National Picture on Homecare Services
Mark Hackett
CEO
Southampton University Hospitals NHS Trust
Southampton University Hospitals NHS Trust
Current position of homecare services
• A rapidly growing market in England @ £1 billion
• Established companies with new market entrants
• Considerable benefits of homecare services
• Need to address key market, taxpayers, patients and NHS
• The NHS needs to be a more co-ordinated customer to maximise
potential of homecare
Southampton University Hospitals NHS Trust
What are key issues in market?
Governance
Homecare
market
conditions
NHS
Trust/PCTs
Patients
Effective organisation
and delivery of
homecare
Taxpayers
Southampton University Hospitals NHS Trust
Market issues
• Differing levels of provider concentration in rapidly growing markets
with new entrants
• Risks are high for certain providers
• Relatively weak contractual, governance and operational control
mechanisms
• Procurement mechanisms need transparency, co-ordination and sensible
commercial arrangements
• Two principle routes of homecare supply
– Manufacturer only homecare route
– Homecare provision from manufacturer or wholesaler
• Need to see homecare services as part of local health system strategy
Southampton University Hospitals NHS Trust
Governance issues
• Role of Trust Chief Pharmacists, Medical Directors and Nurse Directors
needs to strengthen around homecare services
• Internal Trust governance systems need improvement
• Better integration between NHS Trusts and homecare to:–
–
–
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Improve business processes
Set minimum standards for provider accreditation
NHS needs to improve operational control processes
Improve working with local commissioners
Southampton University Hospitals NHS Trust
Collaboration across organisations
• Need for better NHS Trust/commissioning alignment to improve patient
services
• Incentivisation of homecare providers to:–
–
–
–
Reduce transaction costs
Improve cost of whole healthcare system
Management of homecare demand
Improve patient services
• National or regional collaboration needed to incentivise NHS providers
and commissioners to collaborate
• More open procurement models needed with homecare providers
Southampton University Hospitals NHS Trust
Towards a vision for the future
• More stability for new and existing homecare providers by collaborative
purchasing and longer term contracts
• Stable contractual frameworks which are of sufficient duration to secure
best value for patients and taxpayers
• Homecare suppliers should be prepared to take proportionate risks to
invest in new technology, service levels and cost efficacy.
• Consider separating homecare services and supplies of medicines to get
clarity on provision
• Integrated governance with NHS provider as the customer
• Homecare providers and NHS should have a set of industry standards
which cover major areas of governance, operational control and
approaches
• A form of “kite mark” accreditation to enter into NHS contacts
Southampton University Hospitals NHS Trust
Acute providers
• Strengthened roles for Trust Chief Pharmacists, Medical and Nurse
Directors around homecare
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–
–
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Set strategy, annual programme of account to Trust CEO
Identify patient cohorts
Pharmacy only prescribing
Resourcing homecare admin and use of pharmacy systems
Responsible Officer status for Chief Pharmacist for homecare
External scope to other areas, e.g. HPN
Southampton University Hospitals NHS Trust
• Providers should purchase on national or regional collaboratives for
homecare service supplies, based on:–
–
–
–
National NHS contract
Common sense specifications
Clarity on what is national or regional
Formula between Trust and commissioners on sharing savings
Southampton University Hospitals NHS Trust
• Better use of incentives and opportunities
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–
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Secondments from NHS provider to homecare
Improved clarity of responsibility for GPs, patients, Trusts, etc
Use of local DTC to approve homecare plans and strategies
Greater involvement of patients
Incentivising homecare supply
Transparency around profit and costs
Southampton University Hospitals NHS Trust
Commissioning
• Collaborative commissioning and procurement with NHS providers
• Improving strategic focus by:– Homecare services fitting into strategy for chronic disease or stable disease models
– Whole life cycle costs of homecare service across hospital, community and primary
care
– 3 year strategy for non-tariff/tariff therapies
– Even-way share with NHS Trusts on value release
• Integration with local Trust models for improved transaction costs
Southampton University Hospitals NHS Trust
Patients
• Explicit service guarantee with NHS Trust and homecare provider
• Greater choice
• Patient involvement in strategy, planning and marketing contracts
• Individual patient involvement in service contract:–
–
–
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Release time
Link with transaction systems
Satisfaction recording
Governance processes
Southampton University Hospitals NHS Trust