Homecare medicines services: an opportunity lost Contents

Chapter 4: Purchasing

59.We were given diverging figures for the amount spent on homecare medicines services. Alison Davis, Chair of the National Clinical Homecare Association, stated that “Some £4.1 billion of Treasury money is spent on these services per annum”.118 The Government were unable to provide an independent, verified figure—they relied on reports from the National Clinical Homecare Association, however, the figure that the Government quoted from the National Clinical Homecare Association was £3.2 billion.119 This is almost £1 billion less than the figure the same organisation reported to us. We asked the Minister to clarify. He later wrote to us, supplying a third figure:

”According to data that NHS England has access to, the reported spend on homecare medicines for England for the year from September 2022 to August 2023 is c.£2.9bn. This is data for England only based on collated monthly trust data for medicines issues to patients receiving homecare. Figures provided by NCHA may differ as they are based on UK data and include private sector spend. For NHS-funded homecare medicines services, along with the costs of medicines, additional costs could be included for: delivery, clinical waste collection, ancillaries, training of patients and ongoing nursing. For pharma funded schemes these costs are picked up by the companies and are unknown to the NHS due to commercial sensitivities.”120

As the Minister acknowledges, there are additional costs for NHS-funded homecare (including delivery, and any required care or help to administer it). This figure is not, therefore, the whole picture. Moreover, the cost information collected from trusts is collated for all patients receiving homecare, so there is no possibility of comparing how cost-effective different providers may be, nor whether NHS-funded or manufacturer-funded homecare is better value for money.

60.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.

61.The Government must clarify exactly how much public money is spent on homecare medicines services.

62.Despite the (disputed but substantial) cost to the Treasury, witnesses told us that there was extremely limited support for procurement.

Available support

63.We were told that “there is a huge amount of effort involved in managing [homecare] contracts and being aware of the impact on your patients”.121 As explained by the Chief Pharmaceutical Officer for England David Webb, this requires specialist knowledge. He told us that effective contract management “calls for a significant understanding of how the contracts operate and the risks”.122

64.For NHS-funded homecare, NHS England’s Commercial Medicines Unit and regional procurement hubs provide some support to trusts. The Commercial Medicines Unit oversees frameworks for four specific clinical areas, allowing “trusts to draw off that and therefore supply their patients”.123 These frameworks allow for provision of only around 4% of total homecare provision.124 There are also regional procurement hubs to support trusts in arranging NHS-funded homecare. They set regional framework agreements for NHS-commissioned homecare services. An NHS trust can seek a supplier identified in these framework agreements, though they are not limited to the providers identified in them.125

65.The majority of homecare is manufacturer funded. Neither the Commercial Medicines Unit nor NHS procurement hubs support trusts with manufacturer-funded homecare. These contracts are “directly arranged” and “locally established”.126 Service level agreements between the trust and the provider set out expected performance, but this is separate from the contractual relationship.

Lack of expertise

66.Within procurement hubs, which support NHS trusts when they contract with providers, there is not always a homecare specialist. We were told that “funding is variable for those posts”.127

67.Manufacturer-funded homecare is usually arranged between the trust and the drug manufacturer without the involvement of a regional hub.128 We were told that trusts have insufficient staff to support these arrangements. Alison Davis linked this to funding: “Fundamentally, there is a lack of funding in the NHS for homecare teams … many hospitals remain without dedicated or sufficient staff to manage these services internally.”129

68.Such provision and expertise fluctuates between trusts. Richard Bateman, member of the Royal Pharmaceutical Society Hospital Expert Advisory Group, described a “significant variation in funding and resourcing of pharmacy homecare teams between trusts and the mechanisms for funding those teams”.130

Information

69.This section will largely concentrate on information on the performance of providers. We note, however, that given the need (discussed in paragraphs 30–32) for hospitals sometimes to provide services themselves, information on cost, and cost effectiveness, would be useful to front-line clinicians. Unfortunately, such information is not available.

70.On a basic level, staff arranging contracts and monitoring agreements with homecare providers could be expected to know how the provider has performed. This would enable them to make informed decisions.

71.For NHS-funded homecare, such knowledge would usually be in procurement hubs, who “get the collective data for all the hospitals”.131 The performance data is also reported to individual hospitals.132 However, this data is not necessarily passed to clinicians who decide whether a patient should receive homecare.133

72.Marketing Authorisation Holders work for drug manufacturing companies. They are responsible for procuring the homecare services delivered to NHS patients under manufacturer-funded arrangements. Dr Rick Greville, a Director of the Association of the British Pharmaceutical Industry, stated that while Marketing Authorisation Holders “have good insight into the intended design of the service”, “very often the feedback mechanism or the transparency in how successfully that service is being operated as a day-by-day function is sometimes missing … they would prefer greater transparency in the data”.134

73.Though there is substantial variation, in many cases, those procuring and recommending homecare services appear ill-equipped to do so. In some cases, expertise is missing; in others, there is insufficient information. Given this, and the clear commercial incentives for manufacturers to choose cheaper provision, there can be no reliable assurance that a provider is suitable before agreements are made.

74.Given the substantial public cost of homecare medicines, improving procurement processes should be an urgent priority. In their current form, neither the National Homecare Medicines Committee nor regional procurement hubs are equipped to lead the change required.

75.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.


118 Q 20 (Alison Davis)

119 Q 50 (Will Quince MP). See also Written Answer HL9385, Session 2022–23.

120 Supplementary written evidence from the Department of Health and Social Care (HMS0026)

121 Q 39 (David Webb)

122 Ibid.

123 Q 39 (Claire Foreman)

124 Ibid.

125 Q 44 (Joe Bassett)

126 Q 39 (Joe Bassett)

127 Q 44 (Joe Bassett)

128 Q 39 (Joe Bassett)

129 Q 17 (Alison Davis)

130 Supplementary written evidence from Royal Pharmaceutical Society (HMS0013), Q 21 (Richard Bateman), Q 18 and 39 (David Webb)

131 Q 22 (Alison Davis)

132 Ibid.

133 Q 11 (Dr Christian Selinger)

134 Q 17 (Dr Rick Greville)




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