Dáil Éireann debate -
Wednesday, 14 Feb 2001

Vol. 530 No. 4

Adjournment Debate. - Irish Blood Transfusion Service.

Ms Clune

I have spoken on this issue in this Chamber before and I wish to thank you, a Leas-Cheann Comhairle, and the Office of the Ceann Comhairle, for allowing me raise it again.

The Minister is familiar with the story which is that the Irish Blood Transfusion Service is proposing to remove testing facilities in the Cork centre which serves the Munster region, and have a single testing site in Dublin. I am not a medical person but having spoken to doctors and others involved in delivering medical services in the Munster region, I am alarmed at their objection to such a move. They have steadfastly opposed it, saying it is wrong, not in the interests of patient safety and that it could threaten patients' lives. That is an alarming statement to hear from consultants, doctors and other medical staff involved in delivering health services.

According to media reports today, over 250 consultants and doctors have written to the Mini ster asking him to intervene to ensure that the Irish Blood Transfusion Service will continue to provide two testing centres. They do not have confidence in the Dublin centre and they believe that it would be a retrograde step to close the Cork facility. The system in Cork is working well and has an ISO 2000 standard. There is a strong body of opinion that says it should not be changed if it is working well.

The IBTS's claim that the plan to reduce testing to a single site facility in Dublin will provide a better service is not being believed in Munster. Over the past two years, there have been numerous incidents where the blood service in Cork has been called upon to assist medical services outside the Munster region. The Minister has stated publicly that he cannot intervene in this matter, but he should do so in the interests of public health and safety to ensure that the testing centre in Cork is not removed or downgraded. Confidence in the blood service must be restored.

Recently, the Southern Health Board passed a motion of no confidence in the Irish Blood Transfusion Service. Today, 250 consultants and doctors demanded that the situation should not change. Following the motion passed by the Southern Health Board, this is a stark warning from the medical profession that it does not have confidence in the system. This situation must compel the Minster to act in the interests of patient safety.

Many other issues are involved in this matter. When I was a member of the Oireachtas Joint Committee on Health and Children, it examined the situation and produced a report recommending that two blood testing centres should be maintained. It also made a strong recommendation that differences within the Irish Blood Transfusion Service should be addressed in the interest of developing public confidence in our blood services. That has not happened, however, and the report has been ignored. Note should be taken of such a report by a committee of this House. I was surprised and alarmed by the reaction of the IBTS to that report.

I am asking the Minister to intervene in this matter, even though he has said that he cannot do so. He has said it is a matter for the IBTS itself, but the fact is there is public alarm because the medical profession in Cork and elsewhere in Munster says the decision is wrong. They have not criticised the proposed decision lightly. They are highlighting the fact that downgrading the blood services in Cork would be a bad step affecting patient safety and their ability to deliver health services in the Munster region.

Mr. Martin

I thank the Deputy for having raised this issue. Transfusion services are continuing to undergo rapid change to meet the demands of improved quality and safety, and to meet the changes in the demand for products. The Irish Blood Transfusion Service has adapted to change in line with international developments. In fact, the IBTS today is very different to the service which failed in the past. This is as a result of the recruitment of new skills and expertise in recent years and the considerable investment which my Department has made in improving the IBTS at all levels, including the Cork centre.

The service is also fully focused on the changes which are taking place internationally to ensure that it is in a position to respond early and comprehensively to new tests, technology and new quality assurance requirements. The IBTS has been ahead of a considerable number of EU transfusion centres in introducing new tests and processes such as leucodepletion and PCR testing.

One of the major effects of such rapid change has been a considerable reduction in the number of products manufactured or made available by the IBTS, including anti-D, albumin and plasma based factors 7 and 8, used in the treatment of persons with haemophilia, which have been replaced with recombinant products.

The IBTS is also actively considering the following changes: a proposal to cease manufacturing cryoprecipitate because a replacement product from a non-BSE risk country is available and is being sourced; a proposal to replace its fresh frozen plasma with a commercially available product which is manufactured from US volunteer plasma which is BSE free and a proposal to seek supplies of red cells from transfusion centres which are outside BSE risk areas.

