Chief Executive Review

I am pleased to report that 2017-18 has again seen the National Blood Authority deliver significant projects and achieve outcomes that enhanced the provision of a safe, secure and affordable supply of blood and blood products for Australia.

We have negotiated a significant new contract and effectively managed a range of other existing contracts from continuing suppliers that involve expenditure of around $1.2 billion. We have worked closely with governments, patients, patient groups, clinicians, suppliers and others to achieve the best outcome possible within available funding for all Australians who require blood and blood products and services. We have developed and rolled-out new and improved national systems to directly assist patients, clinicians and others to help manage and monitor health, supply and performance issues. We have accelerated the consideration of new blood products that have the potential to improve the health and quality of life for Australians with bleeding disorders. We have also completed some work internally to improve the Agency's management systems, processes, governance and accountability arrangements.

Snapshots of some key highlights for the year are as follows:

• The National Fractionation Agreement for Australia (NaFAA) was executed on 6 December 2017, with CSL Behring (Australia) Pty Ltd (CSL Behring) for the manufacture and supply of fractionated blood plasma products. The new Agreement commenced on 1 January 2018 and continues until 31 December 2026 subject to review in 2022. The NaFAA contract is valued at $3.4 billion over nine years and delivers savings against the existing contract of more than $200 million as a result of improved manufacturing processes and efficiencies
• The NBA initiated an independent review of the Output Based Funding Model (OBFM) that operates under the Deed of Agreement (Deed) with the Australian Red Cross Blood Service (Blood Service), which is the sole supplier of fresh blood products in Australia, and also of the Blood Service's capital program. The outcomes of the review will inform the next cycle of the OBFM to be negotiated in 2018-19 for implementation in 2019-20
• The NBA continued to work with hospitals and laboratories on the redevelopment of BloodNet, Australia's online blood ordering and inventory management system. BloodNet 5 will go live on 1 July 2018. This has been a major program of work for the NBA. Throughout the project there was regular consultation with users to ensure the new system was designed and developed very much around the real needs of those users. The NBA received the OpenGov Recognition of Excellence Award 2018 for the digital transformation of BloodNet 5 and also acknowledgement of the work from the Digital Transformation Agency
• The NBA Immunoglobulin (Ig) Governance Program was strengthened during the year with additional resources that reflected its importance and priority. The Program worked very closely with clinical specialist working groups to develop revised Criteria to govern and manage the use of publicly funded Ig. The revised Version 3 of the Criteria will ensure Ig product use and management reflects appropriate clinical practice and represents efficient, effective and ethical expenditure of government funds in accordance with relevant national safety and quality standards for health care. The revised Version of the Criteria will be implemented in BloodSTAR and nationally on 22 October 2018
• Work to achieve the final national implementation of BloodSTAR also continued throughout the year. BloodSTAR is the national online system developed and introduced by the NBA in 2016 to support health providers in managing their Ig governance. It has been progressively implemented in all States and Territories with the final component of national implementation to occur in New South Wales in the first half of 2018-19
• The National Blood Sector Research and Development Program provided grants to seven recipients in 2017-18 following the conclusion of the second funding application round in 2016-17. The third grant funding round attracted seventeen applications which were under consideration at the end of the 2017-18. Conference presentations and journal publications have resulted from several of the funded research projects
• A review and update of the Patient Blood Management (PBM) Guidelines has commenced. The review is considering a broader scope across the suite of existing PBM modules rather than updating each individual module in isolation from other related modules. It will consider a more sustainable guideline model that will enable clinical guidance to be updated and disseminated more effectively and efficiently as the evidence base and clinical practice evolves. While the review is underway, the current PBM Guidelines will continue to remain available to guide clinical practice
• Continued funding of $1 million per annum was approved for the important educational work of BloodSafe eLearning Australia (BEA). BEA received 58,243 new user registrations in 2017-18 and reached two significant milestones: a ten year anniversary of the first course being released; and the completion of one million courses by BEA users during this period. A major upgrade and migration to a new learning management system was also undertaken that will provide better stability, less reliance on external vendors and improved functionality
• The NBA supported the development and opening of the Blood Service's two pilot plasma donor centres in Townsville and Canberra in September 2017 and April 2018 respectively. These centres are part of a two-year pilot project funded by all governments to trial improvements in domestic plasma collection and donor care. The pilot centres incorporate new technologies and procedures to make the plasma collection process more effective and efficient, and the donor experience more pleasant and convenient
• As part of a broader program of capital works over a number of years, the NBA supported the redevelopment of the Blood Service's processing centre in Perth. The refurbished facility was opened on 14 December 2017. This facility is responsible for approximately eight per cent of the national blood supply. The refurbishment, funded by Australian governments, is part of a capital works program that commenced in 2013 at a cost of $43.5 million
• As in previous years, stakeholder engagement and managing good relationships with the blood sector domestically and internationally continued to be an important activity for the NBA. The NBA met regularly with patient and clinical groups and individuals and with suppliers. It made presentations and participated in key conferences and events. Important presentations were received from Professor John Rasko AO and Associate Professor Huyen Tran on significant advances with potential treatments for bleeding disorders. Also during 2017-18, the NBA hosted two international delegations: one included Indonesian Government trade officials and pharmaceutical company representatives as part of an Australian Government (DFAT) sponsored scholarship program; and the second involved delegates from the Korean Red Cross to learn about patient blood management in Australia
• Following the appointments to the seven member NBA Board in 2016-17 of Professor Lyn Beazley AO from WA as a jurisdictional representative and Associate Professor Alison Street AO from Victoria as the public health expert, Mr Geoffrey Bartle from WA was appointed in 2017-18 as the community representative on the Board. Mr Bartle replaced Ms Patti Warn whose term had expired. The NBA would like to thank Ms Warn for her valuable contributions over many years. Mr Mark Cormack, formerly Deputy Secretary in the Commonwealth Department of Health, resigned as the Australian Government representative on the Board following his appointment to a new role with the Department of Veterans' Affairs. The NBA is very grateful to Mr Cormack for his significant contributions to the work of the NBA, including as Chair of the Jurisdictional Blood Committee. The NBA Board was regularly updated by the NBA during 2017-18 on achievements against strategic and operational plans and provided advice and guidance to inform the development of future programs and plans. The NBA Board Chair and NBA Chief Executive also met with the Blood Service Board in May 2018
• The Australian Public Service Commission (APSC) State of the Service Employee Census and the APS State of the Service Agency Survey were conducted in 2017-18. The APSC set a target of 70 per cent employee participation for the Employee Census. The NBA exceeded this target with a 91 per cent participation rate. This reflected a very active engagement by NBA staff in relation to their employment matters and the contributions from NBA staff were overwhelmingly positive
• During 2017-18 the NBA continued to make important improvements to its management and governance arrangements and to the supporting documentation. It has improved and strengthened its Corporate Plan, Business Plan and operational scorecard. It also revised its Service Charter. These improvements will enhance the Agency's performance management and monitoring capabilities, the transparency of its activities and associated accountabilities
• The NBA received approval during 2017-18 to create a new position of Deputy Chief Executive at the SES Band 1 level. Action is underway to fill this new vacancy. The creation of this additional SES position offers the opportunity to add greater strength, depth and resilience to the NBA's executive capabilities and better position the NBA to manage the current and future challenges and risks we face in an increasingly complex space.

