Blood Donor Programme Strategy - Health and Social Care in ... · * Source – KM (Paper to NIBTS Board October 2015) Donors Reducing (overall) deferral rates, now less than 15%

STG:16:DS:001:01:NIBT

Northern Ireland

Blood Transfusion Service

DDoonnoorr PPrrooggrraammmmee

SSttrraatteeggyy 22001166 -- 22002200

Charles Kinney

APRIL 2016


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Contents

Page Introduction

3

Background

4

Service and Business Environment.

5

Environment - SLEPTECC

7

SWOT

9

Strategic Outlook

- demand for red cells - plateletpheresis - routine blood donation sessions - impact of vCJD related issues - IT/ Donor and Blood Management System - transport - Objectives / KPI’s /performance management - collection - productivity - absence

- staff

- Goods & Services - Customer service - Corporate Social Responsibility - Personal and Public Involvement

16

16 17 18 19

20 20

21

22 24 25 25 25

Positioning

26

Risk assessment

27

Work programme 2016 – 2020

27

Equality statement

27

Appendices

Donor panel – Age/Reliability profile]

Performance management – Summary Data

Commitment to Care and Partnership


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Donor Programme Strategy to 2020

1 Introduction

This strategy is based around the projected demand for whole blood and platelets. In 2015/1

50,590 whole blood donations were collected of which 46,584 were issued – equivalent to just

under 27 units transfused per1,000 population. These figures include around 700 donations

from Haemochromatosis donors, and this may increase as collection from this group is

extended to mobile donation Units (previously having only been available at NIBTS HQ). As

indicated in the previous strategy we do not expect demand to fluctuate outside a range of +/-

2% each year, and the NIBTS Medical Director has recently stated demand for red cells could

reduce to as little as 44,000 by 2020.

In contrast, platelet demand has increased by over 20% over the past five years and it has is

estimated that a similar increase will be seen by 2020.

In previous strategies we predicted the reduction in demand for red cells and this was one of

the drivers for a reduced session programme – which introduced one less session each week,

complemented by another reduction in sessions on public holidays. However, due to the

increasing demand for platelets, a number of public holiday sessions were re-instated. In 2012

the Service introduced a new single-part-session model based on a preferred practice being

adopted throughout European Blood Alliance (EBA) member states. In 2014/15 we held just

over 730 donation sessions serviced by four collection units, with around 5% of these being

single part sessions.

In 2015/16 platelet issues to hospitals increased to an all-time high of 8,979 adult therapeutic

doses (ATD’s) - approximately 4.6 per 1,000 head of population. During that year we also saw

another modest improvement in multiple donation yield with over 1.8 doses per donation

reported, and almost 80% of platelets issued to hospital derived from apheresis. Whilst we

plan to increase the dose:donation yield further, the longer term mix of apheresis : buffy coat

is less clear – although there is a drive nationally to reduce apheresis. Any further deliberations

on platelet arrangements will also need to factor in Platelet Additive Solution (PAS), a

requirement already stipulated by SaBTO. In 2015 the impact of TRALI-related antibody testing

for female donors saw a reduction in the platelet donor panel; however, platelet donor

recruitment activity for the HQ Unit helped ensure we actually ended up with a small increase

in donor numbers.


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Other factors bearing on the way forward will include:-

Challenges to maintain the donor panel/new donor recruitment (influenced by the

reduction in session hours, and another reduction in the number of sessions).

Continued high-level regulatory compliance activity and inspection (it is expected

we will have another MHRA inspection in January 2017).

Further cost/activity efficiency programmes.

2. Background

This strategy is influenced by:

(EU/BSQR/EBA/DOMAINE drivers)

HSC/ NHSBT/Other UKBTS strategic direction

NIBTS Corporate Plan

Specific business plans / assessment of risk

Other influences include:

Performance Management Objectives

Marketing /Collection Programme Objectives

Eight broad areas have been identified, and these are presented in Table 1.

Table 1

Whole blood donation

Plateletpheresis donation

Donor panel/new donors

Platelet donor panel

Performance management

Regulatory compliance

Efficiency measures

DS organisation structure

(introducing East : West teams)


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To meet the needs of our stakeholders, we need to consider:

Current and future collection requirements for red cells - based on no significant change i.e.

+/- 2% on a baseline collection of around 51,000 pa, and issues of around 47,000.

Current and future donation requirements for platelets - based on increased demand i.e. +

5% year on year against a baseline of just under 9,000 adult therapeutic doses (ATDs) p.a.

Following a significant overhaul of the donor panel, an Active Donor panel of over 60,000

has been maintained (with new donor recruitment of less than 7,000 against a target of

8,000 p.a.).

Several initiatives in recent years have improved new donor deferral from over 40% to

around 25%, and overall deferral now less than 15%. However, there is some evidence

that some collection units have, as yet unexplained, higher deferral rates

Regulatory compliance – mainly under the auspices of MHRA Inspections, but also the

professional regulation of nurses and doctors.

Programme funding – against the backdrop of significant budgetary cuts and efficiency

measures.

In 2012 a new initiative (Club 96) was proposed which would see a cohort of 17 year olds

coming on stream from 1st January 2013, who having been born in 1996 post -BSE food-

chain problems may be a safer group of potential donors. However, this particular project

has been further extended in order to carry out more research into the epidemiology of

younger donors ( including existing high risk markers and EBV).

Over the past year it has become increasing likely that PULSE may not be the preferred

donor management system, and an appraisal of options to replace PULSE is likely to be a

significant project to be completed by 2018.

3. Service and Business Environment.

NIBTS remains a Special Agency of DHSSPS, and this was reaffirmed following a significant

review carried out by Deloitte in 2009. However, NIBTS has been included in the Review of

Pathology Services and, at the time of writing, we await a Ministerial decision on whether this

will be published for consultation

Blood components

Red cells issues: continuing to decrease to around 44,000 by 2020.

