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Healthcare at Home - Head Office Inadequate

This service was previously registered at a different address - see old profile

We are carrying out a review of quality at Healthcare at Home - Head Office. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 26 November 2020 - 14 December 2020

During an inspection looking at part of the service

Healthcare at Home supplies medicines to patients in their own home throughout the UK and also provides nursing staff to administer essential medicines where needed.

We carried out an unannounced, focused inspection of Healthcare at Home between 26 November and 14 December 2020. The inspection took place at the headquarters of Healthcare at Home in Burton on Trent. This inspection was carried out in response to concerns raised in relation to patients not receiving their prescribed medicines on time and being unable to contact the provider. We did not look at all the key lines of enquiry during this inspection. However, the information we gathered and the seriousness of the concerns and clear impact on patients provided enough information to make a judgement about the quality of care and to re-rate the provider.

During this inspection, due to the seriousness of the concerns, we suspended Healthcare at Home’s rating. We served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider that we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within four days that described how it was addressing the concerns. On receipt of the action plan we undertook a review and were not assured by the actions the provider described and therefore served a Notice of Decision to urgently impose conditions on the provider registration.

These required the provider to:

  • Ensure all service users who have had a failed delivery of any kind from 1 October 2020 to be reviewed by a suitably qualified professional to ensure that service users have not come to any level of harm.
  • Devise and implement a system to ensure that backlogs of medicine deliveries were effectively mitigated against.
  • Provide an action plan to Care Quality Commission outlining how the registered person intends to make improvements to the areas identified in the Notice of Decision.
  • Provide a report to the Care Quality Commission fortnightly which includes an analysis of audits undertaken to monitor completion and/or implementation of the systems set out in the above conditions.

Following the inspection, information received from the provider in order to comply with the conditions indicated performance had improved.

At the previous inspection in December 2019, the service was rated as good overall. Following this inspection we have rated the provider as inadequate.

This inspection was completed during the COVID-19 pandemic and therefore a considerable amount of activity was conducted remotely. For example, reviews of clinical systems, documentation and talking to staff and patients.

At this focused inspection, the key questions inspected were: Safe, Effective, Responsive and Well-Led. Caring was not reviewed because no concerns had been raised in relation to this key question. The good rating for Caring from the last inspection has been carried forward.

At this inspection, we found:

  • The provider had introduced new information systems into the service in October 2020; these had not been thoroughly risk assessed and tested and resulted in avoidable harm to some patients. This meant that delivery dates for medicines were missed and patients didn’t get their essential medication required to treat their health condition or maintain their health, on time. Some patients’ conditions deteriorated and they had to be admitted to hospital, whilst others experienced psychological trauma because of the uncertainty of not knowing when they would receive their essential medicines.
  • The provider had not acted in a timely manner to address the issues caused by the introduction of the new information systems. In October 2020 we were told by the provider there were 2,397 patients whose medicines were missed or delayed, by December 2020 this had risen significantly to 9,885.
  • As a result of the issues with the introduction of the new information system there was not enough staff to manage the volume of work resulting in a backlog of unfulfilled medicines orders. This included a lack of staff to take calls, pharmacists to make up prescriptions and drivers to deliver the orders to patients waiting for essential medicines.
  • The provider did not always manage safety incidents well, did not always fully investigate and did not always learn lessons when things went wrong. Staff reported incidents but did not always get feedback on what had happened as a result. There were a number of incidents where harm had occurred to patients due to failed medicine deliveries. We found the provider had not adequately followed up the failed deliveries and there were multiple missed opportunities to ensure patients received their medicines on time.
  • The provider did not always adequately assess risks to patients, or act on them. The provider’s systems and processes did not always provide staff with the information they needed to adequately understand when patients were at risk of deterioration or when they were at risk of running out of essential medicines. Patients were not always followed up in time to prevent any avoidable deterioration or harm to patients or ensure patients didn’t run out of medicines.
  • The provider did not always have enough nursing staff to administer essential medicines; in patients’ homes, for those who could either not do this for themselves or who needed clinical support to administer medicines due to the nature of the medicine.
  • The provider did not have adequate systems and processes in place to ensure medicines were always administered safely. The patient record system did not easily enable nursing staff to identify patients who may have a known allergy. In addition, the documentation used by nursing staff did not include a section to record that the patients known allergies had been verbally checked with the patient, prior to administering medicines.
  • Patients could not easily contact the provider when they had missed medicine doses due to a lack of nursing staff to administer medicines or because their medicines had not been delivered. In October 2020, only 55% of all calls into the service were answered, against the providers target of 85%. It was difficult for people to give feedback and raise concerns about care received. The service was overwhelmed with patients trying to contact them. The provider received a high number of formal complaints about their service and was unable to respond to them all in a timely manner.
  • There was a lack of robust governances, oversight and assurance systems in place which led to significant risks to patient safety. The provider could not demonstrate how risks, issues and performance were managed to ensure that services were safe or that the quality of those services was effectively managed.
  • Statutory notifications were not always sent to CQC in line with the legal, statutory requirements responsibility or the provider’s own guidance.
  • The provider did not always have an open culture where patients, their families and staff could raise concerns without fear. Some patients told us that they feared their medicines deliveries would be cancelled if they complained and some staff said they feared losing their job if they raised concerns or contacted CQC.

