Lansley highlights rise in emergency hospital readmissions

Figures obtained by Shadow Health Secretary Andrew Lansley show that the number of patients readmitted as emergency cases has risen by nearly one-third over the last four years.  In the first quarter of 2002-03 5.4% of those sent home from hospital were readmitted as emergencies within 28 days.  That percentage increased to 7.1% by the final quarter of 2005-06.

Andrew Lansley:

"These are worrying figures.  On the face of it, hospitals may be discharging patients sooner than they should be, resulting in a greater risk of emergency readmission.  High bed occupancy rates and the Government's push to achieve waiting time targets may be responsible for compromising patient safety in this way. It is also inefficient to readmit patients, adding extra costs to many hospitals already overstretched by deficits."

Comments

[James Maskell]

How is Lansley these days? Havent heard from him since the fury at the Hewitt speech. This is hardly new knowledge. We know of the performance related pay which leads to NHS staff shoving people through the system as fast as possible to ensure they get paid enough.

Its good to se him saying something at last. The NHS is a huge issue in politics and he should have tonnes to talk about...why is there this silence? We have the worst Government in the history of this beautiful country and the Tories are being soft on it.

[Andrew Woodman]

This happened to me a couple of years ago so I'm not surprised at the stats.

I too have concerns about Andrew Lansley's performance at health. We need someone to be on the offensive pushing this target obsessed government on a daily basis. I just wonder sometimes if Lansley is too nice. Would liek to see Liam Fox back there to show we're serious about the dept.

[Wat Tyler]

NHS safety is a very serious concern- you will all recall the PAC Report a few weeks back ( eg see http://burningourmoney.blogspot.com/2006/07/box-ticking-fails-to-make-nhs-safer.html )One-in-ten NHS hospital patients unintentionally harmed, etc.

And the governmnet hasn't a clue what to do about it. Their top-down solution was the National Patient Safety Agency, set up in 2001. But its job-sharing heads (the two Sues) have just been shot...well, sent on indefinite gardening leave. Another Labour fiasco, which leaves patient safety getting worse.

Big Government is busily wrecking our health services, despite all that money. And now is surely the time to drive home the lessons. What a pity our front bench is so worried about "attacking" the NHS.

[TomTom]

That's a good revenue-raiser ! Check how much each A & E admission to the wards costs the PCT......it is a real cash cow.

[Simon Chapman]

It is vital that we get our approach to health policy right. Of all the public services, it is health which best demonstrates that additional spending does not automatically produce better services.

It was a clever wheeze of Gordon's to stop talking about spending and start talking about investment. The problem, that conservatives have always understood and most of the rest of the electorate is now wising up to, is that unlike ordinary spending "investment" carries with it the implication that there is a strategic aspect at work and that investment decisions are made with an eye to the outcomes - or the return on the investment.

And in health, the disconnect between the billions pumped in and the return we see is at its largest. Two examples: in Grantham, as in other parts of the country, services in our hospital are under threat to the extent that the hospital's very future is in doubt. Even the local Laabour Party is joining the campaign for the hospital. Elsewhere, the Department of Health has caused many health-related charities significant financial problems, leading to redundancies, because of its failure to administer its annual s. 64 grant-making programme effectively.

There is a growing public acceptance that the NHS needs reform, and a growing willingness to look at alternatives. Similarly, it is increasingly recognised that we cannot fund everything and that we need to speak the language of priorities ("rationing"). Sure, we need to win the public's trust on this, but we are beginning to do so. They won't trust us if they think we are ducking the scale of the problem.

[Wat Tyler]

TomTom- good point. PAC reckoned the cost is £2 bn pa in extra hospital bed days, and £400m pa in settled medical negligence claims.

[Simon Chapman]

The BBC has an interesting overview piece on the Health market today:

http://news.bbc.co.uk/1/hi/health/5195482.stm

[sjm]

Instead of attacking the NHS, which is an open invitation to self-destruction, we should be using our time in Opposition to initiate a debate about how best to provide health services in the 21st century.