A number of reasons* for the reduction have been proposed - the majority of red cells are

administered as two unit transfusions to patients with a medical diagnosis and moderate


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anaemia. There have been great advances in the last 5-10 years in surgery including

optimisation of patients, hypotensive anaesthesia (reduces blood loss), cell salvage,

surgical technique including diathermy micro-dissection and acceptance of low

haemoglobin thresholds. Bloodless surgery is now a real objective with the defined

exceptions of solid organ transplantation and emergency vascular repair.

Another important advance has been the recognition of the importance of correcting iron

deficiency as opposed to treating low haemoglobins. Iron deficiency is now recognised as

causally associated with increased infection, delayed recovery, increased tumour

recurrence and cogitative decline in surgical patients. Newer preparations of parenteral iron

for infusion with rapid improvement in iron replacement are now being given routinely to

surgical patients and applied in medical patients potentially reducing allogeneic transfusion.

Platelet issues: increasing to around 11,000 ATD’s by 2020.

Reasons* for this increase include - Platelet components are administered to patients with

a low platelet count to either treat or prevent bleeding. 80% of platelet components are

administered to haematology and oncology patients receiving chemotherapy and/or

radiation therapy. These therapies temporarily injure the bone marrow with an average of

30 days to recovery. 80% of platelet components administered to this patient group are

prophylactic.

Northern Ireland lags behind other UK countries and the rest of Europe in platelet issues

which are 4.6 per 1,000 capita population. Data from other UK Blood Transfusion Services

and the consensus view across the European Blood Alliance is a minimum of 6 per 1,000

capita population platelet component issues will be required

* Source – KM (Paper to NIBTS Board October 2015)

Donors

Reducing (overall) deferral rates, now less than 15%. New donor deferral now less than

25%

With an ageing population, the overall pool of eligible donors may decrease, whilst

demand from the elderly will increase. However, the NI Census 2011 indicates a 7%

increase in the population (compared to 2001), with a total of 1.81m people (in

2015 there were over 24,000 births and 15,000 deaths). With the removal of the

upper-age eligibility limit, and a current pool of younger donors i.e. almost. 20% of the

panel are below 25 years, and 41% under 35 (see appendix 1 ), there are still almost


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1.1m of the population (2011) in the age group 17 – 65 who may be eligible to donate

for the first time.

In contrast, only 10% of platelet donors are under 25, with the proportion of donors

under 40 increasing to almost 50%. The highest percentage (30%) of platelet donors is

in the age group 26 – 55, and there are about 20% aged 56 – 65 years.

Over the past ten years NIBTS has had an established record of very high donor

satisfaction, and whilst changes to the donor programme and periods of poor staffing

precipitated a reduction in satisfaction, our performance continues to exceed the 95%

target. That said, even a very small reduction could be indicative of more significant

dissatisfaction.

Blood Safety

Public expectation is for zero risk, and this is endorsed by our drive to make blood transfusion

as safe as possible. Whilst a number of vCJD-related initiatives have been pursued e.g. prion

filtration and vCJD testing, Club 96 is still being considered. With specific regard to platelets,

Platelet Additive Solution (PAS) may present challenges as yet not quantified. During the 1st

quarter of 2016/17 the rules relating to MSM (male-sex-male) donors changed to a 12 – month

deferral, and these will have to be managed very carefully in the run-up to there

implementation on 1st September of this year.

Regulatory Requirements

MHRA licensing. Since 2013, NIBTS has been inspected on four occasions, with the most

recent in February 2016 being very satisfactory (reporting only five ‘others’ as opposed to more

significant major or critical non-compliances). There is now a possibility that the Service will

return to a two-yearly inspection schedule (in either 2017 or 2018). For the next inspection,

the inspector has already highlighted his plan to look more closely at change management. In

addition, as we progress plans for additional plateletpheresis locations, this too could be the

focus of inspection.

Regulation and Quality Improvement Authority (RQIA). As reported previously, RQIA originally

undertook reviews of NIBTS against only two of the initial five Quality Standards; however, in

2015 they introduced reviews in relation to professional registrants, which in NIBTS included

doctors, nurses and biomedical scientists.


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Other requirements including Personal and Public Involvement (PPI), Investors in People (IIP),

Equality, Human Rights, Freedom of Information, and Controls Assurance Standards will also

contribute to workload planning over the coming years.

4. Environment

NIBTS operates within a changing environment. This expanded PEST (SLEPTECC) analysis

identifies aspects of this changing environment which may impact on the donor programme.

Social Legal

Increasing population

Ageing population

Population changes

More diverse (ethnic) population

EU Directives

BSQR’s

Equality (MSM)

DPA, FOI etc

Employment legislation

Economic Political

Rationalisation of Blood Services

Rationalisation of NI health bodies

Efficiency Savings

Reduced workplace donors

Irregular work patterns

Pay freeze

Ministerial

DHSSPS / HSC

Review of Pathology Services

HSCB-PHA

Shared services

Technological Environmental

Other testing e.g Hep E, vCJD

Data capture e.g blood mixers, COBEs

IT developments

Pulse / replacement system by 2018

Remote working e.g access to email, HRPTS

Computer assisted donor interviews

Corporate Social Responsibility

Green policies

Waste reduction

Energy efficiency

Competition

Other BTS’s (testing)

Trusts (testing)

Shared Services e.g. marketing, PR

Television – multi-channel/digital, on-

demand

Time / leisure pursuits


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Customers

Donor satisfaction/dissatisfaction

Complaints

Community preferences (Halls v BM)

Time / leisure pursuits

Frequency of visits to localities

5. SWOT Product/Service

STRENGTHS WEAKNESSES - Well known public service - Highly respected

- Well developed and maintained reputation - Well defined, and documented processes

- Adverse publicity (in national press) of other BTS’s e.g. recent IBTS HB testing

- Negative impact of ‘cuts’ - Out of hours telephone cover e.g. after 9.00

p.m. and at weekends.

