In his first speech since taking up the post, the Health Secretary, Andrew Lansley, said that hospitals should be responsible for reducing the number of emergency readmissions following treatment, and support treatment at home, as part of a single payment.
He said that making hospitals responsible for a patient’s ongoing care after discharge will create more “joined-up working” between hospitals and community services and shift the focus to the outcome for the patient, rather than the volume of activity paid to the hospital.
Speaking to an audience of patients, carers and staff at an event at the Bromley by Bow Centre in London, hosted by the Patients Association and National Voices, the Health Secretary challenged the NHS to:
• Devolve power through the unleashing of meaningful information to patients.
• Engage people in decisions about their care and give patients the opportunity to provide feedback in real time, reflecting the experience of their care.
• Embrace leadership by setting NHS professionals free from a target-centred and bureaucratic system that compromises patient care, to one focused on the quality, innovation, productivity and safety required to improve patient outcomes.
• Adopt a holistic approach by looking at the entire patient pathway from preventative health and well-being measures, through to hospital and community care.
• Align payments in the NHS to drive up the quality of care that patients receive – in the first instance, through introducing payments which encapsulate a more integrated care pathway by giving hospitals responsibility for a patient’s care for 30 days after they are discharged.
Andrew Lansley said: “We need a cultural shift in the NHS – from a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first. This can only be achieved if patients are put in the driving seat and are informed and engaged in the delivery of their care.”
Explaining his plans to tackle emergency readmissions, he commented: “Over the last ten years emergency readmissions have increased by over 50%. Not, it seems, primarily because patients have become more frail, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner.
“In addition to getting rid of targets that have no clinical justification, we are going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged. It will be in the interests of the hospital for patients to be discharged only when it is ready and safe for them to do so. If a patient is readmitted within those 30 days the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment and reablement and support for people as they return home.”
However, responding to Andrew Lansley’s plans to reduce readmissions, Dr Hamish Meldrum, chairman of council at the BMA, said: “We understand the intentions behind these proposals and look forward to more detail. However, simply using financial disincentives is likely to result in unforeseen consequences. One risk is that we get a situation where decisions about discharge are based not on a judgement about what is best for the patient, but on an attempt to avoid additional costs. This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.
“The best outcomes are always likely to be achieved when primary and secondary care professionals are allowed to work together to achieve what is best for patients. We need models of healthcare that encourage co-operation rather than competition. We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital."