Ensuring the supply of blood products

The NBA's primary responsibility is to ensure Australia has a safe, secure, adequate and affordable supply of blood and blood related products to meet clinical demand. The clinical demand for blood and blood related products in Australia was met without interruption. A saving of $60.8 million was achieved against the annual budget approved and funded by all jurisdictional governments. This saving brings the total amount of funding returned to governments over the last five years to $556 million.

The year saw further improvement in the appropriate use of fresh blood. The 2017-18 demand for red cells decreased by 0.9 per cent. This result builds on the progress already made in this strategic planning cycle to bring the total reduction in red cell demand over the last six years to 23 per cent, realising significant improvements in patient outcomes and financial savings of $107.1 million. Demand for platelets remained steady with no increase in demand in 2017-18 from 2016-17.

Improvements in supply performance and efficiency under the Deed with the Blood Service once again achieved a surplus of approximately $45.2 million. This will return a saving to governments of approximately $39.7 million in 2017-18 after allowing the Blood Service to retain $5 million to invest in further improvements in accordance with the Deed.

In 2017-18 the NBA initiated work in two key areas in relation to the supply of extended half-life (EHL) clotting factor products under the national arrangements for the supply and funding of blood products in Australia. With the support of two suppliers, limited interim supply arrangements were introduced to enable approximately 200 patients to access EHL products under these nationally funded arrangements while assessment processes to determine longer-term supply arrangements were sponsored and accelerated by the NBA.

Supply and risk mitigation continued to be a focus in 2017-18 with a review of the Risk Management Policy and Framework.

Improving the management and use of blood products

Throughout the year the NBA maintained a focus on governments' priorities for the blood sector through activities under the key sector policies and strategies agreed by all governments, particularly the National Blood Product Management Improvement Strategy 2018-22 and the National Patient Blood Management (PBM) Implementation Strategy 2017-21. An ongoing program of activities also supports the implementation of the Health Ministers' Statement on national stewardship expectations for the supply of blood and blood products. These programs contribute to the sustainability of the blood supply by improving the management and use of blood products. In 2017-18, the NBA:

• worked with staff at the Flinders Medical Centre to develop a video case study on the use of small volume tubes in intensive care units to reduce hospital acquired anaemia
• collaborated with the Australian Commission on Safety and Quality in Health Care (ACSQHC) on the second edition of National Quality and Health Service (NSQHS) Standards released in November 2017, with Standard 7 – Blood Management being one of the eight revised National Standards
• managed a multi-disciplinary Expert Reference Group (ERG) overseeing the review of the Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics, and completed the research protocol
• continued a promotion and communication campaign to increase awareness of the need to improve clinical practice and inventory management in relation to blood products through attending clinical and health sector conferences and events; and sponsoring two awards at the HAA national conference - one award for the Australian and New Zealand Society of Blood Transfusion (ANZSBT) Young Investigator of the Year and another award for the best poster/oral presentation on haemovigilance.

Outlook for 2018-19

Next year will be another very busy year for the NBA. A revised organisation structure will be introduced following the filling of the new Deputy Chief Executive position. We will continue to build on our core business activities to ensure the national supply plan and budget and effective contract management provide a safe, secure and affordable blood supply for Australia.

An area of increasing emphasis will focus on supporting the assessment of new and emerging products, the utilisation of products and their appropriate clinical use. The release of BloodNet 5 at the commencement of next year will see the culmination of this year's significant investment of resources in a system to support the work of the NBA. It is expected that a major outcome in 2018-19 will be the inclusion of New South Wales health providers on the BloodSTAR system and the implementation of Version 3 of the Criteria for the appropriate clinical use of Ig.

I would like to again recognise the very substantial contributions of the many stakeholders across the blood sector who gave generously of their time, professionalism and passion in working on some very important issues with the NBA during the year. We look forward to working with you again in 2018-19.

I would also like to thank my executive management group for their ongoing support, commitment and dedication, and especially thank all the staff of the NBA who work tirelessly and are so committed to saving and improving Australian lives through a world class blood supply.

John Cahill Chief Executive