National Blood Authority Australia
Annual Report 2010–11
Part 2: HIGHLIGHTS OF 2011-12
GENERAL MANAGER'S REVIEW
Mr Leigh McJames was appointed in March 2012 as the General Manager of the NBA. He has extensive management experience in government in the defence and health sectors. In his previous health sector appointments, he was the transition manager for the formation of Albury Wodonga Health, the first cross border health service in Australia, and subsequently was a member of its senior executive. From 2006 to 2008, he was the Deputy General Manager at the NBA responsible for supply and contract management.
Before that, he held a diverse range of positions in defence, including senior roles in the management of government corporate support, acquisition and procurement, logistics and the development and implementation of strategic international defence policy. He has also filled representational advisory appointments at the Australian Embassy in Washington and in Baghdad as part of the senior civilian advisory team with the Coalition Provisional Authority.
This is my first General Manager's report, since joining the NBA in April 2012. It has been another highly productive year for the agency.
A major outcome for the NBA during 2011-12 was a decision by Australian governments to increase the agency's base funding from 2012-13. The revised base funding will allow us to achieve savings in the National Supply Plan and Budget (NSP&B), including reductions in the level of inventory holdings and reductions in wastage. It will also generate potential for future savings through the establishment of information management and data analysis capabilities to capture national sector-wide blood data and establish the pre-conditions for a national patient blood management program.
Ensuring supply
The key role of the NBA is to ensure an adequate, safe, secure and affordable supply of blood and blood products. The NBA again delivered on this fundamental responsibility. Key outcomes in 2011-12 included delivery of substantial savings to governments through improved contract prices, improved inventory management, and introduction of measures to decrease demand for products from health providers through appropriate use.
The NBA continued to deliver improvements in value for money through our purchasing activities for blood and blood products. New contracts for imported plasma-derived and recombinant clotting factor products which commenced in July 2011 realised significant savings and service improvements. Over the course of 2011-12 the NBA worked closely and successfully with clinical and patient stakeholder groups and with suppliers to support the transition of a substantial number of haemophilia patients between product brands, as a result of these tender outcomes.
An imported IVIg tender process was undertaken during 2011-12. The outcomes of this tender have maintained the availability of IVIg products for Australian patients and improved supplier performance requirements and supply security. Higher concentration product versions have now been introduced which offer the potential for reduced infusion times with associated benefits for patients and health services. We estimate the price outcomes of the tender alone will save the Australian community between $13-$16 million per year.
Work continued on implementing performance and efficiency improvements to the current Deed of Agreement with the Blood Service for the supply and distribution of fresh blood products. The Blood Service delivered savings across its operations of approximately $11 million in 2011-12. The new Melbourne Processing Centre was opened at a total cost of $213 million by the Parliamentary Secretary for Health and Ageing, The Hon Catherine King, on 30 April 2012. The new centre provides the foundation for state of the art processing of blood and follows similar investments in Brisbane and Sydney over recent years. Work continued on a range of other projects to improve the efficiency and effectiveness of services provided by the Blood Service, including expanding output based funding model arrangements and improved inventory management.
Security of supply
The NBA has a range of measures in place to ensure the security of Australia's supply of blood and blood products. These measures were tested during 2012 with the emergence of risks to the supply of albumin as a result of the recall of some batches of product by CSL Ltd due to manufacturing equipment failure that caused ethylene glycol contamination. The NBA activated the National Blood Supply Contingency Plan (NBSCP) in March 2012 to manage the impact of the recall on inventory levels. The activation of the NBSCP, combined with the existence of contingency reserves, ensured that product availability was maintained and the impact on patients minimised. The NBA, in conjunction with relevant stakeholders, undertook a post implementation review of this incident to help inform future improvement to the NBSCP.
Supply security was further strengthened for the supply of plasma-derived and recombinant blood products with an increase in the range and number of international suppliers contracted to Australia. This is particularly important in relation to IVIg, where Australia relies on a substantial proportion of imported product to meet its needs. The selection of more than one supplier reduces the risk of supply shortages should a problem develop with a single supplier.
