The top doctors organisation has criticised a planned change in the way patients are cared for after leaving hospital.

A senior doctor said they feared a situation where decisions about discharge would be more about an attempt to avoid additional costs than what is best for the patient.

Commenting yesterday on proposals from the newly appointed Health Secretary, Andrew Lansley, to attempt to reduce emergency hospital re-admissions, Dr Hamish Meldrum, Chairman of Council at the British Medical Association (BMA), said: "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," he said.

"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," he concluded.

The BMA comments came as the Health Secretary said that he "would put his heart and soul into the improvement of health outcomes".

Speaking yesterday, Andrew Lansley said this would be achieved by making patients the "driving force of improvements to the NHS".

Specifically, as part of his broader plans to align payments with the quality of patient care, the Cabinet Minister said hospitals should be responsible for reducing the number of emergency readmissions following treatment, and support treatment at home, as part of a single payment.

He said that making hospitals responsible for a patient's ongoing care after discharge would create more "joined-up working" between hospitals and community services.

Speaking to an audience of patients, carers and staff at an event at the Bromley by Bow Centre in London, hosted by the Patients Association and National Voices, the Health Secretary challenged the NHS to adopt a holistic approach by looking at the entire patient pathway from preventative health and well-being measures, through to hospital and community care.

He said this could be done through introducing payments which encapsulate a more integrated care pathway by giving hospitals responsibility for a patient's care for 30 days after they are discharged.

"We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.

"This can only be achieved if patients are put in the driving seat and are informed and engaged in the delivery of their care.

"That way the NHS will be focussed on what matters to patients - safe, reliable, effective care for each patient, and the best outcomes for all patients," he said.

(BMcC/GK)