Healthcare News UK

News, comment, blogposts and tweets across the sector

Clare HortonSarah Johnson

Health secretary Jeremy Hunt is selling the UK as a "global hub of health technology" at the Health Datapalooza conference in Washington today.

NHS managers have rejected the idea of 'Ofsted-style ratings' for hospitals - one of the government's big planned responses to the Francis Inquiry into the scandal at Mid Staffordshire NHS Foundation Trust.

Rebecca Leighton is claiming aggravated damages from Greater Manchester police for breach of privacy and negligence

A nurse cleared of poisoning hospital patients is suing the police for up to £100,000 after officers allegedly leaked her name to the media and made public her private Facebook account.

Rebecca Leighton was arrested by Greater Manchester police in 2011 as they investigated the deaths of five elderly patients at Stepping Hill hospital in Stockport.

She was dubbed the "angel of death" and subject to hostile media attention after being charged in connection with the investigation in July 2011. But in December that year she was cleared of all charges after prosecutors admitted they had insufficient evidence.

Now Leighton, from Heaviley in Stockport, is claiming aggravated damages from the police for breach of privacy and negligence.

In her claim filed at the high court, Leighton alleges that officers requested her Facebook password following her arrest "to minimise the potentially damaging intrusion into her private life and avoid prejudicing public opinion towards her".

However, she claims that an officer then reset her password before deactivating and reactivating her account – meaning previously private details, including wall posts and photographs, were visible to all internet users.

Leighton also alleges that police gave her name to journalists who then gleaned information from her online profile, reputedly including comments about how she liked to get drunk on days off. A number of media reports detailed her Facebook updates, with one Daily Mail article reporting that her profile was "littered" with comments that "tell of a frantic social life that helped her cope with the stress of work".

In an interview with ITV's This Morning in September 2011, Leighton accused the media of fuelling public hostility towards her, which she said resulted in a judge refusing her bail at Manchester crown court following the charges.

"Because of how the media have portrayed me to be … they could not be any more wrong, people have formed an opinion about me, so I believe [the bail refusal] was for that reason," she said.

"It's hard to even say about having a normal life because even now my life is not normal. I am living at my parents', I am not living where I was living. I'm not working. I can't go outside my house without people taking pictures of me.

"I can't walk down the street on my own because I'm a bit scared. Someone has always got to be with me all the time. It's far from normal."

She has hired the prominent media barrister Hugh Tomlinson QC to fight her claim for breach of confidence, negligence and breach of a statutory duty. Her solicitor is Charlotte Harris, of the law firm Mishcon de Reya, whose clients include high-profile victims of the phone-hacking scandal.

Greater Manchester police confirmed it had received the claim for damages, but declined to say whether the force would fight it. A spokesman said: "This matter is ongoing and as such it would not be appropriate to comment further."

• Greater Manchester
• Police
• Privacy
• Facebook
• Internet
• NHS
• Health
• Nursing

Josh Halliday
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EHI Intelligence has published detailed research on the strategies that NHS trusts are following to develop electronic patient records.

Rather than pointing the finger, it would be better to focus on lack of resources and an inability to increase service provision

The strained relationship between central government and healthcare professionals has come to a head, with tensions running high on both sides. The King's Fund NHS leadership and management summit brought both parties together to analyse the failings of the healthcare system, although the conclusions were not entirely impartial.

The health secretary's tactic of being critical of the primary care system in the face of accident and emergency failings is certainly a high-risk strategy.

Senior GPs are unhappy to bear the brunt of finger pointing – particularly considering the extensive reforms to the healthcare sector that they have weathered, from licence revalidation and pension difficulties to Care Quality Commission (CQC) inspections and new clinical commissioning groups. The reforms have all resulted from government policy rather than sector lobbying, so to criticise those that had no hand in creating the system seems unfair.

What has exasperated clinicians are the series of ill-informed decisions that have defined the care service over the last few years. The chaotic implementation of the non-emergency NHS 111 number demonstrated an inherent lack of understanding when it comes to patient demand. No matter how experienced the GP might be, dealing with a patient on the phone effectively is extremely difficult and makes it virtually impossible to prioritise cases properly – something that is essential if the NHS is to provide a continuity of care to its patients.

In the face of scenarios such as this, pinning all blame on the 2004 GP contract, which saw doctors able to opt out of out-of-hours care, only acknowledges one small part of the wider picture. Since 2004 there has been an eight-fold increase in out of hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.

The overuse of walk-in centres, which were wrongly lauded as a means of reducing pressure on A&E units, has certainly played its part in the current state of emergency care. The centres were never meant for urgent care. They were originally created for people experiencing access disadvantages, or who were without a GP, and they served this purpose very well. However, the expected immediacy of care at a walk-in centre has served to dissuade people from visiting their GP as a first step. In reality, this is not the case and has simply redistributed the primary care burden away from GP surgeries to other services.

