Creative solutions to the health sector's problems are unlikely to come from inside the NHS or from large IT companies
Never before have we heard so much support for small and medium enterprises (SMEs), or witnessed such a vibrant start-up scene in Europe. But in the health sector it's a different story, especially for SMEs that have had their fingers burned trying to do business with the NHS.
We surveyed 125 entrepreneurs from the health tech sector around the world and found that three quarters would rate their experience of working with the NHS as difficult or very difficult. Only 30% of UK respondents said they had worked with the Academic Health Science Networks (AHSNs) – the bodies that were set up in April 2013 to work with the private sector, academia and the NHS to encourage innovation.
Entrepreneurs have worked hard to provide clinical evidence to support their business. It's now up to the NHS and the large health providers in Europe to use the AHSN framework to validate this evidence and facilitate pilot programmes to help entrepreneurs roll out their products.
For a small company, it is difficult doing business with the NHS: 85% of UK-based entrepreneurs identified barriers such as excessive decision-making times and difficulty finding the appropriate person to speak to within an organisation. More than 80% thought that procurement processes were too complicated. Nearly 60% claimed there was a resistance to working with private sector companies.
Entrepreneurs could help drive innovation in the health sector. As Tim Kelsey, director for patients and information, NHS England said: "We need entrepreneurs to be given the opportunity to promote their tools and services to anyone who is interested because they are the ones who will help create a better model of care for patients." The most creative technical solutions to the health sector's problems are unlikely to come from inside the NHS or from large IT companies.
Despite the challenging market, health tech entrepreneurs are optimistic about the future. Half of those surveyed currently have revenues of $0.5m (£308,000) or less. But, within this group, 50% believed they would achieve revenues of $0.5 to $1m (£617,000) in the next 12 months.
The UK and US are still the main markets for health tech. And, according to our survey, SMEs sell their products and services mostly to hospitals (both public and private), followed by clinicians and national health authorities. Nearly a third sell directly to the public.
Three-quarters of those surveyed said that patients and health consumers are driving demand – they are the ones who will push reluctant doctors to embrace and adopt new technologies.
When asked if health professionals are encouraging e-health innovation, however, the response was mixed: 32% disagreed, 30% sat on the fence, and 37% agreed. Some 44% said the health innovation 'ecosystem' (including health authorities, universities, medical centres and mentoring programmes) did not support their businesses.
SMEs should be talking to patients directly to encourage them to adopt this technology and take responsibility for their health. And patients should be turning to their local communities for support and funding.
At the moment, early stage finance is a problem, with 59% of respondents complaining that they struggle to access to finance. Only a quarter believed a long-term view was taken on health investments, with almost double claiming the opposite.
It's often said that American entrepreneurs get all the limelight – but, truth be told, it's the US that is coming up with successful business models and exit strategies that inspire investors, providers and payers. There are brilliant minds and promising technologies coming out of Europe – let's make sure that we foster this talent.
Pascal Lardier is international director of Health 2.0
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
Adequate training and safe staffing levels are essential if we are to provide a quality health service
The failings at Mid Staffordshire hospital and the harm that this caused patients and families, is undeniable and unforgivable. However, we must not forget that such appalling standards arerelatively rare within the health service. Throughout the NHS, care is of a high standard, both from a clinical and compassionate point of view. The real concern is whether in the current climate of austerity, the measures put in place by Jeremy Hunt will plunge our better performing trusts into failing institutes and make it impossible for our worst-performing hospitals to raise their standards. The rhetoric that the health service needs yet another "profound transformation" must surely send a shiver up the NHS spine.
The government's response to Francis' 290 recommendations is essentially a political one. It stops short of making potentially life-saving changes, in particular the mandatory nurse:patient ratio. It has been known for sometime that the ratio of nurses and doctors to patients has a bearing on mortality risks. In perpetuating the commitment to 'zero harm' the coalition government chooses to sideline the issues of safe staffing because of monetary concerns. An improved transparency, meaningful engagement and increased accountability will do much to right the wrongs of the past. However, we will only have safe hospitals when there are safe staffing levels. No manner of enhancements of culture and leadership can compensate for this.
A further significant finding by the Francis inquiry was the clear link between the drive to achieving foundation trust status and a subordination of clinical concerns. This fostered a culture of target-chasing and cost-cutting. Francis set out three primary and fundamental causes of what went wrong: a failure to listen to patients; a lack of properly trained staff and a dysfunctional culture.
