increase in fixed assets due

to capital funding invested in assets

and a decrease in provisions primarily

relating to the realisation of the

Agenda for Change provision.

13

Staff costs46%

Consumablesupplies

26%

Premises,equipment

and transportcosts11%

Other costs9%

Capitalcharges

8%

For a full copy of the annual accounts,please contact:

Barry Savery

Director of Finance

NHS Blood and TransplantOak House Reeds CrescentWatfordHertfordshire WD24 4QN


Not letting

The National Blood Service (NBS)

needs to develop to meet changing

circumstances and adapt to new

technologies. The service must also

modernise so as to continue to

provide patients and the NHS with

the services they need now and into

the future.

Over recent years, the NBS has worked

with hospitals and the Department of

Health to encourage better use of

blood and this has resulted in reduced

hospital demand. However, at the

same time, the number of volunteer

blood donors has also reduced, falling

faster than the reduction in demand

for blood.

This has been due, in part, to

increased safety measures, which has

led to fewer people being able to

donate. Research carried out by the

NBS also shows that existing and

potential blood donors require greater

convenience and choice about when

and where they give blood. Whilst

blood stocks remain adequate, the

NBS has had to review its blood

collection strategy in order to avoid

shortages in the future.

The NBS needs to ensure that its

processing and testing facilities are

sufficiently flexible to meet the

increasingly stringent regulatory

requirements. Many of these facilities

are at least 20 years old and it is no

longer possible to adapt all of them

to meet future technical and safety

requirements.

The unit cost of blood has risen by

56% in the last few years, due both

to reduced demand and increased

safety measures. This is diverting

much-needed resources away from

the rest of the NHS and patient care.

The NBS must provide a secure supply

of safe blood at the best possible

value to the NHS.

The National Blood Service in 2006/07

sickle cell anaemia affect her lifeAwele Nwosu-Akeh, 17, was diagnosedwith sickle cell anaemia when she wasten. She has been in hospital manytimes because of her condition but isdetermined not to let it affect her life,despite the obvious challenges. Awelehopes to finish her college course nextsummer so she can go to university. ”I have a blood transfusion every fourweeks to keep my haemoglobin levelshealthy. I am very grateful to all thepeople who give up their time todonate the blood I need to survive.”

I have a blood transfusionevery four weeks to keep myhaemoglobin levels healthy.

‘‘ ‘‘

15


Blood collection

Demand for red cells continues to fall.

At the end of March 2007, NBS issued

1.87 million red cell units, 68,000

lower than the previous year.

Although maintaining blood stocks

continues to remain challenging, the

NBS met its strategic objective over

2006/07 to ensure supply of blood and

blood components by meeting 99.98%

of red cell product requests and

99.79% of platelet product requests.

The demand for platelets and frozen

components continues to remain

relatively static. During 2006/07, the

NBS issued 217,000 units of platelets

and 379,000 frozen components.

The level of platelet production by

component donation exceeded the

60% Department of Health target for

the first time in March 2007.

The active donor base continues to

decline, dropping to 1.42 million

donors – 6% lower than the

comparable figure at the end of

2005/06. This decline continues to

represent a major challenge and forms

a key risk to a sustainable supply into

the future.

Attracting more donors

The NBS must make it easier for

people to give blood. This means

collecting blood at times, in locations

and in environments convenient to

donors. Plans are under way to

provide:

• A more flexible and convenient

service;

• A service that enables donors to

book an appointment at a time and

place to suit them, where they will

be seen quickly, while continuing to

welcome those who wish to drop in

to give blood;

• An efficient service that allows us to

forecast session attendance and

resource.

Donor satisfaction improved over

2006/07 (from 44% to 45%), with the

number of donations given by

appointment increasing from 28% to

35%. The NBS will continue to deliver

strategic change across blood

collection during 2007/08, laying the

necessary foundation for the

sustainability of a secure supply of

safe blood into the future.

