Minister Defends Plans to Fine Hospitals Over Re-admissions

Earlier this week, the Health Secretary, Andrew Lansley, defended plans to fine hospitals whose patients are readmitted for emergency treatment within 30 days of being discharged. Mr Lansley advised that the fine would probably take the form of a withheld payment, whereby hospitals would receive payment for the initial treatment of a patient but not for further treatment if said patient were to be readmitted for emergency care within the 30-day period. Such a move is, on the one hand, extremely ambitious in terms of striving to foster an NHS that cares more about its patients than hitting key performance goals, whilst, on the other hand, it is possible that the penalty system would fail to take into account medical conditions that develop in an arbitrary or less than predictable manner.

In respect to personal injury claims, the notion of fining or penalising hospitals that discharge patients prematurely ought to be welcomed; indeed, financial penalties could fill a hole in the common law that makes it especially difficult – yet not impossible – to claim compensation for injury or illness that has arisen following an early release from hospital. Clinical negligence cases require satisfaction of the Bolam test, which states that doctors do not act negligently if they attain the standard of a “responsible body of medical opinion”. At first glance, personal injury claims involving untimely discharges from hospital could be regarded as acts of negligence on the part of doctors who ought to realise that conditions may worsen without prolonged treatment. Unfortunately, in practice, such a claim can be difficult to establish.

The key reason why such claims are usually without merit is that negligence law requires a negligent act or omission (in this case the discharge) to cause the injury or illness in question. In a factual sense, but for a hospital’s early release of a patient, an illness or injury may not have developed or worsened. In a legal sense, however, there are worthy policy reasons why such decisions ought not to necessarily give rise to personal injury claims; indeed, doing so could expose the NHS and the courts to a flood of litigation. Although exceptional cases do arise every so often, the civil law of tort cannot adequately deal with all claims involving premature releases from hospital. However, by penalising hospitals for readmissions that occur within a 30-day period, the Government may inadvertently raise the exposure of offending hospitals to such claims.

Speaking to BBC Breakfast, Mr Lansley said: “What we must escape from is the perverse situation at the moment where a hospital might discharge patients too early – and we have seen a 50 per cent increase in the number of emergency readmissions – and then when the patient comes back as an emergency, the hospital gets paid again”. Mr Lansley added: “What I am saying today is in part about focusing on patient safety and on better care for patients. This safer, better care is also more cost effective and if I can cut, as I will do, the cost of bureaucracy, the cost of administration, cut out waste in the NHS, then we can get those resources to support increasing quality for patients”. Between 1998 and 1999, a total of 359,719 emergency readmissions within a 30-day period were reported, whereas, between 2007 and 2008, 546,354 such cases were reported.

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