Smokers and overweight patients in need of major operations could be thrown off hospital waiting lists under “desperate” cost-cutting plans.
Any smoker referred for ‘non-urgent’ operations will not be allowed to join the queue until they have either given up smoking, or completed a 12-week course to help them ditch the habit

Patients’ groups described the tactics as an “appalling scam” to enable NHS bosses to claim waiting times are far shorter than they are, simply by denying a place in the queue to many of those referred for surgery.

Under the plans drawn up by NHS bureaucrats in Kent, any smoker referred for “non-urgent” operations – such as hip replacements or cataract surgery – will not be allowed to join the queue until they have either given up smoking, or completed a 12-week course to help them ditch the habit.

Those who are seriously overweight will also be denied a range of operations until they have completed a three month NHS diet programme.

Although every patient has a legal right to be treated in 18 weeks of being referred for treatment by their GP, the protocols agreed mean different rules could be applied for anyone with a body mass index of more than 30, or those who smoke.

Patients groups said delays getting a place on 12-week “smoking cessation” and “weight loss” programmes could leave many patients waiting even longer than 30 weeks implied by proposals drawn up by NHS West Kent Primary Care Trust (PCT).

Katherine Murphy, from the Patients Association, said: “This is an appalling kind of scam – it is a clear device to manipulate the waiting lists simply to cut their deficit. It smacks of desperation, and it is patients who will suffer.”

The plans, seen by The Sunday Telegraph, explicitly say the rules have been introduced to save money by the end of the year.

The document says: “PCTs across the country are making decisions on prioritising treatments in order to match demand to the financial resources available to the economy as a whole and to individual trusts.

“Unfortunately this does not take us far enough: we need to take additional activity to reduce activity in this financial year if we are to be in a position to hand over a balanced budget.”

Under the proposals, smokers already on waiting lists will now be taken off until they have either been on the courses or given up smoking. New referrals will not be allowed on the lists until they have done the same.

All patients with a BMI of 30 or more who are referred for several types of surgery including hip and knee operations will also be cast off the lists until they have been on a three-month diet programme.

Many primary care trusts already try to encourage patients to stop smoking or lose weight before operations, in order to reduce the risks to them.

But patients’ groups said the use of tactics to delay even putting patients on the waiting lists was a far more draconian step.

Mrs Murphy said: “This is a clear way to keep these patients off the lists in order to cut costs, while the PCT can officially claim its waiting times have not lengthened.”

Simon Clark, director of the smokers’ lobby group Forest, accused the PCT of discriminating against smokers and creating a “two-tier” system.

He said: “Of course patients should be told that smoking could have an impact on the success or recovery from an operation, but given that they have paid huge sums in taxation on cigarettes over the years, the question of whether or not they have the surgery should be one for them, not the NHS.”

A letter sent out by the PCT tells local GPs: “There is good evidence that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up.”

Kent doctors accused managers of being dishonest about the real reasons why patients were having their treatment delayed.

Dr Stephen Meech, a GP from Maidstone, said: “Patients are going to be told that they cannot have an operation because they smoke or need to lose weight, when that is not actually true – it is because the health authority can’t afford to pay for it.”

Dr John Allingham, a GP from Hawkinge, said: “The plan is extremely contentious and it is a way of extending the waiting times.

“If you’ve got to do a 12-week smoking cessation course before you can have your hernia fixed, or before you’ve even gone on the waiting list to have your hernia fixed, it immediately makes those waiting lists another 12 weeks longer.”

The PCT said it was in talks with local doctors over the proposals. Marion Dinwoodie, its chief executive, said she regretted the need “to take measures in the short term that may have an impact on local people”.

She said no one with a compelling clinical need for treatment this year would miss out.

From: http://www.telegraph.co.uk/Smokers-and-fat-patients-thrown-off-NHS-waiting-lists

Private hospitals bucked the recession in 2009 – but only by massively expanding the amount of work they carry out for the National Health Service, according to the analysts Laing and Buisson.Overall, revenue rose by 7.5 per cent to £3.76bn. But patients treated under private medical insurance fell by 30,000 between 2007 and 2009 as the recession hit. The numbers paying out of their own pocket dropped further – down by almost 45,000.