2003/04

2004/05

2005/06

2.15

mill

ion

2006/07

2.03

mill

ion

1.94

mill

ion

1.87

mill

ion

Red cell demand

17

Modernising and consolidating blood

production facilities

All NBS facilities must be both

compliant with current licensing and

accreditation requirements and

sufficiently flexible to meet future

demands. The consolidation and

modernisation of its production

facilities will help to ensure a

consistent standard in products

and services and allow the NBS

to implement any new processes

and systems which may be required

to comply with new legislation

and blood safety measures. Such

facilities will also result in improved

working conditions for staff and

increased productivity and reduced

operating costs.

In April 2006, the Liverpool Centre

was officially opened by HRH the

Duke of Gloucester. Based in Speke,

the site is the largest tissue bank in

Europe, collecting and storing tissues

such as skin, bone and tendons to

supply hospitals across the UK.

The centre also provides a base for

blood collection and blood banking

in the region.

Other services based at the site

include the National Frozen Blood

Bank, which provides stocks of rare

blood for patients from all over the

world and a project manufacturing

‘artificial tears’ for patients with

severe dry eye problems.

Work began on the new Filton Centre,

near Bristol, in November 2006. The

project is making good progress, with


the building programme on time and

on budget.

Developing specialist services

The demand for some specialist

services continues to grow. The

use of cord blood in stem cell

transplantation, for example, is

increasing worldwide. The Cord Blood

Bank currently takes donations from

four hospitals, selected to address the

under-representation of ethnic donors

on the British Bone Marrow Registry.

The Bank supplied its 150th unit for

transplantation in January 2007 and,

as at the end of March, had 9,382

units in the bank. Of these, 41% are

from non-Caucasoid donors, helping

to increase the chances of offering a

match for a wider range of patients.

NBS laboratories provide vital testing

and diagnostic services for a wide

range of patients including those

with leukaemia and bone marrow

disorders, those awaiting transplant

and requiring specialist cross-matching

before transfusion. However, many

of these services are subsidised by

income from the provision of blood

components. The NBS must continue

to meet current levels of demand for

specialist products, services and advice

while delivering planned growth and

continuous improvement on a cost

effective basis.

Consideration of specialist services

forms part of the strategy review.

Tissue Services

As the largest multi-tissue

organisation in the country, Tissue

Services supplies hospitals with a wide

range of tissues, including bone and

skin, and led the development of

national and international standards,

policies and regulation in the field.

Following the opening of a dedicated

tissue donation facility in Liverpool in

April 2006, donors are now routinely

transferred from two local hospitals

to the centre for their procedures.

Donors are cared for in the best

possible clinical environment, with

19

their privacy and dignity respected

at all times.

The centre also provides training

for student nurses from Liverpool

University and John Moores University.

The demand for skin continues to rise,

with an average adult patient with

severe burns needing between 6,000

and 27,000 cm2 of skin during the

course of his or her treatment.

Significant work has been completed

to increase skin stocks to meet patient

demand. By the end of 2006/07, the

NBS had met its increased stock-

holding target and filled all orders for

skin over the year, providing a total of

470,000 cm2 to hospitals. Over 2006,

Tissue Services banked more than

1,000,000 cm2 of skin.

An integral Research and

Development department ensures

that new processes and services

continue to be introduced to

support improved tissue repair and

replacement therapies for patients.

Designed to develop new types of

grafts and processing procedures,

the Tissue Technology Centre – in

close collaboration with the Tissues

Development Laboratory – is currently

working on a project to introduce an

arterial allograft service, developing

the UK’s first artery bank. The

department is also collaborating

with the University of York to develop

new methods of preserving reticular

cartilage. While current means of

refrigeration or freezing destroy many

of the cells, new methods will ensure

a high percentage of live cells,

producing a more effective graft.

Pandemic flu

In addition to maintaining the supply

of products and services under normal

circumstances, NHSBT has plans in

place to handle major incidents and

emergencies which might adversely

affect the supply of blood, tissues

and organs.

