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Lords Committee publishes new report on services that could transform patient care

16 November 2023

The Public Services Committee has published its new report, Homecare medicines services: an opportunity lost. The Committee concludes that the services which deliver medicines to patients in their home could improve care for patients and reduce pressure on the NHS but that this significant potential is not being met.


Homecare medicines services deliver medicines and provide medicine-related care to patients in their homes: teaching them to self-inject, and delivering medicine that might need special transport.

500,000 NHS patients use homecare services in England, and the sector of for-profit companies providing these services is growing.

The problem

The Committee heard multiple reports of delays and errors by homecare providers, resulting in patients receiving care later than scheduled. The Committee has concluded that this key service is not working the way it should and, in some cases, is causing patients serious harm.

Key recommendations

In addition to the problems experienced by patients, the Committee found a confusing picture and three key barriers to improvement.

  1. A lack of transparency. Information on how many people suffered from delays or missed deliveries was not available to us. There is no data available on how many people had been harmed.
    Nor, the Committee found, does the Government understand the sector. Alarmingly, the Committee received three different figures for how much money the sector cost.
    Recommendation: The Committee recommends that performance data be published to allow the Government, patients, and the public, to understand the problem. The data must not be diluted, or too complicated to understand: it must truly allow meaningful scrutiny.
  2. Procurement. The procurement for homecare services requires NHS staff to liaise with providers and drug manufacturing companies. The Committee found that there was neither sufficient experience nor expertise.
    Recommendation: A review must outline the path towards a central resource of experienced procurement professionals.
  3. Regulators. The Committee found that the regulators in this sector did not know enough about homecare, and did not have the will to find out. The Committee also found that enforcement action was often very feeble, meaning that regulators are failing to ensure good provision of care.
    Recommendation: The regulatory regime should be revisited, and a lead regulator appointed.

The report also includes recommendations in relation to electronic prescriptions for homecare providers, procurement systems, and giving Chief Pharmacists the powers and resources to ensure high quality homecare services in their area.

Chair's comment

Baroness Morris of Yardley, Chair of the Public Services Committee said;

“An efficient, well managed and well enforced system of homecare medicines services has the potential to deliver high-quality care to patients in their homes and thus reduce pressure on the NHS. They should be a key part of future planning and resourcing for the NHS. However, 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. Our report calls for this as a means to begin the implementation of much-needed improvement across the sector. More long-term, 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. We are clear that this review must not be allowed to delay the many changes that can be made much more quickly.

“We are heartened to learn of some progress made since we started our inquiry. The NHS are running a review, and they have committed to publishing performance data in some form. We hope our report will assist with their work. Most of our recommendations can and must be implemented quickly. They will help to secure clearer, more effective services and provide patients with the safe and reliable care they need”

Further information