Homecare medicines services: an opportunity lost (House of Lords Public Services Committee, 16 November 2023)

Summary

Homecare medicines services deliver medicines and provide medicine-related care to patients in their homes, for example, teaching them to self-inject, and delivering medicine that might need special transport. In this report, the House of Lords Public Services Committee highlights concerns about multiple reports of delays and errors by homecare providers, resulting in patients receiving care later than scheduled. The report states that this key service is not working the way it should and, in some cases, is causing patients serious harm.

Content

Half a million people with chronic conditions in England depend upon medicines which, along with any necessary help to administer them, are delivered to their homes. These types of services are called ‘homecare medicines services’ and replace care that would previously have been supplied in hospital. They are mainly provided by private, for-profit, companies, to NHS patients. This report notes the following points of concern about how this sector currently operates:

• No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare.
• Evidence on key points—including, alarmingly, the amount of public money spent on the sector—was contradictory. The Government does not know how much money is spent on homecare medicines services. It is therefore impossible to make any assessment on value for money.
• Homecare medicines services have the potential to improve care for patients and reduce pressure on the NHS. However, currently this significant potential is not being met.
• Some patients are experiencing delays, receiving the wrong medicine, or not being taught how to administer their medicine.

Recommendations

The report makes the following recommendations:

• The Department of Health and Social Care should, by December 2023, make a ministerial statement on the findings and proposed actions for NHS England’s work on homecare. A further statement should be provided by March 2024 on progress on these actions.
• NHS England must identify how many patients have become unwell or have been harmed because of a failure in homecare services. They should ensure that this information is published and shared with relevant parties. It should also form part of the ministerial statements we have requested by December 2023 and March 2024.
• NHS England must develop and implement one consistent set of performance metrics.
• The Chief Pharmaceutical Officer for England should ensure that the KPI data is published in a consistent, standardised form which is sufficiently specific and regular to ensure meaningful public scrutiny.
• The Government must clarify exactly how much public money is spent on homecare medicines services.
• The review must outline necessary steps towards establishing a central resource of experienced procurement professionals to assist in establishing homecare medicines services. This must be available to all those establishing agreements, whether they are manufacturer- or NHS-funded.
• The Secretary of State should review the regulatory regime for homecare medicines services, considering in particular the lack of enforcement action taken by the CQC against homecare providers where avoidable harm has occurred. The review should identify a lead regulator with the skill and the breadth necessary to take necessary action against providers which are under-performing. These urgent actions should also be reflected in the longer-term review of healthcare regulation.
• The Secretary of State for Health and Social Care should instruct the CQC to conduct a thematic review of homecare medicines services.
• As part of a review of homecare medicines services, the Government should work with procurement specialists, the National Audit Office, and the Competition and Markets Authority to identify barriers to competition and effective procurement in the homecare medicines market. They should agree actions to ensure procurement by the NHS or medicines manufacturers achieves value for money.
• A single homecare portal should be created and provided by NHS England. If possible this should be linked with existing online services such as the NHS App.
• More urgency is required in developing Electronic Prescription Systems for homecare providers to use. These must be developed in collaboration between homecare providers and NHS trusts.
• Chief Pharmacists must have the powers and resources to ensure high quality homecare medicines services in their area. This should include powers and responsibility to develop and support alternative ‘back up’ provision to deliver homecare medicines services, such as through local pharmacies. This would both empower trusts in their market position, and create a more resilient homecare system.
• NHS England should designate a senior, named person with responsibility for the homecare system. That person should be given sufficient powers and resources to discharge that responsibility.
• Following the interim findings of the NHS England review, and by no later than April 2024, the Government should establish and fund an independent review into the homecare system. This review must not delay the enactment of those measures which we, and others, have identified.