pdf SNBTS Strategy - Scottish National Blood Transfusion Service

Meeting the Transfusion Needs of Patients in Scotland 

SNBTS Strategy 2009 - 2014 

STRATEGIC DEVELOPMENT PLAN 

Authors 

SNBTS Strategy Project Team 

Date 06 March 2009 

Version 

Version 2.0 Approved 

SNBTS Strategic Development Plan Version 2.0 Approved NSS Board 06 March 2009 Page 1 of 62

CONTENTS 

Page 

EXECUTIVE SUMMARY 4 

1. INTRODUCTION 10 

2. BACKGROUND 12 

2.1 Context 12 

2.2 Operating Environment 14 

2.3 Key Drivers for Change 15 

3. SNBTS STRATEGIC THEMES 19 

3.1 ENOUGH BLOOD FOR PATIENTS 19 

3.1.1 Introduction 19 

3.1.2 Keeping Blood Safe 20 

3.1.3 Reversing the Decline in Donors 23 

3.1.4 Impact on Staff and Resources 25 

3.2 FACILITIES FOR THE FUTURE 27 


3.2.2 Keeping Blood Safe 28 

3.2.3 Modernising Blood Production Facilities 

to Maintain Safety 31 

3.3 SUSTAINABLE TISSUE SERVICES 37 


3.3.2 Keeping Tissues and Cells Safe 37 

3.3.3 Donor Recruitment 37 

3.3.4 Tissue Retrieval 38 

3.3.5 Processing and Storage of Tissues and Cells 39 

3.3.6 Cellular Products 39 

3.4 SERVICES FOR PATIENTS 41 


3.4.2 Supporting Better Health Better Care 41 

3.4.3 Specialist Services 42 

3.4.4 Local Delivery Supported by National Specialisation 46 


3.5 AN ORGANISATION FIT FOR THE FUTURE 47 


3.5.2 Supporting Effective and Efficient Transfusion Practice 47 

3.5.3 Ensuring Resilience and Compliance with cGMP and 

Clinical Standards 47 

3.5.4 Investing in High Impact Science that Benefits Patients 48 

3.5.5 E-Health and Improving Service Performance 50 

Page 

4. MANAGING CHANGE IN THE WORKFORCE 52 

4.1 Introduction 52 

4.2 Workforce Planning 52 

4.3 Workforce Projection 55 

5. FINANCIAL SUMMARY 56 

5.1 Funding the Blood Supply 56 

5.2 Summary Forecast 57 

5.3 Baseline Analysis – Review of Funding Requirement 58 

5.4 Breakdown of Additional Allocations 58 

5.5 Capital Investment 59 

5.6 Key Financial Assumptions and Risks 59 

6. EQUALITY & DIVERSITY 61 

7. RISKS 61 

8. COMMUNICATIONS STRATEGY 62 

Appendix I Strategy Communication Plan 2009 – 2014 


1 EXECUTIVE SUMMARY 

1.1 BACKGROUND 

SNBTS is charged with the responsibility of providing safe and sufficient supplies of blood 

and tissues for NHS Scotland and also delivers a range of specialist Clinical Services. The 

work is extremely challenging, highly regulated and experience has shown that the scope 

and stringency of the safety agenda and regulatory process will continue to increase. 

As a key part of NHS Scotland and division of NSS, SNBTS operates within the policy 

framework and strategic direction set by these wider organisations and this is reflected in 

the approach set out in the SNBTS Strategic Development Plan 2009-14. 

The plan is described within five Strategic Themes ie: 

• Enough Blood for Patients; 

• Facilities Fit for the Future; 

• Sustainable Tissue Services; 

• Services for Patients; 

• An Organisation Fit for the Future. 

The key strategic outputs from the plan include service modernisation; renewing and future 

proofing the SNBTS estate to maintain licences; continuous improvements in quality and 

efficiency; ensuring ongoing regulatory compliance; delivering improvements in blood and 

tissue safety; building a more resilient service; developing new and improved treatments for 

patients and developing our workforce. 

1.2 KEEPING BLOOD AND TISSUES SAFE 

The Scottish Government, NSS and SNBTS have a responsibility to ensure blood and 

tissue supplies are as safe as possible. Experts from NHSS and SNBTS actively 

contribute to UK Advisory Committees who evaluate possible new safety interventions and 

determine whether their implementation should be recommended to ministers. In the last 

10 years this agenda has been dominated by the introduction of measures designed to 

reduce the risk of transmitting vCJD with blood and tissues. 

A number of further measures are under active consideration and are being scoped for 

implementation within the timescale of this plan. Safety measures come in the form of 

additional criteria for donor deferral, additional processing steps or additional testing 

measures and may require the recruitment of more donors or the procurement of more 

advanced equipment, more staff and, consequently, more space within highly specified 

facilities. 

To provide clarity on the expected source of funding for the initiatives set out in this plan, 

initiatives likely to be funded via NSS are highlighted in green, whereas those where the 

source of funding is expected to be SGHD are highlighted in blue. This codified approach 

is used throughout the plan. 

Whilst NSS would normally fund the modernisation of existing systems, many safety 

measures mandated by government are expensive and cannot reasonably be funded by 

NSS and in these circumstances are funded by SGHD over and above the normal NSS 

funding allocation. 

1.3 ENOUGH BLOOD FOR PATIENTS 

Enough Blood 

In keeping with many countries, SNBTS has been experiencing declining public support for 

blood donation. This has arisen as a result of mandated changes in donor selection criteria 

(ie deferral of donors who themselves have received a blood transfusion (vCJD risk, Apr 


2004)), implementation of the Blood Safety and Quality Regulations (BSQR) Nov 2005 and 

general changes in public attitudes and lifestyle. By 2007, the active donor base in 

Scotland was at the lowest level since national records began. 

At that time it was known that tests to screen the donor population for vCJD were under 

development but might have limited accuracy resulting in further loss of public support. 

Consequently, in Dec 2007, NSS provided £2.32m for an SNBTS proposal to deploy an 

integrated Publicity and Marketing plan to halt the decline and rebuild the donor base in the 

short term. To date this has been highly successful. The longer term plan was to use 

service redesign to transform the donation experience to make it more accessible and 

rewarding. 

It was acknowledged this redesign would need to be developed in partnership and carefully 

evaluated/ piloted to ensure the various changes would be effective, efficient and 

sustainable. The key areas of work are Reaching out to New Donors; Improving 

Communication with Donors; Transforming Donor Venues and Transforming the Donation 

Experience. A number of initiatives have been or are being piloted whilst funding bids have 

been submitted to support other pilots or implement redesign solutions. Further funding 

bids will follow in support of this essential redesign process. 

This is a major and exciting opportunity to modernise our Blood Collection Programme and 

develop our staff. It is expected that some modernisation initiatives will require additional 

resource whilst others will release resource and SNBTS will, as far as possible, seek to 

minimise any increase in resource requirements. 

Blood Safety 

The measures shown below are currently being considered by the government Advisory 

Committee on the Safety of Blood Tissues and Organs (SaBTO), dates and impacts are 

best estimates: 

Measure Implement Comments Staff 2013/14 

£2013/14 

100% 

From 

~80% staging point ~ 29wte £2.3m 

apheresis 

2009/10 

achievable in current 

rev 

platelets 

premises. Significant 

£734k 

challenge to reach 100% 

cap 

Manage the 

adverse 

impact of a 

vCJD test on 

donor support 

From 

2010/11 

Counselling “worried well”, 

impact depends on specificity 

of test. Worst case scenario 

shown. 

~ 22wte, 

reducing over 

time 

£550k 

rev 

1.4 FACILITIES FOR THE FUTURE 

The NSS Property Strategy 2008 confirmed there are significant issues with much of the 

SNBTS estate. In general the estate does not meet the ESTATECODE standards and 

does not provide adequate accommodation or facilities for staff. Over time it will cease to 

meet regulatory requirements. In particular there are difficulties with the space, layout and 

plant in the blood Processing and Testing Centres in Edinburgh and Glasgow and the 

Tissue Services premises in Edinburgh. Although these premises are currently licensed, it 

is firmly believed that this position will be severely challenged beyond the next two rounds 

of inspections by the Medicines and Healthcare Products Regulatory Agency (MHRA) and 

Human Tissues Authority (HTA) unless there are firm plans to provide suitable alternative 

accommodation. 

A comprehensive analysis by Pharmaceutical consulting engineers, followed by an option 

appraisal exercise was carried out in Partnership in March 2008. This identified the co- 


location of processing and testing, IT support, engineering, head office, logistics, selected 

R&D and donor administration, Medical care of Donors and the Tissue Services and 

Quality Directorates on a new national SNBTS site at a cost of some £35m, as the 

preferred strategic option. In Nov 2008, NSS Board supported this approach as part of the 

NSS Property Strategy. 

Doing nothing or minimum is not realistic and undertaking major refurbishment of existing 

properties whilst maintaining services is not feasible. Within the period of the plan we 

expect to be mandated to introduce additional blood and tissue safety measures which will 

compound our current accommodation issues and would almost certainly require 

agreement with MHRA and HTA that we had firm plans to relocate our operations to new 

premises within an agreed timescale. Consequently, the workable options are extremely 

limited and moving outside the chosen option or the timescale for its implementation carries 

considerable operational and regulatory risks and would almost certainly lead to a 

requirement to explore contracting out a proportion of our Processing and Testing to NHS 

Blood and Transplant in England and serious adverse comments from MHRA/HTA. 

Other Property Issues 

• Transforming Donation Venues - SNBTS will assess the feasibility of offering donor 

sessions across a wider range of venues including a move from current hospital based 

locations to convenient city centre locations. 

• Release of Space for use by Health Boards - SNBTS/ NSS Facilities are in discussion 

with Health Boards to determine how property that could be vacated by SNBTS might 

be used in future to the benefit of the wider NHS Scotland. 

• Space for Clinical Services - SNBTS will assess the space required to support the 

delivery of effective Clinical Services as described in this plan. 

Blood And Tissue Safety 

The measures shown below are currently being considered by the government Advisory 

Committee on the Safety of Blood Tissues and Organs (SaBTO), dates and impacts are 

best estimates: 

Measure Implement Comments Staff 2013/14 £ 2013/14 

Introduce Prion Filtration 2009/10 Impacts shown are for 100% red cells, but 

of red cells 

may be phased in by patient group 25wte £10.1m 

Implement Pathogen 

reduced platelets 

Late 2009/10 

Will significantly reduce risks of bacterially 

contaminated platelets, support shelf 

life and wastage 

4wte 

£1.8m 

100% apheresis 

platelets 

From 2009/10 

~80% staging point achievable in current 

premises. Significant challenge to reach 

100% 

~ 2.5wte £357k rev 

Introduce vCJD test From 2010/11 estimated costs guestimated at £7 per 

donation – may be much higher ~ 8wte, £3.5m rev 

Further mandatory safety measures such as pathogen reduction of red cells and screening 

for an as yet undiscovered infectious agent are likely and have been factored into planning 

assumptions. 

1.5 SUSTAINABLE TISSUE SERVICES 

Products prepared from bone, tissues and cells are relatively new therapeutic agents and 

are regulated by the HTA. Close collaboration already exists between SNBTS Tissue 

Services and its counterpart in NHS Blood and Transplant (NHSBT) and this approach will 

be promoted to maximise efficiency of service delivery and make optimal use of the 

significant resources and economies of scale in NHSBT. 


Cellular Therapies 

Haemopoietic Stem Cell and Cord Blood - SNBTS has considerable experience in 

processing these specialist cellular products and, once the location of the National Centre 

is known, will consult with interested parties to establish the extent to which central 

processing and storage of these cells would be the most effective and secure working 

option for NHS Scotland. 

Pancreatic Islet Cells – NSS National Services Division has recently funded the 

establishment of a Scottish Islet Cell transplantation programme in SNBTS Tissue 

Services. 

New Cellular Therapy and Regenerative Medicine - SNBTS has been at the forefront in 

supporting the research and development of new cellular therapies including an 

international T cell immunotherapy bank for post-transplant lymphoproliferative disease, 

adult stem cell therapies for heart, musculoskeletal and liver disease and the generation of 

pluripotential embryonic stem cells at cGMP grade. 

The new SNBTS National Centre will partner with the new University of Edinburgh Medical 

Research Council Centre for Regenerative Medicine in helping to position Scotland in the 

vanguard of this highly competitive international field to benefit the health of the people of 

Scotland. 

1.6 SERVICES FOR PATIENTS 

The SNBTS Clinical Directorate provides front line medical care for patients in Scotland 

over a range of specialties including Immunohaematology, Histocompatibility and 

Immunogenetics (H&I), and Clinical Apheresis and Stem Cell services. Over the course of 

the strategy the Directorate will move from predominantly regional working to a nationally 

managed clinical network, thereby providing secure and effective specialist services, 

supporting more efficient working arrangements and simplifying compliance arrangements. 

The modernisation which will require funding of additional posts will also secure on call and 

out of hours rotas. 

The changing position in terms of increasing workload, regulatory compliance, European 

Working time Directive and new standards of practice means that investment is needed to 

ensure the Clinical Directorate functions to the required standards. The strategy addresses 

these shortcomings, proposing an additional 26 staff over the period of the plan. The 

Organ Transplant Taskforce is recommending a 50% increase in solid organ transplants 

over the next five years and the impact of this major expansion has been factored into the 

plan. 

1.7 AN ORGANISATION FIT FOR THE FUTURE 

SNBTS front line services are enhanced by range of absolutely essential support functions. 

Supporting Effective, Efficient and Safe Transfusion Practice 

The Better Blood Transfusion Programme (BBTP) will continue to improve the quality and 

safety of clinical transfusion processes across Scotland as an integral part of the work of 

the Clinical Directorate. 

Ensuring Resilience and Compliance with cGMP and Clinical Standards 

The key regulatory objective is to ensure that all SNBTS operations remain compliant with 

all relevant legislation and accreditation requirements. The Quality Team will be 

reorganised to take account of the new opportunities that will arise when the National 

Centre is opened and will continue to support the rest of NHSScotland and monitor the 

extent of its compliance with the BSQR on behalf of the SGHD. 

Investing in High Impact Science that Benefits Patients 

SNBTS Research and Development Directorate work in support of clinical delivery will 

continue to focus on regenerative medicine and cellular therapy, making use of SNBTS 

skills in GMP and cell/tissue therapy to assess and deliver novel therapies such as islet cell 

transplantation for the treatment of diabetes or cell therapy for the treatment of post- 


transplantation virus infections. SNBTS has recently received funding from the Welcome 

Trust to attempt to develop blood cells in culture, which if successful, would revolutionise 

transfusion practice. 

E-Health and Improving Service Performance 

The SNBTS Strategy is fully aligned with the NSS Corporate IM&T Strategy and will 

facilitate the delivery of a range of e-health initiatives including the provision of safe and 

secure systems in support of efficient blood and tissue management, efficient and effective 

IT tools for the improved management of donors and enhanced Interaction with NSS 

Corporate business systems to support and inform service decisions and benefit patients 

and the wider NHS in Scotland. 

1.8 MANAGING CHANGE IN THE WORKFORCE 

SNBTS has set out an extremely ambitious and challenging agenda and will take every 

opportunity to facilitate its delivery by working in partnership with staff side and with staff, 

using the full range of NSS and NHS Scotland policies, resources and guidance. SNBTS 

will ensure there are effective partnership structures in place with sufficient time and 

resources to ensure all concerned can deliver successful outcomes through the 

development and deployment of a comprehensive Workforce Plan. 

1.9 FINANCIAL SUMMARY 

In line with planning guidance, the table below outlines a breakeven position based on the 

assumption that 2% savings per annum will be deliverable and that SGHD will normally 

fund those new safety measures which may be mandated over the period of the Strategy, 

but could not reasonably be funded within the NSS funding envelope. It is assumed that 

as far as possible, NSS resources will support modernisation and development of the 

Service. 

REVENUE PLAN 2009/10 2010/11 2011/12 2012/13 2013/14 

£000 £000 £000 £000 £000 

EXPENDITURE 

Modernisation/Business as Usual 

Pay 38,578 39,352 40,392 41,968 43,229 

Non-Pay 20,814 19,873 20,668 21,666 22,661 

Capital Charges 4,408 4,408 4,408 4,408 4,408 

Savings Plan (943) (1,984) (3,056) (4,167) (5,318) 

Total NSS Funded 62,857 61,649 62,412 63,876 64,980 

Anticipated Mandatory Safety Measures 

Pay 1,112 3,178 4,287 4,287 4,287 

Non-Pay 3,448 11,956 13,953 13,650 13,650 

Total SGHD Funded 4,560 15,134 18,240 17,937 17,937 

Total Expenditure 67,417 76,783 80,652 81,812 82,917 

INCOME/FUNDING SOURCES 

Baseline incl inflation uplift 54,169 53,618 55,528 57,563 59,664 

Savings Plan (943) (1,984) (3,056) (4,167) (5,318) 


Additional Allocation - NSS 1,642 2,026 1,951 2,490 2,645 

NHS SLA Income 2,618 2,618 2,618 2,618 2,618 

Third Party Income 964 964 964 964 964 

Total NSS Income 62,857 61,649 62,412 63,876 64,980 

Total SGHD Income 4,560 15,134 18,240 17,937 17,937 

Total Income 67,417 76,783 80,652 81,812 82,917 

Surplus/(Deficit) 0 0 0 0 0 

Some £35m capital investment is required towards the end of the plan to deliver the 

proposed new National Centre for SNBTS. Costs for the New National Centre will be 

phased over the life of the construction works and treated as an asset under construction 


until the building is completed and the asset capitalised which is expected towards the end 

of 2012/13. 

