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Chief Executive Review
I am pleased to report that the National Blood Authority (NBA) has had another good year in managing the continued delivery of a safe, secure and affordable supply of blood, blood products and services for Australia.
This year, we have again worked closely with governments, patients, patient groups, clinicians, suppliers and others to achieve the best outcome possible within available funding for all Australians who require blood and blood products and services. We have developed and rolled-out new and improved national systems to directly assist patients, clinicians and others to help manage and monitor health, supply and performance issues. We have accelerated the consideration of new blood products that have the potential to improve the health and quality of life for Australians with bleeding disorders. We have also continued with our work internally to improve the Agency's management systems, processes, governance and accountability arrangements.
The clinical demand for blood and blood related products in Australia was met without interruption. A saving of $68.9 million was achieved against the annual budget approved and funded by all jurisdictional governments. This saving brings the total amount of funding returned to governments over the last seven years to $624.7 million.
Improvements in supply performance and efficiency under the long-term Deed of Agreement with the Australian Red Cross Blood Service (Blood Service) once again achieved a surplus of approximately $74.8 million. This will return a saving to governments of approximately $69.8 million in 2018-19, after allowing the Blood Service to retain $5 million to invest in further improvements in accordance with the Deed.
There have been a number of very important projects to highlight during 2018-19. In particular, BloodNet 5 was implemented nationally in all states and territories on 1 July 2018. BloodNet is Australia's online blood ordering and inventory management system that now supports more than 15,000 users across the country. BloodNet 5 has delivered substantial improvements in the ease, efficiency and accuracy of blood ordering and management, with significantly reduced timeframes for product ordering activities. Further system enhancements to BloodNet during 2018-19, have also supported the implementation of ISBT 128 barcoding methodology by the Blood Service.
The national implementation of BloodSTAR during 2018-19, was also a very significant development. The implementation of this system in NSW in October 2018 completed the last piece of the national jigsaw for the roll-out of a digital system that provides the sole channel for clinicians to seek authorisation for access to Immunoglobulin products.
The national implementation of BloodSTAR coincided with the concurrent release of revised Criteria for the clinical use of intravenous immunoglobulin in Australia (Version 3 of the Criteria).
The countdown in the NBA Blood Operations Centre.
The smooth and very successful implementation of these systems together with the revised Criteria is the culmination of substantial work that has extended over many years. This has involved not just many NBA staff in policy, program, technology development, training and education activities, but also staff in jurisdictions, clinical specialist working groups and many other individuals and groups.
The completion of these projects is a great example of effective national arrangements at work. They have had good 'buy-in' from all users and beneficiaries to deliver major improvements to the overall clinical management, processes and governance that inform and manage access to precious and costly blood and blood products. Additionally, for the first time the NBA and jurisdictions will have access to a truly national system of information and data that will better inform decisions in relation to the supply and affordability of products into the future.
I am very pleased to note that these systems and the associated program activities have already been nominated for awards. More importantly, there is also early evidence from this work of a slowing in the growth of demand for Immunoglobulin products during 2018-19. We expect this work will be reinforced as the Performance Improvement Strategy for the Immunoglobulin Governance Program is implemented.
This year saw the implementation of a revised organisational structure for the NBA. An additional senior executive position was added to the senior management structure with consequential adjustments made to improve accountabilities, governance and the management of risks in an increasingly complex and more substantial set of program responsibilities and funding. Ms Elizabeth Quinn was appointed to the new Deputy Chief Executive role with primary responsibility for Fresh Blood Products and Business Systems, encompassing the contract management of the Australian Red Cross Blood Service and the NBA's ICT and data management activities. Mr Michael Stone continued in the other Deputy Chief Executive role, with continuing responsibilities for Commercial Blood Products and Business Services, encompassing the management of the national fractionation agreement with CSL Behring as well as commercial supply contracts with CSL Behring and other multi-national companies.
The NBA's continuing active consideration of domestic and global demand and supply issues for plasma derived products resulted in the NBA attending the International Plasma Protein Congress in the Netherlands in March 2019 the Plasma Protein Forum in the USA in June 2019. During both visits, discussions were also held with government officials, suppliers and others, and plasma collection facilities as well as manufacturing sites were also visited. Relevant first-hand information was also obtained through a visit to Canada which has some comparable challenges to Australia in the supply and management of blood and blood products.
The safe, secure and affordable supply of blood and blood products in Australia is influenced by both the domestic and international context, including global developments and issues. The NBA has therefore maintained active international engagement activities since its inception in 2003 and also maintains active horizon scanning across the blood sector. These activities reflect the importance of understanding and influencing global issues, understanding commercial networks and markets in the blood sector, building and maintaining networks and intelligence across the sector, setting and influencing strategic directions where we can, and obtaining the best possible prices and contracts for products on behalf of governments. The engagement includes participation in both domestic and international bilateral and multi-lateral meetings, discussions, conferences and other forums involving patients, patient groups, clinicians, suppliers, governments and others.
