Homecare medicines services could improve care for patients and reduce pressure on the NHS – but their potential is not being met says Lords report

Homecare medicines services are delivered to around half a million people with chronic conditions in England. Service provision includes the delivery of medicines and where necessary, help to administer the medication. They are mainly provided by private for-profit, companies, to NHS patients. The report points out the unacceptably complex nature of the system which can even prove difficult for staff at senior levels to understand and calls for its immediate review and simplification.

The report highlights a complete lack of ownership of key aspects of the homecare sector with no one person or organisation willing to take responsibility for driving improvements or exploiting the full potential of homecare medicines services to bring care closer to home. The report calls for a named individual to be appointed and appropriately supported to lead and take responsibility for homecare medicines services.

In another concerning conclusion, the report finds irreconcilable differences between how clinicians and service users view the quality of service received, and how regulators and governance bodies view the quality of the service delivered. The Committee was persuaded by the weight of evidence from service users that there are real and serious problems in the sector. Alarmingly, no-one: including the Government, NHS England, patient groups, or regulators, was able to say how often, nor how seriously patients suffer harm from service failures in homecare. In reality, delays in, or failure to provide homecare medicines services can result in severe consequences that impact patients physical and mental health and also result in hospital admission or surgery. The report recommends 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.

In addition, the report asks for the Department of Health and Social Care to, 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.

Other significant findings and recommendations in the report include;

• Regulation: The regulatory model for homecare is failing to ensure the safety and quality of patient care. The complexity of the system and the various regulatory bodies with partial responsibility for the many different types of services provided by different organisations means that there is a lack of co-ordination, inconsistency in enforcement activity, and no-one with overall control or oversight. This also means that poor performance can go unchecked. The Secretary of State for Health and Social Care (SofS) should review the regulatory regime for homecare medicines services. The review should identify a lead regulator with the skill and the expertise to take action against providers which are under-performing. The SofS should also instruct the CQC to conduct a thematic review of homecare medicines services.

• Data and measuring performance: Different sets of performance data are available to manufacturers and the NHS, however, the data that is collected is not published regularly. When it is, the data is inconsistent and collated in a way that is so diluted it becomes meaningless and not useful for performance comparison. This creates confusion and prevents effective monitoring. NHS England must develop and implement one consistent set of performance metrics. Performance data must be published regularly in a clear format and include information that acknowledges patient experience or perspective. The Chief Pharmaceutical Officer for England should ensure that the Key Performance Indicator (KPI) data is published in a consistent, standardised form which is sufficiently specific and regular to ensure meaningful public scrutiny.

• Purchasing and value for money: Any assessment on the value for money delivered by homecare medicines services is impossible as the Government does not know for sure how much money is spent on their delivery. Given that the figure is most likely several billion pounds per year, this lack of awareness is shocking and entirely unacceptable. The Government must clarify how much public money is spent on homecare medicines services.

The report also includes recommendations in relation to electronic prescriptions for homecare providers, procurement systems, and giving Chief Pharmacists the powers and resources to ensure high quality homecare services in their area.

Baroness Morris of Yardley, Chair of the Public Services Committee said;

“An efficient, well managed and well enforced system of homecare medicines services has the potential to deliver high-quality care to patients in their homes and thus reduce pressure on the NHS. They should be a key part of future planning and resourcing for the NHS. However, the current system is beset with problems and must improve before benefits can be fully realised.

“The system has grown into a fractured and complex mess, with no one named individual or body having overall responsibility for defining and ensuring performance across the sector. It is not even possible, at the moment, to assess performance: no one is publishing any data.

“The regulators in this sector are weak. We saw a hands-off approach where no one regulator wanted to look too hard at performance, and no one is in charge.

“Accountability in the provision of homecare medicines services is key and someone must get to grips with the entire system and have responsibility for getting things right. Our report calls for this as a means to begin the implementation of much-needed improvement across the sector. More long-term, we have called for a full-scale independent review to find answers to the more embedded structural problems within the system like procurement, competition and enforcement powers and resources. We are clear that this review must not be allowed to delay the many changes that can be made much more quickly.

“We are heartened to learn of some progress made since we started our inquiry. The NHS are running a review, and they have committed to publishing performance data in some form. We hope our report will assist with their work. Most of our recommendations can and must be implemented quickly. They will help to secure clearer, more effective services and provide patients with the safe and reliable care they need”