HEALTHCARE PROFESSIONAL & PHARMA COMPANIES
Clinical Homecare Services Explained
Clinical homecare offers a wide range of benefits whether looking to improve patient treatment outcomes, enhance the service offered, considering patient and carer peace of mind, or searching for important cost efficiencies.
“Clinical Homecare reduces hospital capacity pressure, allowing patients to be treated in the most appropriate location whilst improving patient experience. Nationally agreed service and quality standards ensure patient safety is the highest priority whilst increasing numbers of patients with increasingly complex needs receive Clinical Homecare Services.”
National Clinical Homecare Association (NCHA) represents companies and organisations providing Clinical Homecare Services to over 500,000 active patients in the UK. Clinical Homecare patients receive consultant-led care in community settings. Given the choice, many patients choose to be treated at home rather than in hospital or as outpatients. Clinical Homecare has been relentlessly growing at over 20% year on year. The NHS Five-year-forward view anticipates the further extension of Clinical Homecare Services to treat patients in community settings. Clinical Homecare is often associated with high cost drug treatments and accounts for £4bn or 30% of the NHS secondary care medicines budget. This would rise to 60% if extended to all medicines known to be suitable for homecare.
NCHA Members provide patient centred Clinical Homecare Services that are safe, cost effective and ensure seamless integrated patient care. The NCHA is at the forefront of ensuring high standards are applied across the industry working closely with the NHS National Homecare Medicines Committee, NHS Commercial Medicines Unit, NHS England, NHS Scotland, NHS Trusts, and commissioners to ensure patients who wish to receive homecare can access high quality Clinical Homecare Services.
NCHA was established in 2006 and issued the first Clinical Homecare Industry Code of Practice in 2007. Since then the NCHA has gone from strength to strength, offering membership to Homecare Organisations who sign up to the stringent criteria of the NCHA. Patients, clinicians and NHS commissioners can rest assured that NCHA Members have achieved a core set of standards in terms of the provision of Clinical Homecare Services.
Clinical homecare services often revolve around the provision of specialist medicines which patients administer themselves at home with appropriate support and training. Some clinical homecare services also include healthcare professionals visiting patients at home to provide support and training or regular home visits to administer the medicines. In all cases the clinical responsibility for the patient remains with the clinical referring centre or prescriber. Clinical homecare services are often delivered by a clinical homecare provider, many of whom are NCHA Members.
The details of any clinical homecare service will depend on the treatment pathway, however, they all follow a similar pattern as shown below.
Figure 1: How clinical homecare works
Most clinical homecare services in the UK are provided for NHS patients with 80% of the clinical homecare services cost being funded by the pharmaceutical company that manufactures the medicines. The remainder of the services are commissioned directly by the NHS or provided to private patients. Patients wishing to access clinical homecare services should discuss the options available with their Clinical Team.
National Clinical Homecare Association (NCHA) Members provide a spectrum of clinical homecare services within treatment pathways for acute and long term conditions from infections requiring intravenous antibiotics to specialist medicines for Parkinson’s Disease and home parenteral nutrition for patients who are unable to eat normally.
The list of homecare service types is not exhaustive. If you are a patient seeking to access clinical homecare services, please contact your clinical team to find out about services are available to you.
- Angioedema and other severe allergies (Respiratory)
- Anti-infectives – Viral Hepatitis including Hepatitis B and Hepatitis C
- Anti-infectives – Viral HIV / Anti-retroviral Therapy (ARV)
- Anti-infectives -Infection Management – HPAT/OHPAT
- Blood disorders – Erythropoietin Stimulating Agents (ESA)
- Blood disorders – iron overload including oral and injectable medicines
- Blood disorders including eculizumab haemophilia & thalassaemia
- Cancer – Oncology and Haematology – Injectable
- Cancer – Oncology and Haematology – Oral includes all oral anti-cancer chemotherapy and immunotherapy
- Cardiovascular Pulmonary Hypertension (PH)(PAH)
- Endocrine – Fertility
- Endocrine – Growth Hormone (adults)
- Endocrine – Osteoporosis and bone metabolism
- Endocrine – Somatostatin analogues including Octreotide for acromegaly, lanreotide and pasireotide for all indications
- Endocrine Growth Hormone (paediatrics)
- Enteral nutrition and special diets – Enzyme Replacement Therapy including Lyposomal Storage Disorders (LSD)
- Enteral nutrition and special diets – Low tech enteral feed services; delivery of special foods
- Immune system – Dermatology (skin) including methotrexate for dermatology indications, ustekinumab, ciclosporin, secukinumab etc. for dermatology indications
- Immune system – Immunosuppression – Transplant
- Immune system – Inflammatory bowel and related disorders including methotrexate, ustekinumab, for gastroenterology indications
- Immune system – Multiple Sclerosis
- Immune system Intravenous and Subcutaneous Immunoglobulin
- Intravenous Nutrition and Home Parenteral Nutrition (HPN)
- Musculoskeletal – Rheumatic disease including methotrexate for rheumatology indications
- Nutrition & metabolic disorders unclassified including acute porphyrias
- Parkinson’s Disease (PD) and related disorders
- Psychoses and related disorders e.g. clozapine
- Renal & GU – eculizumab, home dialysis
- Respiratory – Cystic Fibrosis (CF) adults
- Respiratory – Cystic Fibrosis (CF) paediatrics
- Respiratory – Idiopathic Pulmonary Fibrosis (IPF)
- Respiratory – Terbutaline
- Skin also see Immune system – Dermatology
- Clinical Trials
- Orphan diseases and unlicensed uses
For Patients
Clinical homecare is firmly centred around the needs of each individual patient. Freedom, choice and comfort form the basis of every clinical homecare service, and the benefits are clear for each patient to experience. All services are designed to meet the needs of each patient and must be in line with services that are being commissioned.