Whilst there are interim revenue costs for planned maintenance of the current estate, the 

option appraisal for the new National Centre demonstrates the potential to achieve 

recurring savings in property related revenue costs, estimated at around £0.5m, once the 

site is fully operational. However, as described in the approved NSS Property Strategy 

some of these savings are dependant upon releasing accommodation for use by NHS 

Scotland. 


1. INTRODUCTION 

Operating within the support provided by NHS National Services Scotland (NSS), the 

Scottish National Blood Transfusion Service (SNTBS) plays a fundamental role in the 

delivery of healthcare in Scotland. SNBTS works 24/7/365 to ensure that the donor’s gift 

of blood or tissues is transformed into safe and effective medicinal products, which allow 

NHSScotland to save and improve the lives of tens of thousands of people in Scotland 

every year. SNBTS is a key division of NSS, employing almost 1200 staff and is 

responsible for: 

• recruiting blood and tissue donors and encouraging them to continue to support 

NHSScotland; 

• collecting donations of blood, tissue and cells; 

• manufacturing donations of blood, tissue and cells, within tightly prescribed regulatory 

standards, into medicinal products that are judged safe for use; 

• providing ‘approved’ blood, tissue and cellular products to hospitals where they will be 

prepared for patients; 

• providing direct patient care in a range of clinical specialties (including the selection and 

provision of blood components for specific patients); and 

• supporting the delivery of all of the above key services. 

The SNBTS workforce is extremely professional, conscientious and committed to delivering 

the high level of service NHSScotland and the Scottish public expect. Achieving 

continuous quality improvement and full compliance with regulatory and other standards 

are embedded within its culture. 

In common with other blood services, over the last decade SNBTS has experienced a 

number of major, high impact changes with short, often competing, deadlines. These have 

come in the main from statutory and regulatory imperatives requiring additional tests; 

processes and safety measures and increasing levels of compliance, which generally 

require more advanced equipment, more staff and consequently, more highly specified 

facilities. Many of these constraints apply equally to the provision by SNBTS of bone, 

tissues and cellular products such as stem cells, which are a growing feature of modern 

clinical care. 

Several of these additional safety measures have excluded previously eligible donors, 

making it ever more challenging to collect enough blood and tissues from a shrinking donor 

base. Future tests such as that for the infective agent of vCJD are thought to have the 

potential to deter donors from giving blood for fear that they may test positive. 

In response to these changes and anticipating more in the future, SNBTS has formulated a 

strategy. This is designed to consolidate recent developments, modernise our service and 

future proof the organisation, whilst still allowing flexibility to enable it to contribute to the 

challenges that the NHS will face over the next ten to twenty years. The SNBTS Strategy 

has been developed from the paper – ‘The Strategic Direction of SNBTS 2007-2011’ - 

which was endorsed by the NSS Board in July 2007. It has also been the subject of wide 

consultation and the responses to that consultation exercise have been incorporated into 

this document and rolled out to staff in a series of road shows across Scotland and a 

response document has been issued to all stakeholders. 


In this Strategic Development Plan, we outline the steps that SNBTS will undertake to 

modernise and strategically position the Service to accommodate anticipated and likely 

blood safety measures in the near and medium term, for example: 

• Ensuring that there is enough blood for patients by rebuilding the donor base, 

improving accessibility, choice and efficiency for donors; 

• Providing a structured approach to the expected implementation of anticipated and 

future blood safety measures; 

• Consolidating our operations into a new National Centre to allow the introduction of 

lean pharmaceutical-like blood and tissue processing and testing (P&T) that will 

ensure that we can meet the regulatory standards for the future; 

• Delivering new cellular therapies as well as our existing tissue services by improving 

the resilience of the referral, retrieval and processing systems for bone, tissues and 

cells to enable the introduction of emerging regenerative medicine, one of the most 

important medical developments of the 21 st century; 

• Ensuring that our clinical services can deliver both locally and nationally by 

providing services in line with ‘Better Health Better Care’ (BHBC), making certain 

that patients benefit from the best possible delivery of transfusion medicine; and 

• Ensuring that every aspect of support is focussed in delivering the modernisation 

and safety agenda by continuing to invest in our Quality Management System and 

Better Blood Transfusion Programme. 

All of this will take place within the context of enabling our workforce to develop and deliver 

this ambitious agenda. 

This Strategic Development Plan translates the strategic aims into operational terms. A 

project-based approach is being taken to manage the implementation of the SNBTS 

Strategy, the scope of which covers the entire Service. In this way, each of the 

developments is brought together in a single high-level plan. 


2. BACKGROUND 

2.1 CONTEXT 

Government 

The Scottish Government has set out its single overarching purpose – to focus Government 

and public services on creating a more successful country, with opportunities for all of 

Scotland’s population to flourish through increasing sustainable and economic growth. 

The five strategic objectives that support this purpose aim to create a Scotland that is: 

• Wealthier and fairer – enabling businesses and people to increase their wealth and 

more people to share fairly in that wealth; 

• Smarter – expanding opportunities for the people of Scotland to succeed from nurture 

through to lifelong learning, ensuring higher and more widely shared achievements; 

• Healthier – helping people to sustain and improve their health, especially in 

disadvantaged communities, ensuring better, local and faster access to health care; 

• Safer and stronger – helping local communities to flourish, becoming stronger, safer 

places to live, offering improved opportunities and a better quality of life; and 

• Greener – improving Scotland’s natural and built environment and the sustainable use 

and enjoyment of it. 

NHSScotland, as a major employer as well as a provider of services, will have a major part 

to play in achieving each of these five objectives. 

A range of performance management systems, including the NHSScotland Health 

improvement, Efficiency, Access and Treatment (HEAT) targets, ensure that services and 

activities are aligned with the objectives. 

Better Health Better Care (BHBC) 

The Scottish Government Health Directorate (SGHD) ‘Better Health, Better Care Action 

Plan’ reflects a nationwide discussion around the actions that need to be taken to move 

towards creating a “Healthier Scotland”. There are three main components to the Action 

Plan: 

• health improvement; 

• tackling health inequality; and 

• improving the quality of health care. 

A key focus of the approach set out in the Action Plan is moving towards a mutual 

NHSScotland in which the people of Scotland and the staff of the health service are 

partners, or co-owners, and have real involvement in determining how NHSScotland will 

improve health and health care. 


Delivery of BHBC depends to a large extent on the NHSScotland workforce. Uniquely, 

Scotland has in place staff governance legislation that allows priority to be given to the 

workforce role alongside the two complementary streams of clinical and financial 

governance. NHSScotland is also renowned for its strong partnership working with 

Government, employers and trade unions. Together, these two factors provide a robust 

foundation upon which to build the workforce and deliver better outcomes for the people of 

Scotland. 

Building on ’Delivering for Health’, the ‘BHBC Discussion Document (2007)’ further 

underscores the strategic trends in health care: towards care of long term conditions; 

greater emphasis on prevention; the patient as partner with increased responsibilities for 

self care; carers as partners; and high technology. The follow on ‘BHBC Action Plan’ is 

configured around three major themes: 

• Public ownership and mutuality – representing a further move from market based 

approach; greater emphasis on rights and responsibilities of ‘patients’ and on the role of 

staff as partners; 

• Improving health and tackling health inequalities – focus on children and families, 

substance misuse, obesity, sexual health; and 

• Ensuring better, local and faster access to health care - improving quality, patientcentred 

service, patient safety, effectiveness (especially in relation to long term 

conditions), efficiency (including environmentally sustainable), equity and timeliness. 

HEAT targets are being realigned, both to reflect the changed emphasis and to add rigour 

to the performance management arrangements (by integrating the various strands of 

planning, while attempting to reduce duplication and reporting requirements). 

BHBC ‘A Force for Change (January 2009)’, highlights the importance of workforce 

planning being integrated into service planning and redesign. 

Strategic Implications for NSS Services 

For all NSS services, the need to focus on stakeholders and their changing requirements is 

paramount, as is the gathering momentum for re-designed, patient-centred services, which 

have been benchmarked to ensure they are efficient and offer value for money. Aligned 

with this is the requirement to deliver the highest clinical and staff governance standards. 

For the NSS Health Support portfolio, adjustments will be made to meet the range of 

specific ‘BHBC Action Plan’ clinical priorities – rigorous clinical governance to protect 

patients’ safety and meeting the 18-week referral to treatment for example, and changed 

focus for information services. Increased emphasis on prevention suggests enhanced roles 

for disease prevention and Hospital Acquired Infection (HAI) reduction/protection services. 

For the Business Support portfolio, the automation of many routine operations is likely to 

lead to ‘leaner’ services: payments to practitioners, patient registration, and the routine 

acquisition and distribution of health care information, for example. 

Equally the efficiency and joined up working imperatives offer opportunities for NSS, 

notably in providing NHSScotland with the increasingly complex national systems and data 

warehouses it needs, and in the continued drive for cost effective procurement of goods 

and services. This Strategy for SNBTS is fully aligned with these principles. 


The NSS 5-Year Strategy – 2008-2012 

Reflecting the research about our operating environment, the 5-year NSS Corporate 

Strategy, running from April 2008 to March 2013, includes contributions from staff across all 

divisions and has been developed in Partnership. 

The Strategy sets out: 

• what we are planning to deliver over the coming years; 

• how we are proposing to address the challenges of the ‘BHBC Action Plan’; and 

• how we are developing ourselves to become a high performing and valued partner in 

NHSScotland. 

2.2. OPERATING ENVIRONMENT 

SNBTS is charged by Government to be the supplier of blood and tissue for NHSScotland. 

This means it must ensure that supplies are sufficient to meet demand in compliance with 

relevant regulatory and statutory requirements. 

Regulation and compliance in healthcare continues to develop both in terms of stringency 

and increased frequency of change. The introduction of the EU Blood Directive (transposed 

into UK Law as the Blood Safety and Quality Regulations, 2005 (BSQR)) resulted in a 

phased shift in the extent and stringency of achieving regulatory compliance and our 

Tissue Services activity has experienced a similar situation arising from the Human Tissues 

Act (HTA). 

These developments have meant that the standard of premises in which blood and tissue 

manufacturing take place, and the quality systems and resources required to support this 

activity and maintain licences, have significantly increased. Furthermore, the emergence of 

new infectious agents that can be transmitted by blood or tissues and of new technologies 

that improve blood and tissue safety, leads to the need to introduce new tests and 

technology to keep the blood and tissue supply safe by current standards. Not surprisingly, 

this continually drives up the costs of blood, tissues and related services whilst driving 

down operational flexibility. The SNBTS Strategy takes account of these ongoing 

developments and will deliver a renewed, modernised and future proofed Service. 

Prior to these major regulatory changes, accommodation used by SNBTS for the 

manufacture of blood and tissue products evolved around procedures developed in our 

laboratories over many years. These arrangements will become unacceptable and it has 

become abundantly clear that blood and tissue products need to be manufactured in 

premises that meet the standards expected in the pharmaceutical industry. This will 

include a move from general laboratory manufacturing towards manufacturing carried out in 

‘clean rooms’. 

A consequence of many of these changes is the adverse impact on the donor base (for 

blood and tissues). The requirements to enable donors to donate have become more 

stringent leading to a reduction in donors and a resulting drop in donations. All of this is 

occurring at a time when it is proving challenging to maintain a suitably robust donor base 

for the continued supply of blood for patients that require transfusion. Additionally, the 

demand profile for blood and blood components is changing and future demand 

requirements are difficult to predict accurately. 


The changing demographics within Scotland will have an impact on the services that 

SNBTS will provide. Scotland’s ageing population is key to the need for a change in the 

way healthcare is delivered. Longer term, initial indications show that the demand for blood 

usage will increase, though increased efficiencies will stem this in the short-term to medium 

term. These changes will be key in managing the future blood collection programme to 

process and test blood and blood components to meet future demand. 

Health provision has changed a great deal and will continue to change within the timescale 

of this Strategy. 

SNBTS recognises its duty to ensure that it values equality and diversity to ensure equal 

opportunities for both donors and staff. SNBTS continues to review access arrangements 

for donors and will continue to monitor services to ensure that they do not directly or 

indirectly discriminate against staff or donors. All of these developments have an impact on 

SNBTS’s provision of services and products informing the ways in which the Service must 

continue to develop and embrace change to meet the transfusion needs of patients in 

Scotland. 

2.3. KEY DRIVERS FOR CHANGE 

There are a number of key drivers which impact on the whole Strategy and these are set 

out below. 

2.3.1 Keeping Blood and Tissues Safe 

Whilst blood transfusion and tissue transplantation are safe compared with most other 

medical interventions, they are not, and cannot be, zero risk. Nevertheless, the Scottish 

Government, NSS and SNBTS have a responsibility to ensure the blood and tissue supply 

is as safe as possible and to this end, SGHD and SNBTS actively contribute to a number of 

UK surveillance and policy setting committees which evaluate new safety interventions and 

determine whether their introduction should be recommended to Ministers. The processes 

also extend to regular review of existing safety measures to determine whether there is 

scope for improvement/modernisation. 

The amount of testing and processing that blood has undergone has increased dramatically 

over the years either as a result of emerging clinical and scientific knowledge about 

transfusion medicine, or as a result of coping with emerging transfusion transmissible 

threats to the blood and tissue supply. 

From the 1940s, blood was screened for syphilis and various blood group factors. From 

1971 a screening test for Hepatitis B was introduced and this was followed by testing for 

HIV in 1985. 

Later, as Hepatitis C was discovered, tests were introduced from September 1991 and a 

test for the Human T Lymphotrophic Virus (HTLV) was introduced in 2002. These tests, 

along with others, have become more sensitive and accurate ensuring that by all clinical 

standards blood is very safe, but is not, and cannot be, zero risk. 

The emergence of variant vCJD in the UK population as a result of eating contaminated 

beef has been a huge challenge, as this deadly and unusual disease has proven difficult to 

detect and apply countermeasures that we can be absolutely confident about. Nevertheless, 

we have introduced a whole range of measures including, leucodepletion of all blood 

components (except granulocytes), banning the use of UK plasma for fractionation, 


importing some blood components for vulnerable groups of patients and deferring 

previously transfused donors. 

So far, the number of transmissions of vCJD with blood and tissues has been very low 

despite the Spongiform Encephalopathy Advisory Committee still estimating that 1:4000 of 

the population could be “carriers”. However, based on the precautionary principle, we 

expect to be instructed to deploy further vCJD countermeasures over the next few years as 

they become demonstrably effective and available for routine use. 

2.3.1.1 Mandatory Safety Measures 

Over the past decade, reducing the threat of transmitting vCJD with blood and tissues has 

dominated UK Blood and Tissues Policy and this is expected to continue into the future. 

The UK Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) provides 

expert advice on these matters to Government - several experts from Scotland have been 

appointed to this committee. In Scotland, the Cabinet Secretary for Health and Wellbeing 

considers the advice from SaBTO and if it is determined that action should be taken, would 

instruct SNBTS to proceed to implementation within a defined timeframe. Such instructions 

are considered mandatory and those safety measures that could not reasonably be funded 

within the NSS funding envelope would normally be funded directly by the Scottish 

Government. 

Ultimately, having given due consideration to a potential safety measure, SaBTO might 

determine that it offers no significant benefit in health economics or public health terms, in 

which case it would not progress to implementation. Similarly, Government may decide that 

on balance, a measure recommended by SaBTO should not be implemented or should be 

implemented at a later date or in a more restricted way than anticipated by SNBTS. Clearly, 

in these circumstances, SNBTS would not proceed further with the initiative, which would be 

deferred from our planning processes or would adjust the implementation date/plan as 

required. 

Since such mandated measures generally represent major change, it is essential that 

planning for potential implementation begins as soon as possible to inform decision-making 

and prepare for timely implementation. This means that in its normal planning processes, 

SNBTS will identify those potential mandatory safety measures, which are currently under 

active consideration and which need to be flagged up to allow appropriate budgetary and 

operational planning. It is timely planning and a strong science base that has allowed 

SNBTS to deploy safety measures in the past and it is SNBTS strategy to continue with this 

preparedness.. 

These new measures include those which have been fully developed and are undergoing 

final trials, those which are in advanced stages of development of testing and those which 

are very early in development, but which show great promise. In formulating this Strategy, 

SNBTS has used its judgement to anticipate when these measures might be implemented 

and what their impact will be in terms of new resources. For blood and tissue safety 

measures which are currently under active consideration, implementation plans, costs and 

dates shown are best estimates, which will be further refined as implementation is 

instructed. Other safety measures may arise during the course of this Strategy and these 

will be dealt with on a case-by-case basis. 

SNBTS does not rely solely on its own expertise but draws heavily on the advice of the UK 

Joint Professional Advisory Committee (JPAC), which is funded and managed by all four 

UK Blood Services acting in concert though the UK Blood Transfusion Services Forum, a 

body which co-ordinates UK wide inter service activity. SNBTS and the other UK blood 

services also participate in the European Blood Alliance, which has been an effective 


means of representing the common interests of all the member European Blood Services to 

the EU regulators. 

The anticipated impact of these mandatory measures on our strategic themes has been 

incorporated in Section 3, in tabular form and pale blue shading has been used throughout 

to indicate that if the cannot reasonably be funded from within the NSS allocation, they are 

likely to require funding by SGHD and distinguishes them from service improvement and 

modernisation initiatives (see 2. 3.1.2 below) which are shaded green. 