As part of this work, NHSBT has

developed plans which would be

activated in the event of an influenza

pandemic. This planning has been

carried out in conjunction with the

other UK blood services, looking at

the likely impact of pandemic flu on

the blood supply and the way in

which the NBS would respond to

maintain blood stocks and limit the

impact on patients.

In February 2007, the NBS took part in

Exercise Winter Willow, a national

exercise to test the UK’s ability to

manage the effects of a flu pandemic

at national, regional and local levels.

With over 5,000 participants from

across Government and the NHS, this

was the largest such exercise ever run

in the UK.

Donors are cared for in the bestpossible clinical environment,with their privacy and dignityrespected at all times.

‘‘ ‘‘


Last year – for the first time – more

than 3,000 organ transplants were

carried out in the UK. This increase in

lives saved and transformed was the

result of record numbers of living

donor transplants, as well as the

highest number of transplants to date

using organs from non-heartbeating

donors.

This achievement is testament to the

considerable efforts and dedication

of the whole transplant community

and, above all, to the generosity

and courage of the donors and

their families.

At the same time, however, this

should not obscure some less positive

statistics over the year. The continuing

fall in the number of heartbeating

donors – historically the main source

of donated organs – is of particular

concern for those patients waiting for

liver, heart or lung transplants.

Despite the record number of

transplants, the year ended with

the highest number of patients ever

registered for a transplant. This,

combined with the rate at which

those waiting is increasing, serves to

emphasise how much more needs to

be done.

Transplant activity

Over 2,000 people received kidney

transplants during 2006/07, more than

ever before, 690 of them from living

donors. More people than ever were

also cured of type-1 diabetes thanks

to a combined kidney/pancreas

transplant.

Many of those receiving a kidney

had spent years on the transplant

register, undergoing hours of

debilitating dialysis every week,

because their unusual blood group

or tissue type made it difficult to

match them with a donor. A national

scheme was introduced in 2006/07

to ensure greater equality in the

allocation of kidneys for transplant

to these patients.

More hearts (162) and lungs (134)

were transplanted over the year,

together with a welcome recovery

in the number of people receiving

a liver transplant – 655 in 2006/07.

This was due in large part to the

793 people who donated organs after

death, almost 4% higher than the

previous year.

Along with this increased activity, an

additional 1.1 million people added

their names to the NHS Organ Donor

Register during the year.

Increasing organ transplantation

Nevertheless, the rate of transplant

activity in the UK compares

unfavourably with many European

countries. Starkly put, the continuing

critical shortage of donated organs

UK Transplant in 2006/07

21

resulted in over 400 people dying

while registered for a transplant, with

many others – up to twice as many

again – dying before getting on to

the list or having had their names

removed because they were too ill to

survive surgery.

At the end of March 2007, there were

7,219 people on the transplant list, an

unwelcome record – with a predicted

rise of a further 2,000 over the next

few years.

If more lives are not to be lost, UK

Transplant (UKT), the wider transplant

community and the NHS must build on

this year’s record figures to increase

levels of organ donation and

transplantation significantly.

Organ Donation Task Force

The Organ Donation Task Force was

established in December 2006 by Rosie

Winterton, then Minister of State

for Health Services, to examine the

transplantation process, identify

obstacles to organ donation and

report back to the Government with

recommendations as to how to

increase the number of transplants

in the country.

Chaired by Elizabeth Buggins (see

page 29), the task force includes

representatives of all types of organ

transplantation, the four UK health

departments and the wider NHS,

intensive care clinicians, surgeons,

donor transplant co-ordinators and

donor family charities.

The Newport Gwent Dragons and world boxingchampion Gary Lockett helped kick off a life-savingmail drop in Newport inviting people to join theNHS Organ Donor Register.

They were joined by brothers Ashley and LukeCampbell, who both received kidney transplants, to help support UK Transplant’s letter drop.

The bilingual letters, part of UK Transplant’s firstmass mail drop, were sent to more than 275,000homes in South Wales.

