Roundtable: Making community-based treatment a reality through clinical homecare

This HSJ roundtable, produced in association with Alexion, brought together NHS leaders and partners to identify practical actions to accelerate clinical homecare provision’s scale and consistency across the country.

Panellists

• Deborah Clarke, senior director, medical affairs, Alexion
• Stephen Cook, chief pharmacist, Medway Maritime FT
• Laurie Cuthbert, director of fundraising, marketing and communications, Kidney Care UK
• Susan Gibert, director, National Clinical Homecare Association (NCHA)
• Morag Griffin, consultant in haematology (PNH and aplastic anaemia), Leeds Teaching Hospitals Trust
• Zahraa Hammoud, homecare and procurement lead pharmacist, University College London Hospitals FT
• Ross Maclagan, head of supply and distribution policy, Association of the British Pharmaceutical Industry (ABPI)
• Helen Morris, support and advice manager, Metabolic Support
• Paula Sullivan, nurse practitioner in Cockayne syndrome, trichothiodystrophy and Bloom syndrome, Guy’s and St Thomas’ FT
• Dave West, deputy editor, HSJ

As Zahraa Hammoud, UCLH homecare and procurement lead pharmacist, put it, clinical homecare “empowers patients”.

“It gives them a sense of control over their treatment… and for patients with chronic conditions, it enables them to live a relatively normal life,” she added. Having medication delivered at home and specialist nurse visits enables people to continue work or education with minimal disruption.

Paula Sullivan, a nurse practitioner at Guy’s and St Thomas’ Foundation Trust, who specialises in Cockayne syndrome, trichothiodystrophy and Bloom syndrome, added that patients with rare and complex conditions “would always rather be cared for at home”.

“One of our main roles is more around hospital avoidance,” she said. “We are there to support and to help patients stay out of hospital when it comes to the acute illnesses or deteriorating patterns that we see across our patients, that are normal for them but aren’t normal to hospital. You also haven’t got the risk of hospital-acquired infections.”

Ms Sullivan added that homecare also improves clinician insight: “Being able to go out and visit [patients] in their home really helps with the relational aspects of their care. We get a much better view of how their life is when we’re visiting them at home, whereas the clinic is really busy.”

Stephen Cook from Medway Maritime FT said that essentially having another system managing homecare also benefits him as a chief pharmacist: “There’s around £18m stock of medicines that somebody else manages, and it’s a separate supply chain, so we don’t have so many problems with shortages.”

The UK is widely regarded as a global leader in clinical homecare due to its scale and uniquely integrated delivery model, and the benefits to the NHS are well documented, particularly with increased capacity and financial savings. According to a 2025 ABPI report, 2.4 hospital bed days are saved per patient receiving homecare across a six-month period, versus those in the hospital.

Nevertheless, clinical homecare remains “low profile, with its full value not widely recognised by national policymakers and payers”, said Deborah Clarke, Alexion’s senior medical affairs director.

She continued: “From our perspective, we want to see full recognition of its benefits to patients and the health system. So how can we communicate that full value to individual clinical care pathways?”

NCHA director Susan Gibert is quietly optimistic that the 10YHP  could be a chance to increase awareness, as homecare embodies all three of the widely cited shifts, from analogue to digital systems, from hospital to community, and from treatment to prevention.

“We know that we are not going to get a clinical homecare policy coming out of [the 10YHP], but what we will have is some tools to implement the plan. If we can get clinical homecare as part of those implementation documents or implementation guidance, that’s going to go some way to expanding people’s knowledge,” she suggested.

Since this roundtable event took place, the Department of Health and Social Care has published the NHS England Neighbourhood health framework, which includes a strong reinforcement of a shift from hospital to community-based care.

Mr Cook argued that one of the main barriers to scaling clinical homecare nationally is that it is still “presented as an option rather than an expectation”. He called for more standardised pathways that clearly define when patients should transition to home-based care.

