“The UK is experiencing increased demand for NHS and social care services. An increasing number of people are living longer with multiple long-term health conditions, and require support from a wide range of services at home, in the community and in hospitals.”
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This is from a report produced for the Commons Library in 2019, before the pandemic made everything worse.
Meanwhile, in a report from July last year, Age UK noted: “2.6 million people in England aged over 50 are unable to get care.”
In truth, we have a wonderful health service, staffed by exceptional medical professionals, with access to world-leading medicines. Yet, when it comes to actually taking those medicines, there is a major disconnect between hospital and home.
In hospitals, it’s easy to ensure patients are given their meds at the right time and dosage; at home, it’s not.
An ageing population means an unavoidable increase in people simply forgetting to take their meds, known as unintentional non-adherence, but it is intentional non-adherence that’s the real problem, as its causes are complex and its impacts deep and serious.
Medicines are the second biggest spend for the NHS; £17.4bn a year, or one in every seven pounds.
According to statista, community pharmacies dispensed more than a billion prescribed items in England in 2023-24, an average of 20 items for every person.
However, the landmark 2003 World Health Organization report on adherence estimated that patients do not take between 30 and 50 per cent of medicines prescribed for long-term conditions.
So we are taking the horse to water, but seemingly unable to make it drink.
Doing more for less?
In a press release from the government issued in early January this year, NHS England chief executive Amanda Pritchard said:
“Care workers will be better supported to take on further duties to deliver health interventions, such as blood pressure checks.”
All fine in theory, but the hard reality is that it will put even more pressure on an already overstretched and underfunded care sector.
The press release continues: “The government will develop a shared digital platform to allow up-to-date medical information to be shared between the NHS and care staff, including when someone last took their medication (my italics).”
But why stop there? It’s when patients are at home that non-adherence becomes an issue.
Remote possibilities
The simple act of contacting patients each time their medication is due to be taken, then literally watching them take it, has proved to be transformative in increasing adherence rates.
We developed a remote medication administration monitoring system that is based on having an audio/video hub in patients’ homes. Our monitors, qualified pharmacy technicians, contact them whenever their meds are due to be taken.
It has been used by Liverpool City Council and Knowsley Borough Council1,2, with the result that adherence rates rose dramatically.
The system replaces the need for home carers, who would otherwise be required to visit patients at home each and every time their meds were to be taken, a virtually impossible task both logistically and financially.
Adherence and quality-of-life metrics in both councils showed a significant improvement, with full medicine adherence within just four weeks and a quality-of-life score of 96 per cent within three months. This compares to 30 per cent adherence and 40 per cent quality-of-life scores before the system was introduced.
However, the most interesting outcome has been the savings generated for the councils.
Wise council
Liverpool City Council saved more than £400,000 per year for every 100 service users1, and Knowsley saved £1.8m from September 2020 to September 2024, for an average of 100 service users2.
GP practices in both council areas also benefited, because the monitors resolve prescription issues directly with pharmacies.
Another positive outcome is a lower incidence of hospital admission or readmission for medication-related issues.
The service now includes management of time critical medication.
There is much more that could be done, including issuing reminders for appointments and giving advice on medicine-related issues.
Conclusions
Bringing together two very large, complex organisations is not easy. But by focusing on specific problems it is possible to unearth systemic issues and begin to find solutions.
Medication non-adherence is one example – in the hospital, it’s not a problem; at home, it’s serious.
Remote medication monitoring can help reduce the burden on the social care sector, whilst increasing adherence supports the NHS by improving public health.
To find out more about improving patient outcomes whilst saving money, visit our website.
References:
1. A Williams, Liverpool City Council, adult social care department 2022
2. David Tyrrell, head of assistive technology, Knowsley Borough Council 2024
