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Centralising blood services could help trusts achieve huge savings

The number of full service transfusion laboratories in England could be cut from 220 to just 30 if a system about to be piloted by NHS Blood and Transplant in partnership with NHS trusts proves successful.

The special health authority is talking to trusts, including Barts and the London, about introducing a “hub and spoke” system in which a central transfusion laboratory provides services to a number of hospitals using electronic blood transfusion technology.

NHS Blood and Transplant chief executive Lynda Hamlyn said it intended to help trusts achieve the potential £500m of savings indicated in Lord Carter’s 2008 review of pathology services.

“We can see ourselves being able to help trusts unlock a lot more of the [potential] pathology savings identified in the Carter review,” she said.

Ms Hamlyn said trusts often got “stuck” when making savings in transfusion services because even if a pathology service could be shared with another trust all hospitals need on-site access to blood components. It is an area that has had little interest from the private sector, she claimed.

Under the hub and spoke system some hospitals would have smaller transfusion labs used for urgent testing while the smallest hospitals would need only a blood bank fridge. The “spoke” labs and fridges would be linked to the blood transfusion management system at central laboratories.

NHS Blood and Transplant estimates the introduction of the system nationally could eventually mean 30-50 hubs serving the whole country, depending on what is learnt from the pilots about local geography and population needs.

At Oxford Radcliffe Hospitals Trust, where such a system has been operating across its three hospitals and the neighbouring Nuffield Orthopaedic Centre Trust since 2006, there were only two instances of a patient being given the wrong blood in four years. The national benchmark over the same period is eight.

A review of the service, which costs the trust £350,000 a year to run, found it saved it nearly £1m a year, including £400,000 in reduced blood waste and £500,000 in reduced nursing time.

The success of electronic blood transfusion technology at Oxford Radcliffe led to the system being included as a recommended solution in the quality, innovation, productivity and prevention programme.  

Barts and the London director of pathology Professor Adrian Newland is looking to introduce the hub and spoke system as the trust merges with Whipps Cross University Hospital Trust and Newham University Hospital Trust and is talking to NHS Blood and Transplant about sharing expertise, training and logistics.

Professor Newland, who is also chair of the national blood transfusion committee, predicted the biggest barrier to the introduction of the hub and spoke system would be the initial investment required and qualms about the impact of losing services.

“Trusts are nervous about degrading the laboratory or losing it but what we are trying to develop with this is not taking the service away but changing it and hopefully it will be more efficient,” he said.

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