How hard would it be to take as the discussion's starting point the following:

If there were no NHS, how would we ensure a fair and effective system of health provision and education in the UK, and how should it be funded?

Instead all we get is yet more thoughts about tinkering round the edges, or further waffle about reform, which simply infuriates the health professionals.

Let's get the principles right, then cost them, then offer them to the public, and LET'S BE HONEST ABOUT IT!

[Simon Chapman]

sjm: Agreed that "waffle about reform" dispirits and discourages health professionals. But they are also similarly infuriated, as are we taxpayers & patients, by the failures of an out of date system.

The problem is that we cannot start with a clean sheet as you suggest - we have an enormous infrastructure in place that cannot simply be ignored. I do agree though, that we need to be clear and honest about our intentions, and emphasise until everyone is fed up with hearing it that our motivation is to secure better access to better services.

To avoid "tinkering around the edges with yet more waffle" we will need to be clear in our own minds on a substantial 2-term programme for the NHS. We don't need that yet - but by the time of the next election we will need to understand where we are going & how long it will take. Any timetable will need to be very realistic about the sheer length of time it takes to change anything in the NHS as it is currently structured.

I am beginning to think that the main strategic question we need to resolve is whether to go for a controversial "big bang" approach (if indeed that's possible both in practice and political reality), or whether to adopt a more low-key & technocratic approach to this, which may take longer to achieve similar ends but do so rather more quietly. Not as exciting, but possibly more effective. My guess is that Andrew Lansley would prefer the latter approach.

[Adam]

The problem with health is that there are massive expectations of what can or should be done in certain areas - eg cancer care. Consequently money gets squeezed out of areas like mental health or preventative medicine in order to channel into these other essentially political priorities. It would take an exceptionally brave politician to, for example, stop the NHS prescribing drugs like Herceptin in order to pay for mental health.

Newsnight on BBC2 had an interesting piece last week looking at the healthcare outcomes achieved by Cuba on very meagre resources. Very eye-opening.

[Simon Chapman]

"It would take an exceptionally brave politician to, for example, stop the NHS prescribing drugs like Herceptin in order to pay for mental health."

Agreed, and it's probably unrealistic to expect one politician only to do that. It's also a false choice - more of one need not be at the complete expense of the other.

What is required is courage & leadership from our political class, together with a locally-accountable decision-making process so that communities can have some influence on the decisions that are made about the way resources are allocated in their own area.

[christina speight]

On the immediate subject matter I am currently looking after my husband discharged 96 hours after going into the theatre for a hip operation. [Waiting time 6 months minus 5 days] . It was a Saturday so sending him home 2 days earlier than forecast saved all that weekend working.

He was in no state to come home and the district nurse paid to supervise didn't want to know except to remove the stitches. His GP retired, his replacement went on holiday and the locum was a German-speaking Turk from Germany. Luckily all has gone well and it will turn out a success.

Meanwhile I have 6 months of medical disaster all due to side-effects from unwise prescriptions of various drugs. This led via cellulitis, to swollen legs to jaundice to whole body eczema. I cannot fault the specialists I have seen but the GP service - for which we have NO CHOICE - has been lamentable

Now as to the NHS as a whole = my father was Medical Director of the Royal North Staffs infirmary, my brother was vice president of the Royal College of Physicians and Medical Director of London's then largest hospital and my grandson has just started his final year as a medical student [having taken a degree in pharmacology on the way so that HE is not ignorant of drugs' side effects]

My brother fought hard to keep the ultimate decisions about hospital management in the hands of clinicians. Administrators were ancillary and subordinate. He was right!!! My father in another era and pre-NHS ensured that admissions were on need only and nobody was charged anything unless they could obviously pay. Public involvementin fund-raising was enthusiastic and immense.