Changing the culture of the NHS cannot be achieved by policies that sit on shelves or by legislation in the parliament. Too often, the patient complaints system is treated as a process, in an attempt to deflect criticism rather than confront problems. We absolutely need to change that. The culture of apathy, complacency, and lack of shared ownership has eroded the confidence of patients. While senior management have to take the lead, each employee must now look at how they might change their practice – or if they witness bad practice, challenge it.
There are many examples of quality, innovative, and collaborative work happening in our health service – by managers, clinicians, commissioners, and all of those organisations and people who partner with the NHS to deliver the best care and support for people. Yet there are other hospitals that are either failing or at the brink of disaster. Tinkering with policies without an investment in staff, training, education and supportive systems for patients and their loved ones risks further scandals. The undermining of the NHS might suit some politicians but the consequences of this will be measured in due course, and when another local district general hospital fails, the public will, this time, be less forgiving.
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.Kailash Chand
NHS England says people with mental illness have life expectancies about 10 years shorter than population as a whole
NHS leaders are calling on those who are commissioning services to help close the "shocking mortality gap" that sees people with mental illness have life expectancies about 10 years shorter than the population as a whole.
Targeted cancer screening, regular checks for cardiovascular and physical health and smoking cessation programmes should all be improved, according to a blunt message from NHS England. Putting mental health services on an equal footing with those tackling physical health would be a first step to tackling the disparity, NHS England officials will tell a meeting in Manchester on Monday.
While average life expectancy in England and Wales has increased steadily year on year, and is now 83 for women and 79 for men, for people with mental health problems it is the equivalent to that of the general population in the 1950s: about 68 for men and 73 for women.
People with mental illness are at increased risk of the top five health killers, including heart disease, stroke, liver and respiratory diseases and some cancers. Smoking prevalence is twice as high among people with long-term mental health conditions than in the general population, and incidence of heart attack or heart failure is two to three times higher than in the general population.
Bowel cancer is three to four times more likely for people suffering from schizophrenia while up to half of all cancer patients develop common mental health problems compared to 16% of the general population.
Martin McShane, director for patients with long-term conditions for NHS England said: "The 'mortality gap' we see today is shocking. It is not acceptable people with mental health conditions die younger. For too long, physical and mental health problems have been treated separately and people do not get the services they need every time … We must act to ensure mental health is on a par with physical health."
In England, mental health conditions cost approximately £105bn a year, taking into consideration loss of earnings, associated healthcare and welfare costs, far outweighing the £14bn spent by the NHS each year on giving direct care for people with mental health.
Geraldine Strathdee, national clinical director for mental health for NHS England said: "We must design a service that meets the needs of its users, and not expect users to fit in with the services we design.
"We must also work hard to prevent those with physical health problems developing mental health issues. It is clear to me that physical and mental health issues cannot be separated – and our approach to care must change to reflect this."James Meikle
NHS deputy chief executive says service 'pulling out all the stops' to deal with impact of bad weather, flu and vomiting bug
Hospitals are creating thousands of extra beds, hiring more staff and getting doctors to work longer shifts in a frantic effort to avoid the NHS being crippled by major problems this winter.
Fears that the service may face its toughest ever winter have forced NHS trusts to use beds in nursing homes, reopen disused wards and build new ones to boost their capacity. At the same time trusts are recruiting nurses from abroad to tackle staff shortages so they can cope with the expected impact of flu, norovirus and bad weather.
Dame Barbara Hakin, the NHS's deputy chief executive, said the service had "pulled out all the stops" and taken unprecedented steps to prepare for winter in a bid to avert a crisis. Plans have been laid for several thousand more beds being available during the next few months, GPs to offer more appointments and ambulance services to have extra staff, Hakin added.
One trust has even obtained a prefabricated building to use as an overspill ward if it comes under particular pressure.
The moves come amid mounting anxiety in government, the leadership of the NHS and hospital bosses that the service could be overwhelmed by the demand for care as winter bites.
Chris Hopson, chief executive of the Foundation Trust Network, which represents almost all England's acute hospitals, told the Guardian hospitals are under "unrelenting pressure" for so much of the year now that some had to activate winter strategies up to two months ago, ahead of schedule. "Many trusts have had their winter plans running since September to ensure they cope with the level of demand," he said.
As part of its plans, County Durham and Darlington NHS foundation trust has created 25 extra beds at the University hospital of North Durham by reopening a ward, and another 25 at the Darlington Memorial hospital by putting extra beds into existing wards.