I M P A C T

O N

B U S I N E S S

OPPORTUNITIES THREATS MIGHT HAPPEN MIGHT HAPPEN

LIKELY LESS LIKELY LIKELY LESS LIKELY Very Significant

Loss of donors

Funding constraints

Regulatory compliance

Significant Collaboration with IBTS e.g plateletpheresis (west)

Shared services

Significant change +/- in demand

Not significant

Price/Financial

STRENGTHS WEAKNESSES - Costs of collection in keeping with other UK & IBTS - Current dedicated NIBTS Finance support

- Comparable costs across Europe

- Economies of scale

- Reduction in demand – increased unit costs

I M P A C T




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O N

B U S I N E S S

Significant More venues are charging.

Centralised UK testing Further reduction in demand for red cells – increasing unit costs

Not significant

Shared services

Promotion

STRENGTHS WEAKNESSES - Self-contained recruitment team

- In-house capacity / flexibility

- Good social media footprint. e.g. Facebook, Twitter

- Allocated budget

- Experienced marketing staff

- Significant community support

- Purpose-built BloodMobile and good signage on fleet

- Excellent media/public relations

- Insufficient and reducing budget to plan

larger media appeals e.g. television.

Pressure on advertising spend due to

procurement guidelines

- Poor reputation of other BTS’s in national

press.

- Use of direct mail becoming less favoured

(although this appears not to be the case for younger donors)

I M P A C T

O N

B U S I N E S S



Website

improvements–

more hits

Social media –

Facebook, Twitter

Wider use of email

and SMS

Loss of donors

Reduced public

confidence due to

vCJD testing, and its

outworking

Loss of media goodwill– free PR

Significant Sponsorship Further DHSSPS control and reduction in advertising spend

Not significant

Review and re-launch marketing materials

Reaction to SMS/email spam.


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Place / Where We Operate/Sessions

STRENGTHS WEAKNESSES - Good facilities at

- HQ - College Street (refurbished in 2015) - BloodMobile

- Access to around 240 venues - Significant community support

- Purpose-built BloodMobile

- Many premises are free to NIBTS

- Old BloodMobile (significant problems with

replacement Unit))

- Access to some locations- - Fewer workplaces - Workplaces without sessions - Access for BloodMobile

- Reduced flexibility - Some communities preferring local hall

- More venues are charging. - Some donors expressing dissatisfaction

about venues

I M P A C T

O N

B U S I N E S S



Saturday opening

College Street

Significant Increased use of dedicated facilities e.g. HQ (or College Street) Introduce a new Apheresis Unit in Omagh – which could also collect whole blood.

As above.

Not significant

Loss of small, poor viability locations, leading to complaints

Restriction on use of some venues (per MHRA)


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Physical Evidence/How do we present ourselves

STRENGTHS WEAKNESSES - Excellent facilities at HQ, ‘new’ College Street

- Well-presented staff

- Smart uniforms

- Attractive vehicle signage

- Website

- Cleanliness can sometimes be a problem - Vehicles - Facilities not under our control e.g.

heating, cleanliness, general decor

- Keeping the website looking fresh

- Lengthy, complex forms

I M P A C T

O N

B U S I N E S S

OPPORTUNITIES THREATS

MIGHT HAPPEN MIGHT HAPPEN


Further improvements to website

Pressure on advertising spend due to procurement guidelines Loss of free media – Street/TV/Radio

Significant Increased use of dedicated facilities where NIBTS has more control. e.g.

T & F/OELH

possible access to facilities for sessions

Donor access to a donor portal (completion of HealthCheck form)

Not significant

STRENGTHS WEAKNESSES - Most equipment is fairly new and up to date

- Old single pod BM unit remains in service (but has been refurbished)

I M P A C T

O N

B U S I N E S S



PCs, capable of running processes much quicker

Significant

On-line DD114 completion Apheresis - West

Remote ‘live’ access to Pulse

Not significant


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Processes

STRENGTHS WEAKNESSES - NIBTS has well documented processes and procedure. - Existing donors are reasonably familiar with our systems of

working. - Mailing Project appears, to donors, to be more efficient,

quicker.

- These often present as being inflexible for frequent donors

- Terminology. Do we always use ‘plain speak’

and not BTS jargon. - Do we really need two stages for PDI donors

i.e. Session Officer do all steps including finger-prick.

I M P A C T

O N

B U S I N E S S



Significant

Extend the use of SMS/email/ social media (Facebook/Twitter)

Loss of data files

Not significant


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People/ Staff

STRENGTHS WEAKNESSES - Well trained staff (many DSA staff now also have NVQs). - Low turn-over - Current staff

- On a cyclical basis, staff shortages- with resultant downturns in service.

- Loss of knowledge/experience due to retirement

- - Current gap in DSA3 (HB) staffing.

- Lack of local Staff Side representation and engagement.

- Time to complete SDR’s HRPTS

- Difficulties in ‘hard-wiring’ communication

I M P A C T

O N

B U S I N E S S



New NSM Also, recent Donor Admin Mgr

Loss of experienced nursing staff due to retirement

Significant

Improve SDR documentation DSA’s- donation venepuncture. Alternatives to NVQ/QCF

Admin staff NVQ

Not significant


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Research/ Reviews / Benchmarks/miscellaneous

STRENGTHS WEAKNESSES - Some research activity e.g. staff survey, donor survey

(apheresis), donor comments card, EBA/DOMAINE - EBA/DOMAINE has presented many key benchmarks

- Insufficient research to support evidence-based decision-making

- Insufficient data analysis. NIBTS has no

automated systems e.g. BOSS, to collect the data, and manual systems can be cumbersome.

