The London Regional Transfusion Committee
Confirmed Minutes of the London Regional Transfusion Committee London Blood Transfusion Forum (RTC Business Meeting) held on 17 May 2018 Oak Suite, W12 Conference Centre, London
Present: Dr Phil Kelly (Chair) King’s College Hospital Marian Acheampong North Middlesex NHS Trust Abdul Adamu Whittington Hospital Adewale Adeyemo North Middlesex NHS Trust Shubha Allard Barts Health & NHSBT Magda Al-Obaidi West Middlesex Hospital Sandra Amajor Lewisham Hospital Mariam Ammoun St. Mary’s Hospital Vivienne Andrews TDL / Chelsfield Park Hospital Kat Ayscough Parkside Hospital Chetan Bhatt Whittington Hospital Susan Bland Queen’s Hospital Alison Brownell Queen’s Hospital Elaine Carter-Leay Queen’s Hospital Linda Chapple Hammersmith Hospital Fatts Chowdhury St. Mary’s Hospital Sue Cole Princess Royal University Hospital Samantha Conran Croydon University Hospital Bernadette Cruz Northwick Park Hospital Malta Currie Whittington Hospital James Davies Kings College Hospital Candice Davison RCI, NHSBT Clare Denison BSMS, NHSBT Sonia Dhillon London Northwest Healthcare Trust Karian Diaz Galvao North Middlesex NHS Trust Kelly Feane St. George’s Hospital Diana Gabriel Newham Hospital Lisa Gibb Great Ormond Street Hospital Philip Gold Princess Royal University Hospital Jan Gordon Chelsea & Westminster Hospital Catherine Hawkins Princess Royal University Hospital Jennifer Heyes Kings College Hospital Jipsa Jacob Royal Free Hospital Dharshana Jeyapalan Guy’s & St. Thomas’ NHS Trust Lesley Jones Spire St. Anthony’s Hospital Amanda Joseph Kingston Hospital Rebecca Kahari Ealing Hospital SubbaRao Kanchustambam George Eliot Hospital Selamawit Kassa Hammersmith Hospital Niamh Kearney Spire St. Anthony’s Hospital Sarah Lennox Royal National Orthopaedic Hospital Joanna Lewandowska London Independent Hospital Sid Lingam Royal Brompton & Harefield NHS Trust Catherine Lynch Queen’s Hospital Kuziva Makanza RCI, NHSBT Josephine McCullagh Whipps Cross Hospital Denise McKeown Imperial NHS Trust Wendy McSporran Royal Marsden Hospital Confirmed Minutes of London RTC Meeting – 17 May 2018 1
Jennifer Mendoza Kingston Hospital Anne Minogue Queen’s Hospital Rachel Moss Great Ormond Street Hospital Joe Nanuck Queen Elizabeth Hospital Woolwich Anas Nasir Guy’s & St. Thomas’ NHS Trust Lloyd Noble Charing Cross Hospital Eugenia Nweje Charing Cross Hospital Jahanara Parsons St. Mary’s Hospital Mansi Patel Heartlands Hospital Reshma Patel North Middlesex NHS Trust Nithya Prasannan Whipps Cross Hospital Linda Price Queen Elizabeth Hospital Sally Procter OWD, NHSBT Nora Quiniquini Kingston Hospital Tasneem Rahman St. Thomas’ Hospital Fiona Regan NHSBT/Imperial College NHS Trust Brian Robertson University College Hospital Nidhi Sharma Newham Hospital Kathleen Sharp BMI Chaucer Hospital Angela Short Epsom & St. Helier NHS Trust Swati Shukla BUPA Cromwell Hospital Naina Solanki NHSBT Seema Solanki HCA Healthcare Chris Steward University College Hospital David Stokes Spire St. Anthony’s Hospital Bruno Tacco BUPA Cromwell Hospital Ethan Troy-Barnes Imperial College NHS Trust Kathryn Tulley NHSBT Hannah Turner Royal Free Hospital James Uprichard St. George’s Hospital David Veniard Princess Royal Hospital Paul Wadham Royal Marsden Hospital Helen Wadham Guy’s & St. Thomas’ NHS Trust Donna Wiles Barking, Havering & Redbridge NHS Trust Bassey Williams St. George’s Hospital Pascal Winter Barts Health NHS Trust Julie Wright Queen’s Hospital Sasha Wilson PBMP, NHSBT Gemma Fawke PBMP, NHSBT Richard Whitmore CSM, NHSBT Deepa Takhar CSM, NHSBT Angela Pumfrey RTC Administrator, NHSBT
01/18 Welcomes and Introductions PK welcomed everyone to the meeting and informed them of the housekeeping arrangements.