What is interesting is that 80% of urgent care occurs between 8am and 6pm, which contradicts the health secretary's conviction that the strain on A&E services is driven by a lack of out-of-hours primary care. In addition, 90% of this activity could be within the remit of the GP. This suggests that the problem is not GP accessibility, but rather availability. GPs have acquired more and more responsibility, with a greater volume of patients to see in a shorter period of time, which has, inevitably, reduced their overall availability. The burden, and now the blame, has been placed on the shoulders of GPs, who have been soldiering on without necessary support or investment from central government.

The standard of GP premises has been frequently discussed in the press over recent months, and GPs cannot be expected to increase capacity or services without an up to date primary care estate. Many would consider it an impossible challenge to meet the needs of patients while operating from a converted terraced property, for example. Recent Care Quality Commission inspections revealed that 60% of current premises are not fit for purpose and, until the infrastructure is properly in place, primary care providers are never going to receive adequate support to deliver on their new obligations.

Ultimately, Jeremy Hunt's speech at the King's Fund leadership summit was discouraging and unhelpful for GPs across the country who have been ill-informed and operating at full capacity for a number of years. Rather than making criticisms and laying blame, he should instead analyse how to create the investment needed to support A&E departments, and allow GP surgeries to deliver the best possible service to their patients.

The lack of resources and inability to increase service provision is a disease that is blighting the NHS, both in primary and secondary care. It is time to set about treating the disease, rather than being distracted by the symptoms.

Dr James Kingsland is national clinical lead for NHS clinical commissioning and Graham Roberts is CEO of Assura Group

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• GPs and primary care
• NHS
• Health

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Empowering staff to work together and deliver care closer to home will mean the NHS can improve patient care in the long term, the Royal College of Nursing has said.

It is time to stop dissecting the legislation and focus on how to make the most of this initiative

I was a little downhearted when I read Professor Peter Lynn's article questioning the efficacy of the Friends and Family test (FFT) – not because it was negative, but because it was stuck in a reactive phase we ought to have moved beyond. It is time to stop dissecting the legislation and focus instead on how we make the most of this and other patient engagement initiatives.

What is the purpose of patient feedback? A seemingly simple question, but one that has stumped many and confused more. We know it is the job of hospital staff to diagnose, treat and care, and most of us have faith in their decisions and ability to make us well again.

However, the Francis report proved this faith can be misplaced. NHS staff are under huge pressures and it is not surprising that, under specific circumstances, care quality can slip. It is essential that managers and clinical staff have the means to identify and rectify these issues, but, in many cases, systematic failure is not obvious.

There is now a raft of tools to arm managers with this information, but the vast majority suffer a serious weakness: they are retrospective. National patient surveys, analysis of clinically coded data sets and initiatives including patient reported outcome measures all have the potential to identify care failures, but for the most part they are reactive; just look at the heart unit debacle at Leeds General Infirmary.

Many commentators have identified the FFT as another national-level performance indicator, and one that is methodologically flawed. However, its biggest strength is its ability to empower those on the frontline. Near real time, ward-level feedback allows slipping standards to be identified and rectified before reflective analysis highlights a catastrophic failure after the event. As any good clinician will tell you, prevention is better than cure. Given the complexity of the setting, getting the implementation right is everything.

Prof Lynn refers to the FFT as a single question that assumes hypothetical choice and does not explain what is being assessed. Closer inspection of the recommendations, however, reveals that trusts have the option to include a "free text" answer to allow patients to explain their response, and this is where the true power of the FFT lies. Different things matter to different people, but by imposing a set of responses on patients, we assume we know everything that can affect their experience. The truth is, we do not and cannot.

If properly collated and analysed, the latitude provided by this free text allows staff to quickly react to feedback, putting right developing care issues. Without free text, the FFT is really a top-down performance management tool. But, where implemented properly, it will improve service delivery from the bottom up.

Furthermore, it stands to reason that, by improving your delivery based on your patients' feedback, your aggregated total will look after itself.

Even in isolation, the correctly implemented FFT is a powerful tool; it can inform and empower staff, as well as work as an early warning system. As one of a suite of measures, however, it can help trusts communicate and interact with the population they serve, helping to improve the service provided and spot failures before it is too late. This, surely, is the real purpose of patient feedback.

Toby Knightley-Day is managing director of Fr3dom Health, which was central in the design of the FFT question and completed a readiness audit for the implementation of the test

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• Policy
• Data management
• Digital engagement
• NHS

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The first GP data extractions for the care.data programme start this month.

How to implement radiation dose monitoring for the UK population will be discussed at UKRC next week.

