NHS Trust says No capacity for Infected Blood Inquiry recommendation

During a meeting last week, an NHS Trust concluded that it did not have the capacity to implement one of the key recommendations in the Infected Blood Inquiry report, which was published in May.

Among the recommendations made in the damning report by Inquiry chairman, Sir Brian Langstaff, was a section pertaining to monitoring liver damage for people who were infected with Hepatitis C.

Specifically, Sir Brian recommended that those who have been diagnosed with cirrhosis at any point should receive lifetime monitoring by way of six-monthly fibroscans and annual clinical review, either nurse-led, consultant-led or, where appropriate, by a GP with a specialist interest in hepatitis. Such care should also be provided for those who have fibrosis or where there is any uncertainty about whether a patient has fibrosis, the Inquiry concluded.

At a board meeting last Tuesday, the Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust discussed various recommendations from the Inquiry.

In relation to Sir Brian's recommendation on monitoring liver damage for people who were infected with Hepatitis C, the Trust concluded: "We do not have the capacity to deliver the 6 month scans and annual follow ups that are in the recommendations. We do risk assess the patients and manage best as we can within our resource. We have one fibro scanner recently bought by charity and another coming with the Community Diagnostic Centre. Currently these scans are done within our gastro department."

Lack of capacity will be frustrating and worrying for victims of the infected blood scandal who are receiving care from the Trust.

Factor 8 is continuing to investigate the response of other NHS Trusts to the Inquiry's recommendations.

Dr Nick Mallaband, Acting Executive Medical Director at Doncaster and Bassetlaw Teaching Hospitals, said: “We are working diligently on a plan to secure the necessary resources to achieve this work.

“The additional equipment provided by the Doncaster Cancer Detection Trust and our recently established Community Diagnostic Centre at Montagu Hospital will support this effort. We are committed to treating all individuals with Hepatitis C equally, and to providing the best possible care for those affected."

Response of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust to the recommendations of the Infected Blood Inquiry recorded in the board meeting minutes dated 2nd July 2024.

The Infected Blood Inquiry has identified 10 areas that we need to work towards full implementation for. We have created a central action plan to track the progress of these points and ensure delivery. Below we have pulled for the plan an update on each of the points.

1: Tranexamic acid

• Tranexamic acid has been shown to reduce blood loss during surgery. It should be prescribed for any patient likely to have moderate blood loss

• Current practice is it widely used within orthopaedics and less consistently used in other specialities • Current development of guideline and adding to the checklist and team brief. This has to go through governance and PSRG, target implementation date is September 2024.

• When implemented we will report compliance with a target of 80% through effective committee and up to board.

2: Transfusion laboratories should be staffed and resourced adequately

• Current staffing levels are safe when benchmarked. The transfusion lab is staffed at the expense of the general labs when there are gaps. The general lab gaps are then backfilled through NHS Professionals.

3: Training in Transfusion medicine

• Role specific competencies are in place. Staff must have the relevant competencies to perform a transfusion related task / procedure e.g. venepucture, collection of blood products, administration of blood products and prescribing blood products. Competencies are recorded on OLM.

• Advice regarding the relevant competencies is available from the Transfusion Practitioner.

4: Implementing Serious Hazards of Transfusion (SHOT) reports

• Through transfusion practitioner and transfusion laboratory staff to escalate problems to SHOT.

• There is annual SHOT compliance report, that is presented to the effective committee.

• Need to develop further action plans to ensure compliance. The next report is due out in the next month so will develop on the back of this.

5: Establishing the outcome of every transfusion

• We have traceability of all units of blood through a paper system.

• Reactions are reported through DATIX and then through the transfusion practitioner to SHOT. There is a secondary mechanism for reactions to be reported through the lab and then to the transfusion practitioner.

• DBTH currently have 1.0WTE Transfusion Practitioner, should have 2.0WTE for size of Trust (benchmarked with other organisations). Barnsley and Rotherham have 2 WTEs. Need to look at a case to expand in order to fully embed the recommendations.

• We have partially implemented an electronic tracking system for blood products this is currently working on ward 18 and in Chatsfield suite. Further IT integration is required to roll this out to the trust.

• In line with recommendations we are incorporating a transfusion related circulatory overload (TACO) assessment within our prescription

• Current outline plan to move to electronic prescription of blood is being scoped.

6: Monitoring people for liver damage

• We have a dedicated Hep C clinic that is run by a very experienced SAS doctor as well as specialised nurses.

• We do not have the capacity to deliver the 6 month scans and annual follow ups that are in the recommendations. We do risk assess the patients and manage best as we can within our resource.

• We have one fibro scanner recently bought by charity and another coming with the Community Diagnostic Centre. Currently these scans are done within our gastro department.

7: Finding the Undiagnosed

• When doctors become aware that a patient has had a blood transfusion prior to 1996, that patient should be offered a blood test for Hepatitis C.

• As a matter of routine, new patients registering at a practice should be asked if they have had such a transfusion.

8: Giving patients a voice

• Clinical audit should as a matter of routine include measures of patient satisfaction or concern, and these should be reported to the board of the body concerned.

• Measured by comparing the measure of satisfaction from one year to the next, such that the reports to the board concerned demonstrate a trend of improvement by comparing this year’s outcomes with the similar outcomes from at least the two previous years.

9: Duty of Candour

• This is well embedded within the trust processes.

10: Giving effect to the recommendations of the enquiry

• Commitment to a 12 month implementation timetable for the recommendations