By Tony Robson
The failure of UK private contractor Healthcare at Home (HaH) to provide the home delivery of medications correctly and on time has placed thousands of National Health Service (NHS) patients at risk.
The company is one of a number of private providers contracted by the NHS to provide the service upon which the chronically ill and those with life threatening conditions depend for their drugs. HaH delivers in excess of 1 million prescriptions annually to over 150,000 patients whose conditions include cancer, cystic fibrosis, and haemophilia amongst others as well as those with organ transplants.
As much as 7 percent of patients have not been delivered their medications on time. In addition to the risk and anxiety these patients have been exposed to they have also had to endure lengthy waits on the company’s phone line as they try to track their deliveries.
As a result of the growing uncertainty phone calls from patients increased from 3,000 to 9,000 per day. NHS Choices, the Department of Health funded information web site, has been inundated with complaints about HaH with hundreds of messages left on its comments and ratings section by patients.
One signed “Anonymous” states, “The NHS should be rid of HAH.
“After a positive start in Feb, 2013 the service and availability of Healthcare at Home has disintegrated since December. From hours wasted trying to get through on the phone to missed or late delivery slots and nobody I call knowing anything about where the driver is. Just last week I had my delivery of Copaxone handed off to a random person in my office- the driver didn’t even check.
“Disappointing and terrifying- being in the last few days if your medication and not being sure you’ll even be able to keep going with it makes my illness even worse. The NHS needs to fire this company and find someone more competent.”
Another signed “in despair” explained, “There have been problems with this company for months on end now. Many patients are missing doses of medication as they fail to deliver the medication or communicate with patients. I take my medication less frequently than I should as I want to save a few spares – I know I need to as this company cannot be relied upon to deliver the medication. It is a disgrace that public money is being used to pay this company for a service that they are just not delivering, leaving patients in an unsafe situation.”
The decline in the service offered by HaH has been on-going since before the end of last year. Its reputation for unreliability had already led to hospitals around the country ceasing to use its home delivery services or referring new patients and in some cases patients themselves have sought out a replacement in house provider.
Finally the General Pharmaceutical Council (GPhC) which is responsible for regulating pharmacists was obliged to intervene. Along with the Care Quality Commission they inspected the company. However, the company was given a further 3 months to resolve the problems which have wreaked havoc for the treatment of the seriously ill.
The GPhC identified two main factors in the failures of HaH. Both of these are an indictment not only of the company but the socially irresponsible role of private health companies.
The first relates to the withdrawal of Medco – another large private company – from home delivery services last autumn after just 3 years involvement. It claims that HaH was unable to cope with the additional 3,000 patients which were transferred over to the company.
The other factor was its decision in March to outsource its home delivery service to another contractor. The subcontractor concerned is the Movianto Group, a US based logistics firm operating in Europe. Movianto was meant to have a tried and tested IT system but it failed miserably leading to the loss of its delivery tracker system and the resulting chaos.
The Movianto Group is quite clear on the basis upon which it seeks to attract business. On the company website under the heading “Movianto Group – Cut costs by outsourcing to a qualified logistics provider” it states, “As competition for medical device enterprises becomes more intense, and margins come under pressure, many companies are taking the opportunity to rethink their approaches to supply chain management. Some are taking the decision to outsource parts of the logistics processes.”
However, the cost cutting reasons underlying the deterioration of the service will be swept under the carpet, while HaH has been provided the opportunity to mount a damage limitation exercise. HaH Group Clinical director Ruth Poole has pointed to the fact that the company has increased its customer service capacity by 60 percent, to cope with the increase in telephone queries regarding medication deliveries, as if this is proof of its largesse rather than a result of its own incompetence. While pledging to resolve the outstanding problems the company refused to accept new referrals from high risk patients back in March.
Those representing the interests of private companies involved in providing homecare services to NHS patients have bemoaned the comparatively low profit margins in the sector. Dave Roberts CEO of National Clinical Homecare Association a lobbyist group – of which HaH is a member – said, “There’s been a 20 percent growth in this sector on year by year for several years now in terms of numbers of patients – that’s a very rapid expansion. But the profits in this sector are just 2-4 percent.
“That is a poor return given the extent of capital investment needed and governance and logistics issues. As NHS budgets have fallen, all the slack has been cut out of contracts.”
What is absent in this statement is any mention of care. It only serves to expose the fact that patients are viewed merely as an end to a means to be measured in market share and profits. As soon as the bottom line is squeezed the reflex action of private providers is to cut corners and sacrifice the standard of service provided. NHS patients are left at the mercy of such a commercially driven approach.
HaH is one of the UK’s largest homecare healthcare providers with around 1,000 employees around half of which are clinical staff. Established in 1992 it was acquired by private equity firm Vitruvian Partners in 2012. It has expanded as a consequence of the increased delivery of NHS arranged clinical treatment outside of hospitals at home or in the community.
This has proceeded under the guise offering more flexibility and choice to patients. In reality it is being expanded by the Conservative/Liberal Democrat government’s agenda to overhaul the local general hospital system at the heart of the NHS, in order to impose the cuts and parcel up services so they can be more easily outsourced to the private sector.
It should be noted that the Healthcare at Home debacle has been passed over in silence by all the main political parties. Through the Health and Social Care Act 2012 the coalition is committed to the complete dismantling of the NHS and its privatisation. The Labour Party in office was responsible for massively extending the role of the market within the NHS and providing the leverage points through which the private sector could exert greater influence and access to NHS funded patients. Even the most basic calls for accountability and the placing of patient care before profit is at odds with this rotten political set up.