Do we fully understand the realities of moving care closer to home?

The Lord’s Committee found homecare medicines services beset with problems, without clear leadership and accountability. The article invites the sector to consider what the findings mean for the future of the NHS, with healthcare increasingly delivered in people’s homes.

Much of the discussion around moving healthcare closer to home has extolled its virtues. Prime Ministerial visits to virtual wards and Amanda Pritchard’s commendations of ‘hospital care at home’ have hailed these services as pivotal in alleviating strains on existing NHS resources while offering more personalised care.

However, Peers have recently called into question whether the promise of this ongoing technological and innovation revolution within the NHS, as exampled by homecare medicines services, is being fully realised. Committee member Lord Laming remarked, “Looking back over a long career in public services I cannot think of an area of work with such a simple objective but also a hopelessly complicated system of delivery.”

Moving care closer to home has been a long-term goal of governments, a goal which was accelerated during the pandemic. Homecare medicines services, now more than a decade old, deliver vital specialist medicines to people’s home, as well as associated nursing care, to an estimated 500,000 children and adults in England, costing between £2-4billion annually.

For the most part, their rapid expansion, 150% since 2011, has flown below the radar. There is no mention in the Long-Term Plan and barely a mention in parliament.

13 months ago, British Society for Rheumatology (BSR) members bought their concerns to our national Multi-Disciplinary Team Committee. Then, following further consultation with our members, we started to look into these issues on our members’ behalf.  

Speaking to patient organisations and other medical speciality groups BSR found shared concerns about missed doses, long-waits for starting new medications, and healthcare professionals taken away from their clinical work to chase prescriptions or organise medications when deliveries failed to happen. We took these concerns to regulators, NHS leaders, providers and parliamentarians.

Our organisations are grateful to members of the Public Services Committee who were convinced by the weight of service user evidence that there was a problem, evidence which was previously batted away by regulators and in parliamentary questions when raised.

The Committee discovered a service not working the way it should and, “in some cases, is causing patients serious harm,” said its Chair. They subsequently recommended a full-scale Government-sponsored independent review. Additionally, they have found:

• An overly complex system, with a complete lack of ownership. “Simply put, no one has a grip”. No one person or organisation was found to be responsible for driving improvements. It recommended that the NHS designate a named individual to be appointed and appropriately supported to lead and take responsibility for safety and performance.
• A regulatory regime failing patients. It was felt that regulators had insufficient knowledge of the system and little interest in digging into patient experiences, and that enforcement action was often ‘very feeble’. It recommended the Government revisit regulatory system, appoint a lead regulator and the CQC undertake a thematic review.
• Lack of transparency: The Peers were alarmed that they could not tell how many people could have experienced harm. Data on delays and harm to people was unavailable and that Government lacked sector understanding. It recommended the publication of understandable, comprehensive performance data for scrutiny by Government, patients, and public.
• A difficult market, still largely paper based, with poor procurement and digital infrastructure. It recommended the roll out of e-prescribing, including the creation of a single NHS England portal. And increasing resources and expertise of homecare medicines teams.

The Government is required to respond to the Committee’s recommendations within a month. 

Considering these findings, against a backdrop of healthcare at home expanding at pace, we must ponder the implications for patients and clinicians if the government disregard these recommendations.

This report is a rallying call to all of us to work together to shape and strengthen the leadership and accountability of these services, and with it, the direction of healthcare at home more widely, by calling on the Government to take urgent action.

If you have questions or would like to discuss the article, please contact sberry@rheumatology.org.uk.

Biography

Sarah is Public Affairs Manager at the British Society for Rheumatology (BSR). She brings experience in parliamentary, policy and stakeholder engagement from roles at Alzheimer’s Society, NHS Confederation, and Crohn’s & Colitis UK. Dedicated to healthcare improvement, she has worked on campaigns to grow the rheumatology workforce, improve dementia and IBD services and increase access to new and existing treatments.