Independent Review of Medicines Homecare in Scotland: review report and recommendations

Foreword

I am grateful to the Chief Pharmaceutical Officer for Scotland for the opportunity to lead this Independent Review of Medicines Homecare and the approaches to the supply and management of secondary-care initiated medicines. I was asked to identify and understand benefits and challenges associated with each of these approaches and to make recommendations for the future. This is a timely opportunity to take stock, shine a light on the good practice and the difference that medicines homecare services make for patients and address areas for change and improvement.

From the start of this Review, it was clear that the task was going to be complex and involve a wide range of stakeholders from across the medicines homecare community; from the pharmaceutical industry to patient and staff representative bodies, staff delivering services and patients using homecare within NHS boards. I was aware that while there may be challenge in forming recommendations from these wide-ranging views there was certainly no challenge in patients being at the centre of why the Review had been established. Improvements in the quality of medicines homecare, patient safety and experience of services are key ambitions shared across all those involved in medicines homecare.

Medicines homecare, and associated care services, has rapidly expanded over the past 20 years to the benefit of patients across Scotland. Over 41,000 patients, across all NHS boards and geographical areas in Scotland are currently using medicines homecare services. These services provide a vital care for patients to treat and manage their, often long-term, conditions.

Throughout the course of this Review, I have heard from patients and staff about the variance in their experiences of medicines homecare services and concerns over medicines delays, service delivery and homecare supply resilience. At their best, homecare services are robust and person-centred, pairing clinical care with the delivery of medicines in patients’ homes. However, the increase in volume seen over the last three years, particularly during the pandemic, has further highlighted long-term concerns in several areas. These themes and opportunities to enhance the safety and quality of care are woven throughout this Review.

Much of what I heard was consistent in describing many of the current issues and barriers in homecare and what was needed to build on and develop for the future. I recognise that there might be different approaches to how developments might best be delivered. I focus more on the ‘what’ than the ‘how’, although there are practical examples of how a recommendation may be implemented where I believe it is important to be more specific. The Review Report is not intended as a piece of academic research; it is, however, based on evidence, both published and from what we know, and what others have shown, to work.

This Review and Review Report is a reflection of the combined efforts and commitment of many people across the medicines’ homecare community. I am especially grateful to all the members of the Review Reference Group who have kindly given their time and expertise.

Finally, and most importantly, I would like to thank the patients and the public whose views have been fundamental to this Review, and the Health and Social Care Alliance (The ALLIANCE) who facilitated the engagement. Thank you for sharing your own experiences in an open and generous manner.

It is my hope that the analysis and recommendations in this report can guide the Scottish Government to lead improvements in medicines homecare which results in better services for patients.

Benjamin K Hannan MPharm DipClinPharm IP MSc FRPharmS FIoL

Independent Review Lead