Creating a new service as part of the nation’s pandemic response
We recently invited Betsy Bassis, Chief Executive Officer of NHS Blood & Transplant to join us for our first virtual event Transitions, to share her experiences building an entirely new operation as part of the UK’s COVID-19 response.
I joined NHS Blood and Transplant (NHSBT) back in March 2019. When I joined 18 months ago, I can honestly say that I had no idea what would be waiting for me around the corner.
Like every organisation, COVID has hit ours like a bombshell, completely transforming what and how we do things. Our traditional work has always been supplying blood, organs, stem cells and a variety of associated diagnostic and clinical services to the NHS. But since the start of the pandemic we’ve also built an entirely new operation from scratch, convalescent plasma.
I won’t talk too much about our business as usual activities, other than to say it’s been anything but business as usual. At the beginning of the pandemic, I was panicked by the idea of the NHS running out of blood, but thanks to the ingenuity of our workforce and the loyalty of our donors, we’ve managed to keep blood stocks healthy. That said, with a 30-day shelf life for red cells and a four-day shelf life for platelets, you’re never really out of the woods with blood stocks. It’s a finely balanced vein-to-vein supply chain, but one that so far has proved largely resilient.
Convalescent plasma and COVID-19
The dynamics of organ donation and other aspects of our business as usual have been challenging, but I’ll leave those stories for another day because if blood and organs are our legacy operation you can think of convalescent plasma as our internal startup. Plasma is the liquid part of blood which carries the red blood cells around the body. In people who have recovered from COVID-19, the plasma may contain antibodies that can be used to treat patients still suffering from the disease. Or so we think, because whilst the use of convalescent plasma dates back more than 100 years to the Spanish flu epidemic, there’s never been any randomised control trials to prove the efficacy of this treatment.
That’s all about to change because we’ve joined up with RECOVERY and REMAP-CAP randomised control trials, which we hope will give us an answer one way or another in the next couple of months. To our knowledge, this is the largest randomised control trial in the world of convalescent plasma. The eyes in the medical community are watching us, waiting to see the results. So it’s pretty exciting.
Scaling the operation at pace
Our job has been to collect and supply plasma to participating hospitals who recruit patients into the trials. In parallel, we’ve been working to build up our collection capacity should the trials prove successful. This has involved creating a new national testing, donation and manufacturing network, converting all our 23 donor centres to also collect plasma and opening 19 new pop-up plasma collection centres across the country. We’ve also been hiring and training over 600 new people and recruiting thousands of new donors who’ve recovered from COVID-19, and all of this in less than six months.
It’s been an absolutely gargantuan effort that’s included every part of our organisation from HR and IT to clinical services, marketing, blood supply and quality assurance. Even our organ donation and transplantation team got in on the action by lending some of those people to the programme.
To give you a sense of scale, our normal annual change programme at NHSBT is about £20 million, this includes all our IT programmes and other change initiatives. Convalescent plasma is a £100 million programme, representing a fivefold increase on our normal annual change activity.
It’s required us to work in very very different ways. In terms of the pace, I’m told that we normally take about 18 to 24 months to open a new donor centre. We’ve opened 14 in the last three months alone. Our normal training programme takes 12 weeks to get people through and entails lots of classroom training. Those timelines would not have worked for this programme, we would have completely missed the boat or at least the second wave. The team completely redesigned our training, moving all but the practical elements online and reducing the programme from 12 to 6 weeks, whilst ensuring, of course, there’s no impact on donor or patient safety.
As we build this new collection capacity, we’ve also had to recruit enough donors to fill the seats. The problem is, not everyone can donate for various medical reasons, and of those who can, fewer than 10% have the very high antibody levels we need. It’s a bit like looking for needles in a haystack.
Finding donors needed innovative communication and marketing to raise awareness and guide traffic to our new donor registration page. We’ve also been working with NHS digital to get their data feeds from tests and trace, the Office of National Statistics and other sources to find people who have tested positive for COVID-19, so we can contact them proactively about becoming donors.
Many of these people have gone through traumatic experiences in hospital, and so we do everything we can to make their experience with us as pleasant as possible. So they’ll continue to come back week after week.
Learning from our response
I can’t begin to tell you how incredibly proud I am of the team, who day after very long day have moved heaven and earth to solve problems and deliver against extremely ambitious timelines. Timelines I should say that some people said we shouldn’t sign up to, given the high risk and consequent reputational risk should we fail to deliver.
But in my mind, I felt we had no choice but to step up to the plate. Why? Because if we didn’t, who would? We uniquely have the donor recruitment and collection expertise as well as the national infrastructure to build them. It just required us to be willing to rip up some of the pages in our playbook and reimagine different ways of delivering.
It’s been exhausting and exhilarating all at the same time. Having done it, we’ve learnt so much as an organisation. We’ve learned what it takes to scale an operation at pace, to challenge the status quo, to make decisions in a volatile and uncertain environment and to be prepared to test and fail and try again.
Given the pace at which we’ve been working, I worried that my board would have concerns about governance and risk management. When I brought this up in a recent meeting, I was happy to hear that they felt comfortable with the assurances they were getting. If anything, they wanted to see the same pace and the same decisiveness applied to their other activities as well, so that’s exciting.
From an organisation that was managing the slow decline of our underlying business as the clinical demand for blood falls, to one in the desire to support the wider national response to the pandemic has found a way of building a new operation at a scale and at a pace that we’ve never done before. In doing so, it accelerated our pre-COVID-19 ambitions to be bold, to step out of our comfort zone and to use our unique skills and experiences to take a wider leadership role in the NHS.
Having done so, I really hope that there won’t be any going back.
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