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

Policy landscape

The Review was commissioned and has been carried out in the context of Scottish Government policy and with cognisance of the Homecare Medicines: Towards a Vision for the Future report (‘The Hackett Report’) 2011 [17], the House of Lords Public Services Committee Homecare Medicines Services Inquiry 2023 [18], and previous national and local work around the sustainability of homecare in Scotland and the wider UK.

The ambition for Scotland, as described in the Chief Medical Officer’s 2023 Realistic Medicine – Doing the right thing report [19], is to deliver the outcomes that matter to people, through value-based care, while optimising the use of available resources. To do this, people must be meaningfully involved in decisions about their care. [19] Medicines homecare services give patients additional choice, empowering them to be treated at home, where appropriate. Understanding barriers for patients, including identifying and tackling unwarranted variation in health, treatment, and outcomes, can ensure equity of access for those who need our help the most. [19]

The NHS Recovery Plan 2021 defines key actions to address the backlog in care, because of the impact of the COVID-19 pandemic, and meet the ongoing healthcare needs for people across Scotland. The NHS Recovery plan takes a holistic approach and sets out key principles for safe and effective recovery including quality, value and experience and sustainability to ensure that patients are provided with care and support in the right place at the right time. Patients will be benefit from being consulted and involved in all aspects of their care and will have an agreed plan for their treatment that includes support to know when and how to access services. [20]

Scotland’s first Public Procurement Strategy sets the strategic intent and vision to place public procurement at the heart of a sustainable economy to maximise value for the people of Scotland. Procurement capability, supplier development, engagement and collaboration have been identified as enablers to successfully deliver the strategy. [21] These enablers support the national ambition for the successful delivery of high-quality and economically sustainable medicines homecare services which meet the needs of patients from across the country and who rely on medicines via the homecare model.

Over recent years there has been targeted strategies and programmes to provide patients with greater digital access and control over how they manage their own health, where it is safe, legal and appropriate to do so, and for staff to have rapid access to the information they need to deliver the best possible care. [22] It is recognised that digital advancements, specifically the journey towards electronic prescribing, cannot be delivered in isolation. The lack of interoperability between current systems and the existing NHS Scotland IT infrastructure requires a strategic approach to review.

Homecare medicines towards a vision for the future

In 2011, the Department of Health in England commissioned a review of medicines homecare supply in England to establish what were the current challenges and issues and what should occur in the future. [17] The report concluded that there were ‘fundamental issues which need to be addressed’, and noted recommendations which focused on improving procurement arrangements, strengthening governance frameworks, collaborative working and planning between NHS bodies, and greater involvement of patients across the design process. [17] It is notable that between the 2011 publishing of the Hackett report [17] and the 2023 publication of the House of Lords document [18], the stated patient numbers receiving homecare in England increased from 200,000 to 500,000.

Since 2011 there has been significant improvements in medicines homecare services across the UK and notably in areas including governance, procurement, quality and patient engagement. One of the key recommendations of the report was that “homecare providers and the NHS should have a clear set of industry delivered standards”. An updated iteration of the Royal Pharmaceutical Society Professional Standards for Homecare Services 2013 was published in 2024. [23]

House of Lords Public Services Committee

In November 2023, the House of Lords Public Services Committee published its report Homecare medicines services: an opportunity lost. [18] The report is critical of the lack of oversight of homecare services particularly around reporting of harm and associated improvement, transparency of spend, quality and consistency of services to patients, and ownership of services. The report concludes the urgency of action required, with 14 recommendations issued, to ensure that homecare fulfils its potential to deliver high quality care to patients and reduce pressure on hospitals. [18]