2.3.1.2 Service Improvement and Modernisation 

SNBTS regularly reviews the performance of its operations including, blood safety 

measures, to identify whether systems need to be updated to improve performance, 

efficiency or quality. Such modernisation initiatives are generally funded through the normal 

resource allocation process operated by NSS, informed by SNBTS, and a number of these 

are included within the strategic themes described in Section 3 – as mentioned above, 

tabulated detail is shown with green shading to clarify that the anticipated funding source 

would generally be NSS/ SNBTS. Those safety initiatives, which cannot be funded through 

the normal allocation process, are generally funded by SGHD increasing the allocation of 

resources to NSS for use by SNBTS. All of the recent vCJD precautionary measures have 

been funded in this way. 

Whilst SNBTS will continue to focus on the delivery of quality and safety initiatives 

throughout the implementation of the Strategy, modernising our operations is a key driver 

as this will not only set SNBTS up to deliver future challenges, it will enable us to do so in a 

much more efficient way, for example: 

• Making best use of donors' time through the redesign and use of more efficient 

processes is critical to rebuilding and sustaining Scotland’s donor base and blood 

supply in the longer term. 

• We will make use of technology to deliver the concept of ‘intelligent blood component 

inventory’ and improved blood stock management both within SNBTS and Scottish 

hospitals, making the most efficient use of the donors’ gift. 

• By consolidating and re-designing manufacturing and related activities in a single 

national site, we will ensure that our facilities meet regulatory standards required by 

the MHRA and HTA for processing and testing blood and tissues now and into the 

future. We will also deliver significant efficiencies in the use of our resources – staff, 

facilities and equipment and will be able to make use of opportunities for the exploitation of 

synergies and development of staff. 

• Significant future expenditure will be avoided by more efficient implementation of 

safety initiatives on a single site as opposed to the two sites we currently operate from. 

• Consolidating specialist clinical services (see section 3.4 Services for Patients) is key 

to maintaining service delivery and will lead to more resilient service provision and 

more efficient ways of working. It will also deliver more appropriate working 

arrangements for staff. 

• We will also explore opportunities for exploiting operational, quality and other support 

system synergies between blood component processing and the Tissue Services and 

Quality Directorates. 


2.3.1.3 Increasing Quality and Regulatory Standards 

SNBTS products and services must be compliant with regulatory and accreditation 

standards that are continually increasing in scope and stringency e.g. the Blood Safety and 

Quality Regulations (BSQR), which are the subject of criminal law. Our Strategy is 

designed to ensure that our premises and systems of work, which are regularly inspected 

by the MHRA and HTA, are carefully reviewed and modernised to facilitate compliance into 

the future. Achieving these outcomes is extremely challenging and will require further 

investment in resources such as staff, processes, equipment and premises. This is 

particularly relevant to our facilities for the processing and testing of blood and tissues but it 

is also relevant to the modernisation of our blood collection programme, clinical services, 

indeed our entire organisation. 

2.3.2 ‘Better Health Better Care’ 

SNBTS delivers direct clinical care for patients, promoting safe transfusion practice via the 

Better Blood Transfusion Programme (BBTP) and provides specialist testing in related 

fields such as transplantation, and collaborates in the development of new tissue and cell 

therapies. 

The changing demographics in Scotland are driving increasing demand for healthcare. The 

population is getting older, certain parts of the country have persistent health inequalities 

and the paradigm of disease is shifting towards chronic and more complex conditions. 

These changes are driving both the long-term increase in workload in the blood sector and 

our work in the development of new therapeutics for degenerative disease. SNBTS is much 

more than a provider of blood and tissue products and has a strong clinical interface in 

hospital blood banking, screening, testing and directly treating patients. 

The ever-developing areas of clinical application and increasing complexity of healthcare in 

this field means that in the future, the regional structure of our services for patients will not 

be sustainable. We need nationally managed specialisation delivered locally. All of this is 

aligned with delivery of BHBC and is the direction we have set out in our Strategic Plan. 

Specifically and in support of the ‘BHBC National Improvement Programmes for Patient 

Safety, treatment experience and service delivery’, SNBTS will ensure that all aspects of 

the Strategy will be based on delivering the six dimensions of quality as defined by the 

Institute of Medicine – safe, timely, patient centred, equitable, effective and efficient. 

2.3.3 Sustainability 

Analysis of the SNBTS workforce shows there are a large number of staff with very long 

service that will be reaching the end of their career around the time the National Centre will 

be available for occupancy. Many of these staff are in management positions. This 

represents a major risk to the organisation. However the consolidation onto a national site 

presents an opportunity to rationalise and improve management and staffing arrangements 

to ensure ongoing viability. 

It is essential that we make best use of this considerable experience and expertise to assist 

with the transition to our National Centre whilst developing staff to guarantee there is 

adequate succession planning to support service delivery in the future. 


3. SNBTS STRATEGIC THEMES 

Throughout the consultation, response and planning processes we have been using a set 

of themes to describe the SNBTS Strategy. These are: 

• Enough Blood for Patients. 

• Facilities for the Future. 

• Services for Patients. 

• Sustainable Tissue Services. 

• Organisation Fit for the Future. 

The structure and process for creating, managing and implementing the plans which 

emerge from the SNBTS Strategy has trade union representation at all levels, which will 

strengthen our Partnership working. In preparing for and implementing the workforce 

changes, we will ensure that within our Strategy objectives there will be ample opportunity 

to enhance leadership capability and develop our staff. 

The remainder of this Strategic Development Plan deals with each of the strategic themes, 

giving the proposed changes, their benefits, key assumptions and conditions which require 

to be met to ensure success. Timescales, the impact on staffing levels, and potential costs 

or savings are also set out at a high level to be refined later through the NSS business 

case process. Clearly, it will not be possible to define all such impacts and where further 

work is required this will be scheduled into the plan. 

3.1 ENOUGH BLOOD FOR PATIENTS 

3.1.1 Introduction 

3.1.1.1 Operating environment 

The considerable challenges that SNBTS faces in terms of maintaining a safe and sufficient 

blood supply now and into the future have already been described. 

To achieve this we need a strategy that anticipates future challenges, designs effective 

solutions to address them and ensures successful and timely implementation. Our ability to 

achieve this objective will be greatly influenced by clinical demand trends, regulatory 

changes and mandated risk reduction measures. 

Achieving a successful outcome for these difficult challenges will require co-operation 

across the whole blood supply chain in Scotland in a manner that provides added value to 

the NHS. This theme will be led by the SNBTS Supply Chain Directorate, but will require 

the formation of effective partnerships with the SNBTS Clinical Directorate, Better Blood 

Transfusion Team and the wider NHSScotland. 

Sections 4 and 5 show high-level workforce and financial plans in support of this Strategy. 

However, where there are elements of the Strategy which have reached pilot or planning 

stage and are judged to have a significant impact, more details have been provided in 

tabular form to ensure there is clarity of intent. 


3.1.1.2 Future Challenges 

SNBTS developed a new staffing model in 2003 following a review of donor services. 

These changes, together with more effective targeting of particular blood groups (Group O 

or A), resulted in considerable gains in efficiency and productivity. This was clearly 

demonstrated by the results of the UK benchmarking exercises which indicated that SNBTS 

blood collection had the highest level of productivity at that time when compared to the 

other four UK and Irish services, despite more difficult logistics. The gold standard 

benchmark is the number of useable donations per funded Whole Time Equivalent (WTE), 

which measures the effect of donor deferral rates and loss rates on productivity. The 

figures for 2007 for both the UK and European Blood Alliance benchmarking demonstrate 

that other services are now achieving greater productivity than SNBTS. Multiple factors 

contribute to this, which include higher deferral rates for donors and an overall reduction in 

the number of people coming forward to donate. This trend underlines the need to 

streamline and modernise blood collection processes to improve efficiency, ensure cost 

effectiveness and improve donor satisfaction. 

3.1.2 Keeping Blood Safe 

3.1.2.1 Safety Measures Under Evaluation by SaBTO 

Currently, there are a number of blood safety measures that are under evaluation by 

SaBTO. For planning purposes we have assumed that these will be mandated and 

implemented within the timescales described in the document - it should be understood that 

these may, or may not, move forward to implementation. Many of these issues relate to 

vCJD precautionary measures. Others may arise during the course of the Strategy and 

these will be dealt with on a case-by-case basis. 

(a) 100% Apheresis Platelets 

A Department of Health risk assessment indicates that provision of platelets by apheresis 

represents a significant measure to reduce the risk of transmission of vCJD by transfusion, 

by reducing the number of donors that recipients of platelet transfusion are exposed to. It 

is anticipated that the UK Blood Services may be instructed to increase the provision of 

apheresis platelets, initially to 80%, progressing to 100%. 

For planning purposes, it is anticipated that this instruction will be received during 2009 and 

this represents a significant challenge, which will require significant additional resource and 

may take two to three years to complete. 

With our current technology, apheresis platelets can only be reliably collected in our static 

sites, although trials with community based apheresis are underway. SNBTS believe that if 

sufficient additional resource is made available, the target of 80% can be achieved within 

18 months within existing premises. Achieving the 100% target will need collaboration 

between SNBTS and hospitals to improve the usage of platelets (thereby reducing demand 

and the size of the 100% target) and/or the deployment of some additional blood collection 

strategy outwith our existing premises and may take two to three years. 


Proposed source of Funding: SGHD 

TABLE SHOWS IN YEAR MOVEMENT 

Implement mandatory safety measures as 

required by Government (currently under 

consideration) 

2009/10 2010/11 2011/12 2012/13 2013/14 

Implementing 100% Apheresis 

Platelets 

• Increase the % of apheresis 

platelets issued to 100% via a 

staging post of 80%. 

Estimate prepared Jan 2009. 

Additional Staff and Goods and 

services. 

Assumes new or expanded 

collection footprint in 2011/12. 

100% 

apheresis 

platelets 

Staff 

Impact 

Roll out 

100% 

apheresis 

platelet plan / 

keep under 

review 

+ 12.75 WTE 

apheresis 

+1.5 WTE 

management 

£ Impact £813k Rev 

£423k Cap 

Roll out 

100% 

apheresis 

platelet plan/ 

keep under 

review ~80% 

+ 4.25 WTE 

apheresis 

+ 0.25 WTE 

management 

£418k Rev 

£0 Cap 

Roll out 100% 

apheresis 

platelet plan / 

keep under 

review ~100% 

+ 9.4 WTE 

apheresis 

£1017k Rev 

£311k Cap 

Maintain 

donor 

recruitment, 

monitor and 

review 

requirements 

Monitor and 

review 

requirements 

£0 Rev 

£0 Cap 

Maintain 

donor 

recruitment, 

monitor and 

review 

requirements 

Monitor and 

review 

requirements 

£100k Rev 

£0 Cap 

(b) vCJD Screening Test 

SNBTS is currently deploying an integrated marketing and publicity campaign to halt the 

decline in the donor base and rebuild it to a level that will allow us to cope with the 

expected loss due to the introduction of a screening test for vCJD. In preparing for such an 

eventuality, preliminary plans have been developed for the worst-case scenario to provide 

additional staff to counsel and support concerned donors at blood collection sessions. This 

has been factored into our plans for 2010/11. 

However, information is emerging that a test may be available during 2010, which may 

have less impact on the donating public than our current planning scenario. Whilst this 

would be good news and may significantly reduce the number of additional staff required, 

the situation will be kept under continual review and plans will be revised as firmer 

information becomes available. 



Implement mandatory safety measures as required 

by Government (currently under consideration) 

2009/10 2010/11 2011/12 2012/13 2013/14 

Managing the Consequences of a 

vCJD Test 

• Maintain enough blood for 

patients against an instruction 

from Government to implement a 

vCJD donation screening test. 

vCJD test may be available earlier than 

predicted. 

Appropriate Publicity materials 

prepared. 

Costs for Donor Services and Medical 

only shown here, mainly required to 

provide counselling support for 

concerned donors. Staff not 

permanent worst case scenario shown. 

In 2009/10 Publicity/ Appeal to ensure 

sufficiency of the blood supply in the 

face of vCJD test implementation. 

Initiative 

Staff Impact 

£ Impact 

Business as 

usual 

Business as 

usual 

Business as 

usual 

Ensure 

sufficiency 

of the blood 

supply 

+ 20 WTE 

Donor 

Services 

+ 2 MOs 

Review 

performance 

and S&D 

Action as 

required 

Staffing 

needs 

should 

reduce 

£550k £550k 

Business as 

usual 

Lookback 

MOs 

Significantly 

less say 

£250k 

Business as 

usual 

Business as 

usual 

Business as 

usual 


c) Other Blood Safety Measures 

With regard to further vCJD precautions, we know that SaBTO are considering whether it 

would be prudent to reduce donor exposures for patients who are dependant on repeated 

red cell transfusions by providing them with double dose red cells (two donations collected 

in series from a single donor) using apheresis technology. 

This would clearly require careful planning by donor services and would involve coordination 

across all steps in the blood transfusion chain from donor to recipient - 

implementation has not yet been factored into the plan. 

SNBTS is aware that there are other potential safety measures under consideration or that 

will come forward in the future, which will impact on ensuring there is “Enough Blood for 

Patients” and we will determine how these can be most effectively implemented on a case 

by case basis. 

3.1.2.2 Service Modernisation/ Improvements 

SNBTS will regularly review service performance and delivery to identify opportunities for 

modernisation and improvement. Wherever possible and practicable, such change will 

take place within existing SNBTS (or NSS) funds or will avoid the deployment of significant 

additional expenditure. The tables provide details of those activities for which pilots have 

already been planned/funding bids submitted. Clearly, this will extend to other initiatives 

over time. 

Improved Management of Donor Deferrals 

Currently SNBTS defer approximately 18% of all donors who attend to give blood. This 

figure has risen significantly since the implementation of the UK BSQR in Nov 2005. Within 

this timeframe, the number of donors permanently deferred has increased by 50%. It is 

well recognised that deferral adversely affects donor loyalty and retention and is directly 

linked to declining donor numbers. Additionally, increased deferral rates adversely affect 

collection productivity and efficiency. It is therefore clear that we need to ensure that we 

minimise both the number of donors deferred and the impact on those donors who are 

deferred. Some of the initiatives being considered include: 

• SNBTS is committed to the systematic review of donor selection criteria at 

UK/European level to ensure that deferral criteria are accurate and protect the 

safety of both donor and patient whilst minimising the deferral of donors e.g. recent 

changes to high blood pressure, diabetes and upper age limit criteria. 

• SNBTS will develop systems to improve the accuracy and objectivity of donor 

selection e.g. by using Haemocue for haemoglobin screening and browser 

technology for the selection guidelines. 

• SNBTS will design on-session strategies to improve the deferral process to promote 

return e.g. deferral information card. 

• Following the implementation of e-Progesa (SNBTS blood management computer 

system), SNBTS will develop a direct marketing approach for contacting donors at 

the end of the deferral period to promote return. 


3.1.3 Reversing the Decline in Donors 

In the last decade, SNBTS has experienced a dramatic decline of almost 30,000 in the 

number of active blood donors in Scotland. It is essential that we reverse this decline if we 

are to secure enough blood for patients. 

3.1.3.1 Rebuild the Active Donor Base and Build in Resilience 

In December 2007, with donor base levels at an all time low and projecting downwards, the 

NSS Board approved an SNBTS proposal to use a £2.32m integrated publicity and 

marketing campaign to halt the decline in the active donor base and rebuild it to a level that 

would provide sufficient resilience to cope with the potential loss of up to 10% of donors 

when a vCJD screening test was introduced (possibly in 2010/11). 

As of January 2009, excellent progress has been made. The decline has been halted and 

the rebuild is underway with the donor base reaching its highest level since 2005. This 

work will continue to deliver the required level of resilience in the active donor base by 

March 2010. 

Throughout, a key objective is to avoid activating the integrated plan for managing blood 

shortages, which might result in the cancellation of planned surgery because of insufficient 

blood. 

3.1.3.2 Reaching out to New Donors 

SNBTS will deploy a range of measures that are designed to reach out to new donors and 

retain them as active donors once recruited. These measures include: 

• Deployment of new strategies in our integrated publicity and marketing plan (including 

new media); 

• Strategies to improve donor retention; and 

• Sample only donation for those new donors deferred for non high-risk reasons to make 

them feel part of the donor community and significantly increase their retention. 

Proposed source of Funding: Funded 2008/08 by NSS 


Reaching out to New Donors presently being 

implemented 

2009/10 2010/11 2011/12 2012/13 2013/14 

Sample Only Donation 

• Blood samples will be taken and 

tested for new donors deferred for 

low risk reasons. This will increase 

the retention of these donors by an 

estimated 10,000 per annum. 

Recruit new 

donors 

Staff Impact 

+ 10 WTE 

in 2008/09 

baseline 

Review perf 

Business 

as usual 

Business 

as usual 

Business 

as usual 

£ Impact 

£220k 

Funded 

2008/09 

Review perf 

Business 

as usual 

Business 

as usual 

Business 

as usual 


3.1.3.3 Communication with Donors 

SNBTS will deploy a range of measures that are designed to modernise and improve the 

effectiveness of communication with donors to ensure that once recruited we retain them 

as active donors. These measures include: 

• The procurement and use of customer relationship management software; 

• Further development of the SNBTS website and improving accessibility tools for deaf 

donors, allowing on line appointment booking, etc.; 

• Allowing donors to complete their donor session record (DSR) at home – which will 

provide increased confidentiality and reduce queuing at sessions; 

• Exploring the on line completion of the health check form; and 

• Using a range of new media tools to interact more effectively with younger and potential 

donors. 

