Hospitals to be forced to fund community services

Hospitals will have to fund community services to avoid costly readmissions of patients to hospital, health secretary Andrew Lansley has said.

The move will support the government’s policy of not paying hospitals for a second admission of a patient within 30 days of discharge.

Addressing patients at a health centre in Bromley by Bow in London yesterday, Lansley said: “The hospital tariff will be extended to reflect their responsibilities. The hospital will carry a budget for community services and care at home.”

Hospitals are currently paid a flat rate for each episode of care delivered. This is supposed to encourage efficiency in delivering care but Lansley said it created incentives to discharge people too early knowing the hospital would get paid a second fee if they needed to be admitted again.

Colin Angel, head of policy and communication at the United Kingdom Homecare Association, said he was pleased Lansley had recognised the vital role home care could play in keeping people safe after discharge and maintaining their condition during their recovery.

However, concerns were raised about the new policy’s compatibility within the longstanding policy of fining local authorities for delayed discharges from hospital that result from a lack of available social care services.

Helga Pile, Unison’s national officer for social services, said: “In hospitals, the double penalty of charging for readmissions, and charging for delayed discharges, have clearly not been properly thought through.”

Richard Jones, president of the Association of Directors of Adult Social Services, added: “Delayed discharge fines have had a range of effects some positive and some negative. On their own, outside shared responsibility for how we pool resources and shared risk, they are limited, just as this measure will be if it does not move systems towards increased collaboration.”

The number of hospital readmissions after 30 days has risen by 50% over the past 10 years according to the government.

Lansley said the present system of targets for early discharge created risks for patients and described community and acute care services as “disjointed”. He said: “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 benefit of further integrating hospital and community services.”

He cited the integration of health and social care as one of his five priorities as secretary of state for health. However, he added that he did not see structural upheaval as a way of delivering better quality care.

The new system is expected to be in place from April 2011.

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