The market for delivering hospital-prescribed medicines directly to patients in their own homes is growing fast, but the NHS needs to become a much more coordinated customer if it is to maximise the benefits which this service can offer to patients and taxpayers, say a leading expert.
And the industry needs to work with the NHS, investing in technology to develop the homecare medicines supply market, which is currently worth at least £1 billion in England, is expanding rapidly and is here to stay, according to Mark Hackett, chief executive of Southampton University Hospitals NHS Trust. Mr Hackett is chairing a national review of the homecare market for the Department of Health and is shortly to publish his findings.
Homecare services offer huge benefits to patients and suppliers, and they need to be seen as part of the local health system strategy, Mr Hackett told a recent conference in London, organised by Pharmacy Management magazine. To maximise the opportunities which the services can offer, for example in developing care pathways, the industry must work with the NHS to “innovate and give us ideas - we don’t just want the drugs,” he said.
The Department’s decision to sponsor a review of homecare medicines supply notes that the market is expanding and that "arrangements will have to adapt and develop within a rapidly-changing health care environment."
"Correct operational management presents challenges to both the NHS and its commercial partners,” it says.
There are currently two principle routes of home care supply – the manufacturer-only route and the provision of services from manufacturers or wholesalers, the conference heard.
For some providers, the business is proving to be high-risk for a number of reasons; a contract may be loading too much risk onto them, payment systems can produce cashflow problems and there may be few incentives for them outside the initial contract, said Mr Hackett.
Companies also need the roles of chief pharmacists, medical directors and nurse directors within NHS trusts to be strengthened around homecare services, and trusts' internal governance to be improved - companies "need to know who is ordering, what is the treatment plan, quality control, symptom monitoring - the industry is calling out for this,” he said.
And while there are instances of good collaboration across NHS organisations, this is not standard and tends to be due to individuals rather than the organisations themselves. But good alignment is necessary to improve patient services, he said.
Looking to the future, Mr Hackett said that both new and existing homecare providers need better stability, with collaborative purchasing, longer-term contracts and stable contractual frameworks which are of sufficient duration to secure the best value for patients and taxpayers.
For their part, providers should be prepared to take proportionate risks to invest in new technology, service levels and cost efficacy, he added, and also suggested that homecare services and supplies of medicines should be separated, in order to get clarity on provision. “It is unacceptable if we don’t know the cost of a drug,” he said.
Also needed is a clear set of “fair, balanced and open” industry standards covering major areas of governance, operational control and approaches, he said, and suggested that a form of “kite mark” accreditation should be developed for companies to enter into NHS contracts.