It has also hired 39 more nurses to staff the two hospitals' A&E units, created an extra intensive care bed and arranged for local nursing homes to look after 10 patients who need rehabilitation rather than treatment in a bid to ease demand for beds in its hospitals.
Professor Chris Gray, the trust's medical director, said the 50 extra beds were needed to meet demand from the sheer number of patients arriving as emergencies who need to be admitted, and to ensure elective operations and urgent cancer care were not affected by such pressures. Extra beds created last winter at the University hospital of North Durham as a temporary measure have remained open ever since because of what Gray said were now "all-year-round pressures". A rise in emergency patients led to "particular pressures" on the hospital in September and October, he said.
Under its winter plan, Airedale general hospital in Keighley, west Yorkshire, has moved to create 55 more beds. Extra nurses to cover the 24 new medical beds will cost £806,000. It is reorganising which wards handle what types of patients in order to avoid patients admitted as medical emergencies having to "sleep out" – spend the night in wards that are unsuited to caring for their needs, notably those full of surgical patients – or cancel operations due to a lack of beds. It is spending a further £383,395 on extra nurses for its specially designated 30-bed "winter ward". It is also trying to ease pressure on beds by cutting emergency admissions by 4%, reducing the average length of stay from 5.8 to 5.3 days and discharging more patients earlier in the day.
In Leeds, St James's hospital and Leeds General Infirmary are getting an extra 65 beds, with 14 more on standby – though plans for even more extra capacity had to be shelved due an inability to recruit sufficient nurses – while doctors will be working longer hours. Derriford hospital in Plymouth is adding 50 beds and creating a short-stay unit for patients staying up to 48 hours.
The trust that runs Cheltenham general hospital and Gloucester Royal hospital has been recruiting some of its extra 35 nurses from Portugal and plans to open two extra medical wards at Gloucester Royal. "In the middle of winter we can see an extra ward of patients coming in on any day", said Frank Harsent, its chief executive, who wants to avoid a rerun of last year's "difficult" winter.
Although hospitals have been given almost £400m in extra funding to tide them over this winter some have used their reserve or surplus to fund measures to meet winter's extra demand, said Hopson. "Everything that can be done for this winter is being attempted on the frontline. Trusts have been putting more money into meeting this demand by recruiting more staff, buying extra equipment, building and extending wards and emergency units and improving links and working arrangements between community, mental health, ambulance and hospital teams."
Some hospitals, such as University College hospital London, are building completely new and bigger A&E units to cope with the general trend for more attendances and more admissions.
Basildon and Thurrock University hospitals NHS foundation trust has been building a new 28-bed ward as part of its plan to increase capacity by 67 beds, earmarked £1.8m to fund 200 extra nurses across its hospitals and also obtained a prefabricated building to provide extra capacity.
Research by NHS England shows that while fewer people actually attend A&E in winter than in summer, they are much likelier to need to be admitted. That can lead to hospitals becoming full, operations being cancelled because the beds for those patients are needed, patients who have been treated in A&E having to wait on trolleys for hours before being given a bed and new arrivals having to wait in ambulances outside – a condition Professor Keith Willett, NHS England's national clinical director for acute care, calls "congestive hospital failure".
While low levels of flu and norovirus so far this winter, and the absence of very bad weather, mean hospitals have generally not yet been sorely tested, they are bracing themselves for the months ahead. The medical director of one trust told the Health Service Journal recently that despite the extra £400m, "It's all going to go completely pear-shaped and they know it. It's entirely predictable."
Hakin, who is in charge of NHS England's winter preparations, admitted hospitals are already busy. But, she added: "It is absolutely right to be totally alive to the risks during winter but it's also important not to call a crisis before it has happened. We are right at the start of winter and we are not complacent. But we can be heartened that at the moment we are seeing and treating patients quickly in our A&E departments with those not admitted generally seen and treated in under two hours.
"Everyone is working really hard to make sure we manage this winter just as well as we have done in the past. The challenges are significant but the effort we are putting in to meet those challenges has never been greater and our planning and co-ordination has never been as meticulous nor as advanced at this stage of the year as it is now."Denis Campbell
Figures reveal decline in use of electronic referral system that allows patients to choose location of an outpatient appointment
Patient choice in the NHS is "going backwards" after new figures showed a decline in the number of people who have chosen where to receive outpatient hospital treatment, the shadow care minister Liz Kendall has said.
