The Conservatives would give acute trusts financial responsibility for home care following discharge as a way of incentivising the prevention of emergency readmissions.
Under the proposal, budgets for hospital care would be combined with care at home for the first 30 days after discharge. Control of this budget would lie with acute trusts, although they would probably fund a community care provider to carry out the outreach support.
A proper risk model, which would vary by age, specialty and hospital, would be essential to making this work
As part of the proposed reform, acute trusts would be “fined” the cost of the home care if patients were readmitted as an emergency within the first month after their discharge, for a “related condition”.
Shadow health secretary Andrew Lansley said: “Our reforms will ensure that patients are cared for even after they have gone home. Hospital responsibility will not stop at the hospital door - instead we will integrate the two stages of a patient’s care.
“Hospitals will hold the budgets and be accountable for the initial NHS care a patient gets at home. That way, patients can be assured they will make the swiftest possible recovery and will avoid any further unnecessary extra days in hospital.”
According to the Tories, more than 500,000 patients are readmitted to hospital within 28 days of discharge each year.
NHS Confederation policy director Nigel Edwards said: “There is evidence to suggest that paying hospitals for performance in this way works and we welcome these proposals.”
But he warned the 30 day cut-off could lead to problems similar to those seen with NHS targets, some of which have been criticised as arbitrary.
“A proper risk model, which would vary by age, specialty and hospital, would be essential to making this work so we can work out what the unavoidable rate of readmission actually is and then design appropriate incentives,” he said.
NHS Alliance chair Michael Dixon warned commissioners and providers were likely to differ over whether a problem related to an initial stay in hospital had led to a patient’s readmission.
He said the Conservatives were attempting to tackle a valid problem, with patients often feeling abandoned after discharge, but questioned whether their solution would work.
He said in many cases “there is absolutely an issue about whether early discharge is appropriate but I’m not clear in my own mind that outreach secondary care is necessarily the right solution”.