Certain aspects of our communications plan will be heavily dependent upon the renewal of 

our IT infrastructure and the replacement of our core blood systems software which will 

allow the deployment of new customer relationship management software, hugely improving 

our ability to communicate with the 250,000 donors on our database. 

Proposed source of Funding: NSS 


Communication with Donors 2009/10 2010/11 2011/12 2012/13 2013/14 

Home DSR 

• During 2009/10, SNBTS will be 

piloting sending donors their DSR to 

complete at home, thereby improving 

confidentiality and reducing waiting 

times at sessions. If successful will 

be rolled out 2010/11. 

Home DSR 

Staff Impact 

1 year Pilot 

Nil 

Business 

Case 

Business 

Case 

+1 WTE 

Implement 

as 

approved 

Implement 

as 

approved 

Business 

as usual 

Business 

as usual 

Business 

as usual 

Business 

as usual 

£ Impact 

Bid 

Submitted 

2009/10 

£16k 

Business 

Case 

+£134k 

Implement 

as 

approved 

Business 

as usual 

Business 

as usual 

3.1.3.4 Transforming Donor Venues 

SNBTS recognises the need to critically review the current collection infrastructure to 

improve access and opportunity to donate by reviewing where and when we provide 

donation opportunities. We anticipate that increasing workplace and fixed site collections 

will change the shape of the collection programme and would expect this change to bring 

improvements for staff whilst reducing moving and handling and associated Health and 

Safety Issues. During 2009 we will analyse our current footprint, identify opportunities to 

change and model the impact of these. Simultaneously we will research donor and 

company requirements and the current levels of satisfaction in each sector. Specific 

consideration will be given to: 


• Fixed sites - we will option appraise relocation from current hospital based sites and 

whether we should increase the number of fixed or semi permanent sites, we are 

currently in dialogue with several of our host Health Boards; 

• Community Collection, Workplace - during 2009, SNBTS plans to pilot the 

introduction of additional corporate sector collections in the North East with a view to 

assessing the feasibility of increasing corporate collections from 18% to 30%; and 

• Community Collection, Remote and Rural - during 2009 we will review the logistics, 

costs and potential benefits to the donor base and blood supply in accessing more 

remote communities and islands (Orkney pilot planned 2009). 

Proposed source of Funding: NSS 


Transforming our Donor Venues 2009/10 2010/11 2011/12 2012/13 2013/14 

Community Collection: Workplace 

• Plan to increase workplace 

sessions from 18 to 30% of the 

total. 

• 3.42 Wte (£123k) bid for funding in Dec 

2008 to allow pilot to proceed during 

2009/10. 

Increase 

Workplace 

sessions 

Staff Impact 

1 year Pilot 

planned 

+3.42 Wte 

bid 

submitted 

Business 

Case 

Business 

Case 

Prob+9.5 

WTE 

Implement 

as 

approved 

Implement 

as 

approved 

Business 

as usual 

Business 

as usual 

Business 

as usual 

Business 

as usual 

£ Impact £123k NR 

Bid 2009/10 

Business 

Case 

Implement 

as 

approved 

Business 

as usual 

Business 

as usual 

3.1.3.5 Transforming the Donation Experience 

During 2009/10 we will critically review every interaction we have with blood donors ‘on 

session’ to design a care strategy that meets their individual needs, developing systems 

that will transform the donation experience. Factors to be considered include: 

• Appointments - excellent feedback has been received when deployed in the corporate 

sector and we now have an agreed system which has reduced waiting times and 

complaints from the busiest venues; 

• Streamlining the donation process – redesign the blood collection process; review 

staffing structure, skill mix and model; and consider the opportunity for advances in 

technology to support this; and 

• Multi Component Collection - implement ‘intelligent’ inventory control to maximise the 

potential of the donor base. 

3.1.4 Impact on Staff and Resources 

The ‘Enough Blood for Patients’ strategic theme has identified a wide range of activities that 

include mandated blood safety measures, continuing regulatory compliance issues, 

improving customer satisfaction and a major modernisation of the Service. 


For mandated safety measures (and those which we believe may be mandated in the 

foreseeable future) we have detailed resource plans and can clearly show their impact in 

terms of additional staff and other resources. 

The NSS Board has previously acknowledged that redesigning the blood collection 

programme requires careful development of options and extensive piloting to demonstrate 

their effectiveness, efficiency and sustainability. A number of these modernisation/ 

improvement initiatives have been implemented within the existing funding allocation; some 

are being piloted whilst bids have been submitted for non-recurring funds to allow us to pilot 

others. 

This is a major piece of work which, in terms of transforming the donor experience, will help 

us determine which options have greatest impact, are most cost efficient and have greatest 

ease of implementation. However, until the results of pilots have been analysed we will not 

be in a position to clearly identify the impact on staff or funding. 

A number of the options for modernisation and redesign will release resources and 

depending on the options selected, could release up to 25 WTE from the current 

establishment of 311. 

However, the need to redesign the collection programme to increase opportunity and 

accessibility will require additional resources. It is therefore anticipated that, as far as 

possible, the options for service redesign and modernisation will minimise the effect of 

change on the size of the blood collection establishment. More detailed consideration is 

given in Managing Change in the Workforce, Section 4. 


3.2 FACILITIES FOR THE FUTURE 


The NSS Property Strategy 2008 confirmed that there are significant issues with much of 

the SNBTS estate. In particular, there are difficulties with the space and layout in the 

processing and testing centres in Edinburgh and Glasgow as well as the Tissue Services 

Directorate premises in Edinburgh. A number of blood and tissue safety developments are 

anticipated which will compound these difficulties. Currently, these premises are licensed 

but it is likely that they will remain so for a limited period of four or five years, particularly as 

the accommodation becomes ever more compressed and the mechanical and engineering 

plant ages further. 

Also, it is believed that regulators will expect to see blood and tissue manufacturing taking 

place in premises that meet the standards achieved in the pharmaceutical industry. The 

new NHS Blood and Transplant (NHSBT) blood processing centre in Filton, Bristol, 

achieves these standards and this is expected to become the accepted standard in the UK. 

This standard is already adopted in certain other EU countries. Current premises simply 

cannot support such an objective. 

The 2008 ESTATECODE survey established that the majority of SNBTS’ current 

accommodation is in an unacceptable condition (as judged by the ESTATECODE 

standards). Whilst the estate is presently compliant with regulatory standards, it is not 

flexible enough to allow essential changes in work processes, and there is concern over 

the ability to continually meet stringent regulatory compliance requirements. Additionally, 

the current accommodation offers poor facilities for staff in respect of training, canteen and 

changing areas. 

Pharmaceutical consulting engineers employed by NSS carried out a review of the existing 

blood and tissue manufacturing and testing processes, future requirements to support the 

implementation of anticipated blood safety measures and the regulatory standards that 

facilities need to meet to ensure delivery of contemporary GMP requirements. These 

requirements were matched against the existing facilities especially in Gartnavel, Lauriston 

Place and Ellens Glen Road to inform a Site Master Plan study and support a 

comprehensive option appraisal exercise concerning reuse of existing facilities and/ or 

building new facilities. This option appraisal exercise was carried out in Partnership and 

identified the co-location of P&T, IT support, engineering, head office, logistics, selected 

R&D and donor administration, and the Tissue Services and Quality Directorates on a new 

national SNBTS site as the preferred strategic option. The Site Master Plan Study that was 

used to inform the option appraisal exercise identified an estimated capital requirement of 

£35m in 2012/13 for a new National Centre (assuming a capital funded build). 

This approach was approved by the NSS Board in November 2008 and it is intended to 

prepare an outline business case (OBC) for consideration by the NSS Board and SGHD 

Capital Investment Group by December 2009. On the current plan, the new National 

Centre for SNBTS should be ready for occupancy in 2013. 

Sections 4 and 5 show high-level workforce and finance plans in support of the Strategy. 

However, where there are elements of the Strategy, which have reached the planning 

stage and are judged to have a significant impact on staff or funding, more details have 

been provided in tabular form to ensure there is clarity of intent. 


3.2.2 Keeping Blood Safe 

3.2.2.1 Safety Measures Under Evaluation by SaBTO 

Currently, there are a number of blood safety measures that are under evaluation by 

SaBTO. For planning purposes, we have assumed that these will be mandated and 

implemented within the timescales described in the document - it should be understood that 

these may, or may not, move forward to implementation or be delayed for further evaluation 

by SaBTO. Many of these issues relate to vCJD precautionary measures. Others may 

arise during the course of this strategic plan and these will be dealt with on a case-by-case 

basis. 

In the short term, any new safety measure will need to be implemented within our existing 

premises prior to completion of the new National Centre. This will require new safety 

measures being implemented in areas that have been previously used for prior processing 

steps, leading to inefficiency and the imposition of additional controls to guarantee GMP. 

Other tests will need to be located in space not currently used for blood processing, 

potentially necessitating the relocation of staff to create space. Whilst this will be 

acceptable as a short-term measure, it will lead to inefficiency, increased risk and will not 

be sustainable in the longer term. 

(a) Prion Filtration of Red cells 

Abnormal prions are thought to be associated with vCJD infection. Filters have now been 

developed and approved for use, which have been shown to remove prions from red cell 

components. The introduction of these filters would be an additional precautionary measure 

against the possible transmission of vCJD by blood components. These filters are 

undergoing final safety and efficacy trials. Costs and impacts shown below represent prion 

removal for all red cell components on a UK basis. A more limited implementation would 

clearly reduce costs overall but might increase the unit cost of prion removal. 



Implement mandatory safety measures as required by 

Government (currently under consideration) 

2009/10 2010/11 2011/12 2012/13 2013/14 

Introduce Prion Filtration of red cells 

Introduce Prion removal of red cells. 

Start with neonates etc implement 

over 12-18 months. Costs based on 

current estimates. 

Prion 

Removal 

Staff 

Impact 

Implement 

Implement 

+ 5 WTE +20 WTE 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact £2.5m Rev £7.6m Rev 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

(b) Pathogen Reduction of Platelets 

There are now approved pathogen reduction methods for the treatment of platelets to 

substantially reduce their infective risk whilst supporting an extension of shelf life to seven 

days. This would confer significant advantages and facilitate the process, prospects and 

costs of achieving 100% apheresis platelets (as a vCJD risk reduction measure). 






2009/10 2010/11 2011/12 2012/13 2013/14 

Implementing Pathogen Reduction of 

Platelets 

Introduce Pathogen Reduction of 

Platelets. 

Reduces expiry, releases costs 

facilitates 100% apheresis Platelets. 

Pathogen 

Reduction 

of platelets 

Staff 

Impact 

Funding bid 

prepared 

Implement 

+ 1 WTE +3 WTE 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact 

£343k Rev £1.4m 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

c) Universal Apheresis Platelets 

As mentioned under ‘Enough Blood for Patients’, a DoH risk assessment indicates that 

risks of transmitting vCJD to recipients of platelets could be significantly reduced by 

supplying platelets derived by apheresis technology, thereby reducing donor exposures. 

The SaBTO advisory committee has asked NHSBT to determine the feasibility of achieving 

this objective via a staging post of ~80% and will discuss their response in April 2009. 

Proposed source of Funding: SGHD. 




2009/10 2010/11 2011/12 2012/13 2013/14 

Implement Universal Apheresis 

Platelets 

Projected 2009-12 impacts include 

additional lab staff and test kits for 

increased mandatory marker and anti- 

HBc testing, increased BatALert 

testing. 

100% 

Apheresis 

Staff 

Impact 

Funding bid 

prepared 

+2.5 WTE 

Implement Implement Business 

as Usual 

Business 

as Usual 

£ Impact £368k Rev -£11k 

Business 

as Usual 

l 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

(d) vCJD Test 

Testing kits, which are capable of detecting abnormal prions are now under evaluation and 

SNBTS will be closely monitoring this developing situation. Whilst indicative test costs from 

suppliers are not yet available, from experience with, for example, nucleic acid tests, we 

have prepared an indicative assessment of the anticipated impacts on staff and costs and 

these are shown in the table below. 


Proposed source of Funding: SGHD. 




2009/10 2010/11 2011/12 2012/13 2013/14 

Introduce a Donor Screening Test for 

vCJD 

Initially projected availability 2010/11 

May become available late 2009/10 

Donor Services Issues dealt with in 

Enough Blood for Patients. 

Prion 

Removal 

Staff 

Impact 

Funding bid 

prepared Implement Implement 

Funding bid 

prepared 

+4 WTE +4 WTE 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact 

Funding bid 

prepared 

£1.2m Rev 

£1.2m Rev 

Business 

as Usual 

Business 

as Usual 

(e) Pathogen Reduction of Red Cells 

Pathogen Reduction systems for the treatment of red cell components have been under 

development for some time and it is anticipated that by 2012/13 there will be systems that 

are sufficiently practicable, safe for patients and well proven to support their routine 

introduction. Therefore it is essential that we include this activity when planning our future 

facilities. The staffing impact of these systems is currently estimated to be of the scale of 

implementation of prion filtration i.e. around 25 additional WTE (mainly MLA staff). 

(f) Screening for a new Infectious Agent 

We know from experience that we can anticipate the emergence of a new transfusion 

transmitted pathogen within this planning timeframe. Therefore it is essential that we plan 

for the inclusion of such a development in our new facilities, possibly from 2012/13, 

involving some eight additional staff to deal with the introduction of the test and associated 

look back exercise. 

3.2.2.2 Developments of Existing Tests 

The following key blood safety measures represent the modernisation of services already 

provided and have been funded from within the NSS allocation. They will be implemented 

during 2009 and it is anticipated that further quality improvements will be required in the 

future. 

(a) Automated NAT 

The nucleic acid amplification test (NAT) is a highly sensitive method for detection of 

viruses present in donated blood. The manual NAT method currently used by SNBTS was 

developed in-house over 10 years ago. Although this method has been fully inspected by 

the MHRA, the current industry standard uses automated technology and test kits, which 

are approved in Europe through the ‘CE mark’ system. NSS has set aside funding to allow 

SNBTS to introduce this standard of test during 2009. 

(b) Syphilis Testing 

The incidence of sexually transmitted diseases in the general population is increasing. This 

includes syphilis and this increase is reflected in the increasing incidence of syphilis in the 

donor population. A more sensitive test is now available and NSS has agreed that this 

should be implemented during 2009. Funding includes +4 WTE staff. 

(c) Automated Red Cell Antibody Screening Test 

This is a test used in the preparation of specific red cell concentrates for use in infants, 

neonates and in utero. The test needs to be improved as a consequence of an increase in 

standards required. Funding to achieve this service improvement was approved by NSS 


and a tender exercise is underway. This new technology will be implemented during 2009, 

with an associated increase in the P&T establishment of 1 WTE. 

3.2.3 Modernising Blood Production Facilities to Maintain Safety 

3.2.3.1 New National Centre 

As previously discussed under section 3.2.1. , the NSS Corporate Strategy highlighted a 

number of strategic deliverables for SNBTS, which cannot be supported by significant 

elements of the current SNBTS estate. 

a) Options and Outcome 

A comprehensive option appraisal exercise was carried out in Partnership in March 2008 

and a summary of the outputs is shown below. 

No. 

Option Description 

Weighted Benefits Score 

Con’s 

us 

Risk 

Lifecycle 

Costs 

Cost per 

benefit point 

Opt Pess Rank Score Rank £m Rank £000 Rank 

0 

Do minimum (backlog 

maint.) 

233 234 229 5 378 5 104 4 444 5 

1 

Lauriston & Gartnavel refurb 

(P&T) + new build (new site) 

473 473 473 4 368 4 105 5 223 4 

2 Single New build, (new site) 823 835 798 1 126 1 88 1 107 1 

3 

Gartnavel (P&T only) + new 

build (new site) 

644 647 644 3 306 3 101 3 157 3 

4 

Gartnavel (T only) + new 

build (new site) 

726 739 710 2 148 2 97 2 134 2 

As can be seen, Option 2 single new build (all functions) on a new site was the preferred 

option on all appraisal measures. It identified the co-location of P&T, IT support, 

engineering, head office, logistics, select R&D functions and donor administration, and the 

Tissue Services and Quality Directorates on this new National SNBTS site and this was 

identified as the preferred strategic option. This approach was approved by the NSS Board 

in November 2008. 

The new National Centre will allow SNBTS to guarantee ongoing blood and tissue service 

support for patients in Scotland. It will allow future blood and tissue safety measures to be 

implemented in a timely and cost effective manner and will also provide sufficient flexibility 

to accommodate future changes to both operational and workforce practices within the 

‘Patient Focus Public Involvement’ (PFPI) framework for delivering a culture change in 

NHSScotland where patient-focus is at the heart of service design and delivery. 

This approach will also support the introduction of manufacturing processes in premises 

that will meet the pharmaceutical industry standards our regulators (MHRA and HTA) 

increasingly expect to see. We anticipate this approach will become the minimum standard 

in future and it is already in place in the newly opened flagship NHSBT Centre at Filton 

near Bristol. 

Clearly, this initiative will have a significant impact on our staff and these issues will be 

addressed in our workforce plan, which is summarised in Section 4. During 2009/10 in 

preparing the OBC, we will work in Partnership to establish what conceptually different 

ways of operating and achieving compliance will mean for processes and staff. 

b) Outcomes and Possible Solutions if Preferred Option is Delayed/Not Funded 

SNBTS is mindful of the extremely challenging economic climate and has given 

consideration to the outcomes and possible solutions if the new National Centre is delayed 

or not funded. 


