Lloyds Clinical

Updated 14 March 2023

Lloyds Pharmacy Clinical Homecare provides care to more than 100,000 patients, throughout the United Kingdom, in their own homes, places of work and in the community.

The service provides medicines to adults and children to meet their individual needs based on their prescriptions, delivers medicine for patients to administer at home and provides specialist nursing for people with complex conditions in their own homes.

The service had developed a Remote Nurse Training service for patients with long-term conditions and enabled them, through telephone training, to self-inject their ongoing subcutaneous treatments. This had facilitated greater independence for patients and reduced the risk of transmission of the COVID-19 virus to a patient group that were considered vulnerable. With a success rate of 99%, the training programme was rolled out nationally across 13 different biological therapies. As a secondary effect, the Homecare nurses had seen improvements in their working day travel time which had improved capacity to spend more time caring for patients that needed more input and support. The service was a finalist in the Nursing Times Awards 2020 in the category of Managing Long-term Conditions.

The service described the treatment they provided as high, mid and low-tech therapies. Patients who received high tech therapies were prioritised for treatment due to the complexity and risk of deterioration if they did not receive their treatments. The frequency of treatment for patients varied and depended on the type of therapy required for the condition. Some therapies were required daily whereas others were required on a weekly or monthly basis.

The therapies provided were:

Cancer Therapies

Enzyme Replacement Therapy

Growth Hormone

Home Parenteral Nutrition

IV Antibiotics

IVIG

Oral Immunosuppressants

Biological therapies

The conditions treated were:

Crohn’s Disease

Cancer

Cystic Fibrosis

Dermatological Conditions

Haemophilia

Hepatitis

HIV

Intestinal failure

Motor Neurone

Multiple Sclerosis

Osteoporosis

Parkinson’s

Pulmonary Arterial Hypertension

Renal Anaemia

Rheumatoid Arthritis

Thalassemia

The service had several departments dealing with different elements of the service. This included patient services who managed inbound and outbound calls from and to patients. The compounding department managed medication which was made for individuals according to their prescription and needs. There was the pharmacy and prescription processing department where prescriptions were managed, and medicines dispensed and checked. The service had a nurse scheduling team who managed the nurse rotas and schedules and the nursing team who visited patients at home to administer treatment.

The service is registered with the Care Quality Commission for the below regulated activities:

• Treatment of disease, disorder or injury

For this inspection we focused on nursing care as this relates to the regulated activity, Treatment of Disease, Disorder or Injury. This is the regulated activity monitored by the Care Quality Commission.

The service had mobile units in Surrey for oncology healthcare centres and infusion centres where oncology treatment was delivered to referred patients. However, for this inspection, we did not visit them.

The service reported at board level to the parent company, Hallo Healthcare Group. They worked with the National Health Service, pharmaceutical companies, private medical insurers and consultants.

The service has a registered manager and a nominated individual.

Updated 14 March 2023

We last inspected this service in November and December 2021. Following this inspection, we took enforcement action against the provider due to the concerns we identified during the inspection. We issued the provider with 2 warning notices for breaches of regulation 17 and regulation 18 of the Health and Social Care Act 2014. The service was subsequently rated as inadequate and was placed into special measures by the Chief Inspector of Hospitals.

At this inspection in October 2022, we found that the service had made significant improvements.

Our rating of this location improved. We rated it as good because:

• 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. The service-controlled infection risk well on home visits. Staff assessed risks to patients, acted on them and kept good care records. Nursing staff worked within their working hours to deliver effective care at home including good Personal Protective Equipment and hand hygiene. The patient services department responded promptly to calls, the performance on the number of calls answered had improved with an average call wait time of 5 minutes. The patient support programme coordinators supported patients to administer specialist medicines safely at home
• Managers ensured that staff completed all mandatory and specialist training relevant to their roles, and had regular team meetings, supervision and appraisals. Patient facing staff completed safeguarding training. Nurses referred safeguarding incidents to the Local authority via an NHS safeguarding application on their smartphones. Managers made sure staff were competent. Incidents at home and safeguarding incidents were well reported and escalated. Outcomes of incidents were shared with commissioners such as the NHS trust, and lessons learned were shared through ‘head of nursing town hall meetings’.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff reported the warehouse safety hazards via smart survey scan and actioned by senior leadership team. The service had a robust governance process and monitored its performance and risks regularly. The corporate and clinical risk registers included relevant risks and were monitored and managed effectively.

However:

• The patient’s satisfaction survey was last done in 2020.This meant that the service had not captured recent views from patients.

The service had closed other registered locations in 2022 and brought all activities to the registered location in Harlow, Essex. However, there remained in Surrey, a Mobile unit, infusion centre and the healthcare centre. There was also the Patient support programme in Derby.

This report describes our judgement of the quality of care by the provider from this location. It is based on a combination of what we found when we inspected and a review of all information available to the Care Quality Commission including information given to us from patients, the public and other organisations. For this inspection, we looked at the 5 domains of safe, effective, caring, responsive and well led, and have applied ratings to each domain and an overall rating.

Updated 14 March 2023