Homecare medicines services inquiry

15-20 mins

BSR's year-long campaign spurred parliamentarians to initiate an inquiry into homecare medicines services' governance and accountability. The witness sessions have heard evidence on levers for accountability, performance and safety, e-prescribing and workforce. As we wait for the committee's final findings to be published in November, this blog shares some of the highlights of the evidence given to date.

15-20 mins

Pictured: Witness(es): Dr Christian Selinger, Consultant Gastroenterologist and Chair of the Inflammatory Bowel Disease Section, British Society of Gastroenterology; Sarah Campbell, Chief Executive, British Society for Rheumatology; Ruth Wakeman, Director of Services, Advocacy and Evidence, Crohn's & Colitis UK

1

An overview

Parliamentary scrutiny of homecare medicines services across England is revealing a ‘chaotic’ system lacking in ‘direct lines of accountability’ which has ‘gone off the radar’. The inquiry, undertaken by the Lord’s Public Services Committee, has taken evidence from Health Minister Will Quince MP, the Chief Pharmaceutical Officer for NHS England David Webb, regulators, the provider trade body, charities, and medical societies. Originally intended as a short inquiry, the impact of patient and clinician evidence, including your responses to BSR’s homecare survey, has seen it expanded to include more witness sessions.

Sarah Campbell, our Chief Executive, alongside Crohn’s & Colitis UK and the British Society for Gastroenterology kicked off the inquiry by sharing concerns regarding safety and performance.

Over the sessions it has become apparent that there is a disconnect between how patients and clinicians believe the system is performing, and the regulators, providers and some NHS leaders.

So, what have we learned?

2

Homecare provider challenges

There was a consensus that the paper-based system of prescribing is slow, burdensome, complicated, vulnerable to duplication and delay. The lack of interoperable IT system with private providers was impeding communication and performance.

Private providers are experiencing recruitment and retention challenges, with the National Clinical Homecare Association (NCHA), the trade body which represents homecare providers, arguing that their ‘ability to redeploy staff has greater limitations’ than NHS.
The NCHA argued that a delay on average of 14 days caused by the prescriber was causing delays in treatment initiation. BSR has disputed this figure in follow-up evidence to the Committee Members.
NCHA felt patients’ expectations of services cause some of the problems and challenges that they face.
The NCHA argued that 98.8% of medicines were delivered on the day agreed. However, their spokesperson went on to acknowledge that “it does not mean that that was the day the patient was due it (the medicine)”.

3

Regulation

The Committee heard homecare was ‘quite fragmented’ and wanted to understand how it worked, who was responsible for what, and where responsibilities overlapped.

It was explained to the Committee that there was no lead regulator and that the GPhC, CQC and MHRA look at different aspects of the service against different standards, and do, where appropriate, undertake joint inspection. Sector and trade standards are not regulated.
Sarah Billington, speaking on behalf of the CQC said that having a lead regulator was not possible due to current legislation. She said that system ‘is not straightforward’ and ‘there is not one regulator that really has the expertise to scrutinise what is a complicated system’. Their job was to work together to make sure there ‘is no gaps’ in what they do.
Both regulators felt the market was working satisfactorily. CQC stated that “98% of the activity of the delivery of medicines to patients in the system is successful”- and on this basis they would not launch a thematic investigation. The GPhC agreed, saying that as a model it was performing well overall, with just a few not having performed well.

The CQC noted that the ‘system is very fragile and there is not much capacity in it’.
BSR has refuted the claims of the regulators that the system is performing well and in fact submitted evidence to them contradicting this statement. The regulators never responded directly to our evidence submission.

4

Accountability

The NCHA, echoing BSR interventions, highlighted that “there is no named individual team or department accountable and responsible for those essential services to 550,000 patients. Some £4.1 billion of Treasury money is spent on these services per annum, yet nobody has oversight for it”. They added “there can also be the challenge that you are not linking in with people at a level who can make systemic changes”.
Royal Pharmaceutical Society RPS acknowledged fragmentation and argued that there needed to be “better defined routes of accountability and escalation for dealing with these issues on a national level, rather than multiple local conversations trying to deal with the same issue.”

5

Data and KPIs

Committee members heard that there is “no published dataset for the performance data at a national aggregated level for homecare medicines services across England”. The Committee asked the Minister whether ‘because the Government doesn't have direct control, surely the importance of having accurate data is even more so?’
APBI on behalf of market authorisation holder perspective argued that they would prefer greater transparency in data.
The NMHC said they would be consulting on new KPIs ‘as of next week’.

6

NHSE announces desktop exercise

Chief Pharmacist and Director of Medicines Policy and Strategy will undertake a piece of work (in two stages) to “understand the range of arrangements that are in place and the accountabilities that go with that”. This desktop inquiry was triggered by conversations with the BSR. He cited governance, accountable, regulation and the complaints system as specific areas of review.

In response to a question from Committee member Lord Willis, NHS representatives assured the Committee that “KPIs will be national and publicly accountable wherever review happens, so that we have a national set of statistics that we can then review and hold everyone to account, irrespective of whether they are part of a framework, an individual contract or, indeed, a new organisation that might emerge from the development”.
While the Chief Pharmacist said their desktop exercise would be published after the Committee’s report, in later evidence sessions the Minister indicated that the first stage of the work would finish before (Autumn). BSR has written to the Chief Pharmacist for clarification and more information about his desktop review.

The Committee are expected to publish its final findings and recommendations in the Autumn. Once published we will work with the full range of stakeholders to ensure recommendations are adopted by the NHS improve patient care and resource use within NHS.

Homecare Medicines Services Inquiry

1

An overview

2

Homecare provider challenges

3

Regulation

4

Accountability

5

Data and KPIs

6

NHSE announces desktop exercise

1

An overview

2

Homecare provider challenges

3

Regulation

4

Accountability

5

Data and KPIs

6

NHSE announces desktop exercise

1

An overview

2

Homecare provider challenges

3

Regulation

4

Accountability

5

Data and KPIs

6

NHSE announces desktop exercise

View BSR's submitted evidence below