I M P A C T

O N

B U S I N E S S


LIKELY LESS LIKELY LIKELY LESS LIKELY

Very Significant

Improved productivity systems

Significant

Information overload

Not significant


6. Strategic Outlook

The work programme for the next four years is spread over a number of key areas.

Demand for red cells (whole blood collection)

In 2015/16 whole blood collection was 50,590. From this 46,584 units were issued, equivalent

to around 26 units per head of population (the lowest in the UK and Ireland).

Whole blood was collected was across around 670 mobile donation sessions – equivalent to

an average of just under 70 donations per session. However this ranges from as low as 40 – to

over 150 units on some sessions. Less than 10% of all donations are collected from fixed site

locations at NIBTS HQ and College Street.

Our forecast for future activity is based on three assumptions:

a) Reducing demand;

b) There is no significant change in deferral

c) There is no deterioration in session attrition e.g. over/underweight packs

Whole blood collection/issues

YEAR 2016/17 2017/18 2018/19 2019/20

COLLECTION 51,000 50,000 49,000 48,000

SSUES 47,000 46,000 45,000 44,000

Action: At the time of undertaking a previous analysis, session losses prior to

processing were just under 3% (around 1,500 donations). The majority of these were

underweight packs.

NIBTS should further reduce overall whole blood losses as this attrition

due to the introduction of the Euroblood pack is not yet known.

NIBTS donor panel (98% whole blood donors: 2% plateletpheresis)

Around ten years ago a significant number of donors were lost from the pool due to the

introduction of more stringent donor eligibility guidelines e.g. previous blood transfusion; an

increase of 5g/L for haemoglobin acceptance thresholds. Whilst there has been discussion

about using a 60,000 target, we are now more confident in the integrity of this panel size

and plan to maintain this (but at the same time culling redundant or dormant donor panels).

Our projections are also reinforced by a new donor recruitment target of 8,000 p.a. but it is

highlighted that as the number of sessions each week decreases the actual opportunity for

new donors to attend is reduced. This must be monitored closely.


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In Appendix 1, data relating to donor age, blood group and Pulse Reliability is presented.

However, this data does not compare directly with the NIBTS Active Donor Panel dataset

(as it refers to donors ‘donating in the past two years’). However, it does give an indication

of the spread of donors across each blood group, and Reliability [a measure of the

likelihood of a donor returning next time (based on their donation record)], with Reliability 1

(R1) being most likely to attend next time, through to R5 giving the possibility that the donor

may not attend, and actually beginning to cease donating]. The dataset derived from Pulse

remains in the region of 52,000 using this definition.

Action: It is essential that new donor recruitment is greater than or equal to donor

panel losses. As such, annual new donor recruitment of over 8,000 needs to be

achieved with individual marketing plans for NIBTS HQ, College Street,

Schools/Universities and a (new) BloodMobile developed

Plateletpheresis

During the past number of years NIBTS has devoted significant efforts to increase the

number of platelet donors and in recent years around 80% of components issued came

from single-donor plateletpheresis. An increase in demand of 20% is expected by 2020.

YEAR 2016/17 2017/18 2018/19 2019/20

COLLECTION 4,750 5,000 5,250 5,500

ATD’s ISSUED 9,500 10,000 10,500 11,000

.

Action: Similar to whole blood, losses have been identified e.g. failed

venepuncture/ vein collapse/ underweight packs, time-expired etc and further

monitoring of this area is need to ensure losses are kept to an absolute minimum.

Plateletpheresis donor panel.

The plateletpheresis donor panel makes up about 2% of the entire donor panel, and until

now has been solely HQ-based. However, this has presented a number of vulnerabilities

e.g. difficulty in increasing the panel size, and a lack of a robust contingency arrangements

as the current buffy coat platelet component production has not been good.

With a panel of just over 1,300 donors, NIBTS plan to develop another panel from the

existing College Street whole blood donor pool. It is estimated that as few as 20 - 25 new

plateletpheresis donors in College Street could be sufficient to support collection once a

month, with a net yield of up to 200 ATD’s p.a. At the end of a one year pilot it is hoped that

another collection unit will be operational in Northern Ireland – but with this eventually

operating once per week, yielding more than 750 ATDs p.a. when fully established.


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Additional plateletpheresis donations collected/issued

YEAR 2016/17 2017/18 2018/19 2019/20

COLLECTION 100 400 450 500

ATD’s ISSUED 175 700 800 900

Action: Develop a once weekly pilot at College Street by Q2 2016/17, followed by

additional sessions each month as whole blood collection operations increases.

Action: Establish a facility in the West (OELH base). Operational in Q1 2017/18.

Routine donation sessions can normally be defined as comprising of two parts e.g.

morning and afternoon, or afternoon and evening. However, a ‘full day’ at HQ e.g. 8.00

am to 8 pm would still be referred to as a routine session as the hours to be covered are

not dissimilar to a routine mobile session at a remote location e.g. the Ballymoney

session can take a staff deployment of 12 hours for each person).

IN 2016/17 NIBTS plan for 12 mobile sessions each week (670 including College Street)

and almost 250 at HQ. We visit almost 240 different locations, and in some areas we may

operate at more than one location e.g. in Lurgan we have several donation sessions but

these are serviced from a single donor panel. At present the Service uses only two fixed

sites at 16 College Street, Belfast and NIBTS HQ, and this is lower than other blood

services in the UK and Ireland. In contrast SNBTS operate over 25% of sessions at fixed

locations, and NHSBT also plan to increase their operations at fixed locations.