This approach is already embedded within specialist services such as those at Leeds Teaching Hospitals Trust. The service’s co-lead, Morag Griffin, consultant in haematology (PNH and aplastic anaemia), described a model managing around 1,000 patients, including 450-500 on complement inhibitor therapies. Patients begin treatment in hospital before routinely transitioning to homecare, supported through established partnerships with multiple providers.

Internationally, this model is unusual. “We’re one of the only countries that offer homecare treatment for [these] patients,” Dr Griffin said. “Elsewhere, patients must go into hospital for infusions, which takes significant time for both patients and staff – so being treated at home has a massive impact.”

She emphasised that this success relies on upfront investment in pathway design, including detailed process mapping, contracting and communication before any care at home begins.

However, wider adoption will depend on improving understanding across the system. Ross Maclagan, ABPI head of supply and distribution policy, said “top down” education is needed across NHS leadership, policymakers, clinicians and patients to unlock the full opportunity.

Helen Morris, Metabolic Support, support and advice manager, pointed to insufficient understanding about the realities of living with chronic and rare conditions, and stressed the importance of communication.

“We hear from people who have stopped taking treatments because the homecare has been so stressful for them,” she said. “That’s the worst-case scenario for us, so I would really like to include better communication across the system.”

This includes earlier and clearer communication about supply challenges, as well as better engagement with patients and families about their care options.

For Laurie Cuthbert, Kidney Care UK’s director of fundraising, marketing and communications, this communication and awareness raising must come much sooner in the process for patients to truly benefit from clinical homecare.

For many conditions, particularly kidney disease, late diagnosis limits patients’ ability to access home-based treatments. By the time they enter specialist care, they may already be too unwell to benefit from options such as home dialysis, Mr Cuthbert explained.

“If it was a private business, you would see a lot more investment up front in prevention… so more people are aware of these conditions sooner,” Mr Cuthbert said. “It does require an investment up front, but will save billions down the line.”

As with much of the cash-strapped NHS, funding is a central barrier to scaling clinical homecare. Around 80 per cent of the clinical homecare market is industry funded, with 17 private companies providing homecare services and the NHS typically only paying for the medication itself.

Attempts to standardise funding models – including work led by the NHMC, have had mixed success. In some areas, proposed models have been rejected or adapted, requiring local teams to negotiate bespoke arrangements, which ultimately leads to inconsistencies in the treatment and services available across the UK.

Ms Clarke and Ms Gibert both suggested that a national “toolkit” could help share best practice examples across the UK. This would outline the fundamentals required to establish services, including costs, funding mechanisms and workforce needs, enabling more consistent commissioning decisions.

There would, of course, be different pathways for different conditions and levels of care, said Ms Clarke.

Ms Gibert added: “Homecare can be quite adaptable and can provide that personalised care, or at least can really assist in that.”

At the same time, charities are increasingly stepping in to fill funding gaps, raising questions about long-term sustainability.

Mr Cuthbert said: “We often hear as a charity that there’s no more funding. Actually, there should be plenty more funding, but the funding is not being directed efficiently.”

Mr Maclagan agreed, suggesting that with support from both industry and voluntary or non-profit organisations, “we need to look at how we can use the budgets we’ve got; how we can focus them better and prioritise more efficiently… to get the maximum benefit”.

Mr Cook said communicating the value of homecare services to integrated care board (ICB) turnaround teams, who are focused on enhancing financial viability, operational performance and workforce efficiency within NHS systems, could go some way toward ensuring funding is spent adequately.

“Part of making your pound work harder is demonstrating the value you get from homecare. We should be asking: ‘Are we maximising homecare? Are our patients getting the best value? And are we getting the best out of our money?” he said.

Beyond funding, there are significant operational challenges. Administrative burdens are significant, for high-tech through to low-tech clinical homecare services, with many processes still reliant on paper-based systems. Prescriptions are often physically posted, invoices are processed manually, and data is shared inefficiently between organisations. This creates workload pressures for healthcare teams and limits the number of patients that can be onboarded.

