National Picture on Homecare Services

1. National Picture on Homecare Services Mark Hackett CEO Southampton University Hospitals NHS Trust Southampton University Hospitals NHS Trust

2. 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

3. 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

4. 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

5. 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:- • 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

6. 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

7. 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

8. Acute providers • Strengthened roles for Trust Chief Pharmacists, Medical and Nurse Directors around homecare • 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

9. 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

10. Better use of incentives and opportunities • 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

11. 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

12. Patients • Explicit service guaranteewith NHS Trust and homecare provider • Greater choice • Patient involvement in strategy, planning and marketing contracts • Individual patient involvement in service contract:- • Release time • Link with transaction systems • Satisfaction recording • Governance processes Southampton University Hospitals NHS Trust