Implementing blood stewardship
In November 2010, health ministers endorsed a Statement on National Stewardship Expectations for the Supply of Blood and Blood Products. The statement outlines ministers' expectations on health providers to contribute to the sustainability of the blood supply by adopting stewardship measures. A significant proportion of the NBA activities in 2011-12 directly support the implementation of these measures, including:
- detailed input to the development of the National Safety and Quality Health Service (NSQHS) Standard 7 Safety and quality improvement guide on blood and blood products. Implementation of the NSQHS standard will underpin improvements at a health provider level
- development of the next three modules of the National Patient Blood Management (PBM) Guidelines, including publication of Module 2 dealing with perioperative. The guidelines provide a key reference at health provider level to improve appropriate use of blood. Notably, they are also a world first that have generated considerable international interest
- finalisation of the second edition of the Criteria for the clinical use of intravenous immunoglobulin (IVIg) in Australia (the Criteria). The Criteria was approved by health ministers in May 2012 and is expected to be released in early August 2012. It ensures that patient access to IVIg is consistent with the best evidence of clinical benefit
- further development and implementation of a national web-based ordering system (BloodNet) which provides the capability at health provider level to order and receipt blood and blood products. The system provides health providers with visibility of inventory levels, ordering practices and unit discards which in turn makes essential data to improve blood management practices available to governments, the NBA and health providers
- redevelopment of the Australian Bleeding Disorders Registry (ABDR) which will provide comprehensive data to a patient level, thereby improving clinicians' ability to manage patients and the availability of aggregated data for national benchmarks.
Outlook for 2012-13
Since the establishment of the NBA in 2003, the agency has focused on improvements in the key areas of enhancing the security of supply, value for money and safety and quality of the use of products. Significant progress has been achieved and work will continue to build on success in these areas. The approved 2012-13 NSP&B contains operating funds for the NBA to undertake a range of activities aimed at improving the clinical usage of blood and blood products. 2012-13 will see a widening of the NBA activities to deliver the outcomes associated with the increased funding identified in my introductory paragraph and further support for the implementation of the ministerial Statement on National Stewardship Expectations for the Supply of Blood and Blood Products. Key areas for further investment and development over the next 12 months will include:
- improving the sustainability and performance of the sector through enhanced information management, data capture and expert analysis, to capture national sector-wide blood data and establish the pre-conditions for a national patient blood management program
- raising awareness of governments' stewardship expectations of users of blood and blood products, and their management of these products, through the development and publication of evidence-based national guidelines, in close collaboration with clinicians
- promotion and support for the implementation of Standard 7 of the NSQHS and three modules of the PBM Guidelines at the health provider level
- improving supply chain management, including optimising inventory levels and strategies to minimise wastage
- investigating the feasibility and options for integrating blood into the national health reform framework
- continuing to improve strategic planning, supply and governance arrangements for IVIg, including consideration of the outcomes of the current review of clinical governance and authorisation for IVIg.
On behalf of the NBA, I take this opportunity to reiterate the comments made by the Chair of the NBA Board in her report thanking Dr Alison Turner. The NBA owes its many achievements and current excellent positioning for future outcomes to Alison's management and strategic foresight. We wish her well in retirement. I also acknowledge the enormous contribution made by Stephanie Gunn who has accepted a secondment to the Department of Families, Housing, Community Services and Indigenous Affairs after being with the NBA as a deputy general manager since soon after its establishment in 2003. Stephanie was a highly respected powerhouse in the organisation who drove outcomes in any responsibility she was given. I also thank her for the extended period she acted as the General Manager from the departure of Alison in August 2011 until my arrival in April. Our thanks also goes to Dr Chris Hogan, appointed as the NBA's first Principal Medical Officer in August 2008, who resigned in January 2012.
I close this report with a special acknowledgement of the many stakeholders across the sector who again assisted us during the year in delivering the outcomes outlined in this report. There are many clinicians, health professionals, public servants, suppliers and members of the public who gave generously of their time, professionalism and passion. We cannot do our job as well as we do without you and we look forward to working with you again in 2012-13.
Leigh McJames
General Manager
National Blood Authority