The regulatory regime is failing patients when it comes to homecare medicines - Baroness Morris
Instead, a homecare provider, contracted by the NHS, will bring medicines to their home and teach them to administer to themselves. It is a fantastic model, but it is not working.
Patient groups have told us of extremely long waits and delays, receiving the wrong drugs, and not being able to reach the companies to correct problems. This is no small inconvenience: if people don’t get their medicines at the right time, their conditions can get worse, they can end up in hospital, and they could even die.
We set out to discover how big the problems are: is this, as the sector bodies said, just a small number of people? But it was impossible to get to the bottom of it.
While information on delays and errors is collected, it is not published. There is no information collected on how many people have been harmed. This is a total failure of transparency and oversight. The performance data, and the data on harms, must be published. And it must be published in a clear and pragmatic way that allows meaningful scrutiny.
Because at present, the whole system is opaque. Members reflected that in all their years of public life they had never encountered such diametrically opposed evidence. On the one hand, the sector bodies and the regulators said it was working well. On the other hand, patient groups were telling us that real, serious, and long-standing problems were resulting in physical harm to a significant number of patients.
Senior NHS staff told us that they struggled to understand the highly complicated system. The Government does not even know how much the sector costs. We received three different figures, more than a billion pounds apart. That is truly alarming.
Part of this is because the purchasing is done on a local level. But the complexity of these contracts, which are often two, or even three times removed from the NHS, means that real expertise and experience is crucial in ensuring that the taxpayer gets a good deal. And that expertise is so patchy, and so unreliable, that local areas are unable to assure the quality of the services and ensure value for money.
Expertise and experience should be guaranteed, and we need eventually to move towards a central pool of procurement skills for homecare.
Our report has already had an impact. NHS England is running a review, initially to understand the system they run. That is positive. However, this review is internal, and it is unlikely to focus on a key part of the puzzle: the regulators.
There is not one regulator - there are in fact three. They cover different areas. And they do so without the benefit of having a lead regulator. They told us that the system was working well, but we have found that they simply cannot know that: they do not have the necessary awareness.
The Care Quality Commission (CQC), whom many people would think should be in charge, have conducted only three homecare provider inspections in the past year, and they could not tell us how many complaints they had received on homecare services. They repeated “cherry-picked” figures from the sector bodies on performance, which gave us a false impression.
Not only do they not have the awareness needed to perform their regulatory functions, but when they do take action, that action can best be described as feeble. The regulatory regime is failing patients in this crucial sector of healthcare, and it should be urgently reviewed.
There is not one simple problem to solve, and homecare providers are working in very difficult conditions. We were astonished, for example, to find that, due to the lack of digital infrastructure, prescriptions are routinely sent to providers in the post. Those who are responsible for ensuring high quality services do not have the levers they need to ensure that those services are run well, and that leaves patients without recourse, and a complete lack of accountability.
Our most important recommendation, therefore, is for a senior, named person to take responsibility for the homecare system. That person must have the powers and resources to discharge that responsibility.
We have identified specific steps which could be taken: the publication of information, the clarification on costs and harms, and an edict issued to ensure that the CQC conducts a full review. These steps must be taken, and taken quickly. In the longer term, though, we need a full, independent, government-sponsored review which looks at the systemic issues impacting upon the care patients receive.
The homecare system has true potential. It just needs to work better.
Baroness Morris of Yardley is the Chair of the House of Lords Public Services Committee.