The UK NHS Blood Crisis – How bad is it and what caused it ?

 

This week’s news columns are full of reports that our NHS is critically short of blood. 

The plaintive  exhortations in many of them for at least 200,000 new donors would certainly seem to suggest there is a crisis….but what has caused it and what can we as a nation do about it ?

In truth, this is not a new problem. As in most things, the NHS has been ‘making do and mending’ on blood products of all kinds for at least the last 3-4 years, and arguably a lot longer. The current estimate of donors on the register is ca 800,000 and this equates to only around 2.6% of the eligible population donating in any one year.

Why do we need regular donations ?

One of the key problems with blood products is their limited lifetime. Red blood cells, the main product used for transfusions, have a lifetime of ca 35 days; Other blood products vary widely – blood plasma can be stored frozen for up to 3 years, while platelets have a much shorter lifetime of ca 7 days, and granulocytes last only 24 hrs.

This is one of the reasons why the NHS needs at least 4300 donations per day, just to keep up with patient demand.  The other problem is blood groups - there are 8 of them. You can’t just transfuse someone during an operation with ‘any old blood’. If you did, you might easily kill them. This is because each individual has two types of principal surface antigen associated with their blood cells: the so-called ABO antigen type and the Rhesus (Rh) antigen. There are 8 different combinations of these, occurring at widely different frequencies in the UK population:

ABO antigen	Rh antigen	UK Frequency (%)
O	+	37
A	+	29
B	+	9
AB	+	4
O	-	14
A	-	6
B	-	2
AB	-	1

 

If you transfuse a patient with the wrong blood group, the antibodies in their blood will bind to the incoming red cells and coagulate them, causing massive clotting where this happens. Thus transfusion blood is always closely matched with the patient’s own blood, and the rarer the individual’s blood type, the more difficult it can be to obtain supplies of the correct type.

Only one blood type can be given to everyone safely: O negative, which has neither of the two antigens and therefore can’t react with the patient's existing blood group antibodies. It is thus in very high demand for emergency situations where blood type is not known, and therefore always likely to be in short supply.

So much for the impromptu lesson on blood groups and blood products, which is nevertheless important to ‘set the scene’ for possible solutions to the problem.

Why are fewer new donors coming forward and existing ones reducing or stopping donations ?

The answer, as always, is multifactorial i.e. has a number of root causes. What it ultimately boils down to, though, is money and time …we will consider the implications of both, and what to do about them shortly.

Here are some possible reasons for the trend:

1)       * The age range stipulated for donors is 18-65. This was no doubt decided on way back in the ‘mists of time’ and hasn’t responded to the change in demography of our population, which has shifted to a much older profile since then. Many of our over 65’s are perfectly healthy enough to donate and would be happy to do so. Sadly for our nation's health prospects, in some cases their state of health is better than that of their younger peers. Pensioners also have more time to spare for attending clinics once they are retired.

2)       * At the other end of the age scale, Gen Z and younger groups are mostly strapped for cash – you can claim for travel expenses to a blood donation centre, but the claims procedure is quite involved and is retrospective. It also requires the cheapest form of public transport be used. Thus, if your nearest donation centre is miles away, you’ll need to fork out at least £6 for a return bus fare, and will have to go to the trouble of claiming it back later. Taxis are out, and not all Trusts will necessarily approve expenses at all. You may also find it difficult to squeeze in a visit during donation centre opening times, particularly if you’re still on a zero hours contract and scared to lose your job if you ask for time off. All that hassle just isn’t worth it, given that you’ll be doing it for free.

3)      * Many of us have an inherent fear of needles, and just don’t fancy having a beefy cannula stuck in our arms for half an hour or more while the regulation ‘pinta’ is extracted.

I’m sure there will be many more equally relevant reasons why donations are ‘falling off a cliff’, to quote one pundit.

But what can we do about it ?

The short answer, as alluded to earlier, is…recompense donors properly for their time and trouble. Why should we do this ?

