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The Working Group on Trends in the Demand for Blood Products noted in its July meeting that the size of the population with haemophilia could rise significantly. They also said: "It was apparent that clinicians were coming to recognise the supply problems; eg, they were moderating their demands for Factor VIII for prophylactic treatment."

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The estimates which had been reported by the Working Group on Trends in the Demand for Blood Products in late 1977 were largely thought to be reliable estimates for future need by the Standing Medical Advisory Committee in 1978.

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The Standing Medical Advisory Committee was constituted by the National Health Service Act 1946 and Dr Waiter noted that the Committee expected an increasing requirement for Factor 8 for orthopaedic surgery and David Smart recorded the modified figures.

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Dr Lane considered in 1979 that a redeveloped BPL could be commissioned to increase production capacity to 90 million international units between 1985 and 1990, as an intermediate stage, and then to scale up production to 120 million units for the years that followed.

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The approval given by the Treasury in November 1982 for the reconstructed BPL was for a plant capable of fractionating 400,000 kilograms per annum.

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If the PFC processed plasma to produce Factor 8 for England, then less would be needed to be spent on BPL, since BPL would then process smaller quantities of plasma, and since smaller quantities required less manufacturing space and equipment, it would cost less to build.

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A plasma supply target of 435,000 kilograms was broadly maintained, and although estimates thereafter continued to increase, there was a growing consensus that demand for Factor 8 would increase to the region of 100 million international units. The increases in estimated needs were by this time gradual compared to those that came before.

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Peter Wormald, Under-Secretary in the DHSS, understood that the reasons for the policy of self-sufficiency was "that imported products were very expensive and in general were considered to carry much higher risk of cross-infections, particularly hepatitis".

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Peter Wormald noted that "although no decision had been yet on the redevelopment of BPL, there was a need to determine its future capacity; which in turn raised the issue of what part Liberton would play in meeting capacity."

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Peter Wormald noted "There appear to have been some follow-up discussions, but I was not copied into the papers and I do not know what action, if any, resulted. It is possible that the discussions took a back seat in September when the Medicines Inspectors' report on BPL was presented."

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The Policy Steering Group proposed a new laboratory be built at BPL at a cost of £21.1 million spread over the years 1982/83 to 1985/86.

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Dr Diana Walford described the delay in construction of new facilities for PBL production as "unconscionable".

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Dr Walford described the Deputy CMO, Dr Harris, as "exasperated" because of the Ministers decision to defer the eventual decision on whether to build a new laboratory within the NHS.

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Dr Vaughan announced that there would be "no commercial management of Blood Products Laboratory: modernisation programme already underway."

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Dr Walford remembered her frustration about "innumerable and repetitive meetings which generally ended without moving matters forward to any appreciable extent."

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A special health authority was established to take responsibility for the management of the BPL, the PFL in Oxford and the Blood Reference Group Laboratory.

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Dr Walford said that Dr Lane was right to describe the difficulties in meeting the problems of the NBTS as having been "accentuated by the growth in requirement during the 1970s of plasma products, an exercise in production maintained without adequate planning, co-ordination or finance from the outset."

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Regional health authorities were described by Dr Walford as "fiefdoms".

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Dr Walford described the process in deciding to develop BPL as "totally chaotic, protracted and difficult" and "needlessly so".

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Dr Walford described the delays between April 1979, when the Medicines Inspectorate conducted their inspection and condemned the premises operated for BPL as unsuitable for a pharmaceutical company, and the middle of May 1983, when construction began as "unconscionable".

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