NHS Blood and Transplant

NHS Blood and Transplant (NHSBT) is responsible for the supply of blood, organs, tissues and stem cells. It collects and supplies blood to hospitals in England and is the organ donation organisation for the UK. NHSBT is a special health authority, sponsored by the Department of Health and Social Care.

Not all activities undertaken by NHSBT are regulated by CQC, for example, laboratories where blood donations are processed into components, tested, stored and distributed. This is because these activities do not involve direct contact with donors or patients. The Medicines and Healthcare products Regulatory Agency (MHRA) also regulate NHSBT which includes the manufacture of medicinal products for example, medicinal blood components like albumin and platelets.

This is the first inspection of this service. This was a reactive focussed inspection but was not rated as CQC does not have a duty to apply ratings to NHS Blood and Transplant.

We carried out this short notice, announced, reactive, focused inspection at NHS Blood and Transplant (NHSBT) to undertake an assessment of how well led this organisation is.

We took this approach because we had received information giving us concerns about the culture within the organisation and unacceptable behaviours at a very senior leadership level. This can have an impact on the quality and safety of any service.

In June 2022 we inspected the well-led key question for the provider overall.

In August we inspected Birmingham, Bristol, Gloucester, Oxford and Plymouth donor centres based on concerns we had following our well led inspection. These were focused inspections where we looked at some aspects of safe, effective, caring and well led.

This was the first inspection of the Birmingham, Bristol and Gloucester donor centres. Oxford and Plymouth donor centres were last inspected in February 2014.

In August 2022 we inspected Bristol Therapeutic Apheresis Unit and Oxford Therapeutic Apheresis Unit; based on concerns we had following our well led inspection. These were focused inspections where we looked at some aspects of safe, effective, caring and well led.

This was the first inspection of the Oxford and Bristol Apheresis Units. Our inspections of both NHS and independent health organisations have shown a strong link between the quality of overall management of an organisation and the quality of its services. For that reason, in this circumstance, we looked at the quality of leadership at assistant director level and above.

We also looked at how well NHS Blood and Transplant managed the governance of its services.

Our findings are as follows;

• Staff were proud to work in the organisation, people told us that “we save and improve lives”, it was a mantra that staff believed in and one we heard consistently.
• All of the people we spoke with demonstrated both a personal and organisational commitment to provide high-quality services.
• The board and executive leadership team had a vision and set of values that were at the heart of the work within the organisation. They had worked to ensure staff at all levels understood them in relation to their daily roles.
• The organisational strategy was directly linked to the vision and values of the organisation. The organisation involved staff at all levels, donors and groups from regional and local communities in the development of the strategy and from this had a clear five-year plan.
• The organisation had a structure for overseeing performance, quality and risk, and improvements had been identified and were being enacted.
• The board reviewed performance reports that included data about the services.
• The organisation made sure that it included and communicated with donors, staff, the public, and local organisations. It supported the divisions to engage with the organisations communication and engagement strategies and encouraged staff to get involved with projects affecting the priorities of the organisation.
• The organisation had maintained a safe service during the pandemic. Staff had contributed to decision-making and changes to routines to help avoid pressures from the pandemic compromising the service provision.

However:

• The organisation had experienced significantly high turnover in the senior leadership team.
• We saw some silo working. This meant, potentially those working and leading those areas may not have oversight of issues facing the service and those who rely on its products. Furthermore, this may impact in levels of responsiveness when services needed more support.
• Recruitment processes and records were poor with a lack of scrutiny, resulting in the required employment checks not being undertaken for those employed at executive level. Where checks had been completed for some executives, these had only been undertaken at initial recruitment and not annually. This did not meet the requirements of the Fit and Proper Person Regulation.
• Some staff did not have confidence in HR processes and provided examples of the organisation’s policies in relation to recruitment and selection and staff grievance procedures not being followed.
• The induction staff received did not equip them with the knowledge required to integrate them into the organisation. Some donor centres were not meeting the provider’s targets for appraisals.
• Not all staff at the donor centres were meeting their target for safeguarding level 2 training.
• Some staff told us of poor experiences at work. This included fear of reprisal and discrimination.
• Board members recognised that they had work to do to improve diversity and equality across the organisation and at board level.
• There was not an effective overarching equality, diversity and inclusion strategy in place. There had been some work on equality, diversity and inclusion within the organisation, including the development of divisional strategies, but this work had not led to meaningful improvements.
• We heard from staff, employed at various levels within the organisation that some leaders were not approachable, some staff experienced fear, many did not feel respected, valued or supported, and we heard that some staff were bullied and harassed by leadership.
• Staff felt some senior staff above regional level were not visible, this included members of the board.
• There were mechanisms for people to raise concerns, but these were not as effective as they could be.
• The provider had a risk register to document their risks at the donor centres, however, these did not include any actions to minimise these or how long they had been on the register.

How we carried out this inspection

We carried out this short notice, reactive, focussed inspection of the well led key question at the providers main location of Filton for NHS Blood and Transplant (NHSBT) as part of our continual checks on the safety and quality of healthcare services.

We also conducted this inspection because a number of former and current staff whistle blowers had contacted us to raise concerns about the quality and safety of some services. During the inspection staff raised a number of significant concerns in relation to how they or their colleagues were treated, and reports of a toxic and unhealthy culture were also raised to us prior to, during, and post the inspection site visit.

As part of the well led inspection, we spoke with over 60 staff across all disciplines, this included meeting with most of the senior leaders, including the Chief Executive, Chair and Non-executive directors, we also met with some assistant directors. We met with staff representative groups, including those with protected characteristics.

We undertook a staff survey for staff employed at NHS Blood and Transplant and received over 350 replies.

We looked at a range of performance and quality reports, audits and action plans. We reviewed previous public and private board meeting minutes, committee papers, annual reporting to board, board assurance framework and papers to the board. We looked at investigations of internal and externally commissioned reports, serious incidents, complaints and sought feedback from staff and key stakeholders.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.