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Hospital discharge savings 'are false economy'

By Nigel Praities

Government plans to save hundreds of millions of pounds by discharging patients from hospital earlier threaten patient care and are likely to be a false economy, MPs are warning.

A report from the influential public accounts committee says moves ordered by the Treasury to cut up to £500 million from the Department of Health budget by reducing length of hospital stay are ‘statistically unsound'.

The report follows a Pulse investigation, picked up in the national media, which revealed reductions in length of stay and follow-up appointments have been accompanied by a sharp rise in emergency readmissions.

A new investigation by Pulse has revealed over a third of trusts have received complaints from GPs over their discharge policies in the past year.

MPs criticised moves to shorten length of stay in hospital, pointing to the rising rate of readmissions as evidence that the DH's approach was flawed. ‘[The DH is] claiming efficiencies through patients spending less time in hospital, despite the rate of emergency readmissions rising,' the report reads.

The Chancellor announced plans for a £2.3bn cut in DH spending in 2010/11 last month, with savings on length of stay expected to contribute heavily.

Edward Leigh MP, chair of the public accounts committee, said efficiency savings must not backfire and reduce productivity.

‘What must be demonstrated, rather than just asserted, is that improvements in efficiency are genuine and not at the expense of patient care,' he said.

A Cochrane review published in January found PCT schemes discharging patients early from hospital failed in their primary aim of saving the NHS money.

The latest Pulse survey of 110 hospital trusts shows 36% have had complaints from GPs about discharge procedures in the past year, with three PCTs reporting over 10 complaints.

GPs also had to wait an average of six days before receiving formal discharge letters, with some trusts only sending letters to GPs up to four weeks after discharge.

Dr Mohammed Jiva, secretary of Heywood, Middleton and Rochdale LMC, said often in his area patients were being discharged too early and GPs were not receiving information promptly from hospitals.

‘We don't even know what they have had done when they are discharged. The patients are informed before us about what has been done.

‘The concept of a single pathway of care is dissolving. Hospitals are now discharging patients after they have been seen and asking us to refer them back into hospital to another department,' he said.

Problems with discharge

- 36% have had complaints from GPs about discharge procedures in the past year, with three PCTs reporting over 10 complaints

- 96% of trusts have a formal discharge policy, but only 47% have a policy to inform GPs when patients attend A&E

- 6 days average wait before GPs receiving formal discharge letters, with some waiting over four weeks

- 35% of trusts have conducted audits on the quality of the information provided to GPs at discharge

Source: FOI requests from 110 trusts

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