This section provides information on how the NBA ensures that Australians have an adequate, safe, secure and affordable supply of blood and blood-related products. The NBA does this through several measures, including the annual development of a National Supply Plan and Budget (NSP&B) and the negotiation and implementation of Blood Supply Contracts (including Recombinant and Plasma Supply Contracts). For further information on best-practice and safety initiatives, please visit the Appropriate Blood Use section of the NBA web site.
The activities relevant to this role include:
Under the National Blood Agreement, the NBA is responsible for “in consultation with each Party, and for the approval of the Ministerial Council or the Jurisdictional Blood Committee, to undertake annual supply and production and budgeting …”
The national blood supply is a national scheme for the subsidised supply of blood and blood products into the Australian health sector. As such, it is analogous to other national health subsidy schemes such as Medicare, the Pharmaceutical Benefits Scheme, the Aged Care Scheme, the Hearing Services Program, and the National Diabetes Services Scheme, amongst others.
Figure 1: The Australian blood supply chain
Key aspects which distinguish the national blood supply (Figure 1) from other national subsidy Schemes are the particular:
The national blood supply is wholly government funded (no co-payment mechanisms apply), with nine governments providing $967 million in 2010/11 to the NBA for the management and purchase of blood and blood products. Under the scheme, blood and blood products are ultimately provided free of charge to patients in Australia.
Each year, the NBA is responsible for the coordination and presentation for approval by all Health Ministers, a National Product Price List and National Supply Plan and Budget (NSP&B) for blood and blood products. This annual development is a critically important function for the blood sector as a whole and underpins much of the NBA’s work. The NBA is also responsible for collecting data on products issued, reporting to jurisdictions against the approved supply plan, and for making improvements to the national supply planning process. Each year, the NBA has introduced more sophisticated demand modelling processes as it improves its knowledge and understanding of the products and clinical environment.
The process for supply planning is illustrated below and covers the total national volume, mix and cost of fresh, plasma-derived and recombinant blood and blood products, and diagnostics expected to be to be ordered under the National Supply Plan in the year. Supply planning must commence 12 months prior to the next supply year and must be endorsed by the JBC, and approved by Australian Health Ministers, to allow continued funding of blood and blood products to healthcare providers.
The NBA is also improving its information systems to compile detailed information on historical consignment levels over previous years for all product types contained in the annual NSP&B. This information is used to assist in more accurate demand forecasting.
The NBA’s goal is to develop a demand model and risk management strategy for all major products. Fundamental to this is accurate data on product supply and usage, as well as a deep understanding on how product is used. The NBA has developed some parts of the required supporting infrastructure, but data availability from hospitals and the Blood Service remain key impediments to the development of more sophisticated models.
Under the National Blood Agreement, the NBA is required to; “use best endeavours to manage the national blood supply to provide a sufficient level of supply to meet the demand in all states and territories and to ensure that patients continue to access the blood products and blood related products their clinicians determine will best meet their clinical needs do are as practicable in accordance with national best practice….”
To fulfil this function, the NBA monitors the balance between supply and demand throughout the year and is responsible for the intensive management of products in short supply. This is very labour intensive.
Some products require more intensive management. For example, Intravenous Immunoglobulin (IVIg) and Biostate (a CSL plasma derived FVIII product for treating haemophilia), Cytomegalovirus Immunoglobulin (CMV) and red blood cells have been under intensive product management at various stages since the NBA commenced.