Minutes of Last Meeting (11th October 2017) The minutes were accepted as a true record. AP to arrange for the minutes to be uploaded to JPAC website.
02/18 NBTC & RTC Chairs Meeting Feedback The March meeting took the format of a meeting followed by a workshop on appropriate use of blood products.
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RTC Chair update 180517.pdf Please note, the talk given by PK was done without the presentation slides being available. Embedded is the full version of the written presentation. RTC Chairs Update Website issues: Ownership of the content - should be led by users, but is not user friendly. It will be costly to redesign the website. We would welcome any suggestions on what to put on the London RTC website. Twitter: It is increasingly the way people share things. Please feel free to tweet anything interesting. If you do not have your own account, please ask either Sasha Wilson or Gemma Fawke to upload onto our London RTC Twitter account. Attendance at Meetings: Difficulties getting people to attend. Human Factors: An important topic – patients like us to be open and honest. Major haemorrhage – we might do this in London Budgets: Pressures on regional budgets
NBTC Update RCI Assist Programme – still awaiting an update as to whether NHSBT have chosen their partner SHOT - SHOT’s budget has been cut: therefore, they cannot travel to events as often as before Paula Bolton-Maggs is retiring end of July. Many thanks to her for her hard work.
Blood Components Workshop Topic was appropriate use, focusing on extended matched RBC and A-ve platelets. How frequently regularly transfused patients develop antibodies – this is a huge problem for sickle cell patients.
London RTC Update Sasha Wilson and Gemma Fawkes are the two new PBMP’s for London. Gemma’s role is split between the London RTC and BSMS. Thank you to Clare Denison for her hard work as PBMP for the London region. Deepa Takhar is the new Customer Service Manager for Colindale Single Unit – will start up again soon. This time it will be a national project and NHSBT will be supporting hospitals in implementation rather than running the project. The project will start in selected hospitals initially. Events planned for the next 6 months including platelet champion day on 12 October. Next RTC meeting will be held on 19 October – topic is patient safety/human factors. London Twitter account now has 643 followers. If you would like to join, the hashtag is @london_rtc. Other regions recognise our success with Twitter. It is the way to communicate and distribute news.
03/18 NHSBT Update
NHSBT RTC Presentation 170518.pdf Ro project: We have a high demand for Ro units for sickle cell patients and it is difficult to recruit BAME donors. Please accept Ro substitutes and do not hold Ro in stock as we cannot meet demand. Product Shortages: Please review your own shortage policies. During the recent amber alert, some hospitals put in place their contingency plans, but sometimes these were not necessary as only one specific product was affected. The hospitals said it was not clear that just one product was affected, they Confirmed Minutes of London RTC Meeting – 17 May 2018 3
thought it was a general shortage and it was difficult for them to get blood. NHSBT will try to be more specific in future. Transition and Irradiation Labels: Still not ready to implement, but they are definitely coming. CMV products: Please review your need for these products as they are only needed in a few cases. O Neg Kell Pos Units – NHSBT are discarding a lot of these units as hospitals are not ordering them. A pilot study will be carried out, whereby all hospitals will receive a small amount of these units. These units can be used on males and post-menopausal women (avoid women of childbearing age and sickle cell patients). It was asked if NHSBT can write guidelines for the hospitals. NHSBT Update: It is on Hospital & Sciences website. Please look at it once a month, there are lots of things on there. It may also be on the national Twitter account.
