Lack of ownership makes harm to NHS medicines service patients unclear – report

The report warns of a ‘failure of oversight’ and ‘lack of ownership’ within the NHS Homecare Medicines Services.

A House of Lords Public Services Committee report criticises a ‘complete lack of ownership’ by the NHS Homecare Medicines Services (Alamy/PA)

Peers have raised concerns about a lack of awareness around whether or not an NHS medicines service is causing harm to patients.

A new House of Lords Public Services Committee report criticises a “complete lack of ownership” by the NHS Homecare Medicines Services – which sees specialist medicines delivered to a patient’s own home and associated care delivered.

The services are largely provided by private companies.

But the new report warns that “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.

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

Committee report

“This indicates a significant failure of oversight and hinders the ability of NHS England to ensure patient safety.”

Patients can suffer potential harm from delayed deliveries, problems after receiving the wrong medicine or not being taught how to administer it, the authors said.

They warned that there can be severe impacts of such problems, which can potentially lead to hospital admission for the patient involved.

As well as a lack of awareness over safety, the report also says that the Government does not know how much money is spent on these services so it is “impossible” to assess whether they are value for money.

“Given that the figure is most likely several billion pounds per year, this lack of awareness is shocking and entirely unacceptable,” the authors wrote.

“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.”

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

Baroness Morris of Yardley

Meanwhile, the report authors say there is “a complete lack of ownership of these key services”, adding: “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.”

The report, titled Homecare Medicines Services: An Opportunity Lost, states that around half a million people with chronic conditions in England depend upon the services.

Peers have made a series of recommendations to the NHS and Government.

We have heard from many patients whose care was compromised as a result of poor homecare services. Some of them needed emergency hospital treatment and even surgery.

Ruth Wakeman, Crohn’s and Colitis UK

Baroness Morris of Yardley, chairwoman of the committee, said: “The current system is beset with problems and must improve before benefits can be fully realised.

“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.

“It is not even possible, at the moment, to assess performance – no one is publishing any data.

“The regulators in this sector are weak. We saw a hands-off approach where no one regulator wanted to look too hard at performance, and no-one is in charge.

“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.

“We have called for a full-scale independent review to find answers to the more embedded structural problems within the system like procurement, competition and enforcement powers and resources.”

Commenting on the report, Ruth Wakeman, director of services, advocacy and evidence at the charity Crohn’s and Colitis UK, who gave evidence before the committee, said: “Managing a lifelong health condition is stressful enough without having to worry about whether your medicines will turn up on time or at all.

“We have heard from many patients whose care was compromised as a result of poor homecare services.

“Some of them needed emergency hospital treatment and even surgery.

“At Crohn’s & Colitis UK, we have long been calling for a full review of these services and we welcome the report’s findings.”

An NHS Spokesperson said: “The Committee is right that 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.”

A Department of Health and Social Care spokesperson said: “We welcome this report and will respond in due course.

“NHS England has already been undertaking work to understand the concerns that have been raised, including agreeing to publish performance data.”