Professor Anthony Staines:

I thank the Chair for inviting me to appear before the committee today. I have had the honour of being proposed for re-appointment as chair of the Irish Blood Transfusion Service. I am a doctor, a graduate of Trinity and a registered specialist in public health with the Irish Medical Council. I trained in Dublin and then in Yorkshire, before coming back to Ireland in 1997. I have worked as an academic since then, for ten years in UCD and for the last eight in DCU where I am the professor of health systems in the school of nursing and human sciences. I have qualifications in medicine, epidemiology, public health, education and board governance.

I am an applied public health researcher, that is, my work is mostly directed to specific, immediately applicable ends. I have done a lot of academic work on specific types of cancer, namely, leukaemias and lymphomas, and have worked closely with many Irish haematologists as part of this. My more recent work has been on the delivery of services. I have worked on resource allocation for the Irish health services. I have spent much of the last two years working on a draft strategy for ICT in the Health Service Executive. I have worked, and led, EU-funded projects including several major projects on child health and environmental health.

Very relevant to this session, I worked for the national blood strategy implementation group and did the fieldwork and analysis of blood use in Ireland for the report which came out in 2004. I also worked closely with the IBTS, and in particular with the medical director and the then operations manager, to look at stock management in the Irish blood services. This work was funded from 2004 to 2007 by the health research board and the Department of Health and Social Security in Northern Ireland. I was asked to serve as chair of the IBTS a little over three years ago. The invitation was unexpected but I felt that I would have something to offer the organisation, both because of my prior detailed knowledge of the practice and policy on blood use in Ireland and because of my organisational and leadership skills.

I was very conscious of my limited board experience and I have taken every opportunity to improve my skills in this area, including attending board induction sessions and training sessions at the Institute of Public Administration. I am now coming to the end of the Institute of Directors chartered director program, which includes formal training in governance, board performance, strategic planning and general management.

When I came into the post, my board colleagues and I were very clear on our core mission, to provide a safe, secure and reliable blood supply to the people and the health service of Ireland. The tragic history of the infection of many Irish blood product recipients by the Blood Transfusion Service Board will be familiar to members and I assure them it is always to the forefront of my mind.

The IBTS is, among other things, one of the largest voluntary organisations in Ireland. We have donors from almost every parish in the country and a network of local voluntary organisers who support our collection teams in running donation clinics all over the country and in persuading local people to attend. The care of our donors is also a high priority for us. I have the privilege and the very great pleasure of making awards to donors who have donated 50 and 100 times at a series of award dinners held around the country. Our donors are remarkable people and every time I meet them I become more convinced of this.

On taking on the role over three years ago, my colleagues and I identified two big issues which had to be dealt with. Both were of practical significance to the organisation and both took a large proportion of both board time and executive time. The first of these was the Cork centre. A debate had gone on for 12 years with no final resolution as to the nature and needs of our Cork centre. Now, thanks to a great deal of work from our own executive, colleagues in the Health Service Executive, the Department of Health and Cork University Hospital-UCC medical school, an agreement has been reached, and approved by the Minister, to develop a new centre on the CUH site in Cork. This will be a major new laboratory facility, supporting both our own staff's very specialised work with the most complex transfusion cases and the transfusion work now being done by other hospital laboratories in Cork. There will be a donor collection centre, a major blood stock holding centre with one half of the Irish blood stock, and facilities for platelet collection and plasma apheresis.

The second issue was the IBTS pension fund. This is a public sector pension fund but it is run by the IBTS. In common with many other private sector pension funds it is running a deficit. This deficit arises from several sources, such as changes in demography, low bond yields, and the recent recession. This is a major issue for our staff and it inhibits the transfer of staff from the IBTS to equivalent posts in the HSE. After a great deal of work, and with immense support from the Department of Health, we believe that the pension fund issue may be close to resolution and that a fair and equitable solution respecting the rights of our staff, our current pensioners, and our parent Department can be reached. Active work continues on this. Joint agreement from our parent Department and the Department of Public Expenditure and Reform is required.

The pension fund is driving a steadily increasing deficit in the IBTS. Our core business is paying for itself, but the requirement to continue funding pension fund deficits, currently of the order of between €2 million and €3 million a year, is destabilising our finances. Despite extensive cost-cutting, and reductions in headcount, we now need either to sharply increase the cost of our products, or to achieve a reasonable resolution to the pension fund.

Another very important piece of work, which took a good deal of time, was the preparation of a full business continuity plan for the IBTS. This is our contingency plan for any incident threatening our ability to provide a safe and secure blood supply, up to and including the complete destruction of the National Blood Centre.

This has been a very large change project, including moving to single site testing and processing, developing and testing and service level agreements with our suppliers and our international partners to ensure continuity of supply. There were two other important managerial projects delivered over this time. The first was a move to full activity-based costing. Unlike most public bodies, and, indeed, many private sector providers, the IBTS can now accurately cost our services. A second major change project was the introduction of a new IT system to the organisation. This has taken a little over three years to set up and establish, and is due to go live later this summer. Thanks are due to our staff, executive and parent Department for their hard work and support on these major changes.

We have one major challenge, that is, the declining use of blood products. Over the last few years the use of red cells and platelets, our main products, has fallen sharply, by around 13% over the last five years. Incidentally, this is desirable and is something we want to happen. It is hard to know what the optimum level of blood product use is, but Ireland was using more product per head than many of our peers four years ago. We are now using product at a level comparable to that of the best-performing EU countries.

Managing the impact of this on our bottom line has been a real challenge. In common with other public sector bodies, our budget and head count have fallen sharply over the last four years. The additional challenge of falling sales has been difficult to manage. As far as we can see, the decline in blood product usage has now levelled out. We expect that it will begin to rise slightly over the next four or five years, due to an aging population and the expected increase in hospital activity.

The IBTS must have sufficient funds to continue to invest in staff training, equipment maintenance and upgrades and responding to new technologies and challenges. We are now living on past investments. It will be necessary to make further investments in new testing and product preparation methods over the next five years, and we do not currently have the resources to do this.

There are two specific challenges facing us. The first is specific. There is a human virus known as hepatitis E. This virus is spread from pigs and undercooked pork meat products, but it can be also be spread through blood transfusion. The illness caused is mild, but people who are immunosuppressed, for example transplant recipients such as myself, or people with cancer, may be at greater risk of long-term illness. A test for this virus is now available, and we need to make a decision on how to bring this test into routine use and how to fund it.

The second is a longer-term, and more strategic, challenge. As well as blood products, we currently provide a limited number of tissue services, mostly valves for heart surgery and corneas for transplants, and a small number of other tissues, as well as a new service for limbal stem cells used in the repair of serious eye injuries. These services will become more important over time. At the current time stem cell treatments are prepared in five or six places in the Republic. It is hard to argue that this represents the best use of public money. There is a strong economic case, and perhaps a patient safety and quality case, for these services to be further developed on one site. The IBTS is keen to contribute to this work.