Managing the blood supply chain during COVID-19
14 May 2021
Managing the blood supply chain during COVID-19
The COVID-19 pandemic has been the biggest public health crisis the NHS has ever experienced. It resulted in hospitals rapidly adapting the services they provide to safely care for patients hospitalised with coronavirus. As a result, demand for blood components has changed and new challenges have emerged.
In this interview, Oliver Wight Partner Anne Marie Kilkenny talks to Dean Neill, Assistant Director – Planning, Performance and Stock Management at NHS Blood and Transplant about the challenges, solutions, and successes during the past year.
Anne Marie: Hi Dean, thank you for taking the time to speak with me. Can you introduce NHS Blood and Transplant and explain how you know about Oliver Wight?
Dean: Of course. NHS Blood and Transplant is a special health authority that manages the supply of human blood components within England and human Organs and Tissues across the UK. Our blood supply chain serves over 250 hospital customers. In a normal year, we provide over 1.4M units of red cells, 250,000 units of platelets and 200,000 plasma components. We also provide some specialist and made-to-order blood components.
The characteristics of blood are complex, and we provide over 9,000 Stock Keeping Units (SKUs) to our hospital customers! While most people know about ABO grouping, some patients need a more precise match, for instance matching of combinations of antigens found on the surface of the red blood cells.
A few years ago, a colleague and I attended some Oliver Wight educational workshops. Oliver Wight also hosted a private workshop for NHS Blood and Transplant to help us shape our IBP process.
Anne Marie: So you already had some real complexity when it came to planning. How has COVID-19 impacted demand for blood components?
Dean: Demand has changed in three ways:
Overall demand reduction: demand for all blood components decreased compared to what we were expecting before the pandemic struck. For example, annual red cell demand for the financial year 2020-21 was originally expected to be c380M. However, actual demand was c1.280m, or c7% below the original expectation. Similar reductions have been observed for other blood components.
A more variable demand profile: the demand profile has been more variable than in previous years. For instance, it declined by around a third during the peak of the first wave of COVID-19 but as COVID hospitalisations decreased over the summer, demand began to reach fully restored levels. By the peak of the second wave of coronavirus, hospitals had found ways of maintaining much of their routine activity while coping with higher pandemic-related admissions. This meant that demand did not decrease to the same extent as observed during the first wave, but peaked-and-troughed more frequently than usual. As we emerge into financial year 2021-22, demand is now back to pre-pandemic levels and will likely increase beyond those levels as hospitals seek to catch-up on postponed activity.
Differential demand by segment: some segments of demand remained high. For instance, hospitals ordered increased proportions of “universal” components; in other words, blood groups that can be safely transfused into any patient. Demand for O D negative red cells peaked as high as 18%, whereas only c7% of the population possess this blood type.
Anne Marie: What additional challenges did you experience during the pandemic?
Dean: Our supply chain is unusual as our “raw materials” come from donors, who give their blood and time entirely altruistically.
The three main supply challenges we experienced were:
Blood donation venues: we very quickly acted to introduce social distancing measures to make our blood donation environments COVID-secure for colleagues and donors. This led to a reduction in the number of donation chairs we were able to plan at many of our venues. Consequently, we consolidated many of our sessions into larger community halls to retain as much blood collection capacity as possible.
Workforce absence: like many workforces, the pandemic resulted in higher absence levels from teams across our supply chain. This was largely down to periods of shielding for some colleagues, based on government advice.
Donors: the response from our loyal donors has been incredible throughout the pandemic. Blood donation was classed as “essential travel” during periods of national and local restrictions, and we’ve been able to keep the life-saving supply of blood flowing to hospitals, with thanks to our donors. However, we’ve needed to rely more heavily on a smaller group of existing donors because they are more likely to successfully give blood; which is important when we have had fewer opportunities to collect the blood we need. This has led to a reduction in new donors donating. The overall active donor base has consequently declined by 7% in the last 12 months (from 808k to 754k in March 2021). While this has not caused any supply issues during the pandemic, we plan to recover the size of our donor base over the next 12 months to ensure supply resilience.
