National Blood Authority Australia – Annual Report 2008–2009

1.1 General Manager’s review

Introduction

Our key focus this year was to continue to undertake our core business at an excellent standard, so that the community is able to access safe and effective blood and blood products.

We also took the opportunity to build organisational and sector capability that will allow the NBA to better meet the needs of stakeholders into the future—particularly in relation to the provision of information to improve planning, policy making, and the delivery of blood and blood products.

This capability building centred on the development of data, information and intelligence systems, blood sector contingency planning, and standards and guidance for the clinical sector. The NBA is fortunate to have the assistance of a range of people from the health sector who share our vision for saving and improving lives through a world-class blood supply.

Highlights of 2008–09

Management and implementation of planning, funding and risk-management activities

As for every year, the NBA’s principal goal in 2008–09 was to make sure that blood and blood products are available when and where they are needed. The report describes the multitude of planning and risk-management activities that contribute to this goal and will do so in the future. A particular focus of our planning and risk management is to continue to improve the value for money that can be achieved by sector and process reform. There are four major activities relevant to this area: the National Supply Plan and Budget; sector risk planning and coordination; enhanced data capture and analysis; and sector improvement projects.

The National Supply Plan and Budget (NSPB)

Development of the NSPB brings together the best understanding of current and future demand and supply trends. Endorsement by commonwealth, state and territory health ministers of the 2008–09 NSPB ensured the continued supply of a range of products required to meet clinical need. Expenditure on the blood supply was $789.9 million, which was 2.3 per cent less than the Commonwealth Budget estimate of $808.7 million. Most importantly, the NBA was able to ensure that products were available at all times to meet clinical need.

Sector risk planning and coordination

Major achievements during 2008–09 included the following:

• The then Parliamentary Secretary, Senator the Hon Jan McLucas, launched the National Blood Supply Contingency Plan in November 2008. This plan establishes a clear decision-making framework for managing the blood supply in cases of supply shortage or demand surges and integrates with broader health emergency management arrangements. The plan was successfully activated from 22 August to 23 October during a shortage of red cells. Actions taken under the plan resulted in clinical practice not being compromised during this period.
• Three other incidents—the Victorian bushfires, the Ashmore Reef incident and the pandemic (H1N1) 2009 outbreak— had the potential to result in inadequate supply. While none of these incidents required activation of the National Blood Supply Contingency Plan, the NBA worked with governments and suppliers to closely monitor the supply situation.
• Understanding future risks—as well as opportunities—is a core activity within the NBA. Our horizon scanning program continues to deliver, for us and our stakeholders, early warning of possible future pressures and opportunities. In 2008–09 the NBA upgraded its reporting in the area; a comprehensive overview is provided in Part 3 of this report.
• Established a meeting of international colleagues under the banner of the collaboration of National Plasma Products Supply Planners to exchange information and data on planning and risk-management activities.

Enhanced data capture and analysis

Improvement in the blood sector, in both supply chain management and clinical practice, is hampered by a lack of data and analysis. Along with jurisdictions and suppliers, the NBA is taking steps to redress this shortfall.

In 2008–09 the NBA, on behalf of all governments, launched the redeveloped Australian Bleeding Disorders Registry to provide to stakeholders information about patients with haemophilia and other bleeding disorders. The registry also allows for more reliable supply forecasting and planning. Our internal data warehouse capability also improved greatly with the roll-out of our Integrated Data Management System, which will assist in the further development of the National Supply Plan and Budget and the transition to multi-year budgeting and demand and supply planning.

The release of the first Blood Measures Guide is a world first in establishing a nationally accepted set of measures on the use and effectiveness of fresh blood components. It is hoped that over time greater consistency in measurement will enable meaningful comparison of research results and lead to a better understanding of the use of fresh blood components.

Sector improvement projects

Progress on a number of projects continues to identify opportunities to improve the sector, especially in relation to value for money. In 2008–09 this included the following:

• development of a multi-criteria analysis framework for assessing new products or services (Schedule 4 of the National Blood Agreement) that aligns blood sector assessment methodology with that used in the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme and quantifies consideration of each of the objectives of the National Blood Agreement
• completion of the first phase of the review of distribution arrangements for plasma and recombinant blood products
• organisation of the National Blood Sector Conference on 6 and 7 November 2008. The successful conference focused on the identification of barriers to wider adoption of best practice in blood management and alternative therapies.

