Professor Anthony Staines:

Yes. We are negotiating with the HSE on how we can be paid for it. If we take blood from people who are not donors, there is a significant cost to us. We are negotiating with the HSE on who pays for it. On the whole we would prefer if the HSE paid for it. We are much cheaper than hospitals because it is the only thing we do. It takes a significant load off the hospitals. As such, haemochromatosis consultants are keen that we deploy the service further and faster. That is our objective. We have started, but we have a way to go yet.

The second issue referred to was the product mix. We started almost by accident - I think 30 years ago - because somebody was needed to mind heart valves that were being used for heart surgery. The Blood Transfusion Service Board seemed to have the right set of skills and we started by accident, but it has always been a very small-scale part of our activities. It has expanded a little during the years, but our view is that tissue and stem cell services will probably expand substantially in the next decade. There is a need for a strategic conversation on how best to meet that need. We are a highly regulated manufacturer of bio-pharmaceuticals; that is what blood transfusion is about. As such, we have certain skills to bring to the table. However, we are not saying we should do it. That might be how it will end up, but for the moment we are saying we should have a conversation nationally about what is the right, the most effective and safest way to do it for our service and patients. We wish to contribute to that conversation.

There has been a very long, drawn-out discussion about Cork centres. In fact, it started when I came back to Ireland in 1997 and we have been around the houses several times. The final upshot is that we have reached agreement with the Department, Cork University Hospital, CUH, and UCC, which are the relevant parties. We have a facility at St. Finbarr's Hospital which really needs to be rebuilt. It is located in prefabricated buildings and no longer fit for purpose. We have arranged with CUH to build it on a site there. I am told the project team is meeting this month. CUH appointed its delegate to the project team three or four days ago and I gather the plan is to meet this month. We will proceed to planning as swiftly as possible. All going well, we hope to go to planning by Christmas. That is our objective. What we will end up with is a single transfusion centre in Cork in which we will undertake very complex transfusions in which our staff specialise. That is one of the reasons we want to keep the centre in Cork. It is a huge asset to Cork University Hospital which is a very large haematological centre. We will also be able to support the more day-to-day transfusion work. It will allow us to provide our specialised services at a reasonable cost. The service we are providing is not viable as we have quite a number of staff who do not have enough routine work to do to pay their salaries. However, we need the staff to provide the on-call complex transfusion service. This will be a much more stable solution. In the longer term there will be a very good blood centre in Cork providing what we hope will be a really good service for the people of the south and south west. That is our objective.

In reducing the use of blood, there are two sayings in the transfusion business. One is that the most dangerous transfusion is the one you do not need. Giving people blood products is inherently unsafe. There are inherent risks. Our job is to reduce these risks to the lowest possible level. I have had approximately 130 blood transfusions and 100 platelet and plasma transfusions and been at the sharp end of this. We believe our blood products are as safe as we can make them, but there is a limit to how safe one can make them. On the other hand, the next most dangerous blood transfusion is the one you do not have when you need it. Doctors always tread a line between giving blood too freely and not giving enough. I did some work for the national blood strategy implementation group in 2003 and note that in the past doctors used to prescribe two, four or six units of blood. Now, the most common prescription is for a single unit, which is probably right. We understand much better that raising a person's haemoglobin level does not do a huge amount. People can function quite well on a low haemoglobin level and raise their own as they recover after surgery or suffering a trauma.

People are therefore using less blood. We already know that as the population ages, the number of cancer cases will go up. A lot of our blood is used by people with cancer, so we expect that over the next decade the demand for blood will rise again. Our demand for blood was quite high by European standards, whereas it is now low by European standards and will probably go up a bit.

I was trying to explain to one of our new board members, who came from a stockbroker's, why it was in our interest as a trading organisation to reduce demand for our product. It took her a while to get her head around it, but she understood it. Part of our remit is to manage blood use effectively across the country. We have set up a national transfusion committee, which is chaired by one of our consultants. That is designed to provide guidance, advice and training on the proper and effective use of blood and blood products. That is our objective.

Hepatitis E is a fairly new virus. We are struggling to explain it because when people hear "hepatitis virus" they tend to think of hepatitis C, which is the one that caused such devastation from the anti-D that we produced, I am ashamed to say. The hepatitis E virus is relatively newly identified. It causes a disease much more like what used to be called juvenile or infant hepatitis, which is hepatitis A. It tends to be mild and almost everybody gets better. I am not saying it is negligible; it is not. However, it is not nearly as serious as hepatitis B or C. One can get it from pork and it is commoner where one eats a lot of pork sausages, salamis and hams. People who work with pigs are inclined to get infected by this virus and one can transmit it in blood.

A test has been available only since Christmas 2014. We have done a lot of preliminary work on how and who to test. We are now discussing how much it will cost with the Department because we do not have enough money in our own resources to do it. We are having a discussion with the Department of Health about the most effective model for testing and we hope to introduce it in the next while.

Deputy Catherine Byrne asked about donors and kids. A small number of people require multiple transfusions, and a number of them are children. We provide those transfusions. There might be eight or ten donors who donate to those children in Ireland. We take blood from those people and earmark it for those children. We have quite a sophisticated patient-centred process around a relatively small number of children. These are the complex transfusions I was mentioning. We also get complex transfusion problems in adults. We often have matched donors, so we have the information. We have detailed blood groups which go on for about half a page on a large number of people. We draw from those and also work with colleagues abroad to meet some specialised requirements.

The last issue mentioned was the lifetime deferral for men who have sex with men. At the moment, our policy is that if a man has had sex with a man, he is deferred from donating for life. This policy was introduced in the early 1980s at the time of the AIDS epidemic. Different blood services across Europe now have a range of different policies. Some of them have a lifetime deferral policy, while some have a deferral for two or five years. Some services have a policy which says they are interested in a person's sexual history. They are essentially interested if a person has had sex with a new partner recently, because that is where the risk arises.

The issue that arises is that there is a window period between the time one becomes infected with something and the time our test can detect it. The window period is very short - it is six to seven days - but it is not zero. Therefore, there is a small risk that if a person was just infected with HIV, hepatitis B, and we took blood from them in all innocence our test could miss that the person had been infected. We might give that blood to somebody else and the risk of transmission there is not negligible.

We have reviewed the policies across Europe. We are part of a European group of bloodbanks and have had discussions with members of that group. Our chief executive is the vice-president of that group at the moment. We are doing a very detailed risk assessment. We have done the first draft of it and are now going to prepare the second draft. We hope it will be finished in the autumn of this year. At that time, we will bring the draft to our board and to the Department. The discussion will be about our policy and the risk, as well as a couple of other policies and how they will change the risk. We will have to make a decision as to what is the safest policy for our donors and recipients, and what is the fairest policy for all the people in the country.