A growing share of England's medicines bill sits in kitchen fridges. 

Insulin, fertility drugs and weight-loss injections are prescribed in clinics and left to patients to store, inject and manage at home, alongside a widening range of biologic medicines for arthritis, Crohn's disease and other conditions. 

Most must be kept between 2°C and 8°C to stay effective, yet how many patients know what temperature their fridge runs at, let alone what the pack went through on the way home from the pharmacy or in a bag on the commute? 

One study found insulin kept at home, next to the milk, spends over two hours a day outside its safe range.

Meanwhile, half a million people receive their medicines by courier through NHS homecare services, and a Lords committee found in 2023 that nobody could say what it cost or how many patients it had harmed. A supermarket knows more about the journey of a yoghurt than the NHS knows about a vial of insulin.

The Single Patient Record (SPR), part of the NHS Modernisation Bill going before Parliament, is set to join up what GPs, hospitals and social care know about those patients, but it will record nothing about what happens to a medicine once it crosses the patient's threshold.

Medicines sit at the heart of the Government's financial case, with the SPR expected to save over £20m a year and prevent up to 20,000 A&E attendances. Those savings assume medicines are stored, taken and working as intended once they reach the home and on all three counts the record as drafted will be silent. 

NICE estimates 30-50% of medicines for long-term conditions are not taken as intended, and repeat prescriptions cost the NHS £9bn a year, with diabetes medicines the largest item at £1.5bn. The NHS plans to prescribe weight-loss drugs to 220,000 people over three years, yet around 1.6m people already use them, the great majority privately, which leaves most of that use invisible to NHS records.

Patients will carry the cost of that gap, and I have seen why. I spent 14 years in the Lloyd's of London market structuring and implementing risk transfer for Healthcare and Life Sciences clients, including insurance programmes for NHS trusts. There every loss ends with the same question, ‘who was responsible?' And the answer is settled by evidence.

I learned one rule early: blame flows to the party with no record. Manufacturers keep batch data, pharmacies keep dispensing data and prescribers keep notes, so the only link in the chain with nothing to show is the patient at home. 

When a manufacturer recalls a batch, the NHS can trace it to the pharmacy counter and no further; the last mile of a recall is a phone call and hope. The SPR as drafted would write that blind spot into law. 

The Government expects its £20m saving to come from fewer medication errors and less duplicate prescribing. Set that against the scale of the problem: a Department of Health-funded study counted 237m medication errors a year in England, with the avoidable harm costing the NHS at least £98.5m. A University of Liverpool study also found adverse drug reactions behind one in six hospital admissions, two fifths of them avoidable, at around £2.2bn a year. The SPR's proposed saving is less than 1% of that bill. 

None of this is an argument to slow the SPR initiative, only to improve it. Currently, when a medicine fails at home, nobody can say whether the patient, the pharmacy or the manufacturer was responsible, because there is no record. The patient is blamed by default, and the prescriber writes another prescription. When no one can be held responsible, the bill lands on the NHS.

Frailty patients are among the first in line for the SPR, from 2027, and, by the Government's own count, up to one in five hospital admissions among over-65s is caused by adverse effects of medicines. 

Take an 84-year-old on seven medicines, with a carer twice a week and a daughter who visits on Sundays, admitted after a fall that began with a missed dose. Her new record will show a flawless prescribing and dispensing history and not one word about the fortnight that put her in hospital.

Parliament should amend the Bill now, so that the SPR includes medicines at home, beginning with frailty patients and high-cost, temperature-sensitive treatments. That means recording whether a medicine was taken and when, whether it was stored within range, and any reported failure. 

Pharmacies and manufacturers already track every pack to the counter, so the Bill need only require that the record continue past it.

The 10-Year Health Plan promises to move care from hospital to home, and the NHS already runs over 10,000 virtual ward beds in people's living rooms. The SPR as drafted points the other way.

The SPR is meant to give the NHS one honest view of the patient. A record that stops at the pharmacy door will give it an honest view of a prescription, which is not the same thing. 

Parliament has the Bill in front of it and should make sure the record follows the medicine home.