General Manager's Review

General Manager - Leigh McJamesIt is now 10 years since NBA was established, during which time we have delivered a comprehensive portfolio of achievements. Despite our relative small size, NBA again delivered a wide array of impressive outcomes in 2012-13.

Ensuring supply

The key role of the NBA is to ensure an adequate, safe, secure and affordable blood supply of blood and blood related products. The NBA delivered significant outcomes against this fundamental responsibility. The best indicator of this is the delivery of improved performance levels at a significant saving against the supply budget of $85.7 million for 2012-13.

A key contributor to the budget outcome was a marked reduction in the demand for fresh blood products as a result of improvements in appropriate use. These improvements are underpinned by the implementation of PBM at a hospital and clinician level which is outlined in more detail under the section on blood stewardship.

Work continued on implementing performance and efficiency improvements to the current Deed of Agreement with the Australian Red Cross Society (Red Cross) acting through the Australian Red Cross Blood Service (Blood Service) for the supply and distribution of fresh blood products. The Blood Service again achieved savings across its operations of $12.5 million in 2012-13. The NBA finalised a number of key contract changes in the latest Deed Variation that will support further efficiency improvements, including agreement for:

  • a second three year cycle of the Output Based Funding Model (OBFM) that includes a reduction in indexation from 4.1 per cent to 2.95 per cent
  • handover clauses and plan
  • a Blood Service Research and Development Framework, to improve accountability and transparency of research funds provided under the deed.

Work continued on a range of other projects to improve the efficiency and effectiveness of services provided by the Blood Service, including the transfer of South Australian manufacturing and testing operations to the new Melbourne processing centre and improved inventory management.

JBC approved the addition of subcutaneous immunoglobulin (SCIg) to the National Supply List in March 2013 after a comprehensive evaluation process. As the first new product to be added to the list since the establishment of national blood arrangements, this was a major milestone which will significantly improve treatment options for a range of patients.

Security of supply

NBA has a range of measures in place to ensure the security of Australia’s supply of blood and blood products. These measures underwent one of their most serious tests in July 2012. On 4 July 2012, the Blood Service National Blood Management System (NBMS) failed, resulting in a decline in blood stocks and production sufficient to warrant activation of the NBSCP on 6 July 2012. The NBMS is an IT system that supports fresh blood collection, processing and distribution across Australia. The NBA, in consultation with the Blood Service, actively managed the contingency at a national level from 6 July 2012 until deactivation of the NBSCP on 11 July 2012 when it was judged that stocks had returned to levels within manageable operational tolerances. The NBMS returned to its normal operating environment on 22 July 2012. This contingency prompted a number of internal and independent reviews of IT, risk and contingency management arrangements. The recommendations of these reviews have been, or are programmed to be, implemented. Notably this includes significant strengthening of the NSBCP in relation to the management of platelets and infectious diseases.

Supply security was further strengthened for the supply of plasma-derived and recombinant blood products with the completion of a review of supply risks and resultant adjustment of reserve arrangements.

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 improving the management and use of blood and blood products. A significant proportion of NBA activities in 2012-13 directly supported the implementation of these measures, including:

  • The launch of the next two modules of the national PBM Guidelines dealing with medical and critical care. The guidelines provide a key reference at health provider level to improve appropriate use of blood. Notably, they are also a world first that has generated considerable international interest (see p.44).
  • An intensive program of engagement and awareness promotion targeting key health provider and clinical stakeholders including:
    • the hosting of promotional stands and sponsored clinician presentations at a range of key sector conferences
    • The Private Health Sector Forum, hosted by the NBA, to engage key private health organisations in relation to implementation of PBM and improved inventory wastage (see p. 46)
    • implementation of a cost indicator on all fresh blood product labels as a general awareness measure.
  • Further implementation of the BloodNet system to achieve coverage of 95 per cent of volume issued by the Blood Service, including implementation of the fate module which tracks wastage at a single unit level. BloodNet provides health providers with visibility of inventory levels, ordering practices and unit discards which in turn makes available essential data to improve blood inventory management.

Outlook for 2013–14

2013-14 represents the first year of an ambitious three year work program identified by JBC in their approved 2013-15 Strategic Plan. The NBA will deliver further improvements in relation to our core business of ensuring supply with planned improvements to contracted performance and pricing arrangements. In addition, it will build on its program to support implementation of reduced wastage and improved appropriate use, including:

  • establishment of information management and data analysis capabilities to capture national sector-wide blood data and establish the pre-conditions for a national PBM program
  • improving supply chain management, by optimising inventory levels and implementing strategies to minimise wastage
  • promotion and support for implementation of PBM Guidelines and Standard 7 Blood and Blood Products of the National Safety and Quality Health Service (NSQHS) Standards at the health provider level.

I close this report with a special acknowledgement of the many stakeholders across the sector who again assisted us throughout 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 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 2013-14.

Leigh McJames' Signature

Leigh McJames
General Manager
National Blood Authority

September 2012: Launch of Patient Blood Management Guidelines

September 2012: Launch of Patient Blood Management Guidelines

The first three modules of the NBA Patient Blood Management Guidelines were officially launched by Australia’s Chief Medical Officer, Professor Chris Baggoley, on Wednesday 19 September 2012 at the National Portrait Gallery in Canberra.

The patient-focused guidelines provide healthcare professionals with the latest evidence based approach to managing patients to minimise unnecessary exposure to transfusions where possible and deliver better outcomes for patients. The guidelines are developed by experts from clinical speciality colleges, societies and consumer representatives working with the NBA.

The first module, Critical Bleeding/Massive Transfusion provides support for healthcare professionals in managing patients with critical bleeding requiring massive transfusion. The second module, Perioperative, offers guidance on the patient’s blood management prior, during and after surgery. The third module, Medical, focuses on patients with acute or chronic medical conditions requiring ongoing treatment with blood and/or blood products.

When complete the guidelines will be made up of six modules. The fourth module, which focuses on critical care, was published in early 2013. The fifth and sixth modules dealing with obstetrics and paediatrics/neonates are under development.

Since the launch of the modules and promotion of the guidelines at a range of clinical forums and conferences there has been a substantial increase in electronic downloads and requests for the hard copy publications through the NBA website. In 2012-13, 35,282 hard copy publications were distributed across Australia and New Zealand.