Whilst it has been suggested that fixed sites might offer the possibility of greater regulatory

compliance, this has not been well demonstrated as ‘community’ ‘venues are not often cited

in reports.

Based on these factors, it is important that the entire donor programme schedule continues

to be reviewed. It has also been highlighted that we should visit all locations – large and

small donor numbers – at least once a year, and clearly communicate this to local (donor)

communities. In arriving at an optimal, efficient and effective programme, we should look at

a range of factors e.g. if we are to visit only once per year, would donors go to another

location close by to donate on other occasions during that year? Should we continue to visit

some sessions three times a year (three session days p.a. e.g. Derrylin), or visit on only

two occasions, but for one normal session, plus an additional evening ‘single part session’.

The net result would still be a total of ‘three’ days i.e 2 x 1.5, but the reality is we would

actually be travelling to these venues on four different days (albeit some would only be part


Page 19 of 33

days). Would the extra session journey i.e. eight trips (four outbound and four homebound)

outweigh savings on set-up time, breaks, subsistence etc.?

Action: Review the operation of frequently visited multiple-day locations e.g. Lisburn

where we visit six times per year for two days on each occasion.

A) Should this be a normal full day, followed by a single part session next day, or

B) Should we visit four times per year for three days each time?

[Note, the availability of halls on multiple days could be a limiting factor]

Impact of vCJD-related issues

For almost 20 years a number of vCJD- related precautionary measures have been introduced

to help secure the safety of the blood supply, and it had been expected by this stage that

further measures might have been introduced.

The following section (with text struck-through) has been included as these vCJD-related

issues may be taken forward at some time over the next four years.

Prion filtration. As it is likely this process will be undertaken in the laboratories, there may be little

impact on collection unless there is a :

o pack configuration issue

o significant loss of red cells – either through filtration itself, or blocked filters leading to

discard. In addition, there is a possibility that donation volumes might have to increase to

>450 ml e.g. 470 ml (having previously been at this level to facilitate the harvesting of

plasma).

Testing. Perhaps the biggest single challenge to NIBTS is the outworking of vCJD testing –

whether this be donor deferral due to ‘reactive’ results; withdrawal due to confirmed ‘positives’; or

donor fear resulting in people staying away from sessions not wanting to know their test status e.g.

for personal health reasons including life insurance or related issues. Nonetheless, it is estimated

that this test could see the loss of 10% of our donor panel, and it is therefore important that we

continue to focus on maintaining an adequate donor panel.

Club ’96. This name is given to a cohort of donors born after 1st January 1996, who

became 17 years old (and eligible to donate) in 2013. Much work and research has been

applied to this over the past two years; however, further research is underway to review

the epidemiology and other potential risks in this group.

Action. Further research should be completed during 2016, and it will be necessary

for NIBTS medical staff to determine what patient category (probably neonates/

younger children] who should receive this blood.


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A reasonable estimate suggests NIBTS currently could provide in the region of 5%

of blood inventory which is Club-96 compliant

IT / Donor and Blood Management System

For the last 20 years NIBTS has used PULSE as its main IT platform. However, NHSBT

who ‘own’ the system (albeit all development work is carried out by Savant) have

confirmed they intend to replace PULSE by the end of 2018. As such NIBTS must prepare

for this and consider whether to continue to collaborate with NHSBT in this regard, or

follow the lead of the other blood services in the UK and Ireland who have opted for the e-

Progesa system supplied by MAK.

Transport

Donor Services took over responsibility for transport in NIBTS during 2010 and responsibility

was allocated to the Organisation function of Donor Recruitment and Session Organisation. In

addition, the Donor Services Hub provides specific taxi-related support in relation to invoice

payment.

A number of areas require consideration e.g vehicle replacement policy, types of vehicles etc.

NIBTS fleet of 14 vehicles i.e.

o BloodMobile (x2) – donation and tractor unit, people carrier 4

o Belfast Unit - equipment lorry, plus people carrier 2

o Omagh Unit - equipment lorry, plus people carrier and car 3

o Back-up Unit - equipment lorry, plus people carrier 2

o Recruitment vehicle / 4 x 4 1

o Recruitment cars 2

14

All vehicles are within the age advised by HSC guidelines (Refer to separate Vehicle

Replacement Schedule).

Training of some staff with driving duties

o Certificate in Professional Competency (CPC). Some staff, with particular driving

responsibilities, need to undergo at least one week of training and competency

assessment.

o Additional C+E (HGV 1) licensed staff. The plan is to have at least three staff who

are licensed to this level.

Scheduling of blood pick-up from sessions

o Coordinating blood collection from sessions using NIBTS staff and taxis.

Taxis

o Payment of invoices

[A new taxi contract for five years was placed in 2015. Due renewal in 2020]


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Fleet and Transport governance

o Maintenance.

o Costs

o Audit and Controls Assurance.

Objectives /KPI’s These are based on a number of international, national and local benchmarks.

UK and Ireland Business Information Committee (UKIBIC) indicators

Europe-wide (EBA and DOMAINE)

Donor programme targets 2016/17 (see earlier table for the following years):

Meeting demand - whole blood collection circa 51,000 p.a.

Active donor panel 60,000 +/- 3%.

Plateletpheresis 4,750 p.a.

Apheresis: Buffy Coat 80 %

Multiple-dose donation yield > 1.85,

Apheresis donors >1,300.

Blood stocks (>90%) O neg; A neg > three days

Other groups >four days

2nd plateletpheresis facility

and/or

3rd plateletpheresis facility

College Street - operating once per month initially, increasing to every week.

OELH - operating once per month initially, increasing to every week.

Productivity

Collection per WTE (average) >1,250 donations

DSA team /individual productivity 4 donors per hour per DSA

Overall team productivity > 1.6 donations per WTE per

New donor recruitment per WTE > 1,250 p.a.

