Hospitals & Science

Integrated Transfusion Services (ITS) is the term used to describe a range of initiatives that have the potential to transform the way NHSBT delivers services to and work with hospitals.

Currently the provision of blood components to patients involves NHSBT and hospitals working closely together but independently of one another. ITS could mean NHSBT and hospitals harnessing their joint expertise to deliver transfusion services to patients through much more integrated working practices. Examples of the key areas where integration can be achieved include stock management and testing services.

Building and expanding on tried and tested models already operating in the UK and other countries, ITS has the potential to enable more effective and efficient management of blood and component stocks throughout the entire donor to patient supply chain, as well as helping hospitals to adapt transfusion services in response to the wider Pathology Modernisation changes affecting them.

As well as reducing costs through more integrated and efficient ways of working, potential advantages could include reduced blood wastage, better demand and collection planning, reduced blood storage time and improved turnaround times for access to blood and component products.

During 2011 NHSBT worked with a range of trusts and other stakeholders to carry out analysis of the blood supply chain including:

• a thorough evaluation of our internal operations in terms of productivity and efficiency
• considering how extending expertise and IT systems into hospitals could make the supply chain more efficient, improve the service to patients and make best use of blood donations
• working with hospital transfusion laboratory stakeholders to look at how hospital transfusion may be configured in the future as a result of wider pathology modernisation changes
• considering how NHSBT will need to transform or develop services such as Red Cell Immunohaematology (RCI ) and supply chain management in this new environment.

As a result of this analysis NHSBT has established the ITS programme. This will implement:

• Up to 3 hospital stock management pilots
• Developments to the Red Cell Immunohaematology (RCI) function to allow greater integration with hospitals
• NHSBT supply chain optimisation

The ITS analysis showed that as pathology networks continue to emerge and as pathology services are consolidated more broadly to serve these networks, opportunities are likely to emerge for hospital transfusion labs to consider cooperating in consolidated configurations.

It is apparent that the delivery of transfusion in hospitals will change over the short to medium-term as laboratories cooperate within more networked structures. As the main service provider of blood components to hospital transfusion laboratories in England and North Wales, NHSBT is well placed to help hospitals to adapt to this change, and to adapt our provision of both blood components and diagnostic services in this new environment.

During the last year, NHSBT has been approached by a number hospital trusts asking us to support them to develop their plans for transfusion provision within the broader context of pathology modernisation.

The NHSBT Strategic Plan 2011-14 includes a commitment to developing the supply chain by improving planning processes and supported, as necessary, by appropriate IT tools. ITS also supports delivery of the strategic themes for Blood Components, which focus on customer service, sufficiency of supply, safety, compliance, efficiency and effectiveness.

Following approval by the Board of the ITS programme in January 2012, the ITS Programme will be a key part of NHSBT’s Strategic Plan 2012-17.

There are three elements of the ITS programme:

1. Stock management: Working with hospitals to help them to calculate optimum stock levels and to pilot smarter systems for stock replenishment. This could minimise wastage and make the supply chain more efficient.
2. Transfusion Innovation: We will develop our Red Cell Immunohaematology ( RCI ) testing function so that it meets the current and future needs of hospital transfusion services, and also work with hospitals to explore opportunities for greater integration of services.
3. NHSBT supply chain optimisation: We will improve our internal operations by introducing more integrated supply chain planning and performance management...

To ensure ITS reflects hospital needs we have worked very closely with a stakeholder group representing hospital interest. NHSBT will deliver up to three stock management pilots and will also work with hospitals to explore opportunities for greater integration of testing services. Hospitals not directly involved in pilots will be kept up to date with developments as this work progresses so that it can help to inform hospital plans.

The pilots will be used to evaluate a proposed new stock management service and to ensure that any proposed changes can be made safely and effectively. They will also be used to examine more detailed operating arrangements, processes, and costs for wider roll-out.

The stock management pilots are intended to test all the systems which would allow NHSBT to manage the replenishment of blood components that hospitals would normally hold as stock. We will work closely with hospitals involved in pilots to agree their required stock levels and transport arrangements. We will also need to have visibility of all stock within the hospital system so a major part of this work will be to create the IT infrastructure to allow data to be exchanged between pilot hospital stock locations and NHSBT.

The first of the three stock management pilots is due to commence in summer 2012.

A set of criteria will be used to determine appropriate pilot sites. These criteria will include the extent to which individual pilot sites are able to test stock management models and for this to be representative of the wider NHS.

NHSBT will make available the criteria for stock management pilots in April, and provide this to hospitals with information on the mechanism for expressing interest. NHSBT will assess hospitals’ expressions of interest and consider these against the criteria. The first pilot is due to commence in summer 2012.

The return of stock to NHSBT has not, at this stage, been included in the plans for changes to stock management.

Provision of stock will not be disrupted during the pilots. Some systems may need to operate in parallel and we will also use simulation models alongside existing hospital processes.

During the pilots the hospital blood banks will continue to be responsible for the safe storage and allocation of blood components. The division of responsibilities between NHSBT and hospitals will be clearly defined in SLAs.

The details of each pilot have yet to be determined but pilots are expected to be completed by the end of March 2013.

The emphasis is on implementing integrated end-to-end planning process work from the hospital back to blood collection. This will include some changes to our current processes building on a better understanding of hospital requirements

The diagnostic services provided by NHSBT’s RCI laboratories have always responded to the changing requirements of hospital transfusion laboratories. These requirements are now changing more rapidly than ever and during the analysis phase of the ITS programme last year, we worked with hospital colleagues to consider how we could deliver the RCI service in a more integrated way.

Through the Transfusion Innovation project we will develop and improve the service offered to hospitals by RCI to meet the needs of the emerging pathology modernisation environment. As part of this, senior RCI staff will continue to work closely with their hospital counterparts to ensure our services are tailored to local needs. We will also consider how NHSBT can in the future provide cost-effective and high quality services, utilising our expertise in automation for high volume testing, quality systems and regulatory compliance, scientific training, technology innovation, better blood transfusion initiatives, benchmarking best practice and expert medical advice.

Further information on all elements of the ITS programme will be available from your local Customer Service Manager

NHSBT will fund the pilots as part of the Strategic Plan 2012-17. The pilots will help to determine future operating models, including roll-out costs and how these could be funded.

If hospitals wish, on the basis of pilot results and analysis, to introduce integrated stock management, then it is likely that they would need to invest in IT to ensure interoperability. We would anticipate that savings demonstrated through pilots would outweigh costs for implementation.

Pilots will allow initial data from the analysis phase to be validated and NHSBT will continue to communicate widely with all hospital stakeholders and publish the relevant results of the pilots where they may help to inform local plans.

NHSBT plans to develop its own Red Cell Immunohaematology (RCI) testing function to allow it to better serve the current and future requirements of hospital customers as they begin to cooperate more in local networks. In the longer term this may include a working with hospitals in partnership to provide hospital testing.

It is anticipated that savings could be delivered through better management of stock by:

• Reducing wastage and inappropriate use of blood/components
• Optimising transport arrangements
• Improved testing efficiency
• Reduced costs of regulatory compliance

MHRA are aware of ITS, any changes or developments to the service provided by NHSBT will be in compliance with BSQR

NHSBT will communicate directly on progress at key points in the ITS Programme. The Customer Service Managers will always be fully informed and we will use all usual communication routes through the Hospital and Science website, the monthly “Update” and attendance at RTCs, HTCs and Users groups as required