WBU world middleweight champion Gary Lockettsaid: “There’s no better way of pledging the gift oflife and bringing hope to the thousands of peoplewho need a transplant than by talking about yourwishes with your family, filling in the registrationform and joining the register”.

Pictured left to right: Ian Gough (Newport GwentDragons), Gary Lockett, Ashley Campbell and Luke Campbell

There’s no better way of pledgingthe gift of life and bringing hopeto the thousands of people whoneed a transplant

‘‘ ‘‘


Over 2006/07, the task force looked at

the structure of the donation, retrieval

and transplant service, identifying

strengths and weaknesses in the UK

system and comparing them with

other countries, such as Spain and the

USA. Legal and ethical issues have

been closely considered, with work

also being undertaken on the cost

effectiveness of transplantation and its

consequent benefits to the wider NHS.

The task force recommendations will

also address training, performance

management and the prediction of

future need.

A comprehensive review of all stages

of organ donation has also been

undertaken by NHSBT, in parallel to

the work of the Organ Donation

Task Force.

By March 2009, UKT aims to deliver

the following increases in the number

of donors and transplants:

• At least 3,150 organ transplants

every year (up from 2,700 in

2005/06);

• Corneal transplants from 2,500 to

3,000 per year;

• 15.4 million people on the Organ

Donor Register (up from 13.1

million in 2005/06).

Consent for organ donation

Currently, permission for donation to

go ahead is refused by the relatives of

more than four out of ten potential

donors who die in intensive care units.

There were 633 heartbeating donors

in 2006/07 – 59% of potential donors –

resulting in 2,073 organ transplants.

Had permission been given for the

remaining 41%, the 440 additional

23

donors could have resulted in another

1,440 organ transplants.

The introduction of the Human Tissue

Act 2004 and the Human Tissue

(Scotland) Act in September 2006 has

made the wishes of the donor

paramount after death. This means

that relatives no longer have the legal

right to veto or overrule a decision

made during the donor’s lifetime.

Donor co-ordinators play a key role in

encouraging relatives’ acceptance of

donors’ wishes. UKT currently funds

14 in-house donor co-ordinators.

Given encouraging indications of an

increase in donors and a reduction in

rates of refusal by relatives, UKT plans

to appoint more co-ordinators to work

in the neurological and major general

intensive care units which contribute

the majority of deceased donors.

A 9% fall in the rate of refusal by

relatives is anticipated by the end

of 2008/09 as a result of these

appointments, translating into an

additional 100 organ donors and

330 transplants every year.

Living donation

UKT also funds living donor schemes

in 25 transplant units, resulting in a

record number (690) of living donor

kidney transplants in 2006/07.

Building on this success, funding

for more living donor transplant

co-ordinators will focus on renal

units with 400 or more patients

with end-stage renal failure,

potentially generating an additional

50 transplants a year from living

donors by the end of 2008/09.

Transplants from living donors are also

expected to increase as a result of

paired and altruistic kidney donor

programmes, introduced following the

Human Tissue Acts. However, numbers

are likely to remain low for two to

three years while these programmes

develop. At this stage, they may

increase living donation by 30 to

50 transplants a year.

Non-heartbeating donation

Although the number of deceased

heartbeating donors stabilised over

2006/07, a combination of factors,

including better road safety, medical

advances and the prevention of

strokes in younger people, has

resulted in their decrease over

the past five years. There has been

a corresponding rise in non-

heartbeating donors over the same

period – 159 during 2006/07, the

highest number on record, resulting

in 316 organ transplants (mostly

kidney and liver grafts).

Investment in 14 programmes to

support non-heartbeating donations

in renal transplant units is also

expected to result in an increase

in heartbeating donors. With an

UKT’s three-year strategy aims to increase the number oftransplants carried out every year by between 20 and 27%.

‘‘ ‘‘


An instant bond in

established programme in every

appropriate intensive care unit,

there would be the potential for an

additional 100 non-heartbeating

donors per year.