Supply of blood and blood products

The NBA continues to place a high emphasis on being knowledgeable about the international blood sector, so that we can take a highly informed approach to development of the best-value contracts to deliver the blood products Australia needs. In 2008–09 our contract-management and negotiation activities made a key contribution to minimising increases in the overall cost and affordability of the blood supply for governments. Among the highlights were:

• Prices for plasma and recombinant products were effectively restrained. Our analyses demonstrate that during the past six years the collective effect of our activities is that there have been no increases in prices, despite global price rises.
• Three contracts for imported plasma and recombinant products were successfully negotiated, with savings.
• All ministerial recommendations of the Australian Red Cross Blood Service business study progressed according to the agreed timetable, 32 per cent being fully implemented. This includes agreement to move towards a three-year rolling planning cycle and establishment of an output-based funding model.
• New contractual arrangements are in place with the Australian Red Cross Blood Service from 1 July 2009.
• The NBA progressed approvals through governments for the ARCBS’s new principal blood manufacturing sites in accordance with the time frames necessitated by the ARCBS’s project plans. This included managing the independent assessment of the Victoria and Tasmania principal site for the Australian Health Ministers Conference.

Monitoring and implementing the appropriate and safe use of products

Improving product and patient safety is a crucial element of the National Blood Agreement, and good progress in this regard was achieved in a number of projects during 2008–09. Highlights included:

• Information on adverse effects from blood transfusions has been increased through the establishment of the ongoing Australian National Haemovigilance Program. Among other things, this involved finalising the definitions of the national minimum haemovigilance data sets and developing a methodology for assessing the capability of jurisdictions to provide the required data.
• The revised National Health and Medical Research Council’s guidelines for fresh blood will provide the most contemporary evidence-based information on when and how to use fresh blood components. In 2008–09, under the guidance of an expert working group of 27 clinicians, we began an extensive review of international research into blood-related guidelines. Evidence reports and associated recommendations for critical bleeding and peri-operative guidelines are due early 2010.
• The availability and quality of education on blood administration have been improved through the establishment of a national framework for the continued development of the South Australian e-learning project.
• Information on where red cells are used has been improved as a result of the development of a draft minimum data set to guide further red cell use data-linkage activities.

Financial results

The NBA continues to perform within our budgetary allocation, and our end-of-year result was a surplus of $0.105 million. We have agreement from governments to carry forward prior years’ operating surpluses, which will allow us to maintain close to current activity levels and staffing for the coming two years.

Corporate matters

During 2008–09 progress on implementing our capabilities strategy was excellent, and good results were achieved in core areas. In particular, our staff turnover was reduced to 16 per cent for the year and 81 per cent of our staff reached their training point targets. Staff participation in community events was admirable given our workload.

The second NBA skills and knowledge survey was designed and conducted in December 2008, and our second staff satisfaction survey was conducted in April 2009. The results of these surveys helped inform a comprehensive restructure that was implemented with effect from 6 July 2009. The restructure is designed to improve our ability to meet the expectations of stakeholders into the future.

On other fronts, we were pleased to receive a silver medal for our 2007–08 annual report from the Australasian Reporting Awards Committee.

Finally, I was delighted to appoint Dr Chris Hogan as our first Principal Medical Officer. He adds immense strength to our clinical knowledge base and understanding of the clinical environment.

Outlook for 2009–10

The year to come promises to be another busy time, but our new structure will give us the capability to deliver improved information to support government policy deliberations—especially in the areas of data capture and analysis, demand forecasting, and research into blood sector trends. These activities will provide the basis for our continuing efforts to better integrate the blood sector with wider health sector priorities for patients and reforms in data evaluation and performance measurement.

Other priorities for 2009–10 are finalisation of the ARCBS output-based funding model and contractual arrangements with the Service after 30 June 2010. We also expect to release the first set of new guidelines on patient blood management.

The NBA needs to finalise a financial strategy for its future operations, noting that the revenue forward estimates reduce to $9.1 million in 2012–13. The nature of this strategy is likely to be influenced by the outcomes of the review of the implementation of the National Blood Arrangements, as required under the National Blood Agreement. This review, to be coordinated for governments by the Department of Health and Ageing, will produce its first report in November 2009.

Dr Alison Turner
General Manager and CEO
National Blood Authority