The NCHA have set up a Patient Advisory Council (PAC) to ensure that patients are at the for front of decision making. Please visit the General Public/Patient section for details of members of PAC. This section also covers information on the NCHA benefits for patients.
Clinicians and Commissioners
Clinical homecare offers a wide range of benefits whether looking to improve patient treatment outcomes, enhance the service offered, considering patient and carer peace of mind, or searching for important cost efficiencies.
Improved treatment outcomes:
– Additional treatment capacity of clinical homecare services may mean faster access to treatment
– Improved adherence to treatment through regular contact with and education of the patient
– Proactive prescription management and stock checking reduces the chances of a missed dose
– Reduces hospital capacity pressure, allowing greater focus on more complex patients and reducing waiting times
– Access to advice from dedicated teams of healthcare professionals, often 24 hours per day, reducing unnecessary/inappropriate hospital admissions
– During homecare service visits, your patient has undivided attention of an experienced Healthcare Professional throughout treatment, who is extensively trained and equipped for dealing with any medical emergencies
– Fewer & shorter hospital visits means less risk of hospital-acquired infections
Enhances the overall healthcare service offering:
– Reduces hospital capacity pressure
– Patient satisfaction consistently high due to the numerous benefits that clinical homecare services afford to patients
– Additional treatment capacity of clinical homecare services may mean faster access to new treatments
– Offers greater patient choice surrounding care delivery which is high on the NHS agenda
– Ability to treat patients at a time and place convenient to them; at home, at work or at a holiday location.
– Fully traceable, secure, temperature-assured supply chain
– Maintains physical separation of NHS and ‘top up’ treatments where these are deemed appropriate by the referring clinician
Peace of mind:
– Clinical control maintained; all treatment delivered according to protocols and pathways agreed with the clinical referring centre
– Close liaison with and regular reporting to each clinical referring center
– Regular performance review via NHS National Homecare Medicines Committee (NHMC) homecare supplier reviews
– National Clinical Homecare Association (NCHA) members have many years of experience and expertise in the delivery of clinical homecare and abide by the NCHA Code of Practice
– Patients can access dedicated teams of knowledgeable healthcare professionals, often 24 hours each day, reducing unnecessary/inappropriate hospital admissions
– Fully traceable, secure, temperature-assured supply chain
Significant cost saving potential
– Reducing capacity pressure in hospital wards, outpatient pharmacies, outpatient departments etc.
– Reduces the need for capital investment in hospitals as more patients present for treatment
– Working capital is released through reduced requirement for on site treatment capacity and stockholding of high value drugs
– Efficient use of high-value medication through regular education, compliance, concordance, stock, and symptom monitoring
“At 90% occupancy, the cost to the Trust was less than half that of an inpatient stay. ”
Designing and implementing an ‘Acute Hospital @ Home’ service – The Academy of Fabulous Stuff
“A study of 274 NHS patients receiving clinical homecare for a variety of conditions showed that treatment outside of the traditional hospital setting reduced costs by around 80%”
Home healthcare – an economic choice for the Health Service? Prof. Ciaran O’Neill, School of Medicine & Dentistry, Queens University, Belfast
Looking to become an NCHA Member?
The NCHA offers 4 types of Membership: Full Membership, Probationary Full Membership, Associate Membership and Individual.