04/18 Fetal RHD Screen: Overview of Provision in London Presentation by Erika Rutherford, Business Development Manager, IBGRL&RCI
Fetal RHD Screen 170518.pdf We would like all hospitals to sign up to the screening programme. If you want to sign up, you must do a business plan first. You will also need a Project Lead (usually an Obstetrician). ER showed an example of a costing table (the red figures are estimates as these will differ from hospital to hospital). Each hospital will decide when to cap the testing, e.g. at 26 weeks. The costing may look daunting, but ER can assist you and said it shows that the screening is more cost effective than giving Anti D to all pregnant women. Once the baby is born, any discrepancies in the cord blood must be reported to ER.
05/18 Monoclonal Abs and Serological Challenges Presentation by Doris Lam, Head of RCI Laboratory, NHSBT
Monoclonal Antibodies.pdf NHSBT has asked that this is presented at every region’s RTC meeting.
06/18 BSMS: Review of Hospital Stock Holdings Presentation by Clare Denison, Lead Specialist, BSMS & David Johnson, TLM, St. Mary’s Hospital
BSMS Review of Hospital Stock Holding - 170518).pdf BSMS carried out a blood stocks review at St. Mary’s Hospital. Learning point for hospitals is that they already review their stock levels based on what they actually use and waste. St. Mary’s wastage figures were very high, over £90,000 a year. DJ’s presentation showed how much they decreased their stock by since the review, with a saving of £50,000 a year. Lab staff are permitted to order ad hoc deliveries should they need to. Ad hoc deliveries include the full cost where as a collection only charge does not include the cost of transport/delivery. Ad-hoc deliveries may be more cost effective depending on the hospital’s individual delivery methods. The BSMS team offered to do stock reviews for other hospitals upon request.
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07/18 Pathology Networks Update Presentation by Adrian Newland, Professor of Haematology
Pathology Networks Update 17 May 18.pdf Pathology services are effective, but improvements can be made and the Carter Report estimated that millions could be saved by having networks and hubs and spokes. The pilot uses a single LIMS system which is what all regions have at the moment. AN appreciates that staffing is an issue for Trusts and promised any savings will be shared amongst all the Trusts. There are 29 Networks throughout the country – 5 Trusts want to set up their own network.
Q&A’s 1. Cost pressure on NHS - It is good in principle, but cost pressure involved in getting LIMS. There is funding available to help Trusts. Funding has already been given to 4 of the Trusts that want to form their own network. AN appreciates it takes a long time to get a new LIMS system in place and they have warned the government that some hospitals may not be able to do it.
2. Costs and savings will benefit NHSBT but more costly for hospitals. There is a lot of work to do with LIMS as some functions do not work It does not have to be the same LIMS system, but they have to be compatible so they can work together. Centralised activity will incur costs in some areas, but will also make savings in other areas. Trust Boards need to have dedicated people working on this.
3. Problem with staff morale in transfusion labs, people are resigning. Transfusion is a unique speciality. Transfusion was not included at the beginning, but AN is very keen that it is included. They are worried about workforce and morale and are looking at workforce input and training. A properly managed Network is better than the Trust system.
4. Concerns that the transfusion team (TLM, TP) will be lost. TLM feels they are not part of the transfusion team because their employer is not part of the Trust They will need to look at that so that the link is maintained. NHSBT wanted to use large hospitals as hubs 10 years ago to reduce wastage. That ceased in 2010/11 because of money, but AN would like to see it implemented again.
5. Hub & Spoke Model: Staff do not like this term, they think it is a centre model. They appreciate working closely within a team and want assurance that this will remain The financial situation will have to be looked at. For some regions it is more cost effective to keep things as they are with regards to what testing labs do.
6. Where other services have been centralised, there have been catastrophes. How will this be avoided? In terms of clinical impact, it may be better. It will not be managed in a ‘top down’ approach.
08/18 Any Other Business None
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