NHS Confederation report says 64% of senior officials believe £20bn of 'efficiency savings' will worsen patient experience

Waiting times for treatment and the rationing of care have worsened and will get worse still because of the NHS's £20bn savings drive, health service bosses have warned.

Seven in 10 chief executives and chairs of hospital trusts, clinical commissioning groups and other NHS care providers fear that the length of time patients have to wait for treatment and their ability to obtain it will be hit hard in the coming year.

A report by the NHS Confederation says half of health service bosses think the two politically vital areas of NHS provision have already been affected over the last year as the service has sought to make £20bn of "efficiency savings" demanded by Whitehall.

A survey of leaders of 185 NHS organisations shows that 64% also believe that patients' experience of the NHS will suffer, while 27% expect the availability of particular treatments or drugs will be hit and 16% fear patient safety will be compromised.

This gloomy view of the NHS's prospects is compounded by 62% describing the financial situation confronting them as "very serious" (40%) or "the worst I have ever experienced" (22%).

Asked what would stop their organisation realising its share of the £20bn target in the next year, 64% identified rising demand for healthcare and 56% local councils' cuts to social care, which helps keep mainly elderly people out of hospital.

Six out of 10 NHS leaders think financial pressures or cost saving targets are risks inherent in the coalition's NHS shakeup, which took effect on 1 April, found the survey conducted by the NHS Confederation, which represents hospital bosses. A similar proportion see finance as one of the top three challenges facing the service over the next two years.

The NHS in England has been increasingly delaying or denying patients access to operations such as hernia repairs, hip and knee replacements and removal of varicose veins since 2010 as it experiences rising demand for care but flat budgets.

Over half (54%) cited the need to integrate health services and social care as a key challenge, although 93% believe either only slight (59%) or no (34%) progress is being made, despite widespread agreement it is an urgent priority. Failure to co-ordinate both types of care will lead to "an unsustainable service", 61% believe.

Asked if the government recognised the challenges the NHS is facing, 71% said no and only 29% said yes – an effective vote of no confidence in Jeremy Hunt, the health secretary. Those running NHS care providers also strongly rejected (by 71%) David Cameron's plan for creating a new chief inspector of hospitals, who was confirmed last week as Prof Sir Mike Richards, and Hunt's push to bring in tough Ofsted-style ratings for hospitals (73%) – both of which were key elements of the coalition's response to Robert Francis's report into the Mid Staffs scandal.

However, many support Hunt's plan to make would-be nurses spend time doing basic chores in hospitals before they begin training (67%) and for NHS organisations to be put under a statutory "duty of candour" to admit when patients are harmed (68%).

Two quarterly assessments of NHS performance due out on Tuesday, from the NHS regulator Monitor and the King's Fund thinktank, are expected to confirm that performance in key areas, notably A&E care, is slipping.

But Lord Howe, the health minister, rejected the NHS leaders' gloom and painted a much rosier picture. "The NHS is performing well with waiting times overall low, satisfaction high and budgets overall doing well. Overall waiting times remain low and satisfaction with services remains high," he said.

While acknowledging it faced "pressures", he promised that the coalition's care bill would "help integrate services, drive up standards and make sure people get the are they need when they need it."

He dismissed NHS bosses' concerns about the service's financial health. "We have protected the NHS budget and funding will increase by £12.7bn over the course of this parliament.

"Even so we know the NHS is facing pressures, but it is in good financial health with the vast majority of hospitals expected to finish the year in surplus," he said, adding that ministers would press ahead with a new hospital ratings system and a new chief inspector of hospitals.

"We are determined that the Francis report and the terrible events at Mid Staffs will bring about real change in the whole health system. We believe culture change is vital and NHS leaders must do everything they can to help create the open, caring and compassionate service we all want to see," he said.

Dr Peter Carter, general secretary of the Royal College of Nursing, said the NHS Confederation was "right to draw attention to the scale of the challenge the health service faces. This survey reflects real and profound anxieties felt throughout the system about the current financial pressures, pressures which most believe are going to get much worse."

Shadow health secretary Andy Burnham said the survey confirmed the NHS was "seriously struggling with the side effects from the coalition's toxic medicine of budget cuts and top-down re-organisation. The 'real-terms increases' promised by David Cameron have failed to materialise while social care has been cut to the bone. This explains hospitals are full and A&Es are in crisis."

Hunt should ensure that £1.2bn of the NHS's £2bn annual underspend n its £100 billion budget is used to improve social care and provide integrated, home-based support for the frail, elderly people who occupy a large and growing number of hospital beds, Burnham added.