However, work for NHS patients, who now have the right to go to any private hospital willing to treat them at the NHS price for waiting-list type treatments, rocketed.

Their numbers almost quadrupled between 2007 and 2009, up from 55,900 to 212,000, so that NHS patients made up almost 22 per cent of private hospital cases, up from 6.3 per cent in 2007.

The result was a rise in independent hospital activity, with about 975,000 patients treated, against 888,000 in 2007.

Some NHS patients are sent by NHS hospitals to keep waiting times down.

But the numbers exercising their right to choose are rising sharply – running at a rate of 200,000 procedures a year in July this year, according to Laing’s Healthcare Market Review, the bible on private sector activity. That is business worth £400m a year.

William Laing of the review said senior health department officials believe patient choice activity in the private sector could triple. His own estimate is that it might ultimately rise five fold to about £2bn a year – although that would still be less than 20 per cent of NHS waiting list activity.

“Expanding the services they provide for the NHS has obvious attractions for independent hospitals because the publicly paid market is massively greater than the traditional private healthcare market.

“But it has great dangers as well, since too much focus on publicly paid patients could compromise their appeal to traditional, privately paying customers. There is a conflict which independent hospital providers have not yet fully resolved.”

If the independent sector seriously wanted to address the potentially huge public market, he said, it would “have to grow a lot more capacity”.

That could come from a mix of the existing players and new hospital providers entering the market with lower cost business models that generate reasonable profits from the prices that the NHS is prepared to pay.

The figures came on the day the Office of Fair Trading launched a wide ranging review into the private healthcare market – among other issues examining the barrier to new entrants joining it.

From: http://www.ft.com/cms/s/0/675afcb4-07b7-11e0-a568-00144feabdc0,s01=1.html#axzz18ALgaS00

Tens of thousands of GPs’ patients are now waiting more than 18 weeks from referral to treatment following the Government’s decision to scrap performance management of the flagship target.
The number of patients missing out on treatment within 18 weeks of referral jumped by 15% between July and September this year, after PCTs were released from their strict obligation to meet the target in June.

Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution.

Department of Health statistics show the proportion of people treated within 18 weeks increased steadily from 2007.

Numbers peaked this July, when 93.3% of admitted and 98.1% of non-admitted patients were treated within target, just after the NHS Operating Framework removed it.

By September, the proportion of admitted patients missing out jumped from 6.7% to 7.5%, and of non-admitted patients from 1.9% to 2.2%.

Overall, 45,000 patients missed out on treatment in 18 weeks during September, up 15% from 39,000 in July. Some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Ben Troke, partner in health and social care at Browne Jacobson solicitors, warned: ‘When commissioning passes to GP consortia, it’s hard to see responsibilities [for applying the NHS Constitution] not going with it. There’s a real risk of legal challenge.’

‘Whether a claim would be successful is hard to say, but being dragged through the courts can be damaging even if you win. Courts are starting to rely on the NHS Constitution as a ground for decisions and every consortium can expect to keep their lawyers busy.’

At least one SHA has admitted waiting times are slipping.

NHS South Central said health systems in Oxfordshire, Southampton and south-west Hampshire had been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Once you scrap hard targets, it’s likely actions to achieve them will wane. I guess that’s what we’re starting to see.’

Dr Chaand Nagpaul, GPC negotiator, said PCTs were already taking advantage of the target’s removal: ‘We’re getting reports of trusts delaying treatment so they can address financial problems. The Government is engaging in double-speak, removing targets on one hand but committing to patients’ rights on the other.’

From: http://www.pulsetoday.co.uk/NHS waiting times increasing after targets scrapped

The number of cancer patients being admitted to hospital through accident and emergency has doubled in less than a decade amid claims they are being “abandoned” after receiving treatment.
Such admissions are meant to be “the exception” but the number has increased from 70,000 in 2000/01 to 140,000 in 2008/09, according to the National Audit Office (NAO).

