Proposals to reorganise the Scottish blood service bear more than a passing resemblance to recent changes south of the border - and seem set to cause as much controversy, writes Barbara Millar

Scotland's blood service could be heading down the same track that led to organisational chaos for its English counterpart. And the warning comes not from unions or consumer groups, but from its own former boss.

Professor John Cash was medical director of the Scottish National Blood Transfusion Service from 1979 until 1997 and is the author of an 'exceedingly critical' report of the reorganisation of blood transfusion services in England.

He refuses to comment directly on the detail of the proposals to restructure the Scottish service, but instead holds up the lessons from south of the border.

He urges the SNBTS to 'do its homework' so the changes proposed can be justified.

'The SNBTS needs a business plan that will hold water and it needs to consult widely. It must be sure its top management team, including the regional centre directors, who are key individuals, are on its side.'

He asks if the SNBTS is really sure that it has strong support for the programme.

'If you get defections you are going to run into a lot of trouble. You must also be sure that your customers - hospital haematologists and surgical teams - are happy. If you think you can brush off clinicians you are making a mistake.'

Derek King, head of the haematology service at Aberdeen Royal Hospitals trust, raises a number of concerns, which he intends to discuss with the national director and medical and scientific director of SNBTS next week.

'If all the blood donations go to the central belt of Scotland for testing and processing, how can we be sure we will be able to sustain appropriate stock levels?' asks Dr King.

'And what about the availability of rarer blood products which, at the moment, we are able to produce locally? What will happen if there is an emergency situation?'

The proposals will mean job losses in the Aberdeen transfusion centre, but many of the staff there also work on a rota system, staffing the 24- hour blood bank.

The hospital haematology service is too stretched to provide a blood bank service, so there are concerns about how this will be maintained without those members of staff, he says.

He is also worried about the future of related services - stem cell collection and storage, tissue typing, therapeutic plasma exchange and the bone bank.

'The proposals say these services will be maintained but they don't give any details. We fear it could be the thin end of the wedge.'

The SNBTS proposals suggest an initial 67 'job movements', although they stress that compulsory redundancies will be kept to a minimum. They also say there will be 24 'new career opportunities' for existing staff.

Annual savings of around pounds2.62m will be generated by the third year of the project and these will be retained by SNBTS to improve services for patients and donors.

The one-off cost of implementing the changes is estimated to be pounds3.5m, which is expected to be recouped within two years.

George Galea, regional centre director for Dundee, believes the SNBTS proposals are the right way forward for the service. 'There are increasing pressures on the service to produce safer and more high quality products,' he says. 'Having two state-of-the-art testing and processing centres will allow products of consistently high quality to be available on a reliable basis throughout Scotland.'

But Carmel McAteer, regional officer of the MSF union, believes there is a 'robust case' for continuing to carry out some processing at a northern site.

Derek King agrees that maintaining a northern site would make a great deal of sense. 'If Aberdeen was to become the third centre, with Glasgow and Edinburgh, it could carry out processing and testing for Dundee and Inverness and would have the same number of donations as Edinburgh, around 25 per cent of the total,' he argues.

Besides, he adds, donors in the north are loyal to local hospitals - Grampian and Highland have the highest percentage of blood donors in Scotland.

Professor Cash agrees that the northern communities could feel 'manipulated and deprived' if they are left without a local processing and testing centre. 'This could create a monumental political dimension which will make things very lively in a devolved Scottish parliament,' he predicts.

But Ian Franklin, SNBTS medical and scientific director and professor of transfusion medicine at Glasgow University, insists that the proposals will position SNBTS 'at the leading edge of blood transfusion medicine'.

Last week MSF leaders met Scottish health minister Sam Galbraith, who reassured them that he would seriously consider all alternatives. But Ms McAteer is not yet convinced.

'Earlier in the week SNBTS management gave us the impression that they were wedded to the proposals as they stand,' she says. 'This causes us great concern.'