• NHS
• Health
• Health policy
• Public services policy
• Jeremy Hunt
• Doctors

Denis Campbell
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It is vital that access to surgery must be provided when it benefits patients most, says the president of the Royal College of Surgeons

Record numbers of NHS elective operations are being cancelled for non-clinical reasons. Any form of surgery is an important event in one's life. Patients having planned surgery prepare themselves for their operation and make arrangements with family and work, so to cancel them on the day, or just before, is wrong and deeply concerning to me and fellow surgeons.

So what is happening? The population is changing and patients are living longer because of advances in medicine and surgery. This is good news, but an ageing population means more patients with complex health needs, many with conditions that could be effectively treated by surgery. This results in more demand on planned and emergency services.

The first quarter of the year is traditionally busy, with higher numbers of emergency admissions due to the winter weather and the elderly and children tending to make up the lion's share of patients. This is a situation made worse by targets for A&E admissions, which can result in inappropriate admissions as the target is only met once a patient has been discharged or admitted. Many emergency patients end up occupying hospital beds because there just isn't sufficient provision to care for them in the community. We need to strengthen facilities in the community so that once patients have left hospital there are sufficient support services available to them.

In surgery we have no option but to cancel lists, because there are either no beds available, or those that are available are in the wrong units within the hospital. The 48 hours after an operation is a critical period. Patients must be able to access the right facilities after their operation – whether it be intensive care or access to specialist nursing – to give them the best chance of recovery following surgery. As a result, we are seeing operating lists and theatres lying idle despite the surgical team being ready to operate.

Cancelling operations is not only highly stressful and frustrating for patients and their families who have to wait longer for their treatment, but in some cases a patient's condition could deteriorate during an extended wait. It is therefore vital that access to surgery must be provided at a time when patients can benefit most from the results. The past decade has seen real inroads made into reducing long waits for operations and it would be worrying if we now saw those waits lengthening again.

Professor Norman Williams is president of the Royal College of Surgeons

• Hospitals
• NHS
• Health

Norman Williams
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Doctors raise alarm as surgery is hit, after figures show cancellations have reached a 10-year high

More planned operations were cancelled in the first few months of this year than for any similar period in almost a decade, it has been revealed, as senior surgeons warn that the crisis in accident and emergency is cascading through the NHS.

More than 220 operations a day were cancelled with less than 24 hours' notice during the first three months of 2013, official figures show. A similar scale of cancellations of elective surgery has not been seen since 2004-5. NHS England figures further reveal that the proportion of those patients not treated within 28 days of being turned away from operating tables has crept up to 5.6% – a four-year high.

The number of urgent operations cancelled every month has also doubled under the coalition, from 172 in August 2010 to 401 in April this year.

The Royal College of Surgeons (RCS) warns that the crisis in accident and emergency wards is creating chaos across the overstretched health service, with surgeons "up and down the country" registering fears for their patients.

One surgeon took to Twitter to voice his frustration. Mark Cheetham, a colo- rectal and general surgeon at Shrewsbury and Telford hospital, where cancellations have increased by 127% in the last three years, wrote: "The hospital is full with patients admitted as emergencies. Planned surgery is cancelled. It is very frustrating. I haven't done a day list for three months now."

A&E departments have struggled to cope with an influx of an additional 4 million people a year compared with just a few years ago, with trusts across the country failing to meet performance targets to see patients within four hours.

Surgeons say that, as a result, hospital beds are being monopolised by patients attending emergency departments, creating a dangerous logjam in the system.

In the past year, 63,517 elective operations were cancelled on the day of the surgery or on the patient's admission to hospital.

Writing in the Observer, Professor Norman Williams, president of the RCS, says that operating theatres are being left idle because there are not enough beds available for post-operative care. He writes: "The past decade has seen real inroads made into reducing long waits for operations and it would be worrying if we now saw those waits lengthening again."

Scarlett McNally, a consultant orthopaedic surgeon, and council member of the RCS, said: "Many surgeons up and down the country are talking about it and worried about it.

"The problem is that if you don't have a bed to put someone into after an operation then it has to be cancelled. The problem is that all beds, in all the acute hospitals, are full pretty much. The system is now overstretched. I know managers and admissions officers running around desperately trying to find beds anywhere."

Clare Marx, consultant orthopaedic surgeon, and lead spokesman on patient safety at the RCS, said that change was needed to address the deteriorating situation, which was multiplying the risks to patient safety.

Figures obtained by Labour MP Gareth Thomas also suggests the growth of a postcode lottery, with a 32% increase in the number of planned operations being cancelled in hospitals in the north-west in the past three years. The West Midlands has seen a 20% increase in last-minute cancellations, compared with a national rise of 9% over the same period.

Health secretary Jeremy Hunt has accused Labour of causing the crisis by allowing GPs to opt out of offering out-of-hours care in 2005.

However, Labour claims that a failure by the coalition to provide social care for the elderly and frail is pushing them into A&E. Andy Burnham, the shadow health secretary, announced on Saturday that Labour would spend £1.2bn not allocated by the Department of Health last year, focusing on emergency aid to the country's ailing system of social care.