Against the background of shortage of space, increasing regulatory standards and lack of 

ideal working conditions for staff, this plan has described a number of additional, 

mandatory blood and tissue safety measures which are likely to be introduced before a 

National Centre will be available for occupancy. 

These new safety measures will need to be accommodated within existing premises, 

adding significantly to the challenge of working in limited space that will not support optimal 

workflow and will not meet future regulatory requirements. MHRA/ HTA may tolerate such 

arrangements provided there is a clear plan to provide a more appropriate solution within 

an agreed timeframe. In the absence of such an approach we would be at risk of losing 

our Blood and Tissue Establishment licences. 

If the National Centre were to be delayed, it may be possible to continue to operate from 

existing premises for a limited period. This would probably be no more than two years ie 

until 2015 but may be significantly less. Any delay in commissioning the National Centre 

would clearly bring significantly increased regulatory and operational risks. Our Regulators 

(MHRA and HTA) have been advised we are developing options/ plans for new premises 

and will be very concerned at any significant delay. We would almost certainly need to 

enter into extensive discussions with them to outline how we planned to proceed and 

secure their approval. 

The mechanical and engineering plant in the Lauriston Building is approaching the end of 

its serviceable life and, as a result, the risk of its failure will increase significantly over time. 

There are very similar issues with the plant in PFC, which houses Tissue Services and, as 

a result of space constraints within the Lauriston Building, we will need to locate vCJD 

screening and confirmatory tests within PFC. Plant failure in either of these buildings 

would become increasingly likely and could result in acute loss of service with serious 

consequences for NHS Scotland and the patients it serves. 

If the creation of a National Centre for SNBTS is not supported or is delayed beyond 2015, 

the level of organisational and regulatory risk would increase significantly. The increasing 

risk of mechanical and engineering plant failure at the Lauriston facility, allied to the 

increased regulatory risk and with no obvious means of refurbishing or otherwise bringing 

the Lauriston Building up to standard would mean that in order to avoid the risk of 

unplanned failure of the blood supply we would be required to plan to discontinue 

processing and testing of blood components on that site. 

With no suitable alternative accommodation available and authorised by MHRA, we would 

be required to seek to subcontract some or all of this work to NHS Blood and Transplant in 

England. The logistics of this would be challenging and would have the potential to 

adversely impact on blood component availability, especially platelets. Furthermore, there 

would be the potential for loss of control over blood safety policy for that proportion of the 

blood supply being sent to NHSBT for processing and testing. Whilst all UK Blood 

Services work to the same minimum standard, some differences prevail eg NHSBT 

currently do not test all platelet donations for bacterial contamination. 

Clearly, these are radical measures which reflect the gravity of the situation and the 

importance of delivering the preferred option. 

3.2.3.2 Transforming Donation Venues 

Within the Strategy, there is a commitment to transforming the donation experience to 

make it more accessible and rewarding for donors. As part of this, we will assess the 

feasibility of offering donor sessions across a wider range of venues in semi-permanent or 


permanent locations, including a move from current hospital based locations to convenient 

city centre locations. 

Future property requirements for fixed site donor centres will be determined following 

completion of feasibility exercises. Meanwhile, we will continue to operate from our existing 

fixed site donor facilities. SNBTS and NSS Facilities Department are currently in 

discussions with Health Boards about how space currently occupied by SNBTS on their 

sites, could be better used. This will be further progressed during 2009/10. The possibility 

of relocating hospital based donor centres to city centre sites is a key element of those 

discussions. 

The NSS Property Strategy envisages transfer of surplus space from premises occupied by 

SNBTS to territorial Health Boards as a key strand in the creation of a national site for 

SNBTS. 

3.2.3.3 Sustainable Services for Patients 

There are a number of issues relating to the quality, location and size of accommodation 

used by SNBTS in delivering its laboratory and clinical services as set out in the Services 

for Patients strategic theme. In particular, there is a lack of space in Edinburgh and 

Dundee and excess space in Inverness and Aberdeen. 

In Edinburgh, the clinical laboratories and related services relocated to the new Royal 

Infirmary in 2003 where space to deliver current services is extremely tight. In Glasgow, 

where the Clinical Directorate has taken over the delivery of local blood banking, space is 

very tight and this will not be resolved until the relocation of P&T to the National Centre 

releasing sufficient space for expanded clinical activity. 

In Dundee, there are pre-existing space constraints, which will become even more pressing 

if the implementation of universal apheresis platelets is mandated as this will impact 

adversely on available space for delivery of therapeutic apheresis and venesection. 

Initiatives such as the relocation of P&T from the Gartnavel facility and potential relocation 

of donor centres from hospital sites in Dundee, Aberdeen and Inverness will change the 

footprint SNBTS requires in these premises. As mentioned, discussions are ongoing with 

regional Health Boards to explore areas of complementarity between their property 

strategies and NSS in order to maximise the productive use of NHS facilities. 

Finally, there is a need to plan for the likelihood of blood component stockholding depots 

(likely to be within existing regional centres) distributed away from the National Centre and 

these requirements will become clearer after the location of the site is known. 

3.2.3.4 Co-location with other Functions 

The development of the national site offers the opportunity to review our working practices 

in a number of functions. 

(a) Donor Administration and Support 

Following the donor services review in 2003, donor administration functions and processes 

were standardised with minimal regional variation in practice or policy. However, the 

development of the National Centre offers the opportunity to review these functions to 

consider how best these should be delivered in the future. This process will be conducted 

in Partnership and will consider: 

• Which functions are best co-located with processing and testing? 

• Which functions need to be delivered locally? 


• Whether there are efficiencies and service benefits arising from co-location at the 

National Centre? 

• Whether there are new functions that could be conducted locally to improve our 

community liaison and grass roots donor recruitment and retention activities? 

It is proposed that this work be undertaken during 2009. An implementation schedule to 

allow these changes to be phased in in advance of the national site becoming available will 

also be proposed during 2009. 

(b) Medical Care of Blood Donors 

Donor services is nationally led and medical care of donors follows national protocols and 

policy in the delivery of care for blood donors. It is anticipated that the medical 

establishment will undergo significant turnover due to retirement of key personnel and it is 

anticipated that it will be difficult to recruit suitable replacements. A plan to address this 

and to redesign this critically important area will be progressed during 2009. The proposed 

approach mirrors that outlined for donor administration and support. 

(c) National Microbiological Reference Unit (NMRU) 

Currently, the NMRU provides a highly responsive and high quality confirmatory and 

reference service for virus marker testing of blood and tissue donors. It also provides such 

a service under contract for the Northern Ireland Blood Transfusion Service. 

NMRU will benefit from being located within the National Centre where all testing and donor 

samples will be held. 

(d) Interaction with R&D 

Blood products and components has been a ‘Theme Group’ within R&D since the last 

reorganisation many years ago. With the closure of PFC, research into plasma products 

will cease and attention will focus on delivering high impact science that benefits patients 

and supporting developments aimed at improving blood component quality and safety. 

Much of this latter work is more operational in nature and many of the protocols are now 

well established and fairly routine. 

Experience with the development of prion filters has clearly illustrated the need to have 

highly experienced production staff to ensure that the development of technical 

specifications meet operational needs. There is much merit in having multidisciplinary staff 

working closer together to take developments from the validation stage into routine 

operations. The new National Centre will have small pilot plant facilities to ensure that new 

processes can be trialled near to the main plant without disrupting manufacturing 

operations or being carried out in unsuitable R&D labs. Details will be worked up in 

Partnership as part of the OBC development. 

(e) Environmental and Quality Monitoring Tests 

Currently this testing is shared between quality and P&T teams with different arrangements 

in place in Glasgow and Edinburgh. This has previously attracted comment from the 

MHRA and this will be resolved as we prepare to move into a National Centre. Details will 

be worked up in Partnership as part of the OBC development. 

(f) Integrated Working with Tissues 

One potential benefit of co-locating P&T and the Tissues Directorate is the opportunity to 

consider bringing all manufacturing activities under a unified management structure. This 

could have major benefits in terms of improving cover for key activities that require 


24/7/365 support, making out of hours rosters much more robust and sustainable. Details 

will be explored in Partnership as part of the OBC development. 

(g) Co-location with other NSS Divisions 

If a suitable location is chosen for the National Centre, consideration will be given to the colocation 

of Counter Fraud Services from Earlston House, Health Facilities Scotland from 

Kirkhill Business Park and Practitioner Services Division from Bain Square. 

3.2.3.5 Lean and Compliant 

It is almost 10 years since the last major rationalisation and reorganisation of the SNBTS 

manufacturing activities when the number of P&T units was reduced from five to two. The 

remaining P&T site within the Lauriston facility was reconfigured, and the new unit at the 

Gartnavel facility designed to meet the operational demands at that time. There is little 

doubt that this facilitated the implementation of some major developments in a more 

effective and efficient manner. Since then, SNBTS has implemented a number of other 

developments within the constraints of existing restricted space, laboratory workflows and 

layouts, staffing levels/skills mixes and working hours/shift patterns. Processes have 

changed or been adapted to accommodate new technology, respond to quality incidents or 

to correct non-conformances identified by internal and/or external regulatory audits. 

The move to a new National Centre will provide the opportunity to review and modernise 

current working practices and those likely to be introduced in the near future as well as 

ensuring they are designed for purpose. For example, there is ample evidence that 

process improvement strategies based on ‘Lean’ solutions can reduce cost and waste, 

dramatically reduce processing times and free up valuable staff to undertake more 

productive work. The underlying ‘Lean’ principle is to create flow and eliminate waste in all 

its forms and requires a fundamental change in working practices and the thinking behind 

them. 

Similarly our quality systems have evolved to address ever-increasing regulatory demands 

from the MHRA and HTA and to address quality incidents, systems failures and audit 

reports – both internal and external. Although significant effort has gone into the redesign of 

the Quality Management System, some elements of compliance have been achieved by the 

deployment of significant additional resource across all of our sites. Although SNBTS does 

achieve high levels of quality and compliance, there is little doubt that significant 

improvements could be made to how this is achieved. 

The design of the new National Centre will include process improvement strategies such as 

‘Lean’ and will completely modernise all aspects of how we work. 

3.2.3.6 Logistics 

SNBTS will apply the lessons learned in modernising blood component logistics to all 

activities. These developments will provide a real challenge to the transport team who will 

derive significant benefit from being physically and managerially integrated with 

manufacturing. 

In industries such as electronics that are dependent on efficient manufacturing and supply 

chain management, strategies such as Kan-Ban (automatic stock replenishment) and 

vendor managed inventory (VMI) have been deployed to improve efficiency (VMI stocks are 

held close to the point of use, owned by the 'vendor' (SNBTS) and replenished or moved 

around the supply chain by the 'vendor'). 

SNBTS will make extensive use of these and other supply chain techniques to modernise 

this key part of our operation and support the delivery of an enhanced and more efficient 

logistics service. In turn, this will allow efficiency improvements in NHSScotland’s hospital 


lood banks and the SNBTS supply chain e.g. SNBTS will reduce the number of 

emergency deliveries to reduce risks for patients by encouraging more appropriate blood 

stock management practices in hospitals, 

SNBTS will take the opportunity to fundamentally review the entire manufacturing and 

logistics operation, e.g. combine the inbound logistics of collected blood with the delivery of 

finished components thereby reducing journeys and our carbon footprint. 

3.2.3.7 Impact on staff of the creation of a National Centre for SNBTS 

The creation of a National Centre is of critical importance to future proof the provision of 

Scotland’s blood and tissue supplies. The Strategy has described the major blood safety 

initiatives that we expect to be introduced over the next five years, including the estimated 

increased staffing resource that will be needed to deliver them. However, creating a single, 

National Centre will bring significant opportunities and challenges for staff and these will 

potentially impact all staff whose workload will relocate to the National Centre (see 3.2.1). 

These issues are discussed more fully in the workforce plan (see Section 4) but staff should 

be reassured that the NSS Organisational Change Policy will govern all changes. 


3.3 SUSTAINABLE TISSUE SERVICES 


Products prepared from bone, tissues and cells are relatively new therapeutic agents. Our 

experience in preparing biological materials as medicinal products makes SNBTS ideally 

placed to supply these preparations to the NHS in Scotland. This work has become 

established in the Tissue Services Directorate of SNBTS with close links to the Clinical 

Directorate, and the consolidation and development of these products is a significant 

feature of the SNBTS Strategy. Bone, tissues and cells are all regulated by the HTA and 

these products are increasingly grouped together, not only for operational reasons, but also 

to facilitate regulatory compliance. 

The range and number of tissues procured has increased significantly over the past few 

years and it is likely that this will increase further driven by clinical development and 

demand. An example of this is the recent establishment of skin banking and the 

establishment of a pancreatic islet cell processing programme. It is likely that significant 

safety measures applicable to blood will also be similarly applicable to tissues. Measures 

taken in the context of prion diseases is imminent and some pilot work on splenic testing is 

already planned (to ensure that tissues harvested from deceased donors lack evidence of 

abnormal prions). 

Close collaboration already exists between the Tissue Services Directorate and its NHSBT 

counterpart. This will be formalised wherever possible to maximise synergies and will be 

particularly useful in the processing of specialist products. Collaborations like this will result 

in tissues being available more quickly and cost effectively than if SNBTS undertook this 

work solely in house. 

3.3.2 Keeping Tissues and Cells Safe 

3.3.2.1 Anticipated Mandatory Safety Measures for Tissues and Cells 

Testing regimes and safety measures applicable to blood are in the main also applied to 

tissues. Therefore, any mandatory safety measures that will be applied to blood will, in all 

probability, be applied to tissues and cells. Uniquely however, bone washing for the 

removal of marrow is anticipated to become a mandatory measure in the near future and a 

UK protocol has been developed by SNBTS and NHSBT Tissue Services. It is anticipated 

that bone washing will be mandated by SGHD on advice from SaBTO during 2009/10. It is 

planned that this work would be sub contracted to NHSBT at a projected annual cost of 

£150k to be funded through the safety bid process described previously. 

3.3.2.2 Multi Organ Donors 

It is anticipated that a prion blood test will be available for blood donors in the next few 

years. It is anticipated this will also be applied to organ and tissue donors. However, it may 

be possible to routinely test for prions histopathologically in sections of tissues and pilot 

work is being planned to assess the feasibility of testing specific tissues (e.g. spleen, optic 

nerve) for abnormal prions. In the first instance this work will be carried out only on 

deceased tissue donors, currently it is not possible to obtain a test result prior to organs 

being transplanted. 

3.3.3 Donor Recruitment 

3.3.3.1 Referrals from Organ Transplant Co-ordinators 

The recent recommendations of the Organ Donation Task Force are driven by a 

requirement to increase organ donation by 50% in five years. One of the major 

recommendations is the unified management of all transplant co-ordinators in the UK by 


NHSBT. SNBTS has an excellent working relationship with the transplant co-ordinators, to 

the extent that 40% of SNBTS tissue donations are derived from multi organ donors 

referred by transplant co-ordinators. Transplant Co-ordinators also formally support 

SNBTS on call rotas and a formal SLA will be required to maintain this due to recent 

developments in NHSBT. 

3.3.3.2 Designated Requesters 

The procurement of tissues is derived mainly from deceased donors - heart beating (most 

often multi organ donors) and non-heart beating donors. The main sites where the latter 

potential donors can be identified are in A & E departments. The most cost effective way to 

achieve this is by training senior hospital nurses as designated requesters. This will 

enable them to identify potential donors and approach their families for onward referral to 

our nurses. This programme has started and will be further developed. 

3.3.3.3 The Bone Programme 

SNBTS has a well-established bone programme with bone being exclusively derived from 

patients undergoing hip surgery. This programme will continue for the foreseeable future. 

However, should vCJD testing for deceased donors become operationally feasible, 

particularly if this is before routine blood testing, then obtaining all bone from deceased 

donors will be evaluated. This will have a major impact on the bone programme and will 

need a 2-3 year lead time to implement fully. 

3.3.4 Tissue Retrieval 

3.3.4.1 Dedicated Mortuaries 

As part of the condition of our licences, it is important that tissues are retrieved in a 

controlled environment i.e. a dedicated mortuary controlled by SNBTS including 

environmental monitoring. Mortuaries suitable for use by SNBTS have been identified in 

Glasgow and Edinburgh. 

3.3.4.2 Retrieval Teams 

In order to improve the sustainability of our services it is important that SNBTS improves 

the way tissues are retrieved. This has been significantly facilitated by the recently enacted 

Human Tissues Act, which allows tissues to be retrieved by trained non-medical staff. 

Although we receive significant support from pathologists and Anatomical Pathology 

Technicians (APT) at the moment, there are instances where tissues that were potentially 

obtainable were not collected for a variety of reasons. Two retrieval models are being 

evaluated. Firstly, SNBTS retrieval teams will be employed to retrieve in our mortuaries in 

Edinburgh and Glasgow. Secondly, APT’s will be contracted to carry out this task, 

enhancing their role and ensuring their availability. It may be that a mixture of models will 

be used, depending on the level of support received from pathologists. 

Proposed source of Funding: NSS/SNBTS. 


Establish Tissue Retrieval Teams 2009/10 2010/11 2011/12 2012/13 2013/14 

Dedicated Tissue retrieval teams 

2 WTE to ensure sustained 

procurement of tissues for Scottish 

patients. 

