This is the first in a series of articles, written by nurses employed by NHS Blood and Transplant (NHSBT), discussing the purpose and objectives of the organisation, which is responsible for a wide range of blood and transplantation services, including supporting tissue donation, providing life-saving therapeutic apheresis services and patient blood management. The series will provide insight into the diverse and complex nursing roles within NHSBT, outline some of the major challenges faced by NHSBT, and consider what the future may hold. This first article provides an overview of the divisions within NHSBT, which will be of interest to those health professionals who may not be aware of the intricacies of the organisation.
Roles and responsibilities
NHSBT is an ‘arm's-length body’ to the NHS. It is classed as a ‘special health authority’ responsible for saving and improving lives by providing blood and supporting the provision of organs and tissues to the NHS, looking after blood donation services in England and transplant services across the UK. This includes managing the donation, storage and transplantation of blood, organs, tissues, bone marrow and stem cells, and researching new treatments and processes. The organisation's ambition is to ensure that more people receive the organ and tissues they desperately need, that they receive the right blood transfusions at the right time and are given the best specialist support and products to save or improve their lives.
NHSBT was established in 2005 to take over the responsibilities of two separate NHS agencies: UK Transplant and the National Blood Service. UK Transplant (now renamed Organ Donation and Transplantation) was founded by Dr Geoffrey Tovey in 1972. There are now more than 25 million people on the NHS Organ Donor Register, representing 38% of the population. In 1946 the Ministry of Health set up the National Blood Transfusion Service (renamed the National Blood Service in 1996) made up of regional blood centres. At this time, around 200 000 units of blood were collected from around 270 000 donors. Today 1.6 million units are provided thanks to around 900 000 donors.
NHSBT's responsibilities include:
There are three core principles that are critical to our service, guiding everything we do and inspiring us to be the best:
Blood donation and supply
Since the introduction of the National Blood Transfusion Service, countless lives have been saved or improved thanks to the generosity of blood donors. Major developments in blood supply were historically driven by the need to help treat wartime casualties. The First World War saw the adoption of blood transfusions to help save those injured on the battlefields, and donated blood was first needed on a large scale during the Second World War.
Over more recent years there have been momentous changes in the way blood is donated and transfused. NHSBT works closely with hospitals to ensure we can provide the right amount of each blood group at the right time, based on patient need. Changes in our service will continue to ensure that we can continue to support future advances in medicine. The service is facing new challenges today, as half of all blood donors are over 45 years old. Younger people are being called on to start giving blood, helping to meet patient needs now and for the future. More black and south Asian blood donors are also needed to reflect the ethnic diversity of patients. We will talk about this in more detail later in the series.
In the background supporting all of this are a team of clinical support nurses and infection control nurses. Their role is to provide guidance and support to both NHSBT staff and to donors to support donation and transplantation.
Patient blood management
At the other end of the transfusion process are the team of NHSBT patient blood management (PBM) practitioners. This multi-disciplinary team supports hospitals to ensure that patients who might require transfusion of a blood component receive optimal treatment and that inappropriate transfusion is reduced. They provide an ongoing programme of support, education, audit, research and specialist transfusion advice at local, regional and national level.
Organ donation and transplantation
Our specialist nurses for organ donation (known as SN-ODs) are highly trained senior nurses who provide an exceptional level of end-of-life care to patients referred to us by colleagues in hospitals across the NHS. The SN-ODs care for the patient, support their families as they make decisions about organ donation, optimise the care of the patient to ensure as many organs can be donated for transplant as possible and deliver a holistic service that includes supporting NHS colleagues, working with dedicated organ retrieval teams and working across their embedded hospital with colleagues including clinical leads to promote organ donation as a normal part of the end-of-life care offered.
There are currently around 6000 people on the transplant waiting list in the UK. NHSBT manages the NHS Organ Donor Register and National Transplant List of those patients waiting for a transplant. Despite a year-on-year increase in the number of organ donors, with 2018/19 seeing a record 1600 UK citizens donating organs for transplant, there is still a shortage and in 2018 more than 400 people died while waiting for a transplant.
Tissue and eye donation
NHSBT operates the UK's biggest tissue bank and is the largest not-for-profit organisation supplying the NHS with human tissue. Donated tissue, such as skin, bones and eyes, can save or dramatically improve the lives of many people suffering from illness or injury. Thanks to the generosity of our donors and their families, we collect tissue from thousands of living and deceased donors every year. Annually, this provides around 8500 life-changing implants for 2600 patients.
Our team of specialist tissue donation nurses are based at our tissue banking facility in Liverpool. They are responsible for the coordination of tissue donation after death and provide support and assistance to the newly bereaved families of tissue donors.
Therapeutic apheresis
The therapeutic apheresis services (TAS) provide life-saving and life-enhancing treatments using specialist technology to exchange, remove or collect certain components within the blood. TAS support a range of clinical specialties including haematology, oncology, nephrology, neurology and rheumatology. Currently our NHSBT TAS teams treat more than 1200 adults and children every year from dedicated therapeutic units across the country.
NHSBT nursing leadership team, Nursing Council and Nursing Strategy
NHSBT currently has three chief nurses who lead the three NHSBT Nursing Directorates:
Collectively these three chief nurses are known as the NHSBT Nursing Leadership Team (NLT). The NLT is further supported by a group of senior directorate nurses to drive forward excellent practice and delivery of service and care.
NHSBT's Nursing Strategy (2016-2020) is a living document that describes our vision for the future of nursing within NHSBT. It outlines where we are focusing our energy and attention to continuously improve the care we provide (NHSBT, 2016). This strategy recognises many of the challenges facing nursing, including a shrinking workforce and the need to develop innovative approaches to recruitment and retention, with strong leaders who listen to their nursing workforce and deliver improvements in clinical practice and service user experience.
The strategy document is supported by an NHSBT Nursing Council. Formed in 2016 as a direct result of NHSBT's Nursing Strategy, it is composed of nurses working at all levels from across the organisation. The NLT collectively with the Nursing Council are currently developing the next NHSBT Nursing Strategy 2020-2025, ensuring that we continue to support and empower our nurses to be the best that they can be.
NHS Blood and Transplant can only deliver our life-saving and improving work with the support of health professionals working across the NHS and in other agencies. By providing clarity around the purpose and processes of what we do, our ambition is to increase understanding, foster collaborative working and share our ambitions with colleagues. Only by achieving this can we meet our ultimate ambition: to save and improve as many lives as possible.