Macmillan Cancer Support said that showed too many patients were not being cared for properly after being given treatment like chemotherapy and radiotherapy.

According to the NAO’s report, which examines how well the NHS has managed to deliver the last government’s five year Cancer Reform Strategy so far, waiting times have fallen and the number of days cancer patients spend in hospital has dropped.

The strategy, launched in 2007, was meant to make NHS cancer services “among the best in the world” by 2012.

But the NAO report said there was “limited assurance” as to whether the £6.3 billion spent on cancer care annually was money well spent, because such poor information linking spend and outcomes was available.

In particular it illuminated problems caring for cancer outpatients.

Ciaran Devane, chief executive of Macmillan Cancer Support, said: “English cancer services have improved but there is still an incredibly long way to go for the UK to be a world leader.”

She warned: “The NHS won’t be able to support the growing number of cancer patients unless it seriously ups its game.

“The whole NHS needs to realise that cancer is a long term condition for many. If the NHS does not provide appropriate services after patients leave hospital, they can expect to see a massive increase in costs as cancer patients are forced to use emergency services.

“Abandoning cancer patients after treatment is no longer acceptable, nor does it make any financial sense.”

The previous government had pledged to cut the total number of emergency cancer admissions – not just via A&E but also for example by doctors making emergency referrals – but instead the number has been rising steadily.

It has risen from 231,000 in 2000/01 to 300,000 in 2008/09. However, the rate of annual increase has almost halved. Four in five have an existing diagnosis.

Karen Taylor, from the NAO, said there was “poor understanding” of the issue while primary care trusts “don’t appear to be aware of it’s extent”.

Mike Hobday, head of policy at Macmillan, said the reason was clear.

“The traditional NHS approach at the end of cancer treatment has been to say, ‘Go away, you are cured.’ ”

But he explained: “While treatment is in most cases extremely good, people with cancer have ongoing problems. Chemotherapy is toxic – you can’t do it without impacting people’s health.

“Patients aren’t being given the support to manage themselves, so they turn up at A&E.”

A “small investment” in things like better information and dedicated helplines for cancer patients would reap large savings by lowering emergency admissions, he predicted.

With growing numbers of cancer survivors and stretched budgets “the NHS has to do this smarter”, he said.

Dr Jodie Moffatt of Cancer Research UK said the increase could partly be explained by the tripling of cancer patients receiving chemotherapy since 2000. The government was trying to tackle the problem, she argued.

Paul Burstow, the Health Minister responsible for care services, said: “This report is a damning indictment of Labour’s failure to deliver on their promises to improve the quality of cancer care.

“The shocking levels of emergency admissions are the legacy of Labour’s obsession with hitting targets instead of helping patients.

“Under Labour, NHS spending rose to European levels of funding, but they have failed to deliver European levels of quality cancer care. If the NHS was performing at the level of the best in Europe, an extra 10,000 lives could be saved each year.”

Jo Webber, deputy director of policy at the NHS Confederation, which represents health trusts, said: “It is difficult to attribute a rise in emergency re-admissions to any one factor.

“Commissioning appropriate after-care services and providing patients with access to specialist services and home support services all play their part in bringing numbers of re-admissions down.

“Providing patients with access to quality treatment in or close to home, as well as information on local support services, is just as important as the early detection and treatment of the disease when planning an effective cancer strategy.”

From: http://www.telegraph.co.uk/Cancer-patients-abandoned-after-treatment

Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

Patients will be able to view their medical records online, email their GP and compare doctors across Britain under plans for an “information revolution” in the NHS to be led by Martha Lane Fox, the internet entrepreneur.
Martha Lane Fox says that the most useful online services for consumers should be made available to NHS patients over the next few years.

Those requiring treatment for cancer will be able to study survival rates – and waiting times – for different medical teams and then opt to have treatment where they wish, under the plans to be announced today. Proposals are being drawn up to give patients online access to their medical records.