Donor records processed per 0.2 WTE > 1,250 records p.a.


Page 22 of 33

Staff absence

Absence < 6.0%

Staff (as at Q1 2016/17)

During 2015/16 the Donor Services Department experienced a significant loss of staff –

particularly in nursing – due to retirement. Whilst we were aware of an increasing age profile of

this group of staff, the number of people opting for retirement under the ‘special classes’ i.e

retirement at 55 years, was unexpected. As a result the age profile of nursing, DSA/SSA and

admin staff has been reviewed, and this shows:

Nursing: Of the 12+ WTE funded staffing level, three* staff (2.7 WTE) will retire in Q1 of

2016/17. Of the remaining staff, two are over 55 years, and no one is over 60.

Age <50 50 - 54 55 - 59 60+

Number 6 3 5* 0

% 42% 20% 38% 0

DSA/SSA: Similar to admin staff the retirement age (without penalty to pension benefits) is 60

years for the majority of staff. Of the 41+ WTE funded staffing level, one person is over 65

years of age, six over 60 years, and seven between 55 and 59 years. The largest group (48%)

is in 50 -54 age bracket.

Age <50 50 - 54 55 - 59 60+

Number 16 25 7 7

% 12% 48% 30% 10%

Admin: Of the 22+ WTE staff in this group, there are no staff over 65 years. Two staff will be

over 60 years by the end of Q1 2016/17. Five staff are within three years of 60.

Age <50 50 - 54 55 - 59 60+

Number 13 5 8 2

% 68%

12% 10% 10%

Action. It is evident that we have an ageing workforce, and we have a very large

proportion of staff above 50 years of age. With particular reference to the 55+ and 60+

groups there needs to be a well-planned staff recruitment process in place and this

must be remapped each year.


Page 23 of 33

Note, no staff are required to retire due to age unless their performance is affected by poor

health, or the post is longer required.

Staffing level (budget / funding)

BAND WTE (2016/17

WTE (in 2019/20

COMMENTS

2 - Admin - DSA/SSA

5.30 18.50

5.00 16.50

Reducing by 0.3

Reducing by 2.0

3 - Admin - DSA

7.70 22.70

7.20 20.20

Reducing by 0.5

Reducing by 2.5

4 - Admin

- DSA/SSA 4.80 0.00

4.60 0.00

Reducing to 0.2 No change anticipated

5 - Admin - Nursing

1.80 3.80

1.80 4.50

No change anticipated Increasing by 0.7

6 - Admin - Nursing

1.00 6.40

1.00 5.00

No change anticipated Reducing by 1.4

7 - Admin - Nursing

1.00 1.00

1.00 1.00

No change anticipated No change anticipated

8 2.00 2.00 No change anticipated

Total 76 70

Budget £2.13 £TBC Reducing by TBC

This budget profile does not include a provision for plateletpheresis collection in the west which will come on stream in 2017/18

The change noted above, is based on a number of assumptions:

o Red cell demand reduces in line with forecasts i.e. 47,000 down to 44,000.

o The number of donation sessions reduces from 12 per week to 10.

o Productivity gains are achieved.

New ways of working/ modernisation

The current pattern and way of working have evolved over many years, and whilst Donor

Services Department has continued to change and adapt to new challenges, new opportunities

should be seized to improve the efficiency of the donor programme..

A number of schemes should be developed further:-

o Nursing – all registered nurses to be trained and competent in Personal Donor

Interviewing (PDI).

o PDI – consider this as a one-stop-shop (including HB test).


Page 24 of 33

o DSA (3) – an appropriate number of staff, to be trained and competent in blood

donation venepuncture (following on from the previous cohort of DSA 3 staff

trained in routine blood sampling).

o DSA (3) will, where appropriate, be trained and competent in the use of session

computers (with the opportunity provided to attain qualifications e.g. ECDL etc.).

o Admin staff will have further training and development in use of computer

applications e.g. MS Office tools, and the opportunity to attain qualifications e.g.

ECDL etc.).

o Admin staff should also be given to the opportunity to develop blood donation/

donor selection-related skills.

o SSA staff will move to monthly time recording and payment.

o All staff with supervisory responsibility, will be trained in a range of disciplines:

Quality management systems (including incident management, change

control etc.)

Performance management (including those areas outlined earlier)

Leadership skills – including the development of those areas noted above,

and relevant areas of the NHS Leadership Qualities Framework (LQF),

and refreshed, bespoke Equipping Our Leaders programme..

o Session logistics will be reviewed to ensure we have the right number of people,

with the rights skills, at the right time. The old model of ‘one size fits all’ still

persists in some cases and needs to be challenged further.

In addition to the proposals put forward earlier i.e. one day, two day, etc.,

it is clear that donor attendance at different parts of routine blood

donations sessions are skewed, where for example an evening part of a

session may see 60-70% of the overall numbers attending.

Action. The deployment of staff to the busier parts of session should be further

extended, where appropriate, to all sessions e.g. the current mid-session blood

pick-up to be coordinated with staff being brought to the session? Where

necessary, these staff will ensure blood is returned to HQ in an appropriate and

timely manner?


Page 25 of 33

Goods & Services

The budget for 2016/17 is £1.293m (a reduction from £1.370m in 2102, and £1.62m in 2007).

Blood packs and platelet sets - £664k (a reduction from £750k in 14/15)

Stationery and postage - £95k, including outsourced mailings

Advertising - £90k, including poster, leaflets etc., and £66k ‘campaign’ advertising

Travel and Subsistence -£74k

These and other areas of expenditure should be reviewed to identify opportunities for savings.

Customer service

o NIBTS has a well established customer service schedule set out in its

Commitment to Care and Partnership (see appendix 5).