Following initial consideration by the NBA, the Jurisdictional Blood Committee (JBC) approved the inclusion of Extended Half-Life (EHL) recombinant Factor VIII and Factor IX products within the national funding and supply arrangements. This was well received by patients and patient groups and clinicians. The decision was supported by an assessment undertaken by the Medical Services Advisory Committee (MSAC). The NBA has now included EHL Factor VIII and Factor IX products in the national tender for clotting factors and related products that will be finalised in 2019-20.
In March 2019 the NBA welcomed the appointment of Dr Amanda Rischbieth as the new Chair of the NBA Advisory Board. This followed completion of the term of Ms Gayle Ginnane who had chaired the Board for some eight years. Ms Ginnane had provided great leadership to the Board over an extended period and was a great source of advice and guidance to successive NBA Chief Executives. Dr Rischbieth has extensive experience in health and academic positions, including as a CEO and in other roles across health care delivery, clinical responsibilities (including in critical care), public health, research, ethics, and corporate governance. She is a Fellow of the Australian Institute of Company Directors and has continuing responsibilities as a Visiting Scientist at Harvard University in Boston.
L to R: Ms Gayle Ginnane, Past Chair NBA Board, Mr John Cahill Chief Executive NBA and Dr Amanda Rischbieth Chair NBA Board.
The Secretary of the Department of Health, Ms Glenys Beauchamp PSM, visited the NBA in July 2018. Ms Beauchamp spoke with NBA staff and received briefings on many of the NBA's current activities and challenges. She complimented the NBA on its work and the importance of its contribution to the broader health sector and government priorities.
The Secretary of the Department of Health, Ms Glenys Beauchamp PSM, receives a briefing on the Blood Operations Centre.
The long-term contract with CSL Behring continues to be implemented, with significant savings arising from this contract being achieved through progressive implementation of 'Process Migration'. The NBA is participating in governance arrangements for this process, which represents an alignment of operations by CSL Behring in Australia with its operations in other countries.
This important work has been book-ended nicely with the completion of negotiations at the end of 2018 for the new Output Based Funding Model and associated financial arrangements for the Blood Service. Again, this outcome will result in further savings for governments and efficiencies in the operations of the Blood Service.
There is further specific work to be undertaken in relation to the operations of the Blood Service during 2019-20, with a major review of the efficiency of the Blood Service to be undertaken. This has been commissioned by the JBC and will require substantial work and input from the NBA, as well as from the Blood Service, to complete the review by the end of 2019.
The 'bread and butter' work of the NBA is active supply and contract management; and the people, systems and services that support this work. This is where we now spend some $1.2 billion annually. The work can be persistent and, at times, intense and involve challenging discussions, information gathering, negotiation and reporting with suppliers, prospective suppliers, jurisdictions and others. This continues to be done professionally, ethically and consistently well.
The NBA's research and development grants program continued with Round 3 funding finalised that provided grants in early 2019 to address evidence gaps in patient blood management and funding for research relating to Immunoglobulin issues. The NBA R&D program will continue, with the assessment of Round 4 grant applications being finalised towards the end of 2018-19, and decisions to be made in the first part of 2019-20. New and growing work is also emerging with the NBA's increased involvement with health technology assessments and processes for new products and reviewing the utilisation of existing products. Again, this will continue into 2019-20.
In the important area of guidelines and the quality use of blood products, we made significant progress in the review of the national guidelines for the use of Anti-D immunoglobulin, in continuing the complex review and update of the suite of Patient Blood Management (PBM) Guidelines, and in continuing the PBM implementation and wastage reduction programs. Governments approved ongoing funding of $1 million annually for the BloodSAFE eLearning Australia (BEA) program which provides certainty for this clinical education program managed through the Department of Health and Ageing in South Australia. BEA received 56,987 new user registrations in 2018-19, and, by June 2019, it had 550,320 learners registered who had completed 1,214,312 courses. This equates to more than 1.8 million hours of education with courses provided without charge to participants and a suite of short videos being available to participants.
The NBA continued to make critical contributions to the revision of the National Quality and Safety Health Service Standard, including by ensuring the continuation of the Blood Management Standard, and with the development of supporting materials for implementation. There has also been substantial work to refresh the Haemovigilance Advisory Committee and its important work in supporting the national haemovigilance program, including the collection, analysis and publication of national haemovigilance data.
Maintaining effective relationships and communication with all stakeholders and interests is a vital part of the NBA's work and a key challenge for a small Agency in the time and effort required to achieve proper engagement. We continued to meet regularly and share information with patient and clinical representative groups and individuals, with supplier partners and prospective suppliers, with professional bodies and many others. We also attended and participated in conferences and events and made presentations on issues of interest to relevant groups.
I would like to once again recognise the very substantial contributions that many of our stakeholders across the blood sector make through generously giving their time, expertise, professionalism and passion to work on some very important issues with the NBA during the year. We look forward to working with you again in 2019-20.
I would also like to thank my executive management group for their ongoing support, commitment and dedication, and especially thank all of the staff of the NBA who continue to deliver a national blood system that is second to none. It has been a busy year – and the next year promises to be even busier!
John Cahill
Chief Executive