The 'Kitchener Wants You' approach illustrated in the image below, and famously used as a army recruiting tool for WW1, is unlikely to raise much interest in 2025, when most of us are focused on the cost of living and how to deal with the extra tax burden to come this autumn. If we don't provide potential donors with more of a concrete incentive to give up their time, it just won't happen.....

Blood donation is a valuable service, and generates a precious resource which can be used to keep others alive. Although donating blood is generally free of consequences, it can be uncomfortable and may also cause significant local bruising and pain at the cannula site, which in my own experience can take up to a week to subside. The body also has to make up for the loss of the blood taken, particularly the iron involved in the haem group of haemoglobin, which can produce temporary iron deficiency in some donors.

Although as a society we seem to have become ‘hooked’ on the idea that blood donation is an altruistic ‘duty’ that we should all be prepared to perform without recompense, the evidence is clear that the vast majority of us who are elegible to donate….simply don’t. 

Basically, if we want to avoid running out of blood, we need to think again…..

Where's the money to come from ?

As we’ve constantly been hearing from successive governments, and particularly this one, the NHS is a ring-fenced spending priority and is predicted slated to receive at least an extra £15Bn in this week’s spending review. Could not a minuscule portion of this be set aside to reward our blood donors ?

According to my calculations, if we offered, say, a nominal £100 to everyone who remained on the donor register each year and donated at least once, and then paid them £50 per donation, this would provide a small, but significant incentive to remain a donor and provide blood regularly. This would be at minimal cost to the NHS. A simplification of the complex travel expenses claims process and a statutory requirement that all trusts implement this arrangement in full, would also help.

If this scheme were adopted, the maximum payment per donor (assuming a maximum of 1 donation every 2 months) excluding travel expenses would work out to £400 p.a. Assuming each donor actually made an average of just 3 donations p.a, they would receive £250 – if multiplied up by 800,000 this comes to £200M i.e. 1.3% of the additional £15Bn likely to be set aside for NHS in Reeves spending review.

Would this represent ‘value for money’ for the NHS ?

Given the importance of blood products for the smooth running of the service and their key role in saving lives, we should probably answer this question by asking what the consequences would be if we don’t do something to stop donations falling off a cliff. 

The answer lies in the fact that emergency measures always cost more – we will always need blood products to be able to offer even the most basic health service, and we would therefore be forced to import them from other countries (who may also be struggling to maintain donations) if we ran out of UK-generated supplies. The NHS would certainly ‘pay through the nose’ if it had to fly over emergency blood products from the near continent, let alone from further afield. And this assumes that such supplies were available - many EU countries are in a similar fix with regard to avialable donors themselves.

The other deterrent to outsourcing blood product supplies is quality control - it's much easier to ensure UK donors are suitably healthy and disease-free than those from abroad, even 'first world' countries. A look back at the infamous 'blood scandals' of the 1980s, the fall-out from which is still with us to this day, should convince most readers of the inherent risk in outsourcing.

Thus it would make eminent sense to pre-empt this by allocating 1.3% of the additional £15Bn Reeves has offered to rewarding our donors. This in itself would be cheap at the price. I suspect that once this happened, many more potential donors would consider joining up, and the crisis would be averted, thereby heading off any need for expensive, and risky, emergency outsourcing of supplies.

To boost donor availability further, the upper age limit of 65 should also be scrapped and a more sensible set of criteria applied to individuals in the older age groups to assess their suitability for donation. This would enable the use of a valuable additional and often under-used resource…our senior citizens.

Final Thoughts

We have a stark choice when it comes to funding our NHS....either fund it properly, or see it collapse. Follow the link for a more detailed discussion on how we might do this.

Blood transfusions and the various other products we extract from human blood donations are a vital part of the NHS’s efforts to keep us all alive and healthy. We should place a far higher value on them than we currently do, and reward the efforts of those who continue to provide them for us.

First published 10.6.25

Revised 11.6.25