Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the potential role of homecare medicines services in achieving the priority within the NHS long term plan to "boost 'out-of-hospital' care".
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The recommendations of the 2011 Hackett review were implemented with the publications of the Royal Pharmaceutical Society’s ‘Professional Standards for Homecare Services in England’ in 2013 and in 2014 with the Royal Pharmaceutical Society’s ‘Handbook for Homecare Services in England’ to aid implementation of the 2013 standards.
Homecare medicines services deliver ongoing medicine supplies and, where necessary, associated care, initiated by the hospital prescriber, direct to the patient’s home with their consent. Homecare medicines services offer many benefits to patients and the National Health Service including patients receiving their medicines at home, reducing the need to visit secondary care services for example, hospital outpatient settings and improving access to new medicines for patients.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what are the Key Performance Indicators for homecare providers; and what is the actual level of performance against those indicators for each homecare provider, for the latest period for which data are available.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Appendix 10 of the 2014 Royal Pharmaceutical Society handbook contains the Key Performance Indicators for Homecare Medicine service providers. A copy is attached.
Providers of Homecare Medicines services operate in a highly regulated environment with obligations to record and monitor quality metrics, including any trends. To monitor industry trends, providers provide the same data set to the trade association, the National Clinical Homecare Association (NCHA), allowing for the aggregation of all providers metrics. The NCHA report that the delivery performance of providers (delivery to patients on the agreed date) was 99.0% in 2020, 98.6% in 2021 and 98.8% in 2022. Formal complaints and incidents are also monitored and the data shows that the percentage of complaints raised was 1.4% in 2020, 1.6% in 2021 and 1.8% in 2022 of active patients. This refers to complaints opened, not upheld.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Ministry of Justice:
To ask His Majesty's Government what assessment they have made of the reported findings of the study commissioned by the Ministry of Justice, due to be published later this year, that male sexual offenders were twice as likely to claim to be transgender in order to access women’s prison units compared with men jailed for other types of offences.
Answered by Lord Bellamy - Parliamentary Under-Secretary (Ministry of Justice)
The Ministry of Justice and His Majesty’s Prison and Probation Service take the allocation of transgender women in custody very seriously. The study in question concerns the lived experience of transgender women in two men's prisons. None of the participants stated that their motivation was to access the women’s estate, and the preliminary findings of the research did not suggest that any of the participants were motivated by this.
Most transgender women in custody do not request a move to the women’s estate, and of those that do, most are not granted a move. As a result, well over 90% of transgender women in custody are held in the men’s estate.
In February of this year, we strengthened our policy so no transgender woman who has been convicted of a sexual or violent offence, and/or who retains birth genitalia, can be held in the general women’s estate. Exemptions to this rule can only be considered for the most truly exceptional of cases, and each case must be risk assessed by a multidisciplinary panel of experts and signed off by a minister before the individual can be held in the women’s estate.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether Market Authorisation Holders set different (1) Key Performance Indicator measurements, and (2) clinical pathways, for the same therapy.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Marketing Authorisation Holders (MAHs) are encouraged to use the national Key Performance Indicators (KPIs) published in the Royal Pharmaceutical Homecare Services Handbook 2014 in their contracts with homecare providers. MAHs may also use additional or alternative specific KPIs where they consider this necessary. Neither NHS England nor National Health Service trusts are directly party to those contracts between MAHs and homecare providers, and therefore do not have visibility of the KPIs agreed in each case.
The treatment choice is determined by the clinician in the hospital trust in conversation with the patient, based on the best available evidence and cost-effectiveness aligned to national and local guidance where available. The homecare medicines service provider is contracted to undertake supply and delivery, and administration in some cases. The homecare medicines service provider does not determine the clinical pathway.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how many NHS hospitals have issued prescriptions to homecare providers (1) 10 or more days before the delivery is due, (2) between 10 days and the delivery date, and (3) after the delivery was supposed to be made.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
This information is not collected centrally by NHS England or the Department. Each individual trust may or may not collect this data depending on the contracted Key Performance Indicators.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Ministry of Justice:
To ask His Majesty's Government, further to the reported findings of the study commissioned by the Ministry of Justice, due to be published later this year, what steps they are taking to prevent male offenders from seeking moves to the female prison estate due to faking their claims to be female.