Corneal transplants

UKT currently funds eight eye retrieval

centres. Each of these centres aims to

supply 450 corneas a year. Assuming a

70% usage rate of corneas retrieved,

these centres would generate 2,500

corneas per year for transplant.

Together with corneas donated from

other centres, we anticipate meeting

our target of 3,000 corneal transplants

per year by March 2009 in order to

satisfy current demand.

Organ Donor Register

The number of people on the NHS

Organ Donor Register (ODR) had

reached 14.2 million by the end of

March 2007 – 23% of the UK

population.

There are, however, significant

regional variations in those joining the

register, from 29% in South West

England and Scotland, to 21% in

London and Northern Ireland and

19% in the West Midlands, the lowest

in the country. A direct correlation

also exists between those areas with a

high proportion of the population on

the ODR and a low rate of refusal by

relatives. Increasing the number of

people on the ODR to 15.4 million

by March 2009 is, therefore, also

expected to reduce this refusal rate.

Less than one in four people are

registered on the ODR. At the same

time, market research puts public

support for organ donation at more

than 90%. In order to translate this

support into ODR registration, UKT

has been allocated an additional

£1 million for public awareness

campaigns in 2007/08.

UKT’s three-year strategy aims to

increase the number of transplants

carried out every year by between

20 and 27%. While transplantation

already saves thousands of lives

every year, we must reduce the gap

between supply and demand for the

ever-increasing number of patients

whose lives would be saved or

transformed by a transplant.

Good friends Vikki Lock, 22 (left), andNatasha Motterham, 24, met underrather unusual circumstances. The twogirls went into the same hospital on thesame day to donate their bone marrowand made an instant bond when theirconsultant introduced them to eachother. Both had joined the British BoneMarrow Registry and ended up makinga friend for life in the process. Vikki,who flew back from her teaching job inSpain to donate, says, “Although weboth had family with us at the hospital,it was great to have someone there toshare the experience with and chat to”.Both girls come from the South West,love musicals and enjoy travel. “Thecoincidences in our life are scary really,”says Natasha. “We have so much incommon, even the fact that we’ve bothchosen teaching as a career.”

25

helping other people


Bio Products Laboratory (BPL) is the

biggest supplier of plasma-derived

products in the UK. However, in

response to the changing commercial

environment BPL began implementing

its plans to increase the efficiency of

the operation and build a sustainable,

financially viable, business going

forward.

BPL’s plans focus on activities within

four main areas in order to achieve

its overall strategic objective of

moving towards financial viability.

These areas are:

• Increasing sales revenues.

• Reducing operating costs.

• Increasing operating efficiencies.

• Ongoing business development and

search for partners to facilitate

access to international markets.

The first year’s performance exceeded

the plan. This achievement is due to

the successful implementation of these

key work-streams. Overall sales

revenues were up by 25 per cent over

last year and exceeded the plan by 9

per cent. The main contributory

factors were significantly increased

global and national market prices for

the main product lines and an increase

in demand for BPL’s products in its

domestic market. The increased

demand resulted from competitors

diverting product supplies to other

markets and additional demand from

Scotland following the closure of the

Scottish Protein Fractionation Centre,

PFC. BPL increased production and

redirected supplies into the UK

from its export markets to meet

this extra demand.

Bio Products Laboratory in 2006/07

“Our centre is one of the largest specialisttreatment units for haemophilia in the world. We have used BPL products for the treatment of our haemophilic patients here in Oxford forseveral decades.

“In my experience, BPL provides a very good after-sales service. Both the scientific staff andmarketing/sales personnel at the fractionationplant are well qualified and of high calibre. BPLhas a good track record of innovative productdevelopment.”

Dr PLF Giangrande BSc MD FRCP FRCPath FRCPCH

Oxford Haemophilia Centre and Thrombosis UnitChurchill Hospital, Oxford

After reviewing every aspect of the

operation, plans were developed for

the restructuring of BPL. The plans

were announced in October 2006

and, although necessary to secure

the future of the company, the

changes led to a reduction of 55

out of 485 posts.

