Homecare medicines services could reduce strain on the NHS and transform patient care
How can the service live up to this potential?
“It makes me mad, frustrated, but mostly it’s heart-breaking.”
Homecare medicines services deliver medicines and provide medicine-related care to patients in their homes: teaching them to self-inject, and delivering medicine that might need special transport.
Half a million people use this service - and the figures suggest that it is only going to get bigger.
When it works, homecare is a fantastic model. Patients love it and by moving care into peoples’ homes there is great potential to reduce pressure on the NHS.
However our recent inquiry has concluded that this key service is not working the way it should and is causing patients harm.
“There are deep, systemic and long-standing failures in homecare medicine services.”
The potential of the service is not being met. Patients report that homecare medicines services are too often working poorly. Patients can wait weeks for their medicines; or sometimes the wrong medicines are delivered to them. In just a three month period, nearly 10,000 patients had missed or delayed deliveries from one provider.
This is not just an inconvenience: delays in medicines might cause an illness to get worse, or it might mean that the medicines stop working for them. We heard that in some cases, the service was so poor that they had to go into hospital to recover – some even had to undergo surgery.
“Missed doses of medicine makes me have several weeks feeling much more poorly.”
It is very important, not just for patients, but for the NHS, to get this right. At the moment, some doctors are having to firefight problems when the homecare system fails; and some are acting on the assumption that they will have to provide the care themselves.
We set out to investigate how big this problem is, why it is happening, and how we can address it.
In some cases the failure of provision of homecare medicines is so severe, or so predictable, that the NHS can pay twice: once for the homecare provider and, when that fails, to provide the service themselves.
Here are three main challenges facing homecare medicines services.
1. A lack of transparency
Providers are usually private, for-profit companies, delivering medicines to NHS patients. They are either paid by the NHS or the drug manufacturer.
It is a highly complicated system, which even people in the sector struggle to understand.
“It is certainly complicated. That is an understatement.”
How big is the problem?
We were not able to find out how many people suffered from delays or missed deliveries. The data was not available to us. We do not even know – and nor do the Government – how many people have been harmed due to failures in homecare.
This is because we do not have access to the figures on performance. These are collected monthly, but never published. This lack of information and understanding represents a real failure in oversight.
An alarming difference in homecare sector figures
It is not even clear how much the sector costs the taxpayer per year.
|
What the provider told us in July 2023 |
What the Government told us in September 2023 |
What the Government told us in November 2023 |
|
|---|---|---|---|
|
£4.1 billion |
£3.2 billion |
£2.9 billion |
Without knowing which is correct, how can we |
The relevant organisations provide figures to the Government, but the number the providers gave us and the numbers the Government have are very different. We asked for clarity on the cost, and a third number was provided in November, but it doesn’t cover some of the important costs of delivery or administration.
We recommend that performance data be published to allow the Government, patients, and the public, to understand the problem we are dealing with. The data must not be diluted, or too complicated to understand: it must truly allow meaningful scrutiny.
2. Procurement
The procurement for these services requires NHS staff to liaise with providers and drug manufacturing companies. This needs real expertise and experience.
We found, though, that there was not enough of either: hospitals and procurement hubs do not always have access to people who can provide expert advice on managing homecare contracts – in some cases, such roles are part-time.
“Many hospitals remain without dedicated or sufficient staff to manage [homecare] services internally.”
“[There is a] significant variation in funding and resourcing of pharmacy homecare teams.”
We have called for a review, and eventually a central resource of procurement professionals in the NHS who can ensure good, safe service, and value for money for all kinds of homecare.
3. Regulators
Where things go wrong, it is important that regulators are aware of that, and that they can help the provider to improve.
Where this is not possible, or where something has gone very badly wrong, strong enforcement action is necessary.
We found that the regulators in this sector do not know enough about homecare. We were also concerned that they did not have the will to find out.
“The overall picture suggests a vacuum of holistic oversight and a toothless enforcement culture.”
Where something has gone especially wrong, the enforcement action taken is often very feeble. At the moment, the regulators are failing to ensure good provision of care.
We recommend that the regulatory regime be revisited, with particular focus on the strength of enforcement action.
A way forward for homecare services
The homecare sector is highly complex, to the extent that even senior officials find it difficult to understand. This indicates a need for review and simplification.
At all points, we found that no one was willing to take responsibility or ownership for homecare. All witnesses were keen to outline where their responsibilities ended. Without focused leadership, problems will not be properly addressed, and it will certainly not be done quickly.
There must be a named individual with responsibility for homecare, and the powers and resources to fulfil that responsibility. They need to provide assurance that the system is fit for purpose.
We’re very pleased that the Government and the NHS have begun to take homecare seriously. Since this inquiry began, they have launched a review into homecare medicines services - this must not be allowed to delay any progress which can be made quickly.
However, there must also be a wider review of homecare, which would consider all that we have outlined, and make recommendations on the structural problems that remain.
We hope our full report is helpful in their work and we will return to this issue in 2024.
What happens now?
We have made our recommendations to the Government and it has two months to respond to our report.
Read the full report on our website.
Read more about the Government's response to our report.
Find out more about our inquiry and our committee.
Follow us @LordsPublicSCom
Cover image credit: © Vladimir Bikhovskiy (stock.adobe.com)
Built with Shorthand