Answered by Lord Bellamy - Parliamentary Under-Secretary (Ministry of Justice)
The Ministry of Justice and His Majesty’s Prison and Probation Service take the allocation of transgender women in custody very seriously. The study in question concerns the lived experience of transgender women in two men's prisons. None of the participants stated that their motivation was to access the women’s estate, and the preliminary findings of the research did not suggest that any of the participants were motivated by this.
Most transgender women in custody do not request a move to the women’s estate, and of those that do, most are not granted a move. As a result, well over 90% of transgender women in custody are held in the men’s estate.
In February of this year, we strengthened our policy so no transgender woman who has been convicted of a sexual or violent offence, and/or who retains birth genitalia, can be held in the general women’s estate. Exemptions to this rule can only be considered for the most truly exceptional of cases, and each case must be risk assessed by a multidisciplinary panel of experts and signed off by a minister before the individual can be held in the women’s estate.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government which (1) medicines, and (2) medical devices, are currently being provided and delivered by homecare medicines services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Homecare medicines services can be designed to satisfy a variety of different requirements to meet the needs of the patient and the NHS Trust. The different types of services delivered are set out on Page 11 of the Royal Pharmaceutical Society’s 2014 Handbook for Homecare Services, a copy of which is attached; these also describe the use of medicines and medical devices where appropriate.
NHS England’s Commercial Medicines Unit manages four national framework agreements for specialist services covering home parenteral nutrition, enzyme replacement therapy, lysosomal storage disorders and bleeding disorders. The individual homecare medicines contracts and agreements are for the service provision to deliver the required medicine and medical devices where necessary; the devices will take the form of pumps and ancillaries required to administer the medication.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether there is a Key Performance Indicator for the harms caused to patients because of a failure of provision of homecare services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Key Performance Indicators (KPIs) used include reporting of patient safety incidents, which includes all cases of severe or moderate harm or death associated with a reportable incident. Definitions as well as detailed guidance on managing complaints and incidents within the homecare medicine service are contained in Appendix 19 of the Royal Pharmaceutical Society homecare standards, a copy of which is available in an online-only format.
Information is not held centrally on the number of different paper prescription templates currently in use. In 2022, the National Homecare Medicines Committee (NHMC) developed standard template prescriptions which are published in the Royal Pharmaceutical handbook for homecare services. Guidance from the NHMC advises that new services should use the template, and existing services should adopt the template on their next review.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how many different templates exist for paper prescriptions issued to homecare providers.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Key Performance Indicators (KPIs) used include reporting of patient safety incidents, which includes all cases of severe or moderate harm or death associated with a reportable incident. Definitions as well as detailed guidance on managing complaints and incidents within the homecare medicine service are contained in Appendix 19 of the Royal Pharmaceutical Society homecare standards, a copy of which is available in an online-only format.
Information is not held centrally on the number of different paper prescription templates currently in use. In 2022, the National Homecare Medicines Committee (NHMC) developed standard template prescriptions which are published in the Royal Pharmaceutical handbook for homecare services. Guidance from the NHMC advises that new services should use the template, and existing services should adopt the template on their next review.
Asked by: Lord Blencathra (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what is the role of the Commercial Medicines Unit in procuring medicines for homecare delivery; and what steps they take to ensure performance by providers of the delivery service.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Decisions on which medicines can be delivered by a homecare medicines service are made by National Health Service trusts.
NHS England’s Commercial Medicines Unit (CMU) procures medicines on behalf of the four national framework agreements for the provision of homecare medicines services which it manages. As part of the contractual process, a nationally agreed set of Key Performance Indicators (KPIs) form part of the contractual terms which homecare providers report against. The data set used is attached.
The CMU manages performance through robust contract management, in the form of regular contract review meetings where KPIs are reviewed. Contract review meetings include members of the stakeholder group, including representatives from the NHS trusts.
As part of continued quality assurance and governance processes, all homecare providers are assessed against the same KPIs through the NHS supplier engagement group, which is a subgroup of the National Homecare Medicines Committee.