The state has wrecked the whole ethos

[malcolm]

Simon ,of course you're right.It is easy to highlight the faults within the NHS but much harder to suggest workable solutions.I fear it will take much better brains than mine to do that.
My own very simplistic view is that in my exprerience most people trust the NHS so any changes we as a party can make at least in the early days are very much at the margins in terms of better management etc.Also like others I would hope that treatment is decided by clinicians based on need rather than arbitary political targets.I have always felt that the 'internal' market set up by our Government in the early 1990's was a good idea which should have been given far more time than it had before it was abandoned by Labour.

[Simon Chapman]

Malcolm,

"most people trust the NHS so any changes we as a party can make at least in the early days are very much at the margins in terms of better management etc"

This I think is the straegic crux of it. The problem is though, that both Blair & DC's experience shows that the best time to do anything radical is right at the outset in the honeymoon period. Once that's past it becomes increasingly difficult to make deep-rooted changes. You can get a second honeymoon at the beginning of a second term - and a third one at the beginning of the third. But we won't be able to leave it that long.

[malcolm]

You're right about the honeymoon periods.But rightly or wrongly people don't seem to trust us on the NHS so if we were to be radical it would have to be sold better than we've ever managed before.Even Liam Fox who I'm aware you admire immensely was unable to sell our message in 2005.I fear Mr Lansley would not be up to the task.

[Simon Chapman]

Liam was at Health in 2001 & party chairman in 2005 - Andrew Lansley had the health helm then.

It may be that this is a second term issue - but that would mean that we would need to be very clear about what we would use the first term for: to give professionals a break from being reorganised, to remove artificial distortions like targets, build trust in our health credentials, to plan and build consensus around the necessary reforms for a second term, and to prepare the ground for what would then have to be a second-term Big Bang, using the election to secure the necessary mandate.

There are all sorts of scenarioes. My main point is that we need an 8-10 year plan for this that we will stick to. If we come in only intent on managerial change at the margins we will have no strategic vision to guide us when problems arise. We cannot afford to be reactive about this - we need some anchors.

[TomTom]

.I have always felt that the 'internal' market set up by our Government in the early 1990's was a good idea which should have been given far more time than it had before it was abandoned by Labour.

The simple fact is that the Treasury runs the NHS not the DoH - tHe Treasury wants the INCOME from Pensions Funding, NIC, Taxes but does not want to spend money - it wants to offload Pensions and Health and then cash limit budgets to outside providers so they can ration healthcare.

That is why noone can be referred to hospital by a GP now without the PCT "scheduling" the operation for budgetary reasons.

Internal Market ? You have it - what do you think the DRGs are ? DRGs are Diagnostic Related Groups - ie. flat rate reimbursement for operations. If your hospital is too expensive it will stop operating and you must go to a cheaper hospital. This is why the more operations some hospitals do the more money they lose

[David Belchamber]

"I just wonder sometimes if Lansley is too nice. Would liek to see Liam Fox back there to show we're serious about the dept".

I agree entirely with Andrew Woodman at 09:15. The economy and the NHS are two areas where we have to appear massively competent to the public.
Liam Fox did shadow Health once and did quite a lot of research into continetal systems. He is the sort of heavyweight we want in a vital portfolio like Health.
I believe that Stephen Dorrell is looking into what practices, carried out by doctors and nurses, are of real value and what are not.
That should be the first step in putting together a new management structure for hospitals that focues on patients' needs, based on clinical - not administrative or target driven - requirements. Simplistically, hospitals are similar to very large schools to manage: you need a first class Head and a very efficient bursar, responsible to a Board of Governors, who monitor what is going on very closely but who let the Head and Bursar get on with their jobs.

[Richard]

An opinion poll a while ago suggested the public would be prepared to accept a move to a Continental-style social insurance system. The problem, of course, is that the Continental systems suffer from financial difficulties.

The American system has some impressive healthcare statistics but is attacked for leaving millions uninsured. The American system in fact suffers from a great deal of destructive cost-increasing regulation and is subsidised to an extent via the taxpayer - hardly a genuine free market in healthcare.