Miss Lane Fox says that the most useful online services for consumers should be made available to NHS patients over the next few years.

It is hoped this will help drive up hospital standards as patients choose not to use the services of poor doctors, who will then lose funding. Patients will also be asked to rate the service and treatment they receive from different hospitals and medics.

They will be able to choose which GP they register with and whether to be treated at an NHS hospital or private or charity-run institution, within certain cost limits.

Miss Lane Fox, the founder of Lastminute.com, says the data could prove invaluable.

The Department of Health is the only major Whitehall department which will not see its spending cut this week. However, Andrew Lansley, the Health Secretary, still has to push ahead with major reforms as the ageing population is causing a sharp rise in health-care costs.

Miss Lane Fox, the Government’s digital champion said: “A recent YouGov poll found that 40 per cent of people believe the NHS can learn from the service offered by supermarkets, banks and utility companies. I’ve always believed in the power of information and technology as an incredibly useful tool.

“There’s clearly an appetite for a new approach. The Department of Health is launching a consultation this week into how information and technology can help people take more control of their health and make the best choices for themselves and their families.”

The consultation will study how internal data could be offered to websites like TripAdvisor or Mumsnet, which could “empower patients and families”.

Mr Lansley said: “The first principle of the White Paper is that the NHS should ensure that for patients, ‘no decision about me, without me’ is the invariable practice. To realise this means patients must have more say and more choice.”

From: http://www.telegraph.co.uk/NHS-patients-to-see-medical-records-online

The National Health Service (NHS) is the only major area of Whitehall spending in which there will be a rise in real terms. However, an increase of just 0.1 per cent a year will be dwarfed by the rise in the cost of drugs, an ageing population, the cost of reorganisations and inflation.

The cuts:
Technically the NHS has been given an increase in funding but this is less than half a per cent over four years.

£1bn will be diverted from the NHS to social care to help cut emergency readmissions to hospitals.

Psychological therapies will be boosted for those with mental health problems.

A new cancer drug fund for medicines that have been turned down by Nice worth up to £200m a year.

Three new hospitals were given the go ahead including Epsom and St Helier, West Cumberland and the Royal Oldham.

However the extension of free prescriptions to people with long-term conditions will be stalled.

One to one nursing care for cancer patients and a pledge under the previous government to have cancer tests conducted within one week will also be postponed.

The number of quangos will be cut from 18 to 10 by 2014 and the administration costs will be reduced by a third.

Radiographers will examine some x-rays as well as take them in order to save £7.9m of consultant radiologists’ time.

What it means:

Although an increase in funding sounds generous compared to the other departments it is nowhere near enough to keep pace with inflation in the NHS or the increase in demand for healthcare as the population ages and new treatments are developed.

The NHS has already been planning to make £20bn worth of savings over the next four years and it is not yet clear if this will have to be increased in light of the CSR settlement.

The Chancellor said the NHS spent £102bn this year but this is £5bn lower than what was planned for in the 2007 spending round, raising the question of where that money has gone.

Thousands of jobs in the NHS are already earmarked for cuts as primary care trusts and strategic health authorities are to be abolished as part of the coalition’s reforms and it is feared that some hospitals may seek to cut frontline jobs as well.

Experts have warned that plans to give GPs greater control over the NHS budget and the reorganisation this will take will cost between £2bn and £3bn.

What is the department’s budget?

£109.4bn

How well does the department perform?

Waiting times for patients needing treatment in hospital reduced dramatically under Labour, following the introduction of many targets. But with them came an expanding bureaucracy. The number of managers rose by 84 per cent in a decade, while nurse numbers grew by just 24 per cent.

Recent scandals such as that at Stafford Hospital, where patients suffered appalling and basic failings, illustrated the dangers of prioritising finances and targets over care.

Britain’s record in funding drugs for many serious diseases – especially cancer – compares poorly with the rest of Europe, and survival rates are worse than in other countries.

While growth in spending on the NHS in the past decade was at a record level, most of the money went on pay. GP pay rose by nearly 50 per cent in a decade, to an average of £106,000.

