General Comments

We are pleased to see that this outcomes framework aligns with the recently published outcomes framework for the NHS and that the two frameworks are mutually supportive.

However, we are concerned that it does not include any measures in relation to medicines. We would suggest that incorporating medicines safety within the domain of ‘Protecting from avoidable harm and caring in a safe environment’ would help to foster integrated working and provide better outcomes for patients and the public.

The prescribing and supply of medicines to patients is by far the most frequent intervention made within the NHS and these same people receive services from social care and often move between care settings, some of which are provided by the NHS and others that are provided by social care. The RPS is currently leading on the development principles and a minimum data set around the transfer of information on medicines when people are transferred from one care setting to another. This is a multidisciplinary project and is being supported by a number of other Royal Colleges.

Safe management and use of medicines is essential to ensure that patients derive the maximum benefit from treatment and are not put at risk of avoidable side-effects or medication errors. Poor management of medicines leads to increased morbidity, poor quality of life and poor health outcomes. Moreover, poor management of medicines also has cost implications for the NHS due to wasted medicines resulting from poor adherence or inappropriate prescribing. Ensuring the safe and appropriate use of medicines is an important aspect of care management. Therefore we believe that pharmacists should be involved in the training of social care staff in the safe handling of medicines and their expertise sought in the development of medication policy and protocols for social care providers. This expertise should now rest with higher tier local authorities as the PCTs will cease to exist. Pharmacists will be an important resource for such authorities who also commission social care and are responsible for safe guarding service users as well as undertaking investigations in social care, many of which involve medication issues.

In 2009, the findings of the Care Homes Use of Medicines study (CHUMS), which measured the prevalence of medication errors (prescribing, monitoring, dispensing, administering and interface) in nursing and residential homes showed that 70% of care home residents were exposed to one or more medication errors. The investigators noted that many of the errors would reduce the resident’s quality of life and ability to function. They considered that a major hurdle to effective management and use of medicines in these settings is that under the current arrangements no one has overall ownership or responsibility for the system. Consequently, the needs of a particularly frail and vulnerable group of patients are not always effectively addressed. The authors recommended that a pharmacist should have overall responsibility for the use of medicines in a care home or a group of homes in order to improve medicines safety. The report provides clear evidence of the shortcomings in this field and the impact that this is having on a group of frail and vulnerable people.

The RPS has produced some guidance on ‘Pharmaceutical services to social care settings’  and would be happy to discuss this in more detail.

We would also support the development of carer led assessments as this could be a useful empowerment tool and enable carers to have more of a say in the way that social care services are provided in relation to their needs and the needs of the people they care for.

For further information or any queries you may have on our consultation response please contact Heidi Wright or 0207 572 2602.

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