Chapter 8: Next steps
119.We have identified a number of serious problems in the homecare sector.
- Chapter 1 identified the need for further, urgent review of the homecare sector, and its potential to transform patient care.
- Chapter 2 highlighted the detrimental impact of existing problems on patients and on the NHS.
- Chapter 3 identified a serious difficulty—the lack of transparency within the system prevents anyone from understanding the extent of these problems and how representative they are.
- Chapter 4 found that a lack of support, expertise, and information hindered good purchasing decisions.
- Chapter 5 identified that the regulatory model for homecare is failing to ensure safe care.
- Chapter 6 found a lack of competition in the market, and a failing approach to IT interoperability and electronic-prescribing.
- Chapter 7 has identified a lack of accountability, with no one person or organisation in charge. This makes recourse for patients impossible.
120.These problems are not limited to one area. It has been over a decade since the last full-scale review into this sector. While we have welcomed work by NHS England to review the functioning of the sector, and some welcome steps have been taken, the problems are so broad that a full-scale, Government-sponsored independent review is urgently needed. This must not be allowed to delay action that could be taken more quickly. The Minister for Health and Secondary Care acknowledged this, stating that there were several elements to homecare that, “without needing to see the paper-based exercise, I know we need to get on with and do”.210
121.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. The review should consider:
(a)The potential role of homecare as a pillar of the future health service;
(b)The extent and impact of existing problems on patients and the NHS;
(c)A radical new approach to transparency and information sharing;
(d)Support and resources required for effective procurement;
(e)Steps to develop a tougher and more proactive regulatory approach;
(f)Steps to encourage a competitive and fair market for providers;
(g)Digital infrastructure to support effective delivery; and
(h)Robust governance and accountability arrangements, including ministerial oversight.
122.We intend to revisit this issue and assess progress against our recommendations in 2024.