Lean practices invigorate the lifeblood of the NHS

One of the first steps in reducing the cost was discovering that the service had more capacity than it needed. It was processing and testing blood in ten different places, all of which had spare capacity.

By closing some centres, moving services to fewer sites, making some people redundant and building a state-of-the-art processing facility just outside Bristol, it improved efficiency and cut the cost of supplying each centre.

The next step was applying manufacturing-style “lean” thinking to the way blood is processed. “We got staff to map exactly what they did each day, including how much unnecessary walking was involved, and they then came up with a new approach,” she says. “It meant physically moving some of the machines and equipment, and even some of the desks, but it has increased productivity and funded the addition of a £4 million screening test.”

Intriguingly, for a brief period the Blood Service considered whether there was a possible upside to high prices. It wanted to make sure that hospitals used only the blood they really needed, and economic theory suggests that making blood pricier should reduce demand.

“We did think about this but in the end we decided that, as it’s not usually clinicians who manage budgets, we’d just be giving a price problem to the hospital,” Ms Hamlyn says.

“What we really wanted to bring about was clinical change.” To that end they worked with hospital doctors to persuade them not to prescribe more blood than necessary. As a result, blood transfusion rates have fallen by 16 per cent since 2007, but there is still more work that can be done, she says.

A pilot programme, scheduled to start in September, will look at how the Blood Service can improve the hospitals’ blood management on a logistical rather than clinical level. The service looks after a national stockpile of blood but hospitals also keep some that they manage directly. These stocks inevitably include a certain amount of wastage, because there is always extra blood kept in case of a serious accident, for example. This could be reduced, Ms Hamlyn believes, if it were managed by the Blood Service; hospitals would not need to keep as much on site, as they would be able to call on national supplies when needed. “The future is us working more closely with hospitals to manage the blood stocks between us,” Ms Hamlyn says. “Our pilot programme later this year will see us actually take over management of blood stocks for some hospitals, either from our own stocks, because we are often located at hospitals, or remotely, through a ‘just in time’ process of transportation and delivery.”

The Blood Service has four days of blood in stock, which allows for emergencies and lets hospitals schedule with confidence.

“We always make sure that we can bring in more donors if we need to, but that adds to the costs. In a crisis situation you have to use the media, which costs us money. We try to operate in such a way that we don’t drop below our comfort level and need to do this.”

She is already thinking about the possible effects of the London Olympics because donations drop when there is a big event on television. “Everyone knows to make an extra effort over winter because there’s more demand and fewer donors, but they don’t realise that big sporting events also have a big impact,” she says.

“We had to put in a lot of effort during the last World Cup, because [at the one before] we had a serious shortfall. So we did things like ringing donors who were due to donate and saying, ‘You are scheduled to donate during the Uruguay-Paraguay game, is that a problem?’ and they would say, ‘Yes, please reschedule me’.”

So if you plan to spend this afternoon watching Andy Murray take on Rafael Nadal at Wimbledon, it may be worth double-checking your blood donation schedule first.