Corporate Social Responsibility (CSR)

CSR is an important element in the Service’s goal to be a seen and act as a responsible

business, providing support to the wider community, and hence promoting its reputation. A

number of schemes help to deliver the CSR programme, and these should continue:

o Business in the Community (BICNI). NIBTS membership had previously contributed

through projects such as ProHelp, Adopt A School, Silver Surfers, and Time To

Read. However, no one in NIBTS is currently participating. One initiative being

developed is access to the city-centre business community to increase the number

of donors using the College Street facility.

o Personal and Public Involvement (PPI). The main driver for this is the BTS

Communities Partnership (BTSCP). NIBTS is a member of the Regional PPI Forum.

o Environmental impacts. The Service has a number of schemes including a Green

Team, and in 2013/14 a Green Travel plan was developed. This needs to be

reviewed.

Action. Develop plans with BICNI to increase business community donors

in the College Street donor panel.

Action. Review the Green Travel Plan.


Positioning

As has been seen over recent years public services will continue to face significant challenges,

and it will be essential that clear goals, expectations, and consequences are understood as we

strive to deliver high levels of service within constrained budgets. For example, as we

endeavour to improve the numbers of donors processed per WTE, it must be understood that

there could be a negative impact on donor satisfaction e.g. if donors feel rushed.

Cost/performance indicators

Annual collection per WTE 1,400 (2020)

1,200 (2016) TBC

50 60 (£) Cost of collection

Note (1): Cost of collection in 2015/16 per £60 per red cell TBC

Satisfaction

% Donor satisfaction 100

98 (2016)

96 (2020)

94

92

20 30 min Waiting times

Note (2): Average donor satisfaction in 2015/16 was ~98%; waiting times ~25 min


Page 27 of 33

On the previous pages, it has been suggested that there is the potential to maintain the cost of

collection if productivity continues to improve. However, this has become more of a challenge

as the number of whole blood donations collected reduces (without a proportionate reduction in

staffing overheads). Similarly, as staffing levels are reduced to reflect red cell demand and

collection, it is important that waiting times and donor satisfaction are closely monitored.

Complaints monitoring will also be essential to monitor the impact of this strategy.

8. Risk assessment

The Donor Services Risk Register is recorded in Q-Pulse and this has been expanded to

include the potential additional risks flowing from this strategy.

9 Work Programme to 2020

This programme is set out in Appendix 4.

Other more detailed work streams for specific areas, including:

o Headquarters

o College Street

o BloodMobile

o Other mobile units

o Other areas as appropriate

These will be developed in specific plans.

EQUALITY STATEMENT This strategy has been reviewed against the HPSS Bodies and Agencies Equality Screening Template. There is no evidence to indicate that this strategy has any impact on the scheduled groups. In relation to the promotion of good relations, our session planning activity will ensure that sessions are increasingly accessible to all communities.

-----------------------------------------------------------------------------------------------


Page 28 of 33

Appendix 1 Donor age profile

41% of donors are under 35 years, and this indicates a younger pool than five years ago when this percentage related to those under 40 years.

Almost two-thirds (63%) are under 45 years.

One-third (33%) are between 46 and 65 years.

A very small percentage (3.1%) are over 66 years.

Over most age bands the ratio of male to female donors is very similar, apart from 56 -65 years when the split was almost 60 male:40 female. At over 66 years there were almost twice as many male donors.


Page 29 of 33

Appendix 2

NIBTS DONOR SERVICES PERFORMANCE MANAGEMENT

SUMMARY DATA TO END OF 4TH QUARTER (2014/15 in brackets)

Total active donors Apheresis donors

61,510

(61,515) 1,313 (1,285)

Red cell donations Apheresis donations

50,590

(53,543) 4,747 (4,468)

Blood bank Apheresis pooled

1,636

(1,429) (79.3)

Blood stocks Total deferrals

99% (99%) 14.2% (14.8)

New donors New donor deferrals

6,645 (8,037) 22.6 (24.6)

Donor Satisfaction Overall BF OM BM

4th Quarter year to date 98.2% 98.4% 97.7% 98%

Donor Tracking Average BF OM BM HQ` College St

25 30.0 26.7 23.7 22.8 21.3

Complaints Total BF OM BM HQ` ADMIN MISC

26 9 8 3 3 0 3

Quality Incidents Total BF OM BM HQ ADMIN MISC REC

49 8 12 2 20 7 1 4

Some incidents may apply to more than one unit

Whole blood donor attendance per collection team

BF OM BM HQ` Total

April-June 5,348 5,788 2,860 1,390 15,386

July-Sept 4,992 5,584 1,993 1,391 13,960

Oct-Dec 5,426 5,827 2,254 1,391 14,898

Jan-March 4,804 5,796 2,378 1,321 14,299

Sub-Total 20,570 22,995 9,485 5,493 58,543

Haemochromatosis N/A N/A N/A 705 Apheresis N/A N/A N/A 4,747 (Weighting x 2.2) N/A N/A N/A 10,443

Comparative total 20,570 22,995 9,485 11,148

Staffing DSA's 10 10 7.8 7.8 Rec Admin Total (staff incl MOs) 14 14 10.5 12 5.8 11 Donors attended to per wte 1,469 1,643 903 929 1,146 1,167

(per 1,000 new)

(attendance for every 0.2 WTE

staff)

Annualised per WTE Attended 1,469 1,643 903 ***

(Deferral) 15.8 10.9 15 17

Bled 1,237 1,464 768 ***


Page 30 of 33

Appendix 3

Northern Ireland Blood Transfusion Service

*Commitment to care and partnership* ... our principles and standards

Your donation is voluntary and non-remunerated. You should not feel pressurised in any way.

The Health and Safety of our donors and patients are of primary importance to us. On some occasions it may be better not to donate.

