GP leaders and other key healthcare opinion formers give their reaction to health secretary Andrew Lansley's proposals to reduce the number of hospital readmissions.
Read the full original story here: Hospitals to face fines if patients are readmitted within 30 days
Dr Hamish Meldrum, BMA chair
'We understand the intentions behind these proposals and look forward to more detail. However, simply using financial disincentives is likely to result in unforeseen consequences.'
'One risk is that we get a situation where decisions about discharge are based not on a judgement about what is best for the patient, but on an attempt to avoid additional costs. This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.'
'The best outcomes are always likely to be achieved when primary and secondary care professionals are allowed to work together to achieve what is best for patients. We need models of healthcare that encourage co-operation rather than competition.'
'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.'
Nigel Edwards, director of policy at the NHS Confederation
'While in the longer term a focus on outcomes and patient experience will deliver better quality care, there is evidence to suggest that having something like a manufacturer's warranty on hospital procedures and paying hospitals for performance in this way works. The main challenge will be in implementing the policy effectively.'
'Sometimes discharging people with complex health problems back home as quickly as possible is the result of a finely balanced clinical judgement, and, because of the level of ill-health such patients have, there will inevitably be some who need emergency readmission.'
'Being able to distinguish these cases from those where discharge has simply occurred too early is difficult but will be key to making something like this work. Complex policy ideas like this need rigorous evaluation to ensure they produce the desired results without too many adverse effects.'
Dr Anna Dixon, director of policy at the King's Fund
'The government is right to place greater emphasis on improving quality, cleanliness, safety and giving patients more choice and control over their health care - the real challenge is how to secure these gains while facing increasing financial constraints.'
'These proposals could offer an opportunity to drive quality in the NHS by ensuring that hospitals are incentivised to provide good quality care, but the key to the success of this policy will be to ensure sufficient care can be provided in the community following a patient's discharge.'
'This will require hospitals to work with primary care and community health care providers to ensure that services are in place for patients on discharge and that they are not kept in beds for longer than necessary.'