However, we also found:

  • The provider tried to fill gaps in the nursing rotas with bank and agency staff and were running regular recruitment campaigns to recruit new nurses. The provider shared information following the inspection which provided assurance that vacancy rates had reduced.
  • Staff had training in key skills. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Staff we spoke with told us they had regular appraisals and were supported by their line manager.
  • Staff delivered care and treatment which was based on national guidance and evidence-based practice. For example, nurses followed national protocols and guidance when administering chemotherapy.
  • Patients who received homecare visits from nurses had regular health assessments and were given practical advice and support about how to lead healthier lives.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other and communicated effectively with other agencies.
  • Staff controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. The provider had clear and effective systems for the management of COVID-19.
  • Staff understood the service’s vision and values. Staff were focused on the needs of patients receiving care and all staff were committed to continually improving services.
  • The provider had an action plan to recover their services back to pre-incident level. As part of conditions placed on the provider, we received a fortnightly report which showed an improving picture of recovery to pre-incident level. The provider hoped to achieve this by the end of January 2021.
  • The provider participated in national networks and associations seeking to find innovative ways to improve access to and the quality of healthcare.

The Chief Inspector of Hospitals is placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 11th to 12th and 18th September 2019

During a routine inspection

Healthcare at Home was operated by Healthcare at Home limited. Healthcare at Home provides a clinical homecare, operating UK wide, and works with the NHS, pharmaceutical companies, private medical insurers, consultants, GPs and charities.

The company was established in 1992 and since then have treated over 180 million patients across 49 therapy areas, 450 different chemotherapy regimens and over 90,000 medication orders delivered every month.

Clinical homecare is a term used to describe integrated care and treatment that takes place in a person’s own home to minimise the likelihood of an inpatient stay or outpatient visit for the patient.

Healthcare at Home services centres around a specialist nurse team providing clinical homecare to patients in areas including chronic disease, cancer care, supported early discharge complex care and rheumatoid arthritis.

The services provided by Healthcare at Home, were either NHS funded or privately, and dependent on a referral from a GP, hospital consultant or private health insurers.

In detail the services provide:

• Medication support.

• Medication home treatment including chemotherapy.

• Supported hospital early discharge.

• Hospital admission prevention.

• Cancer services.

• Healthcare at Home pharmacy.

• Healthcare at Home care bureau. (on demand call centre).

Services we rate:

This was the first time this service was rated. We rated it as Good overall.

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, and stored securely and were easily available to all staff providing care.
  • The service-controlled infection risk well. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Heidi Smoult (Deputy Chief Inspector of Hospitals)