"For older people this could make a huge difference by enabling them to stay in their own homes for longer and providing the support they need to return home after hospital," he said.

"For example, it could allow for an extra 70 million hours of home care across England over the next two years, or provide home care for an extra 65,000 older people each year."

A spokesman for the Department of Health said: "We need to put these figures in the context of the millions of operations performed by our NHS each year. Our NHS is performing well, with more operations carried out last year than ever before, and only 0.9% of all NHS operations being cancelled.

"However, we expect hospitals and local NHS managers to keep the number of cancelled operations to an absolute minimum. Where this is unavoidable, patients should receive treatment as soon as possible.

"Our focus on better community care for the frail elderly, and creating a more joined-up health and social care system, will help to reduce unplanned hospital admissions and ensure that patients are discharged in a more timely way, which will free up beds for other patients."

• NHS
• Hospitals
• Health policy
• Health

Daniel Boffey
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The government's economies have wreaked a dreadful price on healthcare

Up and down the country, A&Es are struggling. More and more people are facing long waits to be seen, often in pain. More and more patients are being left on trolleys, because they can't be admitted to hospital wards. And more and more patients are held in the back of ambulances as they queue to come in – and even, as Labour showed last week, being diverted to hospitals further from home.

This is an A&E crisis that started on this government's watch. When Labour left office, A&E was holding up well with 98% of patients seen within four hours. But since the election, the number of people waiting longer than four hours has nearly trebled.

What is going on? Undoubtedly, the NHS is reeling from David Cameron's toxic medicine of budget cuts mixed with a wasteful reorganisation that nobody wanted and nobody voted for. Cameron has broken all his promises on the NHS and now patients are paying the price. On his watch, more than 4,000 nursing jobs have been lost. And the closure of many NHS walk-in centres, coupled with the chaos with the 111 helpline, has placed a growing burden on A&E.

But there is a deeper cause too. The government's devastating cuts to budgets for care mean fewer older people are getting the help they need to stay healthy and independent in their own homes. Council leaders warn that care services are close to collapse.

Last week, I heard directly from front-line NHS staff who have seen how these cruel cuts are affecting A&E. For the lack of simple support at home, older people are struggling and having to come into hospital. And too many become stranded there, due to delays in the NHS arranging discharge plans with overstretched councils.

So we are spending thousands on expensive hospital care when a few pounds at home can keep people well. And with hospital beds not being freed up, the pressure backs up through A&E, which can't then admit new patients to the ward.

This is what is happening across our NHS right now. It is an unspoken scandal and Labour will not stand for it.

It is bad for older people, bad for all patients using A&E and bad for taxpayers.

Today, to relieve the pressure on A&E, I am announcing that Labour would provide extra support for these vital care services.

In March, George Osborne carried out a silent raid on the NHS budget, grabbing back more than £2bn in "underspends" to massage his budget figures.

By contrast, Labour would return half of this to support our struggling health and care services. We would invest £1.2bn over the next two years to ease the crisis in social care – tackling a root cause of the pressure on A&E.

For older people, this could make a huge difference by enabling them to stay in their own homes for longer and providing the support they need to return home after hospital. For example, it could allow for an extra 70 million hours of home care across England over the next two years, or provide home care for an extra 65,000 older people each year.

Over the longer term, Labour will bring health and care together into a single service to meet all of a person's care needs – physical, mental and social. Your care would be organised by a single professional who you know, ending the frustration of having to repeat the same story over and over to different people.

Instead of accepting responsibility for the mess it has created, the government has spent recent weeks casting around for scapegoats, blaming GPs, nurses and everyone else. It is just not good enough.

While the causes of the A&E crisis might be complex, the lesson is simple: you can't trust David Cameron with the NHS.

• NHS
• Health
• Public services policy
• Health policy

Andy Burnham
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Doctor credited with major progress in cancer care now charged with improving hospital standards

A doctor credited with instigating significant improvements in NHS cancer care has been appointed as the first chief inspector of hospitals, a post David Cameron suggested be created after the Mid Staffs scandal.

Professor Sir Mike Richards, who was the government's cancer tsar from 1999-2012, will be responsible for ensuring that hospitals across England are delivering safe, compassionate, high-quality care.

David Prior, chairman of the NHS regulator the Care Quality Commission (CQC), where Richards will be based, said the inaugural inspector would play a vital role in improving hospitals' care and performance.

Richards will head a team of specialist inspectors who will visit hospitals where concerns have been raised about standards and how patients are treated as well as regional teams of inspectors.

He will also have the difficult task of devising the new system of rating acute and mental health hospitals' performance demanded by health secretary Jeremy Hunt in a way that also commands the confidence of NHS bosses whose organisations will be monitored more closely than ever before.