Had any savings already been identified?

The Government says more than £1 billion will be saved by halving the size of NHS bureaucracy in four years. 150 primary care trusts and 10 health authorities will be scrapped. However, redundancy payouts to get rid of so many managers will be expensive. Quangos such as the Health Protection Agency will be culled. Funding for a £75 million public campaign against obesity and drinking is to be stopped, with food and drinks companies asked to foot the bill.

From: http://www.telegraph.co.uk/Spending-Review-What-it-means-for-the-National-Health-Service-NHS-Department-of-Health

Hospital waiting times have begun to rise again after years of decline following the introduction of European rules on junior doctors’ working hours.Waiting times in the NHS had been dropping since the 1990s but the rules limiting junior doctors to a 48-hour week, which were implemented last August, had reversed the trend.

Thousands more patients were now waiting longer than 18 weeks for surgery because of eu red tape.

Ministers were seeking to renegotiate Britain’s position on the European Working Time Directive, including a possible opt-out for NHS staff. The Royal College of Surgeons carried out the first comprehensive analysis of how the directive had affected waiting times.

According to the research, the proportion of NHS patients having to wait longer than the 18-week target for non-emergency surgery such as hip replacements had almost doubled from 1.5 per cent 18 months ago to nearly three per cent in March this year.

Waiting times reached an all-time low at the end of 2008, with patients waiting just a few weeks for surgery on average.

However, since the EU directive cut junior doctors’ hours from 56 to 48 per week, these gains had been wiped out, the Royal College said.

According to data from the Department of Health, the number of patients waiting longer than 18 weeks — from GP referral to being treated as an inpatient — fell steadily from April 2007, when almost 34,000 people were waiting, to 8,674 in December 2008.

The figure remained stable at about 10,000 until June 2009, just before the new rules came in, when the rise began.

In March this year, it had risen to 17,515, a level last seen in September 2007.

John Black, the president of the Royal College of Surgeons, said the increase was predictable.

“If you have the same number of patients, no more doctors and ask them to work less then it is inevitable that the time available for elective procedures will reduce and waiting lists grow,” he said.

Almost two thirds of consultants now frequently operated without assistants because departments were so stretched.

Mr Black said most European countries had bypassed the legislation by either not monitoring compliance or, as in Germany and Holland, finding ways around the directive.

“We look forward to this happening in the UK,” he said.

Sir Richard Thompson, the new president of the Royal College of Physicians, said the directive had been a “complete disaster” for both patient care and the quality of training for doctors.

“We are not providing the service or the training that we require,” he said. “I cannot overemphasise the damage to service provision and to training.”

According to the survey, 80 per cent of consultant surgeons and two thirds of surgical trainees said patient care had deteriorated since the directive was implemented.

Dr Matt Jameson-Evans, a spokesman for Remedy UK, a junior doctors campaign group, said the impact of the directive on services was inevitable.

“Patients are simply not being treated by as many doctors as before,” he said. “A second consequence of this and equally important is that doctors are not receiving as much training as they were and this has serious implications for the future quality of care.”

The Royal College of Surgeons has argued for an opt-out to allow trainees to work up to 65 hours per week because they were not getting enough practical experience on a 48-hour week.

The Coalition has abolished the 18-week target, saying it was not backed by evidence that it benefited patients.

Dr Mark Porter, the chairman of the British Medical Association’s consultants committee, said the drive for cuts within the NHS was also a factor in the rise in waiting times.

From: http://www.telegraph.co.uk/NHS-waiting-lists-rise-after-doctors-hours-cut

NHS Hospital waiting times have been relaxed or scrapped as part of a drive by the new Government to rid the NHS of Labour’s ‘target culture’.

Nursing and doctors’ leaders welcomed the greater flexibility they have been given to treat patients according to clinical need rather than being forced to stick to strict central guidelines.

But patients’ groups expressed concern that the reforms could result in a “free-for-all,” and that without targets long waiting times could return to the NHS.

GPs will no longer be forced to see patients within 48 hours of them seeking an appointment.

