The blood transfusion service and the National Health Service.

In 1974 the Medical Research Council's blood transfusion research committee expressed its concern at the continued inability of the UK transfusion services to meet the blood product needs of patients with haemophilia.' This view was reiterated in 1977 by Dr Rosemary Biggs, on behalf of the haemophilia centre directors, and concern was also expressed at the predicted rapid rise in demand, the high cost of commercial products, and their higher risk of transmitting viruses when compared with products derived from voluntary blood donors.2 In 1974 the average annual amount of factor VIII used per patient in the UK was 12 500 IU, of which almost a third was from commercial sources; in 1985 the corresponding figures for patients in England and Wales were 30 000 IU and two thirds respectively. In Scotland, on the other hand, in 1985, though the annual usage per patient was identical, there were no commercial purchases. The consequences of these figures in terms of infection with the human immunodeficiency virus in this group of patients is self evident. The sustained failure of the transfusion services in England and Wales, known as the National Blood Transfusion Service, over the past two decades to meet the needs of the National Health Service extends far beyond the provision of factor VIII concentrates. In London and the home counties there are chronic and occasionally serious shortages ofblood, which have an appreciable impact on both the NHS and a large uncontrolled private sector. There are many areas of the country in which the supply of platelet concentrates from regional blood transfusion centres is restricted for operational reasons, and there are severe shortages through-