Fishburn Hedges

08.06.2010

Emergency patients are too likely to return to hospital after being discharged, according to health minister Andrew Lansley.  Today he has announced plans to reduce readmissions, which grew by more than 50 per cent between 1998 and 2008.

The previous Government was committed to targets as a way of driving performance in the NHS.  Lansley says the focus on making beds available has been partly responsible for the rise in readmissions.  He wants a change of focus, so that the NHS concentrates “on improving public health rather than on short-term treatment targets”.

This seems a worthwhile ambition, but there is another less obvious aspect to today’s announcement.  It has the hallmarks of ‘nudge’ theory, which has been embraced enthusiastically by the Conservatives in recent years.

Could this become an example of ‘nudge’ at work?

The change needed

Using hospital beds efficiently means balancing the availability of beds for future patients (i.e. making sure beds are empty) against the medical needs of today’s patients (i.e. making sure beds are occupied for as long as necessary).

Medical professionals currently make decisions to send patients home based first on medical need, but also on the cost of keeping a patient in hospital.  It is a delicate balance.  Now the Government is hoping to reflect the broader financial impact of such decisions by making hospitals in England responsible for a patient’s health and wellbeing for up to a month after they leave hospital.  Hospitals could lose funding for emergency patients readmitted within a month.

‘Nudging’ patients home

At first sight, this looks like a financial disincentive to send patients home quickly.  In fact, it’s a more nuanced readjustment of the factors medical professionals have to take into account when making such decisions.   Once medical need is satisfied, they must consider both the savings made possible by sending patients home and the cost of readmission.

The Government is attempting to change the ‘choice architecture’ influencing medical staff when they decide whether to send patients home.  In theory, good data collection should allow medical staff to make better decisions, reducing emergency readmissions, without unduly increasing the time patients spend in hospital beds.

Could this become an early poster child, under the new coalition Government, for ‘nudge’ theory?

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Posted by Peter Sigrist