David Labanyi talks to the head of the IBTS about moving the service forward
Maybe Irish Blood Transfusion Service staff should consider supporting Germany in the World Cup: both labour under history and both are desperate to reinvent themselves.
"I don't think there is anybody in the IBTS who wouldn't love to turn the clock back and change the events from 1977, 1979, 1991 1994. Unfortunately, we can't do that and a lot of people out there suffered tragically," says Andrew Kelly, IBTS chief executive.
He admits there is an undoubted legacy of past mistakes. "Because of our history we are more likely to get a negative headline than another organisation."
This perception frustrates many of the 560 IBTS staff, including Kelly, who is quick to praise the staff at an organisation he has run for four years and does not believe the service gets praised for successfully introducing new technologies, in many cases before other European blood agencies.
The modern IBTS, says Kelly, is renowned internationally for its clinical excellence.
But part of the challenge for the IBTS is that a number of "legacy issues" remain unresolved.
In the early 1990s, the IBTS diagnosed a number of people with Hepatitis C but did not inform them immediately, putting the patient and their families at risk. In some cases, it was years before people were told. This issue is the subject of four legal cases, one of which is going through the High Court.
The legacy includes the deaths of at least 88 haemophiliacs who contracted HIV from contaminated blood products and the infection of more than 1,000 people with Hepatitis C from infected batches of anti-D.
Sixteen legal claims following this viral infection remain outstanding. Kelly says the IBTS is "trying to accept the past without denying or discarding it but that the service has moved on".
One of its central daily challenges is trying to secure an adequate blood supply at a time of rising hospital demand.
Elective operations were cancelled for three days last June because of blood shortages. The same thing happened in 2002.
Kelly explains the problems are partly a result of rising hospital demand caused by the recent appointment of more oncology and haematology consultants. As a result, more have been cancers diagnosed earlier and treated more aggressively.
"These specialities use about 50 per cent of all blood sent to hospitals. Demand is growing by 4 to 5 per cent a year."
Meeting this demand was complicated by new restrictions on who can donate blood because of vCDJ. "We lost in the order of 20,000 donations after that. But we have replaced those donors and we are hoping there are no shortages this year."
Summer is a difficult time for the IBTS as exams, holidays and good weather result in deferred donations. The World Cup is an added factor.
To counteract this, the IBTS has launched an ad campaign calling on people to donate before they go on holidays, part of the service's €750,000 annual advertising.
The IBTS also hopes to introduce a "donation bus", which will visit industrial estates in the greater Dublin area allowing people to donate in the shortest possible time while at work.
With a combination of these measures and an increased focus on attracting younger donors Kelly believes the IBTS can meet demand for the next five years.
However, there is one development that the IBTS fears could negatively effect donations and that is a reliable test for vCJD, the human form of mad cow disease.
Five years ago the IBTS introduced precautionary restrictions on accepting donations from people who have lived in Britain between 1980 and 1996 - when mad cow disease was at its height; those who had had certain operations; or received blood transfusions outside of the Republic. In 2003, it was confirmed that vCJD could be transmitted in blood.
The IBTS is at the forefront of international clinical trials on a new filtration system to take prions from the blood, thereby reducing the likelihood of vCJD transmission. "This is a major challenge for us. The first tests could produce a lot of false positives. You might also be diagnosed but never get the disease."
Would donors want that information Kelly wonders?
"If we had a positive test we would have to tell them because in the past we have been very severely criticised in the past for not telling someone when they first tested positive for Hepatitis C. Donors might decide that they'd rather not know and just not turn up."
Here Kelly is referring to the delayed notification of patients with Hep C. German haematology expert Dr Bernard Kubanek was appointed early last year by the IBTS to carry out a review of delayed notification of patients with Hepatitis C. Thirty four people were found to have waited for significant periods of time before being informed of their infection.
"We gave a copy of Dr Kubanek's to the patients' groups. We met them with Dr Kubanek and gave them access to Dr Kubanek on their own. We issued an apology in August 2005," Kelly said.
He now considers the matter closed and does not think the statutory inquiry promised by the former Minister for Health in 2002 will happen.
"The protocols have been changed. People are automatically informed if there is ever a positive test. That is absolutely adhered to," Kelly says.
Although a national service, the IBTS often appears split over another "legacy issue". Dr Joan Power and her team in Cork first identified the problems causing the Hepatitis C infections leading to tensions between the Dublin and Cork centres ever since.
"There is a perception by some people that there is view in Dublin that the Cork centre brought all hell on us and has to be punished for that. I certainly wouldn't subscribe to that theory and I wouldn't support it."
These tensions came to the fore last year when Power was warned in writing by Kelly not to proceed with a press conference outlining problems facing the Cork centre.
He denies this is evidence of deep internal difficulties. "Look, I'm in Cork every month. I have a good working relationship with Joan. There are still some problems but I think what would help significantly would be a new centre for Cork. We have a state-of-the-art facility in Dublin but there is insufficient space for the level activity and level of people in Cork."
Kelly makes little effort to hide his frustration at the failure to provide funds for a new regional centre in Cork. A design brief was submitted to the Department in 2003 with a cost of €30 million (in 2006 prices).
But this money was never released. Last month, Mary Harney wrote to the IBTS asking for a review of the design with regard to Department of Finance circulars on major capital programmes.
The Irish Medicines Board regulates the IBTS and regularly highlights problems with the condition of buildings and facilities available for the IBTS staff working in Cork.
"The longer that debate goes on the stronger the view will be that we are not serious about doing anything about Cork."
Asked to describe the public opinion of the IBTS, Kelly believes the IBTS compares very well with other European blood services but feels the IBTS does not get a fair hearing in the media.
"In certain sectors we get recognition but we haven't showcased ourselves to the public. Technologically we are making progress: we are one of the few countries doing seven day platelets, we are one of only three countries screening for autoplate bacteria. So we have moved on and we will continue to do so.
"We have very good risk management, we are highly regulated but every nation's blood supply is vulnerable because it comes from humans. There is no such thing as a zero risk transfusion."