The requirement for 98 per cent of patients attending Accident and Emergency wards to be seen within four hours has been relaxed to 95 per cent.

And the target for patients to be given a hospital appointment within 18 weeks of being referred by their GP has been abandoned altogether.

Andrew Lansley, the Health Secretary, insisted that people would still have the right to demand high levels of service from the NHS, but that this would be done locally rather than dictated from the centre.

“I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes,” he added.

“Doctors will be free to focus on the outcomes that matter – providing quality patient care.”

Katherine Murphy, director of the Patients Association, said: “The targets focused minds in the NHS, made people start realising services had to get better.”

But Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, welcomed the relaxation in targets.

He said: “Patients should have good access to GPs. However, while this target may have been intended to improve access it has in fact had adverse consequences.

“At the moment practices need to have enough appointments available on the day or the following day to meet the target, so those who want to book in advance find there are fewer appointments available.”

Under the changes to the NHS Operating Framework, Mr Lansley has also ordered health bodies to reduce management costs from £1.85 billion to £1 billion by 2013.

While spending on the health service will continue at current levels, he said it was crucial to make “immediate” savings which could be reinvested in patient care.

From: http://www.telegraph.co.uk/NHS-waiting-times-are-relaxed-and-abandoned

NHS Hospitals will face financial penalties if patients are readmitted as an emergency within 30 days of being discharged, under new government plans.
The scheme was unveiled yesterday by Andrew Lansley, in his first major speech as the new health secretary.

Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he said.

It has been argued that patients are being discharged early to free up beds.

The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.

Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354. But there was also a significant rise in the number of procedures performed over the same time period.

Readmissions as a percentage of all patient discharges went up marginally, from 8% in 1998-99 to 10.5% in 2007-08.

Speaking about his vision for the NHS, Mr Lansley called for patients to be given more control over their healthcare.

And he said hospitals would have the responsibility of looking after patients’ health and well-being for up to a month after they are discharged.

Currently primary care trusts and GPs look after patients once they are discharged from hospital.

Under the new plans hospitals would receive funding for the first hospital stay plus treatment for the patient’s first 30 days after discharge.

Mr Lansley promised to “empower patients as well as health professionals” and “disempower the hierarchy and the bureaucracy”.

He said: “We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.

This change of direction will send a ripple through hospital managers with some enterprising chief executives will see it as a chance for hospitals to extend their services into the community.

If they are to provide extra follow up care, and bear the cost of unavoidable complications, hospitals will be hoping to see that reflected in the price they are paid for each operation.

England is unique in the UK in paying its hospitals for each treatment they carry out, a system called payment by results.

This will be the main lever which the Health Secretary can use to change the incentives in the system.

He said that targets focused on processes, data returns and more Department of Health circulars would not achieve these aims.

“Over the last ten years emergency readmissions have increased by 50 percent. Not, it seems, primarily because patients were more frail, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner – process targets creating risks for patients.

“So in addition to getting rid of these targets – we’re 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 they are ready and safe.”

And if a patient is readmitted within that time the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment, he said.

Nigel Edwards, policy director of the NHS Confederation, which represents most NHS trusts, said the proposal to withhold money for readmissions was a good idea.

“The principle of offering this, as long as we don’t have hospitals getting in the way of GP care, is a perfectly sensible one and certainly one we see in other countries.”

Dr Anna Dixon of the King’s Fund said readmissions can occur because of a lack of proper care provision in the community. And she warned that abolishing targets might lead to a rise in hospital waiting times.

The British Medical Association’s Dr Hamish Meldrum agreed saying: “This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.

“We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital.”

Katherine Murphy, director of the Patients Association, said: “We have always campaigned for patient safety to be at the forefront of services and withholding payment to fix poor outcomes and giving patients more information to help them make informed decisions about their care are significant steps towards this.

“We welcome a much greater emphasis on the patient experience and a focus on patient needs and helping patients play a bigger role in shaping their health service.”

From : http://news.bbc.co.uk/1/hi/health/10262344.stm