Just over half (52%) of NHS outpatient appointments were made through the "choose and book" service in the third quarter of this year, according to figures released in a parliamentary answer to Kendall by the health minister Dan Poulter. This marks a decline on the 57% of such appointments made in the first quarter of 2010 – the last full quarter when Labour was in office. Choose and book is an electronic referral system designed to allow patients to select the date, time and location of an outpatient appointment at a hospital or clinic.
Kendall said the decline in choose and book appointments highlighted a fundamental flaw in the reforms introduced by the former health secretary Andrew Lansley who handed commissioning powers to GPs. Lansley, who was demoted by David Cameron after the furore over his reforms, famously said his approach could be summed up in the phrase – "no decision is made about me, without me".
But Kendall said: "Andrew Lansley claimed it was no decision about me without me. But in fact what he did was fundamentally shift the power to GPs rather than really shifting the power to patients.
"The fundamental flaw in the Tories' reform is that they have failed to realise the ultimate goal has got to be giving more power to patients and families. It is really important that clinicians are leading changes but the goal is patient power, people power. That is the only way you are going to get the big and sustainable changes we need."
Kendall said the Tory approach contrasted with changes introduced by Labour. "Labour gave people a choice over where to have their operation for the first time. We also enshrined the right for patients to make choices about other local services in the NHS constitution. But under David Cameron, patient choice is going backwards. The proportion of people getting outpatient appointments at the hospital of their choice has gone down since 2010."
Jeremy Hunt, who was promoted to the post of health secretary last year with instructions to reassure voters after a collapse in trust under Lansley, is keen to portray himself as the patients' champion. Kendall said Hunt was simply seeking to "airbrush" changes that are occurring anyway.
"The Tories don't want to talk about their reforms any more. Hunt is trying to airbrush what they have really been doing for three and a half years – airbrush it out of history. But in fact we are starting to see the consequences of the changes just as we warned when the bill was going through parliament."
The shadow minister said recent closures of walk-in centres, established by the last government to provide primary NHS care at the weekends or evenings, highlighted the danger of handing too much power to GPs. Earlier this month Hunt cited the British Medical Association, which said that money had been wasted on urgent care centres located in the wrong places, to say the government was "sorting" a mess left by Labour.
Kendall said: "GPs are responsible for commissioning services. Lo and behold they are not commissioning services like walk-in centres which provide alternatives to GPs. Walk-in centres have flexibility and a range of different services – it is about fitting services around people's lives as they are now. The Tory policy is let's go back to the old family doctor. Well actually people want different kinds of services. They are championing the producer rather than the user."Nicholas Watt
Details from a database of patients' conditions, treatment and medical histories could even be sold to private companies
The relationship of confidentiality between doctor and patient may be ending. From next year, our medical records are likely to be seen by many more people, in addition to our GP, hospital doctor or nurse, and potentially used in different ways, including by private companies aiming to increase their profits, without our consent being required.
Early in 2014, all 22m households in England are to receive a leaflet on the "care.data" programme, being run by an offshoot of NHS England, the Health and Social Care Information Centre (HSCIC). Its role is to harness information in patient records to use in planning, commissioning and improving health services, in line with a pledge by David Cameron to open up the use of patient information to NHS planners and commercial companies. A large part of the remit is to sell "aggregate" patient information to the private sector. The General Practice Extraction Service will start to download details of patients' conditions, treatment and medical histories from GP-held records and build a central database, unless patients opt out.
There are growing concerns that the use of patient data has the potential to damage the relationship between patient and doctor. Some critics fear that many patients will be more reluctant to have an open discussion with their GP or consultant if they suspect that information could be shared with outside bodies, within the NHS and the private sector and be stored for future use, without their consent.
At a press briefing, Dr Mark Davies, medical director of the HSCIC, said the question of who owned medical records was a legal grey area, but that "ethically and philosophically" they were owned by patients. However, in a recent letter to Stephen Dorrell, chairman of the all-party Commons health committee, the information commissioner, Christopher Graham, says that "technically, medical records are owned by the secretary of state for health". He then adds: "However, in data protection terms, the issue is not one of ownership but of control over the information contained in the record."
The first phase of the programme will join up patients' GP and hospital care records, a huge task in itself. Its long-term goal is to merge medical and social care records, opening up another area of concern. Sue White, professor of social work at Birmingham University, said this could cause many women with mental health issues or problems with domestic violence to withhold information from their GP if they think it could be passed on to social services, potentially affecting their medical care.