Richards, an ex-breast cancer oncologist, will join the CQC from NHS England, where he has been leading efforts to reduce avoidable mortality from big killers such as cancer, heart disease and stroke.

Don Berwick, the ex-healthcare adviser to president Barack Obama whom Cameron has asked to review patient safety in the NHS, said: "It is crucial to the success of the chief inspector of hospitals that the inspector be trusted by clinical leaders, staff, and managers throughout the NHS. Mike Richards perfectly fits that bill; he is ideally equipped by background, achievements, and personality to engender trust between managers and clinicians."

• NHS
• Health
• Hospitals

Denis Campbell
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Our roundup of the best healthcare news, comment and analysis from around the web

Welcome to the weekly roundup of what's been happening across the sector from the Guardian Healthcare Professionals Network.

This week's big story emerged after a BMJ study found that the risk of death from surgery was greater at the weekend. The Guardian reported that the mortality rate within 30 days of operation rises each day and is 82% higher at weekends than on Mondays.

The Guardian also featured a video of the NHS's medical director who said statistics suggesting that patients are more likely to die on the operating table as the week progresses should not be cause for alarm. Sir Bruce Keogh said surgeons often timetable high-risk cases for the end of the week to give patients more time to recover, which may skew the figures.

In response to the news, the Telegraph commented that the NHS is sick, but there are cures to hand and that trusting healthcare professionals more will help get the NHS back on its feet.

Another week, another disturbing story about the NHS. A study of more than four million patients has found that those who had operations on a Friday were 44 per cent more likely to die than those who underwent an operation on a Monday. The frightening implication is that the standard of hospital care declines over the weekend. This is typical of a service that often seems to be designed more for the convenience of its staff than its patients – functioning at its best Monday to Friday, 9am to 5pm.

It also ran a piece by Dr Steven Allder with suggestions for how to cure for the NHS. He claimed that simple changes introduced at his local hospital trust would revive the health service if copied across the country – and could even help put an end to "fatal Fridays".

Over the past nine years, I have run a series of eight projects aimed at increasing the quality of patient care while also reducing costs. This involved securing the support of the chief executive and, at times when I was not working in a formal management capacity, putting in extra hours in the evening and at weekends. It was not easy, but the results were startling – and the NHS could make significant savings if the same approach were applied across England.

Following on from Jeremy Hunt's speech last week, the Observer ran an editorial saying that the health secretary should not pick on GPs and instead should have engaged politically with the problems in the NHS.

Hunt's decision to lay the blame for this squarely at the door of GPs for shunning out-of-hours provision smacks of panic. There is an immediate flaw in a member of the political class trying to engage GPs in a war of words.

On the network, Richard Vize wrote that Jeremy Hunt had waged war on GPs while he focuses on his campaign for the next election and that the health secretary's policies are driven by political point scoring, and many are little more than empty gestures.

He wrote:

Hunt is attacking GPs from three directions; he is trashing their reputation, forcing them to take on a responsibility they don't want and undermining their new clinical commissioning role in the process.

This confrontational posturing means all the wrong conversations are taking place. Instead of debating the primary care issues that matter – quality, access, integration – Hunt has pushed GPs into yet another confrontation with ministers. Never slow to be roused, the BMA and Royal College of GPs are retaliating with cries of a crisis of too much work and too few doctors.

Meanwhile, the Telegraph reported that Claire Gerada, chairman of the Royal College of General Practitioners, warned that GPs can no longer provide safe care because they are too overstretched.

And, the BBC had a video saying that the NHS in England needs more community doctors. The government announced that the NHS will need more nurses and doctors who have been trained to provide community health services so it can cope with a growing elderly population.

Murray Anderson-Wallace and Roland Denning wrote for Comment is Free asking if health services can learn from their mistakes over baby Alexandra's death.

The Independent reported that overcrowded A&E units forced to turn away ambulance calls on 350 occasions leading to the conclusion that the NHS is under increasing pressure. And, the BBC ran a story claiming that Scotland's A&E waiting times are at their worst since monitoring began.

The Guardian also said that dementia care is to be given priority in new NHS training guidelines. Andrew Sparrow wrote that the Department of Health training blueprint promises to give NHS education unprecedented focus and importance.

And, Denis Campbell reported that "virtual wards" are being urged as the answer to the strain on NHS. A report said that the service could create 5,800 "virtual beds" in people's homes to help hospitals cope with bed shortages and overcrowded A&E units to deal with patients arriving as emergencies.

