National Blood Service

What is the National Blood Service?

The National Blood Service is an NHS body responsible for the collection and distribution of blood and blood components in England and North Wales.

The National Blood Service is reliant on voluntary donations of blood from members of the public, which it collects through a network of blood centres, and has responsibility for ensuring the security and adequacy of this supply.

It is also responsible for providing laboratories for manufacturing and screening blood products and plasma fractions, and for providing specialist medical advice and clinical support to hospitals, as well as educating and training transfusion machine specialists.

The rest of the UK is covered by three other blood services: the Northern Ireland Blood Transfusion Service (a Special Agency of the Northern Ireland Health and Personal Social Services Department); the Scottish National Blood Transfusion Service (an agency of NHSScotland, responsible to the Scottish Executive); and the Welsh Blood Service (a unit within Velindre Hospital NHS Trust, responsible to the Welsh National Assembly, which covers south, mid and west Wales).

Background

Blood transfusions have been carried out since the 17th Century, with varying degrees of success. Procedures and technology advanced rapidly during the first half of the 20th Century, however, stimulated by the huge demand for blood generated by the two World Wars.

Blood collection had been organised centrally during the Second World War, and in 1946 the National Blood Transfusion Service was established to put this arrangement on a peacetime footing. The NBTS also took over central responsibility for the eight regional transfusion centres. With the foundation of the National Health Service in 1948, responsibility for the NBTS was given to the Regional Health Boards (later Regional Health Authorities).

This arrangement led to the transfusion centres developing very differently over the following decades, as different authorities gave differing levels of priority to blood services.

In 1970, the directors of the services set up a central committee, and in 1980 an advisory committee was added. In 1988, a National Directorate for blood services was established. By this time, there were 14 regional transfusion centres in England: Northern; Oxford; Yorkshire; North West Thames; North Western; North East Thames; Mersey; South East Thames; Trent; South West Thames; West Midlands; Wessex; East Anglia; and South Western.

The National Directorate managed to establish a formal system for transferring blood supplies from one centre to another management information system and quality assurance policies, but it was hampered by a lack of executive authority - a situation worsened by the introduction of the NHS internal market.

In 1992, the Conservative government announced measures to remedy this situation, proposing the creation of a National Blood Service - governed by a special health authority - that would take over the responsibilities of the National Directorate and the Central Blood Laboratories Authority, which had previously been responsible For the Bio Products Laboratory (BPL) and the International Blood Group Reference Laboratory (IBGRL).

The NBS took over the Central Blood Laboratories Authority's role in 1993, and assumed responsibility for the transfusion centres in 1994, along with blood services in North Wales.

It moved gradually to a nationally organised service, initially consolidating services into three regions (Northern, Midlands and South West, and London and South East) before shifting to national pricing and service agreements in April 1999, and becoming fully national in April 2000.

The National Blood Service, the Bio Products Laboratory Ltd., and Organ Donation and Transplantation are all now part of NHS Blood and Transplant.

NHSBT was established as a Special Health Authority in October 2005 to provide a reliable, efficient supply of blood, organs and associated services to the NHS.

Controversies

The National Blood Service's creation was controversial, insofar as the changes to regional services involved in the "nationalisation" of the Service caused local concerns. That the restructuring plan was developed by the private sector consultants Bain and Co. served to increase the controversy.

In particular, concerns about plans to move bulk processing and testing facilities from Liverpool to Manchester were widespread in the North West and North Wales. In response to these concerns, Health Secretary Stephen Dorrell appointed Professor John Cash to investigate the proposal in 1997.

Although Professor Cash approved the merger, his report warned that the shift to a national service had made the NBS more remote from the NHS - a situation exacerbated by contractual elements of the internal market. He also criticised the management of the NBS and the National Blood Authority, and warned that some of the mergers - notably Plymouth and Bristol - potentially posed a risk to patient safety.

Professor Cash was highly critical, moreover, of the NBS's consultations with the people of Liverpool, which led the then-Health Secretary Frank Dobson to sack NBS head Sir Colin Walker in April 1998.

A second area of controversy involving the NBS was the BSE crisis, and the perceived risk of the transmission of variant CJD through blood transfusions. In February 1998, the Government required all plasma for the manufacture of blood products be procured from outside the UK, and in July 1998, the Government announced that all blood destined for transfusions would be leucodepleted (the white cells would be removed) to reduce the risk of vCJD.

The shift to procurement from overseas (principally the USA) cost the NBS £23 million in 1998-1999, while the introduction of leucodepletion had a measurable impact on donations. Indeed, in 1998 the NBS was heavily criticised when blood shortages occurred in a number of areas.

Another highly controversial issue was the lifetime ban on blood donations from men who have sex with men which was imposed in 1983 amidst concerns about transmission of HIV.

Following a lengthy campaign by gay rights groups and others, it was finally announced in September 2011 that the outright ban would be lifted. 

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) recommended that in future only those men who have had anal or oral sex with another man in the previous 12 months, with or without a condom, would be asked not to donate blood.  Men whose last relevant sexual contact was more than 12 months ago would now be able to donate, subject to meeting the other donor selection criteria.

SaBTO's recommendations were accepted by Health Ministers in England, Scotland and Wales.

Statistics

ABO Blood group - Percentage of population with this Group

O positive 37%
O negative 7%
Total type O 44%

A positive 35%
A negative 7%
Total type A 42%

B positive 8%
B negative 2%
Total type B 10%

AB positive 3%
AB negative 1%
Total type AB 4%

Source: National Blood Service 2012

Quotes

"Blood isn't just needed in accidents and emergencies; many patients, such as those undergoing treatment for cancer and leukaemia, need regular blood transfusions.

"Donated blood saves and improves lives. Each donation can potentially save the lives of three adults and just a teaspoon of blood could save the life of a newborn baby."

NHSBT – October 2012

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