Funding bid submitted 2009. 

Initiative 

Staff 

Impact 

Prepare bid 

+2 WTE 

bid 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact £80k bid 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 


3.3.4.3 Pathologists 

Pathologists currently provide retrieval support through semi formal arrangements at the 

discretion of individual pathologists. In the West of Scotland, a semi-formal rota of 

pathologists are available to cover tissue retrievals; the support in the East is mainly via the 

forensic pathologists. The latter situation is more tenuous, particularly in view of their 

workload and other staffing issues. Discussions are taking place to ascertain whether it is 

possible to have a formal commitment to support the programme. 

3.3.5 Processing and Storage of Tissues and Cells 

Due to the volumes of some of the tissues and cells processed, it will be more efficient to 

do so in one site under an all embracing quality system to ensure regulatory compliance. In 

many instances appropriate process validation to enable a uniform approach has already 

been carried out and the infrastructure already exists for such processing. The advantage 

is tissues and cells are available for clinical use quicker and in a more cost effective 

manner. Such a mechanism is already in place for skin and should bone processing 

become a requirement, a similar collaboration with NHSBT will be requested. 

3.3.6 Cellular Products 

3.3.6.1 Haematopoietic/Cord Blood Stem Cells 

The Tissue Services Directorate currently process and bank peripheral blood 

haematopoetic stem cells (HSC) for patients in Lothian. This service was transferred from 

the Western General Hospital to SNBTS a few years ago and the necessary infrastructure 

and expertise to run this service to the required standards is in place. The proposed move 

of HSC processing and banking to the new national site and the establishment of national 

cell banking facilities will provide an opportunity to raise quality, efficiency and regulatory 

compliance whilst retaining the clinical interface in our clinical centres. There are models 

where HSC are remotely processed and banked prior to reinfusion into patients locally. 

Once the location of the National Centre is known an option appraisal will be carried out in 

consultation with clinicians and other interested parties to determine the best model for 

Scotland. 

3.3.6.2 Pancreatic Islet Cells 

The NSS National Services Division has recently funded the Edinburgh Clinical Transplant 

Unit to establish a Scottish islet cell transplantation programme. Initially, islet cell 

processing and transplantation will cover the needs of Scottish patients, however, it is likely 

that in the medium term we will become one of three islet cell transplantation units in the 

UK and part of the UK allocation process. This facility is currently being developed in 

redundant clean rooms in Ellen’s Glen Road and would relocate to the new National 

Centre. 




Establish Islet Cell Transplantation programme 2009/10 2010/11 2011/12 2012/13 2013/14 

Establish Islet Cell Transplantation 

programme 

Initiative 

Prepare bid 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Funding bid submitted 2009. 

Staff 

Impact 

+3 WTE 

bid 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact £165k bid 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

3.3.6.3 New Cellular therapy and regenerative medicine 

Scotland continues to experience some of the worst morbidity and mortality rates relating to 

neoplastic and degenerative disorders. Building on its experience in providing tissues and 

haematopoietic stem cells for transplantation, SNBTS has been at the forefront in 

supporting the research and development of new cellular therapies including an 

international T cell immunotherapy bank for EBV-driven post-transplant lymphoproliferative 

disease, adult stem cell therapies for heart, musculoskeletal and liver disease and the 

generation of pluripotential embryonic stem cells at cGMP grade. 

The new SNBTS National Centre will partner with the new University of Edinburgh Medical 

Research Council Centre for Regenerative Medicine in helping to position Scotland in the 

vanguard of this highly competitive international field to the benefit of the health and 

wellbeing of the people of Scotland. 


3.4 SERVICES FOR PATIENTS 


The SNBTS Clinical Directorate delivers front line medical care for patients in Scotland over 

a range of specialties including hospital blood banking, reference immunohaematology, 

histocompatibility and immunogenetics (H&I), clinical apheresis and stem cell services. 

This embodies the theme ‘Services for Patient’. 

3.4.2 Supporting Better Health Better Care 

3.4.2.1 Develop a Coherent National Management Structure 

Currently, the Clinical Directorate is managed on a regional basis, which leads to 

replication of management duties and acts as a barrier to single system national working. 

An Associate Medical Director will be appointed from the existing Clinical Directors to 

create formal national leadership for the Clinical Directorate and to formally deputise for the 

SNBTS National Medical and Scientific Director. The intent is to develop a managed 

clinical network with an emphasis on national functional leadership and coherence of 

specialist services, balanced by the flexibility in accommodating local clinical requirements 

where required i.e. the approach is directly aligned with BHBC. 

From the existing Regional based staff, National Clinical Directors and senior managers will 

be appointed to lead the specialist services outlined below. The plan envisages that 

freeing the BMS3 staff from routine out of hours shift rosters will improve management 

continuity and communication and allow improved focus on quality, efficiency and 

regulatory compliance, service improvement and implementation of corporate initiatives. 

3.4.2.2 Single System Working 

The historical regional organisation of the Clinical Directorate has led to diversity in 

operating procedures and practices and some differences in the quality or extent of service 

offered between Centres. It is important that our customers, clinicians and patients enjoy 

access to a similar high quality comprehensive service wherever they are in the country 

(again this is fully aligned with the principles of BHBC and Delivering for Health which 

placed the reduction of health inequalities at the centre of NHSScotland business). 

This theme captures five strategic benefits: 

• Continuous quality improvement - good practice and new developments can be rolled 

out to all Centres, lessons learnt through complaints, incidents or regulatory inspection 

in one Centre can be applied to all. 

• Enhanced regulatory compliance - with compliance now required for multiple regulatory 

and accreditation bodies (e.g. MHRA, HTA, Clinical Pathology Accreditation (UK) Ltd. 

(CPA), European Federation for Immunogenetics (EFI), Joint Accreditation Committee- 

ISCT & EBMT (JACIE) and NHS Quality Improvement Scotland (QIS), a single 

operational and quality system is increasingly sought by inspectors and allows the 

correction of non-compliances in one centre to be applied across all. 

• Improved efficiency - management tasks such as procurement of new equipment and 

reagents, validation, change control and quality management documentation can be 

managed once and rolled out to all centres rather than reinvented five times. 

• Equality of access - patients and clinicians supported by every centre experience similar 

quality and availability of local service and access to national specialisation. 


• Fair and equitable terms and conditions for staff - supporting and embedding the 

principles underpinning Agenda for Change. 

Considerable progress has been made towards single system working over the past two 

years. This progress will be embedded by a national management structure, single 

operational and quality management systems within individual specialist services. 

Proposed source of Funding: NSS/SNBTS 


Supporting Better Health Better Care 2009/10 2010/11 2011/12 2012/13 2013/14 

Improve management Structure 

BMS 3 staff off shift, increase in 

BMS 1 staff to provide shift cover. 

Funding bid to be submitted 2010. 

Improve 

M’anageme 

nt 

Prepare bid 

Funding bid 

submitted 

Business as 

Usual 

Business as 

Usual 

Business as 

Usual 

Staff Impact 

Negotiate 

change 

+ 5 WTE 

Business as 

Usual 

Business as 

Usual 

Business as 

Usual 

£ Impact 

Negotiate 

change 

£181k Rev 

Business as 

Usual 

Business as 

Usual 

Business as 

Usual 

3.4.3 Specialist Services 

3.4.3.1 Hospital Blood Banking, Antenatal and Reference Immunohaematology 

SNBTS blood banks prepare almost half of all blood components transfused in Scotland. 

Continued provision of these, along with antenatal and regional reference 

immunohaematology provides the platform of experience and expertise which SNBTS 

leverages in support for non-specialist hospital blood banks and identifying interventions to 

improve the quality of the clinical transfusion process. The SNBTS Strategic intent is to 

keep urgent reference and testing work that needs to be close to the patient in hospitals 

where it can be deployed most effectively. 

The Scottish Government has placed particular emphasis on patient safety through the ‘Six 

Dimensions of Quality’ and has charged SNBTS with supporting the rest of NHSScotland in 

maintaining compliance with the BSQR. However, there are a number of challenges, 

including sustainability of BMS and medical 24/7 rotas, increasing direct patient workload 

and increasing indirect workload due to quality and regulatory requirements principally CPA 

and MHRA. Significant progress has been made towards single system working through 

implementation of the ‘Traceline’ clinical laboratory computer application. Further work will 

be carried out to extend this application to other hospital blood banks (where appropriate) 

and provide links to other hospital laboratory information management systems. This will 

enable, for example, ward order communications and contribute to the delivery of the e- 

Health agenda. This work will be embedded through a national Clinical Director for blood 

banking and immunohaematology and appropriate restructuring of the medical and BMS 

management structures. Additional staff will be required to maintain blood bank shift rotas 

in the face of year on year increases in workload and in compliance with the EU Working 

Time Directive. 


Proposed source of Funding: NSS/SNBTS 


Delivering Specialist Services 2009/10 2010/11 2011/12 2012/13 2013/14 

Increase staff to maintain service 

delivery 

Increased establishment on each 5 

Clinical Directorate sites by 1x BMS 1 

per year. 

Cope with increasing workload. 

 

Establishment 

Staff 

Impact 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

+1 BMS1 +1 BMS1 +1 BMS1 +1 BMS1 +1 BMS1 

£ Impact £36k £36k £36k £36k £36k 

3.4.3.2 Histocompatibility and Immunogenetics, and Immunology 

Considerable progress has been made in the modernisation of H&I services over the past 

12 months. This includes redistribution of work between the centres in the East of Scotland, 

consolidation of solid-organ transplant work in Edinburgh, platelet and granulocyte 

immunohaematology in Aberdeen and disease association and transfusion related H&I 

from Edinburgh to Dundee. 

BMS out of hours services have been consolidated in Edinburgh in support of the solid 

organ transplant service and two H&I Consultant Clinical Scientists appointed. 

The overarching aim is to support a high quality, comprehensive service across Scotland. 

This will include a national Clinical Director for H&I and Immunology for the services 

delivered by SNBTS, better local integration between SNBTS and NHS Greater Glasgow 

and Clyde (GG&C) H&I laboratories and national collaboration between SNBTS and GGC 

on issues such as Consultant cross-cover, common practices and standards, and 

procurement. 

Operational targets include EFI accreditation and replacement of the current H&I IT 

systems with a common, up-to-date platform. There is a requirement for greater support for 

allogeneic haematopoietic stem cell transplantation and Scotland’s cellular therapies 

research and development programme. In addition, the Organ Transplant Taskforce has 

recommended a 50% increase in solid organ transplantation over the next 5 years and this 

has been supported by SGHD. Clearly, this change will require additional resource in the 

form of reagents, consumables and staff. It is estimated that 2 additional staff will be 

required in 2009/10 and again in 2011/12 and is envisaged that the increase in funding will 

be met from an increase in the current cross charge arrangements to reflect the higher 

activity levels. Consideration has been given to H&I support for blood testing and 

processing and If the anticipated instruction is given to implement the procurement of all 

platelets by apheresis, there will be a significant additional body of H&I work. It is 

anticipated that this would be funded by Government as set out below. 






2009/10 2010/11 2011/12 2012/13 2013/14 

Implement Universal Apheresis 

Platelets 

Projected 2009-12, impacts include 

additional lab staff and test kits for 

increased H&I testing. 

100% 

Apheresis 

Staff 

Impact 

Funding bid 

submitted 

Implement 

Implement 

+2 WTE Implement Implement 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact 

£195k Rev 

£186k NR 

bid 

Implement 

£36k rev 

£303k NR 

bid 

Business 

as Usual 

Business 

as Usual 

The immunology laboratory service in Edinburgh will be led by a Clinical Scientist following 

the retirement of the current Consultant Immunologist. Better local collaboration is being 

discussed with the Clinical Consultant Immunologist and immunology laboratory service in 

Aberdeen, opening the prospect of developing a managed clinical network in this speciality 

across Scotland. Such a network would facilitate maintenance of quality and CPA 

standards, procurement, training and clinical advice. Recruitment and retention of specialist 

staff remains a key objective. 




Delivering H&I and Immunology 

Services in line with new standards 

These services had previously been 

unable to secure funding to meet 

emerging new standards. Some funding 

released 2008/09, this represents phase 

II. 

 

Establishment 

Staff 

Impact 

Implement 

+2 trainee 

Clinical 

Scientists 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact £85k 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

3.4.3.3 Clinical Apheresis and Stem Cell Services 

Four centres provide clinical apheresis services on a 24/7 basis including therapeutic 

apheresis, stem cell collection and venesection. Progress has been made towards single 

system working around standards for stem cell collection through the NHSScotland 

Scottish Advisory Network for Therapeutic Apheresis Services (SANTAS) group. This will 

be consolidated through a national Clinical Director, senior nurse and management 

structure. 

Continued 24/7 local provision is contingent upon enhanced staff numbers, common 

standards of practice and training, procurement of a new suite of apheresis machines and 

compliance with enhanced regulatory requirements. 


Haematopoietic stem cell (HSC) processing and storage is provided by Aberdeen and 

Dundee clinical centres, the Tissue Directorate in Edinburgh and NHS GGC. The Glasgow 

clinical centre is also engaged in the establishment of the Scottish Cord Blood Bank. 

SNBTS R&D cellular therapies group also has an interest in this service and has been 

involved in the establishment of Roslin Cells and the new GMP facilities at the Scottish 

Centre for Regenerative Medicine. The creation of a tissue and cell processing facility 

within the National Centre would provide an opportunity for the centralisation of all HSC 

and cord cell banking from other SNBTS sites leaving the clinical interface in our clinical 

centres. There are models where HSC are remotely processed and banked prior to 

reinfusion into patients locally. Once the location of the National Centre is known, an 

option appraisal will be carried out in consultation with clinicians and other interested 

parties to determine the best model for Scotland. 




Clinical Apheresis and Stem Cell 


These services are currently delivered by 

a combination of Supply Chain and 

Clinical Directorate Nursing staff, 

additional resource is needed to 

consolidate service delivery. 

Requirement to replace equipment 

 

Establishment 

Staff 

Impact 

£ Impact 

Edinburgh Glasgow Aberdeen 

Possible 

relocation 

of Donor 


(Dundee) 

+1 Nurse +1 Nurse +1 Nurse +3 Nurses 

£36k 

£200k Cap 

£36k 

£200k Cap 

£36k 

£200K Cap 

£112k 

£200k Cap 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£200k Cap 

3.4.3.4 Support for the Clinical Transfusion Process 

The BBTP initiatives have seen considerable enhancement in the quality of the clinical 

transfusion process across Scotland. Developments include, educational materials, training 

programmes, audit, support of the development of NHS QIS standards and peer review, 

support for clinical incident reporting and management, traceability, clinical blood wastage 

and hospital transfusion committees. This work needs to be embedded within the overall 

mission of the Clinical Directorate both to consolidate progress and achieve sustainability in 

the longer term. However, flexibility will also need to be retained to support local Health 

Board agendas. Continued work by the BBTP clinical effectiveness team with the R&D 

Directorate, NHSScotland and University colleagues, will be required to further develop the 

evidence base for the clinical effectiveness and safety of blood components. 

Proposed source of Funding: NSS/SNBTS . 



Support for the Clinical Transfusion 

Process 

This post reflects the need to commit 

resource to continuously improving the 

delivery of the Clinical transfusion 

process. 

 

Establishment 

Staff 

Impact 

Bid 

submitted 

+1 Nurse 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

£ Impact £50k 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 

Business 

as Usual 


3.4.4 Local Delivery Supported by National Specialisation 

3.4.4.1 Sustainability of Local Services 

The ageing demography of medical, scientific and nursing staff within SNBTS predicts a 

significant loss of experienced staff over the next 5-10 years. In addition, out of hours rotas 

in most centres and across most professional groups are under pressure in terms of 

compliance with the EU Working Time Directive and proposed AfC unsocial hours terms 

and conditions. It is unlikely going forward that the Clinical Directorate will be able to 

continue to support a multiplicity of stand-alone 24/7 local services. The approach to 

sustainability has a number of strands: 

• Continued provision of local services where rapid turnaround is required - for example, 

hospital blood banking, antenatal red cell immunohaematology and clinical apheresis. 

• Better integration with other local services – for example it may be possible to provide 

cross-medical coverage of blood bank and apheresis with local haematology 

colleagues. Cross-disciplinary working with colleagues may also be possible in 

support of some nursing and biomedical science rotas, though key specialist expertise 

needs to be protected from dilution. 

• National support for specialist functions - for example, specialist H&I and 

immunohaematology advice provided by a national rota. 

• Proactive strengthening of the workforce - through recruitment of additional staff to top 

up fragile rotas and enable succession planning. 

• National provision of highly specialist functions - to allow critical mass to be built in 

specialist facilities and staffing. 

• Structured training - to provide the new generation of professionals to support the 

Service and enhance career development opportunities. 

Single system working and national integration of specialist functions should support 

continued provision of local services. The funding requested to modernise and build 

resilience into the delivery of specialist services will also play a key role in improving and 

sustaining the provision of local services for Health Boards and the patients they serve. 


3.5 ORGANISATION FIT FOR THE FUTURE 


The ‘Organisation Fit for the Future’ theme in the SNBTS Strategy is concerned with those 

functions that support front line delivery. In an organisation like SNBTS, which is driven by 

the collection of a raw material (blood or tissue) and processing it to a product for issue, the 

distinction between front line and support is often blurred, especially in areas such as 

logistics, IT and quality. For this reason, some of the support functions and their impact on 

the Service are contained in previous sections of this document. 

