Homecare medicines supply in England has been growing fast and is now worth around £1 billion a year, but a new government review finds "fundamental issues which need to be addressed" in the sector, including a much greater role for patients.

The report was carried out for the Department of Health (DH) by Mark Hackett, chief executive of Southampton Universities NHS Foundation Trust. He says that while his review had found many examples of "admirable services and best practice," these were “not the norm – they were the minority.”

The importance of homecare medicines for patients "cannot be underestimated," says Mr Hackett. Up to 200,000 people in England receive this service, "which has helped to transform their lives whilst they suffer from chronic or stable conditions that require regular treatment and monitoring. Since 1995, the NHS has been able to provide these homecare services at patients' homes and in the last four years there has been a rapid development of services," he adds.

The "fundamental issues" which need to be tackled in this rapidly-expanding marketplace are, he says:

- a need to secure more open, collaborative procurement of homecare medicines delivery and services, based on modern commercial arrangements and underpinned by improved clinical governance arrangements between NHS Trusts and homecare suppliers, plus a set of clear industry standards;

- strengthened internal governance frameworks within NHTS Trusts, with the chief pharmacist becoming the "responsible officer" for all homecare medicine services and accountable for them to the Trust chief executive. Homecare medicines needs to be set in the context of a strategy for chronic and stable conditions for patients who are best managed at home and should be part of the integrated planning between Trusts and their commissioning agencies. As such, a strategy for homecare medicine should be developed with the local drugs and therapeutics committee (DTC) and an annual plan, which the Trust chief pharmacist needs to deliver;

- commissioning agencies need to work with acute providers to deliver an effective strategy and an annual plan to involve homecare in collaborative procurement. and develop incentives between themselves and the authorised provider to maximise value for money; and 

- moving forward, there needs to be a much greater role for patients and their representatives in the design, operating and monitoring of homecare medicines deliver and services.

Dr Nick Payne, chairman of industry body the National Clinical Homecare Association (NCHA), said he welcomed the review and added that clinical homecare "brings a triple benefit - patient preference, better outcomes and cost-savings for the NHS."

"It is our ambition to work with the different parts of the NHS to develop common approaches and common standards for clinical homecare throughout the NHS, replacing the current situation where standards and expectations vary from one Trust to another, and to remove any inequity and lack of access for certain patients who would otherwise benefit from clinical homecare services," says the NHCA.

Steve Davis, head of marketing at Healthcare at Home Ltd, the UK's leading clinical homecare provider, also welcomed the report's recognition of the valuable and growing role that clinical homecare plays within the NHS. 

"Market access initiatives are the talk of the pharma community at the moment, and I can think of no better market access initiative than clinical homecare, which can touch every phase of the product lifecycle," said Mr Davis. "When I look at the type of products coming through the pharma R&D pipeline in the next few years, the need for clinical homecare support will be even more paramount, so pharma needs to factor this into the planning process," he added.

- The DH welcomes questions or comments on the report, and these should be directed to homecare@cmu.nhs.uk, said Dr Keith Ridge, chief pharmaceutical officer at the DH. "Homecare is an expanding part of healthcare delivery to patients and the public, and is set to grow further. Therefore it is essential it is delivered through robust arrangements that are safe, effective and represent good value for money," said Dr Ridge.