Trusts face readmissions penalties totalling £600m

The findings show the potential full year impact of rules which came into effect in 2011-12 stating there will be no payment for many emergency readmissions occurring within 30 days of an elective admission.

• Read the full report from Sg2 healthcare intelligence, watch Sg2 senior vice president Joan Moss discuss the analysis and download the Emergency Readmissions service kit

The calculations also assume commissioners will follow guidance that payment for eligible emergency readmissions occurring within 30 days of a non-elective admission should be reduced by 25 per cent, although the precise reduction is open to local negotiation.

If the maximum 25 per cent reduction is applied, the combined changes will cut 2-4.6 per cent from the income trusts would otherwise generate from the tariff for eligible patients in 2011-12. According to analysts Sg2, acute trusts face a loss of nearly £600m, which averages out as a 3 per cent tariff income drop. The analysis excluded specialist hospitals.

The total loss is lower than the £790m predicted by the NHS Confederation in February as it takes account of the additional exclusions made by the Department of Health since then. These covered multiple trauma, road accident patients and those who discharged themselves against advice or were transferred from other hospitals.

Maternity and cancer patients, as well as those under four, were already excluded.

In the Sg2 analysis – the first time a trust-by-trust breakdown has been undertaken – the Royal Free Hampstead Trust emerged as set to lose the biggest proportion of tariff income, with the loss equivalent to £6.61m a year.

A Royal Free spokesman said its own figures showed the potential loss to be 3.1 per cent. The trust said its potential loss was £1.3m after local commissioners agreed to exclude renal and haemophiliac patients from the penalty.

The other trusts in the top five for potential loss of income include Aintree University Hospitals; Royal Liverpool and Broadgreen Hospitals; University Hospitals Birmingham; and Salford Royal.

A Royal Liverpool and Broadgreen spokeswoman said relatively poorer health of the city’s population increased demand. The trust is introducing clinical case managers for some patients and is working with community services to reduce readmissions.

University College London Hospitals Foundation Trust will lose the smallest proportion of tariff, about £4m.

Sg2’s analysis is based on 2009-10 admissions. It showed nearly half of admissions occurred within seven days.

It states: “This indicates that they may have been discharged too early due to suboptimal management during the initial stay or been discharged to an environment with an insufficient level of care. It is a poor experience for the patient to be readmitted so soon.”

Kingston Hospital Trust has the highest proportion of readmissions within seven days, with 59.3 per cent. This is followed by the Royal Free, Chelsea and Westminster Hospital Foundation Trust, Buckinghamshire Healthcare Trust and Newham University Hospital Trust.

A spokeswoman for Kingston said it had excluded some patients referred by GPs from the figures, resulting in lower readmission rates.

South Tyneside Foundation Trust had the biggest proportion of readmissions – 59 per cent – after seven days. An Sg2 report attributes readmissions between eight and 30 days to “socio-economic factors, limited post-acute care follow-up and inadequate patient education”.