BPL is continuing its strategic

capital investment programme,

predominantly to continue to achieve

UK and international regulatory

requirements, to facilitate new

product and process development and

to further upgrade its manufacturing

plant.

A number of business development

opportunities are in the process of

being explored, including transfer of

technology. Market expansion plans

are progressing well with the

preparation of the EU mutual

recognition applications for products

and a range of product developments

to consolidate and improve BPL’s

product portfolio. BPL will continue

its ongoing business development

programme. These developments will

bring additional sales income in future

financial years.

During 2007/08 BPL will continue to

increase sales revenues, improve

efficiency and exploit business

development opportunities. The

organisation continues to work with

the Department of Health’s

Commercial Directorate to determine

the best way forward for BPL.

27

The first year’s performanceexceeded the plan…due tothe successful implementationof these key work-streams.

‘‘ ‘‘


1 2 3 4

5 6 7

8 9 10 11

12 13 14 15

16 18

The Chairman

1. Bill Fullagar has wide experience

at director and chairman level in the

industrial field. He was Chief Executive

of Novartis Pharmaceuticals in the

USA and UK. He was President

of the Association of the British

Pharmaceutical Industry from

2001 to 2003.

Non-executive directors

2. Elizabeth Buggins is Chair of

NHS West Midlands and was a

non-executive director of the

National Blood Authority. She is also

a director of engage2excel, a company

specialising in patient and public

involvement in the NHS. Over 2006/07,

she has chaired the Organ Donation

Task Force (see page 21).

3. John Forsythe is a consultant

transplant surgeon and Clinical

Director (renal/transplant surgery) at

the Royal Infirmary of Edinburgh. He

is Chairman of the Scottish Transplant

Group and a non-executive member

for NHS Quality Improvements

Scotland. He was chair of UKT's Kidney

and Pancreas Advisory Group.

4. David Greggains is a management

accountant, with experience of

working in both the public and

private sectors. He is a member of

the Independent Monitoring Board

for Harmondsworth Immigration

Removal Centre.

5. Jennifer Gubbins is a practising

solicitor and partner in Trowers &

Hamlins and was a non-executive

director of the National Blood

Authority. In her career in commercial

law, she has specialised in corporate

legal issues.

6. George Jenkins is Chair of East

Kent Hospitals Trust and was a

non-executive director of UK

Transplant (UKT). He has held many

non-executive and executive director

roles in both the public and private

sector. He is also chair of UKT's

Patients' Forum.

7. Dr Diana Walford CBE is Principal of

Mansfield College, Oxford, and former

Chief Executive of the Public Health

Laboratory Service (PHLS). She was

Deputy Chief Medical Officer of

England between 1989 and 1992.

29

The Board of NHS Blood and Transplant


Executive team

Chief Executive

8. Martin Gorham OBE joined the NHS

as a national management trainee. He

has run a number of hospitals, was

Chief Executive of the London

Ambulance Service and Director of

Projects and Corporate Affairs at NHS

regional level. He was appointed Chief

Executive of the National Blood

Authority in 1998, becoming Chief

Executive of NHSBT in 2005.

Martin Gorham stepped down as

Chief Executive of NHSBT in July 2007.

Lynda Hamlyn takes up the role in

early 2008, with Barry Savery covering

the post on an interim basis in the

intervening months.

Managing Director,

National Blood Service

9. Peter Garwood has worked at the

National Blood Service (NBS) for nearly

30 years. He trained as a biomedical

scientist, working at King's College

Hospital before moving to the Tooting

Blood Centre in London in 1975. In

1994, he became Operations Director

for the London and south east zone of

the NBS. Peter was national NBS

Director for Processing, Testing and

Issue from 1999 until March 2004

when he was appointed as Director of

Service Delivery/Deputy Chief

Executive and subsequently Managing

Director of the NBS. He took on the

role of Group Director of Strategic

Supply and Specialist Services at

NHSBT in July 2007.

