Private healthcare companies are harming NHS patients in their own homes by failing to deliver vital medicines, and then escaping censure amid an alarming lack of oversight by ministers and regulators, members of the House of Lords have warned.
More than 500,000 patients and their families rely on private companies paid by the NHS to deliver essential medical supplies, drugs and healthcare to their homes. The homecare medicines services sector is estimated to be worth billions of pounds.
A report by the Lords public services committee says patients are being harmed due to “real and serious problems” with the services provided by for-profit companies. The absence of a single person or organisation with overall control or oversight of the sector means poor performance is going unchecked, it says.
The 44-page report, published on Thursday, does not identify any companies by name, but it comes after an investigation by the Guardian exposed how patients were repeatedly being harmed as a result of botched, delayed or missed deliveries of medication by the sector’s biggest provider, Sciensus.
“There are serious problems with the way services are provided,” the Lords report says. “Some patients are experiencing delays, receiving the wrong medicine or not being taught how to administer their medicine. [This] can have serious impacts on patients’ health, sometimes requiring hospital care. This leaves NHS staff either firefighting the problems caused by problems in homecare medicines services, or working on the assumption that those services will fail.”
The report also confirms reporting by the Guardian that the failure to provide adequate services “is so severe, or so predictable” that NHS clinicians often feel compelled to step in to safeguard patient safety.
“The taxpayer is effectively paying for the service twice – once for the private provider to deliver it, and again for the NHS to pick up the pieces where private providers fail,” the report says.
Ministers have no idea how much is being paid to private companies to provide homecare medicines services and so they cannot judge value for money, the report says. Given the figure is likely to be billions of pounds a year, it adds, this lack of awareness is “shocking” and “entirely unacceptable”.
The Guardian has previously revealed how patients who were already seriously ill became sicker as a result of failings by Sciensus, Britain’s biggest private provider of homecare medicines services. Watchdogs had been made aware of failings but had not acted.
Peers confirmed they too had found “irreconcilable differences” between how NHS patients and clinicians perceived the quality of homecare medicines services and how regulators viewed them.
The committee said it was persuaded by the “weight of evidence” that “real and serious problems” existed in the sector. Witnesses described a “toothless enforcement culture”, it said.
The report details harrowing cases of harm to patients as a result of failing homecare medicines services, including irreparable joint damage, skin and eye problems and abdominal pain. In some cases, patients let down by private providers ended up in A&E. Others required surgery on the NHS.
Estelle Morris, the chair of the committee, said: “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.”
Despite clear failures by private health providers, many NHS patients had been left “yelling in the dark”, she added, because watchdogs had failed to hold for-profit companies to account.
“The regulators in this sector are weak,” Lady Morris said. “We saw a hands-off approach where no one regulator wanted to look too hard at performance and no one is in charge.”
She said: “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.”
The committee’s report calls for an independent review of the sector and for the government to urgently appoint an individual to lead and take responsibility for homecare medicines services.
NHS England must identify how many patients have been harmed by these failures and develop and implement a consistent set of performance metrics.
“Most of our recommendations can and must be implemented quickly,” Morris said.
Sarah Campbell, the chief executive of the British Society for Rheumatology, said the report vindicated her members’ and patients’ experience, and she called for all recommendations to be immediately adopted in full.
“The chaotic and disjointed nature of the home care system has been clearly highlighted, and the voice of patients and clinicians have finally been heard,” she said.
Ruth Wakeman, a director at the charity Crohn’s & Colitis UK, said the report’s recommendations were “an important step forward in improving the accountability and quality of homecare medicines services”.
She said: “We have long been calling for a full review of homecare medicines delivery services. Patients have told us of their great distress and the harm caused by the poor quality of their homecare delivery services.”
An NHS spokesperson said: “The committee is right that homecare services can cut pressures on hospitals and the wider NHS, and while many services are working well, the NHS is working with trusts, regulators and commercial suppliers to support safe, effective and efficient homecare provision for patients.
“We have already taken steps towards appointing a single responsible officer for homecare services, who will be supported by the national homecare medicines committee to implement measurable improvements to the performance of homecare services across the country.”
A Department of Health and Social Care spokesperson said: “We welcome this report and will respond in due course. NHS England has already been undertaking work to understand the concerns that have been raised, including agreeing to publish performance data.”
