A Staffordshire-based clinical home care service has been placed into special measures after an inspection found that almost 10,000 service users failed to receive essential medicines or had medicines deliveries delayed.
The Care Quality Commission reported that Healthcare at Home, which has its head office in Burton-on-Trent, deployed new IT systems in October that were not thoroughly risk assessed, resulting in delivery dates for medicines being missed.
This meant that some patients experienced avoidable harm and needed hospital treatment. Others experienced psychological trauma because of the uncertainty of not knowing when they would receive their essential medicines.
Healthcare at Home provides care and treatment to people with chronic conditions – including Crohn’s disease, haemophilia and HIV – in their own homes. At the time of the inspection, it delivered around 110,000 prescriptions a month.
CQC undertook the inspection following reports that people were not receiving their medicines on time or able to contact the service to raise concerns.
It found that the provider had not acted in a timely manner to address the issues caused by the introduction of the new IT systems.
In October 2020, Healthcare at Home told CQC that 2,397 patients had a missed or delayed dose of their medicine. But from 1 October to 9 December 2020, it identified significantly more patients (9,885) may have missed a dose of their medicine due to a failed or delayed medicine delivery.
In its report, the regulator said the provider was working through a plan to contact all 9,885 patients and establish exactly how many patients had missed a dose of medicine. As of December 14, 2020, the provider had contacted 40% of patients.
In October 2020, reasons for missed medicines included 91 failed deliveries because the patient had not been called by the provider at the appropriate time to arrange a delivery; 72 had orders which were not raised correctly by the provider; 80 packages went missing and 167 prescriptions were not dispensed by the provider, despite a current order being in place.
The CQC also found that the provider’s dispensing sites were unable to meet all demands for medicines. During its inspection, the regulator saw emails which were sent to call handlers regarding the dispensary services’ capacity that day. This evidence indicated for several days the dispensary services were operating above capacity.
In addition, the provider did not always have enough nursing staff to administer essential medicines in patient’s homes despite trying to fill vacant shifts with agency and bank staff.
Other shortfalls in the service included a failure to always investigate safety breaches and assess risk; poor record keeping, including regarding people’s allergies; insufficient governance, oversight and assurance systems to manage quality, performance and patient safety; and a failure to provide statutory notifications to CQC following service disruption.
Following the inspection, CQC rated the service ‘Inadequate’ overall, and for being safe and well-led. It was rated ‘Requires Improvement’ for being responsive to people’s needs and ‘Good’ for being effective. The service’s ‘Good’ rating for being caring is retained from its previous inspection.
If insufficient progress is made, CQC said it will use its enforcement powers further to protect patients from the risk of harm and hold the service’s leaders to account.