Ms Hammoud suggested that efficiencies could be made with some digital investment: “If we had a similar model to what we have in primary care, where we utilise the NHS Spine, so prescriptions go electronically to the homecare companies and they retrieve them from there, that could reduce our burden by about 60 per cent, I’d say.”

Ms Gibert explained that homecare services are being considered as part of NHSE’s work to expand the electronic prescription service (EPS) in secondary care. But for her, investment should also be made into “true e-commerce” to help manage the tens of thousands of invoices that are currently processed manually as part of homecare services.

Workforce constraints also create a barrier. Specialist nurses are central to homecare delivery, but are often stretched, handling large caseloads and acting as key points of contact for patients and families.

With every new specialised medicine the National Institute for Health and Care Excellence licenses comes the expectation that homecare services will provide it. Ms Hammoud said many services lack the capacity or additional nursing staff to accommodate this.

On the contrary, “the homecare providers have no capacity issues”, said Ms Gibert. “The capacity issues and some of the blockers are within the NHS, and that we completely understand and are very sympathetic about.”

She emphasised the willingness of industry and providers to support the NHS in overcoming these barriers.

“One of the unique attributes of clinical homecare is the amount of collaboration we have between manufacturers, the NHS, NCHA and NHMC, etc. The collaboration is something that is special to this area,” Ms Gibert said.

With this cross-sector backing, the discussion then becomes about taking this collaboration forward, said Ms Clarke: “How can we include all of our different stakeholders and collaborate to improve?”

Mr Maclagan pointed to the ongoing review led by NHSE and NHMC, looking at homecare’s future and understanding how the service should develop.

“Understanding where we want to go and who is funding it is absolutely critical for where and how it evolves,” he said.

At a time when treatment innovation typically directs resources towards hospital-based settings, Ms Clarke said the evidence is clear: “Effective clinical homecare provides a proven model that enables patient-centred care to be delivered in the community.”

Department of Health and Social Care (2025) Fit for the future: 10 year health plan for England. Available at: https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf (Accessed: 21 April 2026).

Clinical Homecare Association (2024) The best kept secret: Clinical homecare report. Available at: https://www.clinicalhomecare.org/wp-content/uploads/2024/03/Best-Kept-Secret-Report-Final-Version-March-2024.pdf (Accessed: 21 April 2026).

UK Parliament (2023) Inquiry into homecare medicines services. Available at: https://committees.parliament.uk/publications/42033/documents/209781/default/ (Accessed: 21 April 2026).

Scottish Government (2023) Independent review of medicines homecare in Scotland: Review report and recommendations. Available at: https://www.gov.scot/publications/independent-review-medicines-homecare-scotland-review-report-recommendations/ (Accessed: 21 April 2026).

Association of the British Pharmaceutical Industry (ABPI) (2022) Bringing healthcare home: A blueprint for collaborative clinical homecare. Available at: https://www.abpi.org.uk/publications/bringing-healthcare-home-a-blueprint-for-collaborative-clinical-homecare/ (Accessed: 21 April 2026).

UK Government (2024) Neighbourhood health framework. Available at: https://www.gov.uk/government/publications/neighbourhood-health-framework/neighbourhood-health-framework (Accessed: 21 April 2026).

Association of the British Pharmaceutical Industry (ABPI) (2025) Modernising UK homecare will boost neighbourhood health services and save money. Available at: https://www.abpi.org.uk/media/news/2025/july/modernising-uk-homecare-will-boost-neighbourhood-health-services-and-save-money-says-abpi (Accessed: 21 April 2026).

Specialist Pharmacy Service (2021) Proposal for the funding of pharmacy homecare teams. Available at: https://www.sps.nhs.uk/wp-content/uploads/2018/05/NHMC-Proposal-for-the-Funding-of-Pharmacy-Homecare-Teams-FINAL-March-2021-v2.0.pdf (Accessed: 21 April 2026).