Dáil Éireann debate -
Tuesday, 25 May 1999

Vol. 505 No. 3

Blood Product Testing.

Ms Clune

I welcome the opportunity to express the worry and concern which exists about the Blood Transfusion Board requesting that its chief executive officer and its national medical director explore the implications to patient services of providing a single site for donation testing in the State.

There are currently two sites, one in Cork and one in Dublin. It is feared by medical staff in Cork that it is the preferred option to close the donation testing centre in Cork, thus downgrading the facility there.

I understand that no report has been produced yet and no decision has been made. If such a report recommended the downgrading of the Cork facility, hospital staff in Cork have told me that it would have dire consequences for patient care. Some newspapers have reported that patients' lives could be put at risk by such a move. Recently a newspaper carried a letter signed by more than 40 doctors and consultants in the Cork University Hospital which outlined the negative impact of such a proposal.

The hospital deals with all acute services in the southern region. Services are provided at that hospital which are not available in any other hospital in the State. It has a good relationship with the Blood Transfusion Service Board in Cork. Even the hint of a move to downgrade such a service has led to warnings of the risks to patients' lives. The proposed move is seen as financially driven rather than based on scientific or social imperatives. There is no scientific or medical evidence available which justifies the downgrading of the service. Samples which had to be tested in Dublin would be one day in transit. Platelets have a limited life span and this day is vital.

Cork provides a back up service to Dublin which has been called upon on many occasions. Waterford is served by Dublin but on several occasions lately Cork has had to provide a service which Dublin was unable to provide. Now we are told that if the Cork service is downgraded, Belfast and Edinburgh will be used as back up. Why would this be necessary when there is a perfectly reliable facility in Cork? Why withdraw something which is working well? Blood from Amsterdam had to be brought to Dublin last year because Dublin could not provide its own supplies.

On four occasions last month, 40 to 60 pints of blood were required in the hospital. The Blood Transfusion Service in the area arranged for extra clinics so the blood could be provided that day. It is not only Cork University Hospital which will be affected, all hospitals in Cork are concerned about this proposed move and have expressed their concerns strongly. They say that their medical opinions have not been taken on board and they were not consulted during the preparation of this report. Why were the providers of medical services in the region not consulted? Why did 40 of them feel it necessary to express their sentiments in a national newspaper? It is alarming to me, as a layman, at a time when there is low confidence in the Blood Transfusion Service Board, that the service in Cork is being undermined.

There has been an outcry from the consultants and staff of Cork University Hospital and I ask the Minister to give serious consideration to their request for a meeting. It is alarming that so many medical staff do not agree with such a move.

Mr. Fahey

Responsibility for the organisation and management of the Blood Transfusion Service rests with the Blood Transfusion Service Board. Following the report of the Finlay tribunal of inquiry, the BTSB is in the process of implementing a wide ranging programme of modernisation to adapt to emerging developments in blood transfusion. Measures to further improve blood safety are being introduced this year. The cost of the new measures will be £6.8 million in 1999, resulting in the price of one unit of red cells increasing from £63 to £94. A new IT system is also being introduced at a cost of £4 million. At the Cork centre, the BTSB recently completed the refurbishment of the component processing and compatibility testing laboratory at a cost of more than £500,000.

Transfusion medicine is undergoing rapid change. New technology and additional safety tests continue to emerge. The BTSB assesses these developments to ensure its practices are in line with the highest international standard and consistent with efficiency and effectiveness. One such development is PCR testing, which has been introduced on the advice of the medical consultant to the board following the evaluation of international best practice. PCR testing is the most sensitive way of testing for viruses in blood donations and requires expensive, high grade laboratory technology and expert technical support.

In February 1998, the BTSB decided, having regard to international practice, PCR testing at both Dublin and Cork centres could not be justified. It was decided, therefore, that PCR testing of all donations would be carried out at the new national headquarters of the BTSB currently under construction.

The proposal now being assessed by the BTSB is whether all serological testing and not just PCR testing should be performed at the national headquarters. The board of the BTSB has asked the chief executive officer and the National Medical Director to prepare a report on the practical implications for patient services of developing a single site for donation testing in Ireland. Among the issues being addressed are: how best to provide a transfusion service in the light of the rap idly changing environment in transfusion medicine; the application of accepted international standards of practice in leading centres and blood services; the achievement of the goal of the organisation in supplying 100 per cent of hospital blood components on time and without fail; how best to prepare for a substantial reduction in the use of blood components given the alternatives to blood transfusion which are currently available and being developed; the concerns of health boards and hospitals, including their concerns about the substantial increase in the costs of BTSB products; and the achievement of a service that is efficient and effective.

As part of this process, the chief executive officer and the National Medical Director are consulting international transfusion experts.

I will now respond to a number of misleading statements which have appeared in the media recently. I assure the House that the closure of the BTSB Cork centre is not on the agenda of the BTSB or my Department. All that is being considered is a possible change in one aspect of the Cork operation. There is not any suggestion of change in relation to the other scientific and technical services currently carried out at the Cork centre such as blood grouping, components processing, compatibility testing and ante-natal screening.

With regard to claims that patients' lives will be put at risk as a result of the proposed changes, the BTSB says there is no evidence to suggest that life-saving operations in hospitals throughout the country will be affected by having one national testing centre. The BTSB points out that there are many acute hospitals in the country which are a considerable distance from a blood testing centre and this, of itself, does not pose a threat to patient safety. It has also been suggested that the removal of testing operations from the Cork centre would delay the supply of blood components to hospitals in the region. The BTSB rejects this and points out that, at any given time, 75 per cent of blood stocks are held by hospitals, with the remainder being stocked at the BTSB facilities in Dublin and Cork. There is no proposal to change this policy.