A review of blood donation and apheresis services run by NHS Blood and Transplant (NHS BT) has found safe and effective care and treatment provided by competent and skilled staff, working together effectively to meet local patient needs.
However, Care Quality Commission (CQC) inspectors, who carried out the review earlier this year, identified areas where NHS BT’s organisation-wide governance processes needed to be strengthened. They also found that action is needed to fully embed a culture where all staff feel respected, valued and supported.
NHS BT manages the supply of blood, organs, tissues and stem cells. It collects and supplies blood to hospitals in England and operates multiple donor centres and therapeutic apheresis services which fall into scope of CQC regulation.
CQC carried out a provider well-led review of NHS BT between 22 June and 8 July 2022 to follow up on concerns raised by NHS BT staff about the organisation’s culture and leadership, and the safety of some of its services. Separate further inspections looking at the safety and quality of services delivered to patients at NHS BT’s Oxford and Bristol Apheresis Units and at five individual NHS BT Donor Centres took place in August 2022.
Visiting inspectors looked at a range of performance data, quality audits, board papers, internal and externally commissioned reports and complaints handling records. They also spoke to over 60 members of staff.
The CQC review found that infection risk was controlled well at the blood donor centres and apheresis units and areas where donations were taken were clean and well maintained.
Safety incidents were managed well. Staff recognised incidents and near misses and reported them appropriately so that a full investigation could take place and learning shared with the team involved and the wider service.
Blood donors’ views and experiences were gathered and acted on to shape and improve services. At an organisational level, agreed processes were in place to manage performance and identify and escalate any risks, however those processes were not always effective, and inspectors were not assured that board members were sighted on all issues that needed addressing.
The provider well-led review also found that some parts of the organisation were working in silos and different directorates did not always communicate with each other to share information about governance, quality and risk.
There was a mixed view among the workforce in relation to the organisational culture, with some staff describing poor experiences. These included some staff who said they suffered detriment when they tried to raise issues or concerns, and staff from a Black and Minority Ethnic background, as well as others with protected characteristics, who said they experienced inequality and discrimination. However, staff were proud to work for the organisation and all staff CQC spoke to had personal and organisational commitment to provide high-quality services.
While leaders understood the importance of staff being able to raise concerns without fear of retribution, the culture did not always encourage openness and honesty at all levels and learning or action was not always taken as a result of concerns raised.
Fit and proper person’s processes and records were poor and lacked scrutiny. The required employment checks had not always been carried out to ensure that members of the executive team were “fit and proper”. Documents provided by NHS BT did not always evidence that references and disclosure and barring service checks had been sought during recruitment, or that bankruptcy searches or checks for having been disqualified or prohibited from being a director previously had been undertaken. This was recognised by the organisation at a senior level and CQC was told that action was being taken to ensure improvements as a result.
Deanna Westwood, CQC’s Director of Operations – South Network, said: “Our review of services provided by NHS Blood and Transplant identified areas where governance and oversight of risk at a senior level needed to be strengthened. We also heard concerns from staff about the organisational culture – particularly in relation to diversity and inclusion and the experience of staff from a Black and Minority Ethnic background. We have made clear that these issues must be addressed.
“The quality and safety of services provided by local blood donor services and at the apheresis units was of a high standard. Local managers ran these services well and supported staff to develop their skills. Blood donors and those receiving apheresis treatment were shown compassion by staff, were treated with dignity and respect and provided with information about their care and emotional support.
“NHS Blood and Transplant provide a vital service and staff are doing an excellent job. One member of the inspection team has recently signed up to donate blood, a decision that was directly influenced by the impressive work witnessed on this inspection.
“We shared our immediate feedback from the inspection with senior leaders and they are clear on the areas of concern and governance issues that need to be addressed. Board members recognise and accept they have work to do to improve diversity and equality across the organisation, and we will continue our regular contact with NHS Blood and Transplant to monitor the quality and safety of services as they progress their improvement plans.”
The report can be downloaded here.
