Homecare service failures having ‘serious impact’ on patients’ health, finds House of Lords report

“Serious problems” with the provision and governance of homecare medicines services in England are “preventing the system from reaching its full potential” and putting patients’ health at risk, the House of Lords Public Services Committee has said.

In a report — ‘Homecare medicines services: an opportunity lost’ — published on 16 November 2023, the cross-party committee said the homecare medicines system is “unacceptably complex”.

It added that there is “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”.

“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,” the report said.

“Where this happens, it is no small inconvenience — it can have serious impacts on patients’ health, sometimes requiring hospital care.”

The committee also found that any assessment on the value for money delivered by homecare medicines services is “impossible” because the government does not know how much is spent on their delivery.

It called this lack of awareness “shocking and entirely unacceptable … given that the figure is most likely several billion pounds per year”.

The report also found “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.

“Patient groups and clinical representatives told us that the problems with homecare were extensive and long-lasting. By contrast, providers, regulators and industry bodies, while they recognised that on occasion there had been problems, told us that these problems were small in scale,” the report said.

“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 committee called for an immediate review and simplification of homecare medicines services, and made several recommendations, including:

• NHS England must identify and publish how many patients have become unwell or been harmed because of a failure in homecare services;
• The health secretary should review the regulatory regime for homecare medicines services and identify a lead regulator with the skill and the expertise to take action against providers that are under-performing; and
• NHS England must develop and implement one consistent set of performance metrics for the homecare medicines sector.

Noting that chief pharmacists are responsible for homecare services in their area but in most cases do not have the powers to fulfil this responsibility, the report recommends that they “must have the powers and resources to ensure high quality homecare medicines services in their area”.

“This should include powers and responsibility to develop and support alternative ‘back up’ provision to deliver homecare medicines services, such as through local pharmacies,” it said.

Baroness Morris of Yardley, chair of the Public Services Committee, said: “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.

“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, [and] our report calls for this as a means to begin the implementation of much-needed improvement across the sector.”

The committee has asked the Department of Health and Social Care to make a ministerial statement on the findings and proposed actions for NHS England’s work on homecare by December 2023, with a further statement provided by March 2024 on progress on these actions.

In May 2023, the Care Quality Commission said it was reviewing concerns raised about Sciensus, one of the UK’s largest medicines delivery services.

In a statement, a spokesperson for NHS England said: “The committee is right that homecare services can cut pressures on hospitals and the wider NHS and, while many services are working well, the NHS is working with trusts, regulators and commercial suppliers to support safe, effective and efficient homecare provision for patients.

“We have already taken steps towards appointing a single responsible officer for homecare services, who will be supported by the National Homecare Medicines Committee to implement measurable improvements to the performance of homecare services across the country.”