Homecare medicines services: an opportunity lost Contents


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.

We found very little understanding or consensus on anything in this sector. 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. This indicates a significant failure of oversight and hinders the ability of NHS England to ensure patient safety. 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. Given that the figure is most likely several billion pounds per year, this lack of awareness is shocking and entirely unacceptable.

Our report acknowledges the potential of homecare medicines services—they could improve care for patients and reduce pressure on the NHS. This significant potential is not being met.

There are serious problems with the way services are provided. Some patients are experiencing delays, receiving the wrong medicine, or not being taught how to administer their medicine. Where this happens, it is no small inconvenience—it can have serious impacts on patients’ health, sometimes requiring hospital care. This leaves NHS staff either firefighting the problems caused by problems in homecare medicine services, or working on the assumption that those services will fail.

In some cases, the taxpayer is effectively paying for the service twice—once for the private provider to deliver it, and again for the NHS to pick up the pieces where private providers fail.

We identified several areas where improvements were needed. In this report we deal with them in turn. We found:

Improvements can and must be made in some areas quickly. We have made recommendations which, if implemented, would help secure clearer, more effective services.

Most concerningly, we found a complete lack of ownership of these key services. Our final two chapters deal with the fact that no one person or organisation was willing to take responsibility for driving improvements or exploiting the full potential of homecare medicines services to bring care closer to home. Simply put, no one has a grip on this. We therefore recommend that a named individual be appointed and appropriately supported to lead and take responsibility for homecare medicines services.

Our final recommendation is for a full-scale independent review tasked with finding answers to the more embedded structural problems. This review is essential, but it must not be allowed to delay progress where it can be made more quickly.

We were heartened to learn of substantial progress since we launched this inquiry. An NHS England review is underway. Its first task is to establish the facts. There has also been a commitment to publish performance data. Discussions with the department on system ownership have also been promising. We hope this report will be of assistance to NHS England and the Department of Health and Social Care as they continue this work.

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