Here are our top five stories from the network this week:

• Will Healthwatch give patients a better deal?
• Adopting a pharmacy-first approach can improve health and wellbeing
• Anti-stigma project helps GPs treat people with mental health problems
• Jeremy Hunt wages war on GPs as he focuses on campaign for next election
• We need to use technology to get smarter about care

And, here are some other healthcare stories from around the web:

BBC: Dutch district nurses rediscover 'complete care' role
GP Online: Monitor to review walk-in centre closures
Nursing Times: Half of student nurses to do community placement within two years
Pulse: GPs cut work commitments to cope with rising workload and stress
HSJ: Exclusive: Chief inspector of hospitals revealed

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Sarah Johnson
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Weekly alcohol consumption is down but alcohol related hospital admissions are up. What are the key numbers on alcohol?
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We're drinking less but the number of hospital admissions related to alcohol consumption has increased, according to a new government report.

An estimated 1.2m hospital admissions in 2011/12 were alcohol related, more than twice as many as in 2002/2003.

The report by the Health and Social Care Information Centre (hscic) also shows a massive 73% increase in the past nine years for the number of items prescribed for the treatment of alcohol dependency.

So what else does the report tell us? Here are some key points we've picked out:

We're drinking less both inside our homes and outside. Maybe the difficult economic times have forced people to tighten their belts – perhaps contributing to the disappearance of many of England's pubs. The British Beer and Pub Association report that in 2011 there were 50,395 pubs in the UK compared with 67,800 in 1982. But the reduction in the amount drunk per person each week could be down to a range of factors.

Prescriptions are up

More than 178,000 prescriptions were given out in 2012 - up 6% on the previous year when the figure stood at 167,764. The cost of prescriptions came to £2.93m in 2012, up 18% on the previous year and up 70% on the 2003 figure.

Information on estimated costs to the NHS of alcohol misuse show that it costs £3.5 billion every year, which is £120 per taxpayer.

In 2011, there were 6,923 deaths directly related to alcohol - a 26% increase since 2001, with the most common cause being alcoholic liver disease (this accounted for 64%).

Of the 304,200 admissions wholly attributable to alcohol in 2011/12, nearly 207,000 were diagnosed as mental and behavioural disorders due to use of alcohol. The number of admissions due to alcoholic liver disease and the toxic effect of alcohol have also risen since 2010/11.

Of the 916,100 admissions partially attributable to alcohol, 454,500 were diagnosed as hypertensive diseases and more than 200,000 for cardiac arrhythmias. The number of admissions for accidents and injuries and violence have decreased slightly since 2010/11.

The percentage of school pupils drinking is down

Despite the media's obsession with underage drinking, the hscic report suggests that the percentage of school pupils drinking alcohol has decreased. 12% of school pupils had drunk alcohol in the last week in 2011 - a marked decrease from 26% in 2001, and is at a similar level to 2010, when 13% of pupils reported drinking in the last week – still a serious concern, but a reassuring trend all the same.

The table below shows hospital admission figures by diagnoses. Breakdown by gender can be found in the downloadable spreadsheet. What do you think of the figures? We'd love to read your thoughts on this topic in the comment thread below.

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Ami Sedghi
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Using data can help develop a fuller understanding of individuals and the factors affecting their social and physical health

Everywhere in the world, health and social care is getting bigger – more patients, more caregivers, more facilities, more drugs, more cost. Healthcare spending alone is already a large percentage of the economy in most of Europe. It's 12% of GDP in the Netherlands and more than 11% of GDP in France and Germany. In the US healthcare consumes 17% of GDP.

Unless we want to further disrupt already fragile national economies, it's time for us to get smarter about care. Moving from aspiration to reality requires an approach to care where the focus is on the individual. Care isn't just about the doctor's office or intensive care unit, nor is it just about face-to-face relationships between patient and doctor. It's about everything that affects the patient, from age to work history to neighbourhood to social relationships.

According to the Institute for Alternative Futures, healthcare accounts for only 10-25% of the variance in health over time. The remaining variance is shaped by genetic factors (up to 30%), health behaviours (30-40%), social and economic factors (15-40%), and physical environmental factors (5-10%).

Too often, every stakeholder in the system views care through their own lens – the data they collect and the interventions they can sponsor. Doctors want to identify symptoms and treat them. Hospitals want to bring patients in for procedures that will cure them. Pharmaceutical companies want to find people who might benefit from their medication. Public health specialists want to cut the number of premature births or the incidence of diabetes. Social workers want to change harmful behaviours.

Unfortunately that information is scattered in various databases and departments, making it hard to achieve a holistic picture of the patient. Healthcare organisations can magnify their impact on individual health by dealing with issues beyond office visits and hospitalisations.

There's an opportunity to dramatically improve the care ecosystem, making it more efficient, by applying analytics to data generated at every point in the care cycle. This phenomenon, known as big data, would develop a fuller understanding of individuals and the factors affecting their social and physical health.