Acceptable donations will be made available to all those in need.

Your donation will remain anonymous upon subsequent distribution.

Information given by you will not be used for any purpose other than that intended and will be treated in confidence.

Information about you which is held by us will be made available on request, but not all information will be available at the donation session you attend.

We ask you for personal information as part of our HealthCheck screen. Please answer the questions as accurately as possible.

You are asked to sign your HealthCheck questionnaire. If as a result of your contact with the Service we detect anything which may affect your health, we will let you know.

It is best if you can attend your donation session during the earlier part of each session period. This should prevent undue waiting for you and allow your donation to be returned to our headquarters without delay.

If you are unhappy about any aspect of our service, you are entitled to comment and seek an explanation. If you have a complaint, it is better if you raise the matter with staff at the earliest possible opportunity. Alternatively, you may telephone or write to one of the people noted on the Information Point which is available at each donation session. An advice leaflet: Complaints - Can We Help? will provide further details. It should take us no longer than 20 days to deal with your complaint.

Blood donation sessions will not finish before the stated closure time. However on occasions it may be necessary to end sessions early due to advice from local organisers or where large numbers attending may prevent blood being returned to our laboratories for processing.

98% of sessions will start on time.

At 90% of sessions your time from arrival to being brought through to donate will be less than 30 minutes.

On all occasions you will know the name of the donation staff looking after you. All members of the donation team will be wearing a name badges.

Your invitation letter to the donation session should be delivered to your home at least 3 days prior to the session.

When you telephone our offices you will be told which section you have contacted and the name or designation of the person you are speaking to.

In order that your telephone call or letter to our offices is dealt with as quickly as possible we ask you to provide us with your registration number. This can be found on your donor book or invitation letter.


Page 31 of 33

Appendix 4 Donor Programme Work Programme 2016 - 2020

Activity 2016/17 2017/18 2018/19 2019/20

Strategyschedule Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Review X X X X X

SESSION PLANNING (mobile units including College St)

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

COLLECTION /ISSUES 51,000/47,000 50,000/46,000 49,000/45,000 48,000/44,000

- reduce: 12 sessions pw X

- additional single -part X


- additional single -part X


Marketing plan X X X X

College St 2nd day per mth X

College St 3rd day per mth X

College St every week X

COLLECTION (per month) 0 8 16 16 16 16 24 24 24 32 32 32 32 32 32 32

PLATELETPHERESIS


COLLECTION/ISSUES (TOTAL) 4,750/9,500 5,000/10,000 5,250/10,500 5,500/11,000

- >85% issues X X X X X X X X X X X X X X X

- Yield > 1.85 X

- Yield > 1.90 X

- Yield > 1.95 X

- Yield > 2.00 X

- Plateletpheresis West

- detailed planning

X ◊ X

- regulatory approvals X X`1

- initial sessions X (x1 day) X (x 2 days) X (x3 days) X (x4 days)

COLLECTION (per month) 0 0 0 0 8 8 16 16 16 24 24 24 32 32 32 32 STAFFING


New Band 6 SN/UL X X

New Band 5 Nurse X X

Review Nursing B7 role

X

Revised structure in DS X

DSA 3 donation venep. X X X X X X X X X X X X X X

SSA monthly contracts X

Absence < 6 % X X X X < 5.5 % X X X < 5 % X X X

BLOODMOBILE

Single-pod final refurb X

Double pod resolution X

Upgrade tractor unit X

KEY: X Planned activity X Activity not complete/ carried forward # Cancelled ◊ Unplanned/additional


Page 32 of 33

Activity 2016/17 2017/18 2018/19 2019/20

Strategy schedule Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

PERFORMANCE MGT (mobile units including College St)


Blood stocks (3/4-days) X X X X X X X X X X X X X X X X

Active donors 60k +/-3% X X X X X X X X X X X X X X X X

PROCESSES

New DD114/218 (MSM etc) X X X

IT

Donor/Blood Mgt System X X X X X X X X X X

Implementation X X X X X

INSPECTION Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Controls Assurance X X X X X X X X X X X X X X X X

MHRA mock inspection X X

MHRA - inspection X X

IIP- Dept plans / assess X X X X X X X X X X X X X X X X

SCHOOL/ UNIVERSITIES

- annual report X X X

- annual plans X X X

TAXIS

Contract renewal) X X X X

RESEARCH Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Club 96 – epidemiology X X X>>

Risk register

Review X X X X X X X X X X X X X X X X

Business Continuity

Review / test X X X X X

KEY: X Planned activity X Activity not complete/ carried forward # Cancelled ◊ Unplanned/additional


Page 33 of 33

2016 – 2020 Donor programme Strategy Development

4 – 15 January 2016 Review of 2012 -2016 strategy - CK

7 – 29 January 2016 Draft high-level strategy drafted - CK

3 February 2016 Internal DS scoping exercise (1) CK, CH, PM, PMcE

9 March 2016 Internal DS scoping exercise (2) CK, CH, PM, PMcE

SA MD, ES, MA, SMcG

31 March 2016 NIBTS-wide review CK, CH, PM, PMcE, SA, AC, ES, CS LJ,

GB, HK, SJ, PM, IR, PS, KMe, PG, CB

18 April 2016 Internal DS review CK, CH, PM, PMcE

25 April 2016 Final draft CK, CH, PM, PMcE

26 April 2016 Strategy equality screened CK

26 April 2016 Doc Control reference allocated (STG DS001) IG

May 2016 Communicate with DS staff via line management.

TBC BTSCP communication

JNCC communication

Documents

Blood Donor Programme Strategy - Health and Social Care in ... · * Source – KM (Paper to NIBTS Board October 2015) Donors Reducing (overall) deferral rates, now less than 15%