An open letter to the people
of New Brunswick
I am writing this letter for several reasons. First, I wish to personally thank both our dedicated New Brunswick donors, who have continued to give their life-saving gift, and our Canadian Blood Services staff, who have shown great professionalism during this time of transition.
We have reached a critical turning point in New Brunswick as the government charts its course for the future of blood services in the province. Many claims that are not backed by evidence have been made by opponents of our consolidation plans and I wish to set the record straight. We believe New Brunswickers deserve the facts to better understand what is at stake in this issue.
We remain committed to New Brunswick
Canadian Blood Services is not leaving the province of New Brunswick. Only one part of our operations in the Maritimes – namely blood component production (manufacturing) – is going to be consolidated into Dartmouth. Most of our operations in New Brunswick will continue to operate the same way they do today. Blood, plasma and platelets will continue to be collected in New Brunswick. An inventory of ready-to-use blood products will continue to be housed in New Brunswick as it is today.
The benefits of consolidation
Governments and industry in Atlantic Canada are realizing that, for financial health and sustainability, more collaboration is required across provincial boundaries. The blood system is no different.
- Consolidation provides greater safety. Having fewer sites handle more volume increases standardization in process and allows blood operators to afford the latest technology to enhance safety and efficiency.
- Consolidation reduces duplication. Centralization of blood component production is a worldwide phenomenon and it is ongoing in other parts of Canada. Consolidation creates greater specialization and critical mass, where facilities and technology do not sit idle for periods of time due to low volume activity. Every dollar saved by reducing duplication is a dollar that can be reinvested into other healthcare priorities.
Claims have been made that patient care will be negatively impacted - that surgery or cancer care will be delayed - and some have even gone so far as to say that lives will be lost as a result of the consolidation of our production laboratory. Nothing can be further from the truth:
- About two thirds of all the blood supply in Canada is already inside hospitals, at their in-house blood bank, just metres away from their emergency/trauma departments and operating rooms. Canadian Blood Services’ role is to replenish that supply.
- Blood will continue to be available in Saint John. Although we were confident with our Darmouth plan based on past consolidation experience elsewhere in the country, we listened to local healthcare providers and changed our original plan. We will now keep an inventory of ready-to-use blood products in Saint John and continue to distribute products from Saint John, as we do today.
- No preferential treatment is given to hospitals closer to a production site. Some have suggested Halifax area hospitals would be given first priority over blood from the production site. Once again, this is simply not true. Blood distribution is prioritized by patient need – not by proximity to a production site. On any given day, a New Brunswicker may receive a blood product that was collected in the province, or they may receive it from St. John’s or Victoria or somewhere in between. The advantage of a national system is that we move hundreds of blood products around the country every day, to ensure every patient who needs blood, gets it, regardless of where they live.
Safety always has been, and always will be, at the heart of every decision we make at Canadian Blood Services. There is no evidence whatsoever that the planned consolidation will negatively impact patient care for any New Brunswicker. In fact, all the evidence, both from our prior experience of similar consolidations in other parts of Canada, as well as the international experience, suggests otherwise.
Security of Supply
Concerns have also been raised that our planned consolidation would compromise the ability to get blood where and when it is needed in New Brunswick. Again, the evidence and facts speak to the contrary.
- Our plan will move New Brunswick from a single source of inventory to a dual source, with locations in Saint John and Dartmouth to serve the province’s hospitals.
- As part of our consolidation plans, we have also introduced air transportation to complement ground transport. This will benefit hospitals throughout the province, particularly in the north.
Whether it is for routine orders of blood products, emergencies, or deliveries through inclement weather, our new model will ensure the right product gets to the right place at the right time. To that effect we have committed to:
- Thorough testing of our logistics. A one-year trial is currently underway and is already showing positive results.
- Continuous monitoring of the plan by an independent expert group of blood bankers and physicians from New Brunswick to ensure there are no negative consequences for patient care.
Cost effectiveness and efficiency
Some have suggested that the province could establish and run its own blood system for less than what New Brunswick currently spends to derive all the products and services from Canadian Blood Services. Again, this is not only inaccurate, but based on assumptions that have not been tested.
- KPMG, a reputable, multinational consulting firm estimates the costs to start a provincially-run blood system could be up to $40 million, plus an increase in yearly costs of 30 per cent over the current Canadian Blood Services model. While KPMG stopped short of making a recommendation, its report rated remaining with Canadian Blood Services as the best option for New Brunswick in terms of safety and cost effectiveness.
- A recent Growth Strategies report that recommends an independent blood service in New Brunswick is critically flawed. The plan is based on an export model, for which there is no customer. Presumably, the authors of the study were counting the U.S., Quebec, or Canadian Blood Services to buy New Brunswick’s excess blood, but none of these options are realistic from a regulatory or practical point of view. Without customers and a revenue stream, not to mention the underestimated transition costs, and the lost economies of scale in purchasing power, the plan for an independent system is significantly costlier than staying with Canadian Blood Services.
The risks of New Brunswick going on its own
Severing from a national blood system to create an independent, provincially-run system will not only duplicate services and increase costs; it means New Brunswick would lose a number of other important benefits, including:
- Access to a national inventory of blood and blood products. This offers protection against local supply disruptions (e.g. hurricanes, pandemic, labour disruption, spikes in demand, etc.), and the ability to better meet demand for rare blood types. Having the backing of donors, volunteers, staff and facilities in other parts of the country is the ultimate business continuity plan.
- Access to other nationally-shared programs and services, such as Organ and Tissue Donation and Transplantation, and the OneMatch Stem Cell and Marrow Network
- Capacity for investment in state-of-the-art technology to enhance safety and efficiency (e.g. genotyping, pathogen reduction, HLA-matched platelets to support bone marrow transplant recipients)
- Access to a national bulk purchasing power for supplies as well as expensive blood-derived and synthetic drugs;
- International expertise, research and development, knowledge creation and dissemination;
- Prefunded insurance against catastrophic loss.
Strength in numbers
Leading blood systems worldwide have moved or are moving towards increased consolidation. Mega production sites in the US and UK have been designed to output half a million units of blood or more per year. This critical mass is the only viable way to deal with the escalating costs of new technology and infrastructure. As for the Canadian experience, Canadian Blood Services has over a decade of experience transforming the blood system, including consolidating operations in other parts of the country. At the same time as we are consolidating production in the Maritimes, we are conducting similar, yet much larger consolidation of production facilities in southern Ontario. We draw on both our own and international experience to reap the benefits of consolidation for our hospital customers, as well as plan appropriately to mitigate the risks.
The legacy of Krever and the tainted blood scandal
Since Canadian Blood Services took over the failed blood system 13 years ago, we have built an integrated and safe system that is trusted by Canadians and of which our staff are justifiably proud. We followed the recommendations made by Justice Horace Krever in the Royal Commission of Inquiry on the Blood System in Canada and have transformed the blood system from a series of disconnected, provincially-operated systems into a streamlined and nationally-focused organization.
My personal and professional commitment
As the Chief Executive Officer of Canadian Blood Services, I stand fully accountable for the decisions we make. At the same time, as a physician, and a hematologist who has prescribed blood products, I would never permit change to occur that would undermine patient care.
Dr. Graham D. Sher
Chief Executive Officer, Canadian Blood Services