Each of the support functions is committed to delivering a quality, professional service that 

is focussed on operational business needs and priorities yet is flexible enough and 

adaptable to accommodate changing requirements. However, it is imperative that there is 

a robust mechanism for service planning and prioritisation of business requirements to 

enable the support functions to deliver a focussed, value added service and avoid the 

adoption of solutions that are fragmented, crisis-driven and sub-optimal in the long term. 

3.5.2 Supporting Effective, Efficient and Safe Transfusion Practice 

The Better Blood Transfusion Programme and Effective Use of Blood (EUB) initiatives have 

significantly improved the quality of the clinical transfusion processes across Scotland and 

in the process reduced the demand for blood. In order to maintain these advances, the 

initiatives made by BBT/EUB in, for example, the development of educational materials, 

training programmes, clinical blood audit and support for hospital transfusion committees, 

will become an integral part of the work of the Clinical Directorate. 

3.5.3 Ensuring Resilience and Compliance with cGMP and Clinical Standards 

The key regulatory objective is to ensure that all SNBTS operations remain compliant with 

all relevant legislation. In the last few years, the regulatory expectations placed on SNBTS 

have increased and this has been reflected in a wider range of regulatory inspections by 

various inspection bodies, e.g. MHRA, HTA, CPA and in future this will be expanded to 

include JACIE (a body concerned with standards for Stem Cells). Not only is the range of 

regulatory requirements increasing, the intensity of inspection is also increasing. In 

response to this increase of regulatory demands, the role of the Quality Directorate has 

broadened and expanded. The greater expectations placed on our Quality professionals 

has resulted in an increase in our establishment from 60 to 70.5 WTE. 

3.5.3.1 Expansion of Expertise 

Through the Workforce Plan, attention will be given to expanding and developing the skills 

mix in the current Quality Directorate team to ensure that there is a broad awareness of 

practice in the pharmaceutical industry and the operation of an effective, modern Quality 

Management System (QMS). Where required, external expertise and consultancy will be 

used to ensure that our QMS is state-of- the-art. 

3.5.3.2 Provision of Quality Support 

Currently, QMS support is largely provided on a geographical basis, with some support from 

the head office team. The intention is to move to provision of quality management on a 

functional basis by appointing senior quality managers as support for each of the main 

functional directorates (Supply Chain and Clinical). This will prepare the organisation for the 

implications of the planned Property Strategy, when the manufacturing and clinical functions 

will be located in separate buildings, which are geographically distinct. 


In addition to the provision of widespread quality support within SNBTS, there will be closer 

links with other parts of NSS (e.g. facilities, IM&T and procurement). This will ensure that 

QMS support is provided and delivered to those parts of the wider NSS organisation which 

provide SNBTS with key services and therefore are subject to regulatory scrutiny. 

3.5.3.3 Development of Quality Support to NHSScotland 

SNBTS is already delivering a significant service to non-SNBTS blood banks in support of 

their requirement to comply with the UK BSQR. This new requirement commenced in 2005 

and is imposing great demands on Hospital Blood banks who have no previous experience 

of formal regulatory scrutiny. SNBTS has arranged audits of the QMS operated in some 

blood banks and have assisted blood banks in preparing for MHRA inspections. This 

process will continue and expand, with closer partnerships being formed with relevant 

hospital and laboratory management throughout Scotland. 

3.5.4 Investing in High Impact Science that Benefits Patients 

The Culyer review of Research in the NHS commenced in 1995 and in Scotland was taken 

forward through the Chief Scientists Office. It was recognised then that SNBTS conducted 

Research and Development of products and processes that required integration and were 

important to the delivery of blood safety and should not be left to a reliance on the grant 

funding mechanism. SNBTS forward planning for the Research and Development 

Directorate calls for investing in high impact science. This applies to both the delivery of 

direct service needs and in high impact areas that are currently relevant to SNBTS and 

attracting high levels of Grant Support. SNBTS uses grant support to leverage its Science 

base. Up to half of all SNBTS research funding comes from externally awarded grants, 

often on three year cycles, and this will continue. The intent is to focus the work of this 

directorate in two main theme groups in support of clinical delivery (including tissues and 

cells) and processing and testing (including donation). This approach was set out in the 

latest R&D four-year plan, which was agreed with our external Research Advisory Group in 

January 2008. 

Work in support of clinical delivery will continue to focus on regenerative medicine and 

tissue services, making use of SNBTS skills in GMP and cell/tissue therapy to assess and 

deliver novel therapies such as islet cell transplantation for treatment of diabetes or cell 

therapy for the treatment of post-transplantation virus infections. SNBTS has recently 

received funding from the Welcome Trust to attempt to develop blood cells in culture, which 

if successful, would revolutionise transfusion practice. Work undertaken will also ensure 

that our diagnostic services remain state-of-the art (e.g. pre-natal assays of blood groups on 

mothers’ blood samples to enable more cost effective prevention of haemolytic disease of 

the new born). 

Work in support of processing and testing will ensure that SNBTS maintains a strong 

presence in the development of assays designed to ensure the safety of blood (virus 

confirmatory assays, development of vCJD confirmatory assays), as well as processing 

developments intended to improve the safety or utility of blood and tissue components. 

To achieve this, requires an appropriately skilled workforce working on projects relevant to 

the organisation with sufficient resource and links to other research groups to ensure the 

work will have high impact. 

This impact is demonstrably beneficial to other aspects of the NHS Scotland and Scotland’s 

economy. R&D works closely with Scottish Higher Educational Institutes to secure external 

grant and commercial funding in areas of mutual interest. By taking this collaborative 

approach, SNBTS is remarkably successful for its size - recent examples include 

involvement in the new MRC Centre for Regenerative Medicine in Edinburgh, the Paul 


O'Gorman Leukaemia Research Centre in Glasgow and funding from the Welcome Trust, 

the European Union and Scottish Enterprise, inter alia, for work on novel cell- and immunotherapies. 

Skills arising form such joint working have supported innovative companies in Scotland 

such as BioScot, Alba BioScience and Roslin Cells and have also facilitated educational 

initiatives aimed at maintaining the skills of the Scottish workforce such as a BSc course at 

Strathclyde University, MSc course at Edinburgh University and training of medical students 

in Glasgow, Edinburgh and Aberdeen. Finally, SNBTS has generated considerable income 

from the licensing of intellectual property and technology arising from its R&D programme. 

3.5.4.1 Developments and Benefits 

The move to two theme groups will provide focussed, high quality support: in the following 

areas: 

Clinical & Tissues 

• Developing, trialling and providing existing and novel cell and tissue therapies within 

GMP facilities; 

• Cell and tissue matching and; 

• Assessing and validating new diagnostic screening and confirmatory assays. 

Processing and Testing 

• Assessing options in terms of component pathogen reduction; 

• Ensuring methods for the removal and assay of prions are assessed; 

• Undertaking basic research and providing reference facilities to ensure that methods for 

screening for emerging and existing transfusion transmitted infections are available 

when needed and that the epidemiology of infections of concern is understood; 

• Supplying library and teaching support to enable life long learning and; 

• Supporting further training initiatives such as the Edinburgh University MSc. 

3.5.4.2 Location of R&D Activities 

The cell therapy group will remain in academic centres of excellence in Glasgow and 

Edinburgh and potentially in Aberdeen, although support for tissues and GMP cell therapy 

development will require a presence of some of this group alongside the proposed new 

National Centre. 

For component development and virus reference work, proximity to the new National 

Centre is required. Basic research would ideally be carried out close to academic groups 

with similar interests, however as SNBTS has been unsuccessful in identifying suitable 

sites close to any relevant academic groups, the preferred option is also to co-locate these 

parts of R&D in the new National Centre. Academic links will be maintained by developing 

joint working through provision of sponsorship for joint studentships. Hence, three of the 

current theme groups will come together on one site to support processing and testing 

activities. 

The other current theme group is immunohaematology, whose work falls into two current 

areas of activity; reference work on red cells and white cell diagnostic work (which could 

either remain in R&D or become a reference laboratory for the Clinical Directorate, possibly 

in Aberdeen) and developing alternative therapies and diagnostics for clinical conditions 

that make use of the resource of transfusion services. This includes the work on peptide 

analogs of blood groups for use in tolerising patients that otherwise might develop 

antibodies and use of such analogs as an alternative to red cells in diagnostic assays for 

such antibodies. This work could either form the basis of a ‘spin out’ commercialisation or 

be incorporated into the P&T theme group. 


3.5.4.3 Staffing 

The age profile of the current R&D staff is such that a number of retirals at senior level are 

expected over the next five years. Mitigating actions to deal with this envisage clear and 

robust succession planning; increasing career enhancement, training and development 

opportunities available for staff; developing current mid-grade staff as leaders of the future 

and recruitment of new students and post-doctoral fellows. 

3.5.5 e-Health and Improving Service Performance 

Over the last three years much effort and investment has gone into the stabilisation of 

critical applications used by SNBTS. Due to the age of some of the technology and systems 

involved, they will not sustain business requirements into the future consequently they will 

be renewed in line with the Corporate IM&T Strategy. 

3.5.5.1 From Stability to Sustainability 

SNBTS plans to move forward with the implementation of modern systems on modern 

platforms, allowing flexibility to introduce business change with less effort in terms of 

resources required than is currently possible. This Strategy is fully aligned with the NSS 

corporate IM&T Strategy, built on the principles of consistent technologies, modern systems 

and joined up information. This will provide an agile IT environment that can support 

change and provide stable and sustainable systems in the organisation that are fit for the 

future and will facilitate involvement of SNBTS in a range of e-health initiatives. 

3.5.5.2 Enabling Improvements in Service Delivery 

(a) Provide safe and secure IT systems in support of efficient blood and tissue management. 

Information technology supports efficient blood and tissue management, being integrated 

into many of the service developments and initiatives within the Strategy, e.g. blood 

express, donor relationship management, traceability and quality management systems. 

The overarching Core System Replacement Programme (CSRP) incorporates multiple 

related projects that will improve technical platforms aligned to the broader NHSScotland e- 

health infrastructure strategy, supporting systems to provide additional business 

functionality across all areas of the Service. SNBTS will engage with the wider 

NHSScotland to explore the benefits and opportunities that would arise from a wider 

implementation of the Traceline Clinical Blood Banking system and to what extent 

interoperability with other hospital systems could be exploited to enhance patient safety and 

exchange information. Technical solutions to support the standardisation and streamlining 

of the interface between SNBTS and its customers in the areas of manufacturing and 

testing, ordering of blood, issue and inventory management and control will be sought. 

These solutions will reduce costs, waste and increase efficiency for SNBTS and 

NHSScotland. 

(b) Provide efficient and effective IT tools for the management of donors 

Closely related to and with dependencies on the CSRP, it is planned to provide efficient 

and effective IT tools that will support improvements in donor relationship and session 

management including, developments in user interactive technologies e.g. home DSR, 

health checks, session selection and registration, session planning and queue 

management. 

(c) Interaction with NSS Corporate business systems 

Another major area for development is information services. The current operational 

systems hold a vast amount of data on donor, patient and blood usage that could provide 

valuable information on to help predict future services requirements. These data also have 

the potential to show how current processes are performing and where improvements can 

be made. The SNBTS National Information Services Department aim to support the 


availability of such data to provide information management solutions including e.g. 

‘Account for Blood’ and ‘Corporate Data Warehouse’, to support and inform service 

decisions and benefit patients in Scotland. 


4. MANAGING CHANGE IN THE WORKFORCE 

4.1 INTRODUCTION 

SNBTS has developed this Strategic Development Plan to ensure it can continue to meet 

the transfusion needs of patients in Scotland with high quality products and services and in 

full compliance with all regulatory and accreditation requirements. It has been developed in 

Partnership, refined following extensive engagement, consultation with staff and 

stakeholders, and sets out the route map by which we will introduce new safety measures 

and modernise the organisation over the next five years. 

SNBTS recognises that staff are its biggest asset and absolutely key to delivering our 

strategic aims. As will be clear from this document, we have identified multiple changes 

that will impact on staff: 

• Increasing numbers of staff to deliver new blood and tissue safety initiatives; 

• Increasing numbers of staff to cope with significant increases in workload; 

• Increasing numbers of staff to deliver improvements in test/process quality; 

• Increased development needs for staff to deliver new or expanded services/ roles and 

develop their potential; 

• Potential changes to staff reporting lines; 

• Introduction of working to nationally agreed protocols; 

• Delivery of rationalised specialist services; 

• Potential changes to working hours and other terms and conditions; 

• Agenda for Change on-call and unsocial hours arrangements; 

• Changing policy around registration of healthcare workers; 

• Changes to place of work; and 

• Reduction in staff required as a result of consolidation and more efficient ways of 

working. 

We have set out what we believe is an extremely ambitious and challenging agenda and 

will take every opportunity to facilitate its delivery by working in partnership with staff side 

and with our staff. 

4.2 WORKFORCE PLANNING 

4.2.1 Governing Principles 

The Strategy represents a major change programme, which will be progressed in 

Partnership within the full range of NSS and NHSScotland policies including: 

• Staff Governance Standard. 

• Better Health Better Care. 

• NHS Organisational Change Policy. 

• NSS Policies and Procedures. 

• NHS and NSS Training and Development Strategies. 

• NSS Workforce Strategy. 

• Diversity and Discrimination Act. 

• NSS Nursing Strategy. 


Making use of the following resources and guidance: 

• Personal development planning and delivery via e-KSF; 

• NSS Learning Centre; 

• NSS Leadership Development programme and Leadership Academy. 

SNBTS will ensure there are effective Partnership structures in place with sufficient time 

and resource available for managers, trades union representatives and staff to deliver 

successful outcomes. SNBTS will also need considerable support from NSS Corporate 

Services (especially HR, OD and Estates) to deliver the Strategy. 

4.2.2 Analysis of Current Workforce 

High-level analysis shows that in 2008, the workforce was 68% female and 32% male. 

With regard to age distribution, the high level breakdown is shown below. Additional detail 

is awaited from NSS OD, however, the high level analysis shows that >55% of the SNBTS 

workforce is > 45 years old, some 20% is >55 years old and only 19% is

4.2.3 Recruitment Challenges 

Challenges are already being experienced in the recruitment of medical, nursing and 

biomedical scientist (BMS) roles. It is likely that SNBTS will replace some medical roles 

with nurse consultant and consultant clinical scientists. Nurse led apheresis will become 

normal practice, releasing medical staff to use their skills to better effect. Consideration will 

be given to the use of non-BMS Science graduates in processing and testing roles. 

4.2.4 Future Workforce Needs 

Workforce changes that can be predicted, have been set out in the strategic themes. Other 

changes will only become clear after pilot exercises have been completed and outcomes 

reviewed. Where strategy implementation necessitates new roles, skills and/or 

responsibilities, the key skills and competencies will be developed to ensure operational 

requirements can be delivered in a way that provides value for money and development 

opportunities for staff. 

4.2.5 Future Operational Needs 

The Strategy describes the major operational and strategic changes SNBTS will deliver 

over the next five years. These will improve process, service and product safety, build in 

regulatory compliance, renew our estate and modernise the Service. This will affect almost 

all SNBTS staff and the Workforce Plan will ensure that all staff have the opportunity to 

maximise the contribution they can make to deliver this agenda. 

In executing the Strategy, the challenge of delivering effective and compliant business as 

usual operations, mandated blood safety measures, service improvements, preparing for 

the commissioning and validation of the National Centre and, ultimately, relocating will place 

a significant burden on staff. The Workforce Plan will address how that burden can be 

minimised by providing timely and appropriate development opportunities for staff and 

increasing the contribution individuals can make to our organisation. Clearly, this will 

dovetail with activity and workforce demographics and will include: 

• Career Transition Opportunities - where staff will have access to training and 

development opportunities that will broaden their skill base into different areas; 

• Enhancing our Leadership Capacity - identifying leadership opportunities arising from 

our Strategy and anticipated business/workforce changes and encouraging staff to seek 

leadership development. This will include the development of a robust succession plan; 

• Training and Development - SNBTS will ensure that through e-KSF processes, all 

staff receive the training and development they need to support their personal 

development and deliver this Strategy; 

• OD and Support During Change - it is envisaged that a range of support mechanisms 

and services will be offered to staff through the Workforce Support Programme and OD 

Plans; 

• Healthy Working Lives - ensure that support and opportunities are provided to enable 

individuals to maximise their contribution whilst optimising their well being; 


• Diversity and Equality - ensure there is no discrimination and actions are taken to 

ensure there is equality across all areas of recruitment, retention, promotion, training, 

capability, grievances and discipline; 

• Organisational Change - NSS has a clear and comprehensive policy on organisational 

change, which will be used to guide implementation. This provides clear guidance on 

issues such as - recruitment of staff into new roles; identification of posts continuing 

under business continuity; relocation of staff to new places of work; identification of 

training and development requirements; and redeployment of staff into other areas of 

SNBTS/NSS. 

4.3 WORKFORCE PROJECTION 

The indicative anticipated impact on staff numbers across SNBTS of the developments 

proposed in the Strategy related to service modernisation and mandatory safety measures 

are shown below as increases (+) or decreases (-) in Whole Time Equivalents. 

