New Government proposals to penalise hospitals for readmissions have been branded as ‘idiocy’ by surgeons.
The policy, outlined in Andrew Lansley’s first significant speech since becoming Health Secretary, will make hospitals responsible for patients for 30 days after they have been discharged, and deny them additional payment for treatment upon readmission.
Lansley says the policy encourages hospitals to focus on successful initial treatment. But the Association of Surgeons of Great Britain and Ireland said it would mean day surgery patients would be kept in overnight at extra cost and labelled it as ‘shortsighted and counter-productive’. Vice-president Professor John MacFie said: “It will encourage hospitals to keep patients in. The policy is idiocy.”
Lansley said the NHS is not just paying for activity, but for ‘performance and results’: “The outcome for the patients is the only outcome that matters – and so we are sending a clear message to the NHS that patient care doesn’t end when they walk out of the hospital door. This will have the added benefit of driving the further integration of hospital and community services where it most matters. Patients don’t talk about ‘primary’ and ‘secondary’ care, they see it simply as treatment and care for the problem they have, whether at home or in hospital.”
Lansley’s plans to build a patient-centred NHS were presented at a health centre in East London.
There would, he said, be no “trade-off between safety and efficiency”. “Good care is safe care. Unsafe care costs more, in lives and cash. High levels of infection, CTE, emergency readmissions, falls, pressure sores – all lead to more suffering and more cost,” he said. “I will not countenance a ‘production line’ approach to healthcare which measures the volume but ignores the quality.”
Lansley promised an information revolution across the NHS, saying that patients need to know who is providing quality, safe, effective and accessible services. “It’s not just about choice. The combination of information and choice will hold people to account and drive up standards.”
Dr Anna Dixon, Director of Policy at The King’s Fund, backed the plans. But, despite Lansley’s insistence that “this isn’t about money, it’s about raising standards and quality”, Dixon said the real challenge was how to secure these gains while facing increasing financial constraints.
“These proposals could offer an opportunity to drive quality in the NHS by ensuring that hospitals are incentivised to provide good-quality care, but the key to the success of this policy will be to ensure sufficient care can be provided in the community following a patient’s discharge,” she said. “This will require hospitals to work with primary care and community health care providers to ensure that services are in place for patients on discharge and that they are not kept in beds for longer than necessary.”
