Health Secretary, Andrew Lansley, has announced that hospitals should be responsible for reducing the number of emergency readmissions, 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 volume of activity. Explaining his plans, 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: “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.”