Clive Ronaldson became interim

Managing Director of the National

Blood Service in July 2007.

Medical Director, NHSBT

10. Dr Angela Robinson has been a

consultant in the NHS since 1976,

originally specialising in paediatric

haemato/oncology and transfusion

medicine. She was involved in the

development of the first bone marrow

transplant centre in Leeds. She

became the Director of Yorkshire

Blood Transfusion Service in 1988 and

Medical Director of the NBS in 1994.

Angela has been the UK Government's

designated transfusion medicine

expert for both the Council of Europe

and the European Commission for the

last 10 years. She is also chair of the

Council of Europe expert committee in

transfusion medicine.

Dr Robinson retired in April 2007.

Dr Lorna Williamson was appointed

as Medical Director of NHSBT in

September 2007.

Managing Director,

Bio Products Laboratory (BPL)

11. Clive Ronaldson became Managing

Director of Bio Products Laboratory

(BPL) in October 2005. His previous

experience includes employment

with Baxter Healthcare from 1976 to

1993. He joined BPL in 1993 to take

responsibility for manufacturing and

associated activities. He is also a Board

member of the International Plasma

Fractionation Association.

Jane Martin became interim Managing

Director of BPL in July 2007.

Managing and Transplant Director,

UK Transplant (UKT)

12. Chris Rudge was appointed UK

Transplant's first Medical Director

in 2001 and has played a leading role

in developing effective relationships

between UKT, the clinical transplant

programmes in the UK and the

critical care community. He was

consultant transplant surgeon at

Guy’s Hospital and then at St Peter’s

Hospital. In 1995, he became Director

of Transplantation at the Royal

London Hospital, where he continues

to spend one day a week. He became

Managing and Transplant Director of

UKT in 2005.

Finance Director, NHSBT

13. Barry Savery joined the NHS in

1987 as Director of Finance at

Bio Products Laboratory (BPL). Before

joining BPL, he worked in the

private sector, holding financial and

general management posts in the

pharmaceutical, chemical and printing

industries. He was Director of Finance

at the National Blood Authority from

1993 to 2005.

Director of Estates and Facilities,

NHSBT

14. Dougie Dryburgh joined NHSBT in

August 2006, having spent 16 years in

the Royal Air Force. His responsibilities

encompass infrastructure, transport

and warehousing.

Director of HR, NHSBT

15. David Evans was Director of HR

and Organisational Development at

Barking, Havering & Redbridge

Hospitals NHS Trust before joining

NHSBT in June 2006.

Director of Information Technology,

NHSBT

16. Alan McDermott joined NHSBT in

August 2006, having held a number of

senior IT executive roles in private

sector manufacturing, services and

financial organisations in Ireland,

Australia and the UK.

Director of Strategy Management,

NHSBT

17. Terry Male (not pictured) joined

the NHS in 1975 and trained as a

biomedical scientist before joining

Life Sciences International as R&D

Manager in 1986. He worked as

Organisation Development Specialist

at the Yorkshire Regional Health

Authority and then joined the NBS

in 1993.

Director of Communications &

Corporate Affairs, NHSBT

18. Liz Reynolds worked at the NBS

for nine years, having worked for

Sears PLC leading change programmes

and Kingfisher PLC in a marketing

strategy role for Comet. She is also a

non-executive director and trustee

for Traidcraft.

Henrietta Joy joined NHSBT as Interim

Director of Communications & Public

Affairs in July 2007.

31

NHS Blood and TransplantOak HouseReeds CrescentWatfordHertfordshire WD24 4QN

Tel 01923 486800Fax 01923 486801

www.nhsbt.nhs.uk

nhsbt annual review 2006-2007

Documents

board of nhs blood

cost of blood

safesupply of blood

blood products inengland

transplant services

clinical outcomes of

appointment togive blood

transplant backgroundpages