The situation is further complicated by the continuing decline in the use of blood in our hospitals, despite the increase in hospital activity. The number of units of blood issued by the IBTS has reduced from 159,000 in 1996 to 145,000 in 2000. This is a drop of approximately 10%. The IBTS considers that efficiency measures, such as reducing outdating in the IBTS and in hospitals, would reduce that figure by a further 8,000 units in the immediate short-term.

A national blood users group, established by my predecessor, whose membership comprises blood user experts from hospitals nationally, has prepared "A Guideline for the Transfusion of Red Blood Cells in Surgical Patients". The guideline states that the use of proven strategies that reduce exposure to donated blood should be made widely available and applied where appropriate. Such strategies include autologous transfusion techniques and surgical, anaesthetic and pharmacological approaches that reduce blood loss.

My Department is currently making this guideline available to all hospitals, general practitioners and medical schools. The implementation of this guideline throughout the health services will further reduce dependency on red cells. Patients will also have access to other strategies which do not depend on red cell transfusion. The IBTS considers that the combination of these measures will result in a further substantial reduction in the volume of red cells transfused.

The above developments will have repercussions for the core business of the IBTS. Many key questions arise concerning the organisational structure of the IBTS and what the impact of the changes that are coming downstream fairly quickly will be on the role and function of the IBTS, and how we can use the skills and expertise within the organisation to meet these particular challenges.

This is where the real debate about our transfusion services should take place. A debate on traditional geographic lines, which sees Dublin and Cork as separate or competing elements, is not the way forward. This is not a platform on which to develop a national transfusion service in a rapidly changing environment. By that I mean that the days of saying the Cork centre will give blood to somewhere outside Cork or Waterford should—

Ms Clune

The issue is that there should be an alternative service.

An Leas-Cheann Comhairle

Please allow the Minister to continue as his time is running out rapidly.

Mr. Martin

I have said to all involved that it is a national service.

Ms Clune

Yes.

Mr. Martin

It does not matter where the blood is generated, we should help out. That is the kind of thing I want to see happening. The IBTS took a decision in 1999 to have a single testing site for the country which would be based in Dublin. This decision has caused considerable controversy and has led, along with other issues, to a breakdown in relations between the IBTS and the wider medical community in Cork, to which the Deputy alluded. I have had numerous meetings with representatives of the staff and interested parties in Cork, and with the IBTS itself, and I am very much aware of the anxiety felt by all concerned.

Nonetheless, there has been considerable additional investment in the Cork centre. A new components laboratory has been provided at a cost of approximately £500,000. A second consultant post has been approved. New posts in quality assurance and IT have been approved in recent years. Furthermore, at its meeting in January, the board of the IBTS approved a draft planning brief for a new transfusion centre in Cork for submission to my Department. My Department will reply to this request shortly with a view to providing a new state of the art facility in Cork as a matter of priority.

The IBTS operates in a fast moving and challenging area of the health system in which there is a full and demanding role for the board, management and the entire staff of the organisation at all levels. There is a responsibility on all concerned to resolve the difficulties which exist between the Cork centre of the IBTS and its national headquarters to ensure a truly national service and to progress with its core business of developing best transfusion practice for the future. Recent public disagreements between the IBTS and the Southern Health Board are not conducive to the effective co-operation and partnership between complementary organisations which is to be expected and which prevails generally in the health system. This is all the more regrettable at present when the energies of the IBTS and hospitals generally should be focused on developing best transfusion practice, including important strategies to address the possible risk of the transmission of the vCJD by blood transfusion.

I understand the board at its meeting in January decided to engage external human resource expertise to assist in achieving a resolution of current problems and to establish an improved platform on which to move forward. I welcome this initiative and urge all concerned to fully engage in this process. It is only by such engagement that a resolution can be found to the complex issues which surround this problem.