Some forward-looking European healthcare organisations are starting to build smarter-care systems.

In Catalonia in Spain, where 65% of the over-60 population has a chronic disease, the Catalan Institute of Health is working to develop a patient portal that will display health-related data from several departments that now resides in 20 databases. With the information, caregivers will be able to determine what the daily living activities of individuals are and how they should be changed. In Denmark, where there are already extensive programs for identifying and treating people with chronic diseases, the Region of Southern Denmark is funding a pilot program to boost co-ordination among agencies that could improve care for heart disease patients.

Giving individuals the best care means creating an ecosystem of organisations that come together to support them. Hospitals that treat patients and then make sure nurses check on them after they leave get fewer readmissions. Doctors that co-ordinate with social services can combat alcoholism or depression. Integrated communities of support can deliver personalised care that is more effective than any one working alone.

Smarter care systems have five common attributes:

• intervention – discovering the points in their lives where individuals can be influenced, and the most effective intervention strategy

• knowledge – assessing what has worked and applying that information to improving the system going forward

• collaboration – leading individuals to work with the right care-givers to make healthy choices or change their social determinants

• co-ordination – sharing care, knowledge and accountability across clinical and social boundaries

• learning – using analytics to study communities and understand who is at medical risk and how those risks are created, whether by medical, psychological or social factors

Innovation makes it possible to co-ordinate smarter care that is focused on treating the individual, rather than just reacting to a health crisis. That offers the potential of both improving care and controlling the seemingly inexorable rise in spending.

We must move rapidly to tap technology to get smarter about care. It's the right thing to do for the economy. It's the right thing to do for society. And, most important, it's the right thing to do for the individual.

Dan Pelino is general manager of IBM's Global Public Sector

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Chris Stirling leads training programmes to help healthcare professionals improve behaviour management and avoid crises

My day starts at 5.45am and I usually arrive in the office by 7am. I am a bit of a golf fanatic so in the summer I will sometimes try to squeeze in a round before I head in. Getting in early lets me get a head start on the day and I start by responding to emails from organisations we work with. The rest of the morning will be taken up by research and development for our new training programmes and meeting with colleagues to discuss business strategy.

At the moment, my days in the office are focused on preparing for the NHS Confederation conference. We're going to be there talking about our two new training programmes.

These will help people working in specialist mental health and learning disability settings to reduce the need for restraint, protecting the rights of the people who use their services and showcase safe behaviour methods for those administering acute treatments.

As much as I love what I do now, it was not my initial career plan. At 16, I wanted to do a fine art degree but after seeing how little money students had, I decided to follow my brother into nursing. As a disability nurse I started training my colleagues in both physical and non-physical approaches for the management of aggression and violence.

In 1993, with some colleagues, I set up Positive Options and due to the demand for the training (called MAPA), we took the leap to work exclusively on organisational training and development. In 2008, the Crisis Prevention Institute approached us to work collaboratively and because the cultural values and philosophy of the two companies were a great fit we merged in 2010, changing our name to CPI Europe at the beginning of this year.

My experience as a disability nurse means that I know how important our training is. What I find most rewarding is getting involved in developing new programmes for organisations and seeing the positive impact they have. We recently completed a two-year project to support a forensic mental health service in the NHS to retrain their staff in MAPA. As a result the organisation has seen a reduction in violent incidents and, more importantly, in the use of restraint and injuries to staff and patients.

For CPI it is not just about the course content – it's about extending new and existing core knowledge and skills into the workplace and seeing a change in working practice that benefits staff and patients. While some organisations take a tick-box approach to training, a good organisation wants to work in partnership with CPI so there is a specific focus on how our training programmes impact the people who use their services.

A significant part of my role is to advise organisations thinking of commissioning training, many of whom face increased pressure due to budget restraints and heightened levels of scrutiny. I ask organisations to think of three key issues before choosing a partner training organisation: firstly, take note of sector guidelines or national benchmarks for practice quality; secondly, ensure training commissioned builds on existing experience and expertise; finally, look for an organisation that you can establish a longstanding partnership with and ensure you understand all aspects of the training they offer, particularly when training involves restrictive physical intervention.

I always try to finish by 6pm but my job takes me all over Europe so this is never guaranteed. When I arrive home in the evening, I am often straight back out as I'm the resident taxi service for my football-mad son. Then my wife, who also has a demanding job in the health sector, and I like to spend some time chatting about our day as we both find this a valuable and effective way to debrief and de-stress.

Although my job is always busy and sometimes demanding, I usually go to bed concluding that I am privileged to be doing something I really enjoy, and which can make a positive impact on professional staff as well as the people they support.

Chris Stirling is the executive director of European development at Crisis Prevention Institute (CPI)

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Community and mental health trusts in London and the South can share patient information using a new feature from BT.