Anne Marie: What effect have the changes to demand and collection had on stock and supply?
Dean: While most supply chains seek to minimise inventory, we are mindful of needing to keep some inventory because a stock-out or delayed fulfilment of an order can mean the difference between life and death.
Red cells have a shelf-life of 35 days, so we aim to keep between 5.5 and 7 days of stock (DOS), which ensures resilience of supply, while also minimising time expiry. On the other hand, platelet components have a short-shelf life of just 7 days. Consequently, we only keep around 1.5 days of platelets in stock.
Aligning a variable demand profile to a variable supply profile across all our SKUs has been tricky! While we have been able to forecast short-term demand throughout the pandemic fairly accurately, effecting changes in supply has sometimes been difficult to achieve rapidly. Largely, we’ve managed to keep red cell stocks within our target range, although for brief periods stocks declined to around 5 DOS and rose as high as 10 DOS while we adjusted operational activity to peaks and troughs in demand.
Anne Marie: During the past year did you ever experience a supply shortage?
Dean: Despite the challenges, there were no instances of supply shortages over the pandemic. In fact, from 2020 to 2021 we have worked extremely hard to improve on our outstanding levels of service to hospital customers and donors at both ends of our supply chain:
- Our ‘On Time, In Full’ (OTIF) performance is at a record high level of 98.6%. Where we are unable to meet demand in full, we always provide a clinically suitable alternative.
- The percentage of hospitals scoring us 9 or 10 out of 10 for Overall Hospital Satisfaction also increased to 82% (from 77% in 2019-20).
- The percentage of donors scoring us 9 or 10 out of 10 for Overall Donor Satisfaction is also at the highest on record at 83%.
Anne Marie: What lessons were learnt in the Integrated Business Planning process?
Dean: Firstly, in reacting to hospital demand, we realised early on that we would need to gather more frequent commercial intelligence and rely less on statistical modelling of historic demand to produce an accurate demand plan. We therefore increased the cadence of our demand review meetings and involved more clinicians who had a deep understanding of the acute pressures the wider NHS was facing.
We ordinarily publish a demand forecast for 5 years ahead and achieve typical forecast accuracy of +/-2% for the following 12 months. But we learnt that things were changing so frequently for our customers that we could only achieve a high degree of accuracy for the following 6 weeks. We therefore focused on achieving an accurate forecast for a rolling 6-week window around which we could fix collection and production plans. Beyond 6 weeks, we frequently reviewed our best assumptions around how demand would change and provided the collection and production teams with an anticipated range within which they could expect their plans to be set. This gave them the ability to plan their operational activity beyond the very short-term.
While we have always used scenario planning, we found during the pandemic we were doing more scenario exercises than ever before! By identifying our best assumptions, we were able to identify the most likely scenario and a variety of alternatives at any given time. This gave our executive team and board members confidence in our plans as we were able to demonstrate that we had considered how things could change and how our operations would adapt in the circumstances.
Anne Marie: Can you tell us about the convalescent plasma collection programme?
Dean: In addition to the impact of the pandemic on our routine activity of supplying hospitals, this year we established a convalescent plasma collection programme as part of the national COVID-19 response. The goal was to supply two clinical trials with enough convalescent plasma collected from recovered COVID-19 donors to establish whether the antibodies in their plasma were an efficacious treatment for severely ill patients who are hospitalised with the virus.
In less than a year, we had opened over 40 plasma donation sites and supplied enough convalescent plasma to supply 16,000 randomised patients over both clinical trials. This gargantuan effort has provided some clear answers to the international scientific community and we are incredibly proud to have taken part in this ground-breaking work!
Anne Marie: That is fantastic news and truly something to be proud of!
Dean: Absolutely! My colleagues at NHS Blood and Transplant and the wider NHS have adapted incredibly throughout this global health crisis. I’m very fortunate to use my supply planning skills in this truly fantastic organisation that saves and improves so many lives.