Current 2009/10 wte 2010/11 wte 2011/12 wte 2012/13 wte 2013/14 wte Total 

Function wte Head Mod Safe Mod Safe Mod Safe Mod Safe Mod Safe wte 

Count 

Donor Services 302 482 +3.5 +14 +26.5 -2.5 -4 339.5 

Processing & Testing 159.5 162 +8.5 +27 +4 +33 -48 184 

Logistics 44.5 46 44.5 

Clinical Directorate 222 251 +5 +2 +9 +1 +4 +4 +1 248 

(inc BBTP) 

Tissue Services 32.5 35 +7 +1 40.5 

Quality (Inc Engineering) 67 71 -4 63 

R&D (Inc PTU) 54.5 56 -1 -1 -2 -2 48.5 

Head Office 12.5 14 12.5 

Finance & Procurement 27.5 28 27.5 

NISD 16 16 +2 +2 20 

Total 938 1161 +17.5 +25.5 +10 +54.5 +3 +1.5 +2 +29 -53 0 1028 

Notes 

i) Staff figures will be validated as part of the establishment of a Workforce Plan. 

ii) 

The reductions in numbers shown in 2013/14 arise from moving into a new National 

Centre. These will be considered and agreed in Partnership as this plan and the 

SNBTS Property Strategy are developed. 


5. FINANCIAL SUMMARY 

5.1 FUNDING THE BLOOD SUPPLY 

Resources will play a fundamental part of the strategy implementation as new technology is 

introduced and significant organisational change is undertaken to deliver longer-term 

efficiencies and continue to meet changing patient needs. Our challenge for the future is to 

ensure the provision of SNBTS services, maintaining and enhancing safety and quality of 

products and services, whilst at the same time achieving financial sustainability. 

5.1.1 Current Position 

SNBTS has had the lowest cost per unit of blood in the UK. However, the unit cost of red 

cells has, in common with other UK services, risen significantly over the last five years, 

mainly as a result of the introduction of mandatory, often expensive, blood safety 

requirements. As far as possible, SNBTS is committed to mitigating future rises in the cost 

of red cells through the development of more cost efficient and ‘lean’ working practices, and 

improved cost effective procurement, whilst ensuring the continuity and safety of the supply 

of blood and tissues. 

5.1.2 Future Pressures 

SNBTS is facing an unprecedented set of challenges now and over the near term that will 

require robust long term financial and service planning. As a division of NSS and in 

common with territorial Health Boards, we can expect to receive smaller funding increases 

over the next three years, whilst at the same time, will be expected to deliver increased, 

cash releasing efficiency savings. Over the period of this Strategy there are a number of 

safety and quality initiatives which will continue to tighten supply and increase the cost 

base, and when taken with Government spending and efficiency programmes, present 

significant challenge to securing funding to facilitate the timely introduction of safety 

measures. 

(a) Anticipated mandatory blood safety measures 

Known blood safety measures pending instruction to proceed, include the move to 100% 

apheresis platelets, pathogen reduction of platelets, prion filtration of red cells and the 

introduction of a vCJD test. The anticipated indicative full annual cost of these safety 

measures amount to almost £18m. In order to ensure and enable deployment of these and 

future safety measures, SNBTS needs to undertake a programme of modernisation, some 

aspects of which have already commenced and have received funding support from NSS 

reserves. Further developments will be required over the course of this Strategy to 

facilitate business as usual and the modernisation agenda and these are expected to 

continue to be funded through NSS uplift. It is envisaged that where mandated blood and 

safety measures cannot reasonably be funded by NSS, they will be funded directly by 

SGHD. 

(b) Cross Charging 

Most blood services in the developed world operate on a cost recovery system to fund the 

blood supply. The cross-charging mechanisms in use by other blood services vary in their 

complexity but mostly operate on a unit price basis, which develops the link between 

funding and levels of blood usage. It is SNBTS’ desire to consider such an approach and 

develop a flexible financial mechanism, such that it clearly links activity to cost. To this end, 

during the Strategy process SNBTS will engage with stakeholders to explore and evaluate 

options for an appropriate cross charging model for blood components, tissues, cells and 


services as a way of funding strategic developments in SNBTS and enable the rapid 

introduction of safety measures. 

5.2 SUMMARY FORECAST 

The financial forecast has been built up incorporating known commitments and well 

advanced development proposals. However, in the absence of detail, it does not yet 

include the fully profiled financial impact of all strategic developments. In particular, the 

financial impact of the introduction of pathogen reduction for red cells has been excluded at 

present and whilst it is not anticipated to impact until 2013/14 at the earliest, the costs will 

be significant. 

At present the model presented is a framework on which to build the more detailed financial 

impact resulting from the strategy development work, as it crystallises and as business 

cases are developed. 

In line with planning guidance, the table below outlines a breakeven position based on the 

assumption that 2% savings per annum will be deliverable and that SGHD will normally 

fund these new safety measures which may be mandated over the period of the Strategy, 

but could not reasonably be funded within the NSS funding envelope. It is assumed that 

as far as possible, NSS resources will support modernisation and development of the 

Service. 

REVENUE PLAN 2009/10 2010/11 2011/12 2012/13 2013/14 

£000 £000 £000 £000 £000 

EXPENDITURE 

Modernisation/Business as Usual 

Pay 38,578 39,352 40,392 41,968 43,229 

Non-Pay 20,814 19,873 20,668 21,666 22,661 


Savings Plan (943) (1,984) (3,056) (4,167) (5,318) 

Total NSS Funded 62,857 61,649 62,412 63,876 64,980 


Pay 1,112 3,178 4,287 4,287 4,287 

Non-Pay 3,448 11,956 13,953 13,650 13,650 

Total SGHD Funded 4,560 15,134 18,240 17,937 17,937 

Total Expenditure 67,417 76,783 80,652 81,812 82,917 

INCOME/FUNDING SOURCES 

Baseline incl inflation uplift 54,169 53,618 55,528 57,563 59,664 

Savings Plan (943) (1,984) (3,056) (4,167) (5,318) 


Additional Allocation - NSS 1,642 2,026 1,951 2,490 2,645 

NHS SLA Income 2,618 2,618 2,618 2,618 2,618 

Third Party Income 964 964 964 964 964 

Total NSS Income 62,857 61,649 62,412 63,876 64,980 

Total SGHD Income 4,560 15,134 18,240 17,937 17,937 

Total Income 67,417 76,783 80,652 81,812 82,917 

Surplus/(Deficit) 0 0 0 0 0 

The elements of funding required from NSS to resource modernisation and business as 

usual is further analysed in the review of the baseline. 


5.3 BASELINE ANALYSIS – REVIEW OF FUNDING REQUIREMENT 

A breakdown of the baseline is tabulated below showing, on a cumulative basis, the 

additional uplift required to fund inflation and deliver both anticipated blood safety 

measures and business as usual objectives (excluding the impact of a consolidated 

national site and pathogen reduction of red cells). 

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 

£000 £000 £000 £000 £000 £000 

Baseline 49,174 50,667 50,667 50,667 50,667 50,667 

FYE 08/09 developments 1,493 

One-off commitments 2,119 - - - - 

Inflation 1,383 2,951 4,861 6,896 8,997 

Additional Allocations 

NSS Reserves - Modernisation 1,642 2,026 1,951 2,490 2,645 

SGHD - Safety Measures 4,560 15,134 18,240 17,937 17,937 

Revised Baseline 50,667 60,371 70,777 75,718 77,990 80,245 

Movement 9,704 10,406 4,941 2,271 2,256 

%Uplift 19.2% 17.2% 7.0% 3.0% 2.9% 

CAGR 9.6% 

NSS Impact 

NSS Funded Baseline 50,667 55,811 55,643 57,479 60,053 62,309 

Movement 5,144 - 167 1,835 2,574 2,256 

%Uplift 10.2% -0.3% 3.3% 4.5% 3.8% 

CAGR 4.2% 

Over the period of the plan the increase on 2008/09 baseline is £29.6m, which equates to a 

Compound Annual Growth Rate (CAGR) of 9.6%. This assumes that costs of 

modernisation to enable the implementation of future safety measures will be funded 

through NSS uplift, whereas the full costs of safety measures will normally be funded by 

SGHD where these could not reasonably be funded within the NSS funding envelope. The 

impact on NSS of funding developments, business as usual and inflation is an increased 

recurring revenue requirement of £11.6m by 2013/14, an equivalent CAGR of 4.2%. 

5.4 BREAKDOWN OF ADDITIONAL ALLOCATIONS 


2009/10 

£000 

2010/11 

£000 

2011/12 

£000 

2012/13 

£000 

2013/14 

£000 

Move to Universal Apheresis Platelets 1,562 1,783 3,139 2,836 2,836 

Pathogen Inactivation of Platelets 343 1,370 1,370 1,370 1,370 

Prion Filtration of Red Cells 2,525 10,100 10,100 10,100 10,100 

vCJD Test - 1,750 3,500 3,500 3,500 

Pathogen Inactivation of Red Cells 

NYK 

Total 4,429 15,003 18,109 17,806 17,806 

Distinction Awards 131 131 131 131 131 

SGHD Funding Requirement 4,560 15,134 18,240 17,937 17,937 

Modernisation - Business As Usual 

Enough Blood for Patients 679 655 660 1,008 1,104 

Facilities for the Future 241 198 198 198 198 

Sustainable Tissue Services 26 38 50 74 98 

Services for Patients 465 705 774 911 945 

Organisation Fit for the Future 230 430 270 300 300 

NSS Funding Requirement 1,642 2,026 1,951 2,490 2,645 


5.5 CAPITAL INVESTMENT 

Over the period of this Strategy there is a need for modest capital investment to support 

modernisation objectives and maintain rolling equipment replacement and renewal 

programmes. However, significant investment of an estimated £35m is required towards 

the end of the plan to deliver the proposed new National Centre for SNBTS. Whilst there 

are interim revenue costs to perform planned maintenance of the current estate, the option 

appraisal for the new National Centre demonstrates the potential to achieve recurring 

savings in property related revenue costs, estimated at around £0.5m, once the site is fully 

operational. This is largely due to efficiencies leveraged on hard FM, primarily energy 

costs, coupled with the release of existing costs upon the sale of Ellen’s Glen Road and 

transfer to Health Boards of surplus property. 

Note: Costs for the New National Centre will be phased over the life of the construction works and 

Capital Investment Plan 2009/10 2010/11 2011/12 2012/13 2013/14 

£000 £000 £000 £000 £000 

New National Centre 940 35,150 

Anticipated Mandatory Safety Measures 605 466 

Total SGHD 605 - 1,406 35,150 - 

Modernisation 750 187 90 

Rolling Replacement/Maintenance 1,368 1,388 1,007 704 810 

Total NSS 2,118 1,575 1,097 704 810 

Total 2,723 1,575 2,503 35,854 810 

treated as an asset under construction until the building is completed and the asset is capitalised 

which is expected towards the end of 2012/13. 

5.6 KEY FINANCIAL ASSUMPTIONS AND RISKS 

• Assumes funding will transfer for plasma products and any residual cost pressures will 

be met by NSS outwith SNBTS core budget. 

• Inflation uplift has been applied at a rate of 2.45% in respect of pay and 2.75% for nonpay 

in accordance with current planning guidance. 

• Over the next three years uplift expected to be 3.15% with further 2% savings target 

available for reinvestment. 

• The new national site is assumed cost neutral on revenue over the period of this plan 

with resource savings anticipated once fully operational. 

• The costs for prion filtration are in respect of 100% of red cells with implementation 

forecast for the last quarter of 2009/10 but may be sooner as, once instructed, we will 

be expected to implement rapidly. Filters account for £8.7m of the £10.1m and the 

price is based on current estimated UK volumes. If not all of the UK introduces at 100% 

level, this will likely impact on the filter price and potentially increase the financial 

exposure by c£6m for Scotland to introduce universal prion filtration in isolation. 

Costings are based on the need to filter 240,000 red cell units. 

• The scale up of apheresis platelet issues to 100% has been included at current 

estimates based on achievement via a staging post of 80% and assumes a new fixed 

site centre in 2011/12. Costs incorporated in 2009/10 are phased based on a 

commencement date around July 2009. 

• Estimated consumable costs for pathogen reduction of platelets assume a reduction on 

list price once through tender processes. If this were not achievable the annual costs 


would rise to £1.7m (this includes savings arising from discontinuation of platelet 

irradiation, BacTAlert and CMV test). Assumed introduction in last quarter of 2009/10 

but this is subject to variation dependent on an instruction to implement. 

• Assumption that will introduce vCJD testing as soon as feasible, for the purposes of this 

plan estimated mid 2010 but possibly sooner. Costs shown are a broad estimate for 

the test costs themselves (£2m) with a more robust staffing resource plan (£1.5m). It is 

highly likely that staffing costs will reduce by £0.5m to £0.6m after 2 years due to less 

lookback activity, fewer confirmatory tests and less donor counselling at sessions. 


6. EQUALITY & DIVERSITY 

Within the overall NSS Equality and Diversity Policies, SNBTS aims to be a leading 

organisation for promoting equal opportunities, as well as meeting the equality duties 

required by legislation. The Strategy will be impact-assessed using the NSS Equality & 

Diversity Impact Assessment procedure, in order to determine what actions are needed to 

ensure that there is no discrimination across the six strands of Equality and Diversity (Age, 

Disability, Faith/Belief, Gender, Race and Sexual Orientation). 

The Strategy will also be determined through full consultation and inclusion with all 

communities in Scotland who are served by SNBTS’s operations. 

7. RISKS 

The Strategy Project Team has identified the risks to the delivery of the Strategy and has 

agreed the mitigating actions that will be used to manage the risks. These are located in 

the Project Risk Register, which is held within the Project Library. 

The key risks are summarised below: 

Key Risk Issues Risk 

Score 

Mitigating Actions 

Revised 

Score 

Failure to maintain 

sufficient supplies of 

Blood and Tissues 

to meet the needs of 

patients in Scotland. 

Need to rebuild the active 

blood donor base to cope 

with public lifestyle and 

attitudinal changes and the 

adverse impact of vCJD test. 

12 

AMBER 

Deploying integrated Publicity and 

Marketing Campaign. Decline halted 

rebuild underway. 

Undertake research into the impact of 

vCJD test on donors. 

Closely monitor test developments 

Develop confirmatory assay 

Make better use of the donor’s gift 

6 

GREEN 

Need to modernise the 

Blood Collection Programme 

to better meet the needs of 

donors. 

12 

AMBER 

A number of partnership working groups 

are developing options for change that will 

allow us to Transform the donation 

experience to make it more accessible and 

rewarding. 

6 

GREEN 

Need to deliver increased 

tissue donation via the 

cadaveric programme. 

12 

AMBER 

Increased liaison with pathologists 

Develop Tissue Services retrieval teams 

6 

GREEN 

Failure to Keep 

Blood and Tissue 

Supplies Safe. 

Need to ensure effective 

surveillance systems are in 

place to identify candidate 

blood and tissue safety 

measures. 

12 

AMBER 

Active contribution to SaBTO and UKBTS 

JPAC. 

Active contribution to evaluation of new 

blood and tissue safety measures. 

Develop implementation plans and identify 

associated funding requirements. 

Implement new Blood and Tissue safety 

measures as instructed. 

Maintain compliance with continually 

developing QMS. 

6 

GREEN 

Failure to maintain 

MHRA and/ or HTA 

licenses 

Premises currently used for 

Processing, Testing and 

storage of Blood and 

Tissues do not meet 

ESTATECODE standards 

and will not meet future 

regulatory requirements. 

Implementation of new 

safety measures will 

16 

RED 

Create a compelling Business Case that 

sets out the business imperatives for the 

creation of new, future proofed 

accommodation and describes the 

resulting opportunities for increased 

efficiency. 

Secure the support of regulators that new 

tests and processes can be satisfactorily 

accommodated within existing space on a 

6 

GREEN 


exacerbate this position. 

temporary basis. 

Failure to secure 

funding to support 

the Business 

Strategy and its 

associated Property 

requirements. 

Against an extremely 

challenging financial 

situation, this plan proposes 

additional revenue funds of 

£18m for blood and tissue 

safety (SGHD), and £35m 

capital from CIG (SGHD). 

16 

RED 

SGHD will determine whether mandatory 

blood and tissue safety measures are 

implemented. 

SNBTS will endeavour to keep service 

modernisation costs to a minimum but 

NSS/ SNBTS will need to determine 

funding priorities. 

Create a compelling business case for the 

Property needs of the Strategy 

12 

AMBER 

Failure to implement 

the Plan because of 

conflicts with other 

business critical 

initiatives 

SNBTS faces multiple 

challenges: 

• Maintaining licenses and 

BAU 

• Implementing new safety 

measures, systems and 

services 

• Implementing Corporate 

initiatives 

• Developing plans to 

deliver the Strategy 

• Developing the workforce 

to deliver the strategy 

16 

RED 

Rigorously prioritise workload 

Continuously monitor performance 

Develop a comprehensive Workforce Plan 

Enhance partnership working 

Use Corporate NSS Support 

However if too many safety initiatives are 

required for overlapping implementation, 

delays to the modernisation and service 

improvement are inevitable as meeting 

current needs and implementing safety 

measures will take priority 

12 

AMBER 

8. COMMUNICATIONS STRATEGY 

As significant structural and operational changes will be progressed in Partnership, it is 

important that SNBTS is focussed on both staff needs as well as stakeholder 

communications. There is also continued media interest in the organisation, therefore a 

proactive and positive approach to building relationships with media contacts must continue 

to be a priority for SNBTS, particularly during the life of the Strategy. 

Appendix I sets out the Strategy Communication Plan 2009 – 2014

pdf SNBTS Strategy - Scottish National Blood Transfusion Service

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