However, as a genuine free market in healthcare is unlikely to be accepted in this country we need to work out what the least worst other option is. Could we have a Continental-style system that doesn't go bust?

[Ben Herbert]

"I just wonder sometimes if Lansley is too nice"

I just wonder if he's too useless. He should have nailed Patricia Hewitt over NHS deficits and hospital closures by now. One of the most important political issues and we have heard very little for a long time.

[sjm]

Sorry, but many of you are falling into the trap of thinking NHS means National Hospital Service.

I think you'll find the majority of funding and care episodes are in Primary Care. Then there is the funding of medical education, further training, pharmacology, research, the increasingly corrupt prescription mess, optical and dental services being privately supplied, and charged for by the NHS because somehow 'free at the point of delivery' doesn't seem to apply to eyes and teeth.....

I go back to my original point - we need a debate with the public first. The public will want everything, and will want it now. So tell them what that will cost.

A District General Hospital with full A&E, intensive care and Maternity in every Ward in the country? Certainly Sir, we can do that. Are you happy that you will therefore be taxed at 120%, and that there will be no money for education and the police force? No, thought not.

If our policy-makers don't have the guts to initiate this tough debate, they don't deserve to run the country.

[Annabel Herriott]

For the first time since joining CHhome, I find myself in total agreement with christina!!!!!
I started nursing in 1953. We were, and still are, a teaching hospital. We had a board, and a bursar, and a medical director, and a dragon of a matron who was on top of her game. We nurses knew about bugs, washing, cleaning, sterility, etc etc etc. We knew patients had to be observed at meal times, to make sure they could reach, and eat their food, and that food was nutricious. Our Ward sisters were in CHARGE of their wards, and it was no surprise that one of the most effective was called "Bugger Bell"
Todays nurses simply would not stand for it. Human rights, health and safety, its all gone far gone far too far. Responsibility and common sense has gone along with the bath water.
The managers have taken over the asylum, and they only know about figures. Forget human beings, clinical need, all that rubbish. But how do we put the Doctors back in charge??? And how do we put cleaners back in charge of the cleaning???
An object lesson is to watch Casualty. There is a wonderful portrayal of the worst sort of manager ever. "Nathan" the actor playing him must have personal insight.

[Patsy Sergeant]

I agree with Annabel entirely as I have the some background experience as she does, only I started as a student nurse in 1951, and spent a year as a pre-student nurse at the Queen Victoria Hospital in East Grinstead where Sir Archibald MacIndoe was grafting miracles with dreadfully burned airmen. The operating theatres had the sort of viewing seats that only American hospitals had at that time, and probably most English hospitals don't have them even now!! I wasn't allowed to watch the skin grafting, but I remember one day watching a 'nasal reduction' (making the nose smaller), which many more people have nowadays; well if they had seen what it looks like when the surgeon has to 'do' the reduction, they would never have it done!!

[Richard]

http://www.iea.org.uk/files/upld-news239pdf?.pdf

Starting on page 46 is an interesting vision of what a future health service under less statist lines might be like.

[David Belchamber]

Annabel at 22.10 sums it all up where hospitals are concerned:
"I started nursing in 1953. We were, and still are, a teaching hospital. We had a board, and a bursar, and a medical director, and a dragon of a matron who was on top of her game. We nurses knew about bugs, washing, cleaning, sterility, etc etc etc. We knew patients had to be observed at meal times, to make sure they could reach, and eat their food, and that food was nutricious. Our Ward sisters were in CHARGE of their wards, and it was no surprise that one of the most effective was called "Bugger Bell"
You have the management structure clearly set out, the focus is on the patients and there was a clear-cut chain of command to ensure that the jobs got done.
All we need is a political party with the guts to take hospitals back to a system that worked and then put someone in charge who will implement it and help drive up standards. Perhaps s/he will also be brave enough to revert to the old type of training for nurses for the reasons that Annabel sets out.