"Many women are already reluctant to be completely open with their GP as they don't trust the system, and if this scheme goes ahead, there will be a risk that some women will not be open with their doctor, as they will think it is not completely confidential," White added. "So a woman facing domestic violence may not tell their doctor about it – I certainly wouldn't if I was in that position."
The HSCIC, which claims its IT safeguards will ensure there is no breach of confidentiality of patient records, aims to make data available in three formats: identifiable data, containing identifiers such as date of birth and postcode, but only where there is a legal basis or with patient consent; potentially identifiable data, containing a unique "pseudonym" for each person but no "real world" identifiers; and non-identifiable or aggregated data.
Phil Booth, a co-founder of MedConfidential, a campaign group on data privacy, said: "Many IT experts say it will be possible to re-identify this so-called pseudonymised patient data if you know how to go about it, and this is what many commercial companies want – to be able to identify groups and types of patients, and use that data for marketing."In addition, around 800,000 NHS employees can already access a certain level of patient data with their NHS swipe cards, so how many of these people will be able to access this pseudonymised data? This is all being done quietly behind the scenes and patients need to know more about how their data will be used before they give their consent to their records being used in the care.data programme."Paul Dinsdale
Health secretary takes medical chiefs to task over targets for time patients should be seen within
Jeremy Hunt has taken the unprecedented step of personally calling hospital bosses to ask why they have been breaching the NHS-wide target of treating 95% of A&E patients within four hours.
The health secretary's intervention comes amid growing evidence that pressures on the service are increasing as it heads into what doctors and NHS leaders fear will be its toughest winter ever.
Bed blocking has reached record levels while the number of cancelled operations and delays to patients being transferred are higher than last year, according to new official NHS England performance data.
NHS insiders said Hunt's decision to ask five hospital trust bosses to explain why they had not met the 95% target, revealed by the Health Service Journal, showed that he is worried about the NHS being overwhelmed this winter and risked alienating and demotivating frontline staff.
It follows David Cameron's summoning of the leaders of the two organisations that supervise England's 161 hospital trusts, and also of the NHS care watchdog the Care Quality Commission, to discuss the performance of A&E units.
Many hospitals where A&E units are short of doctors and nurses are struggling to meet the requirement to treat 95% of all A&E patients within four hours of arrival, which is politically important. Hunt's phone calls could lead to questions from NHS bosses over whether he is seeking to control the service to an improper degree, given that as a result of the coalition's NHS shakeup in April it is NHS England, not the health secretary, that should monitor performance and take action if necessary.
Asked about the phone calls, a spokesman for the Department of Health said: "As the public would expect, the secretary of state takes a close interest in the issues facing hospitals experiencing particular A&E pressure. Jeremy Hunt would not be doing his job if he wasn't keeping in touch with hospitals on the frontline in the runup to winter and it is ridiculous to suggest he should not be talking and listening regularly to feedback about how things are going," he added.
But the Labour party responded by accusing ministers of being "in panic mode" over the NHS. "Ministers denied there was a crisis for so long and now they're turning to desperate measures," said a spokesman.
It is unclear which five trust bosses Hunt rang and had what were described as "friendly and constructive" conversations. But the 10 trusts that have fallen furthest short of the 95% figure include the Heart of England foundation trust in Birmingham, Barnet and Chase Farm hospitals trust in north London, Cambridge University hospitals foundation trust, and East Cheshire trust.
A total of 78,424 bed days were lost in hospitals in England in October as a result of bed blocking, data collected by NHS England about delayed transfers of care makes clear. That is up from 55,332 days recorded in August 2010.
Of those 78,424, about one in five – some 14,830 bed days – was due to a delay in getting a patient out of hospital because of problems with social care provision.
Andy Burnham, the shadow health secretary, blamed the prime minister for the inadequacy of social care services, which NHS leaders complain is leading to hospitals running out of beds.
"These worrying figures expose the intense pressure that England's hospitals are under," he said. "David Cameron's severe cuts to older people's home care services have left people without adequate support and at risk of hospitalisation."
Last week, Hunt persuaded NHS England to provide another £150m to help A&E departments this winter, on top of the £250m announced in September.Denis Campbell
Room for improvement in 41.5% of aneurysmal brain haemorrhage cases examined by charitable body
Delays in diagnosing and treating patients with brain haemorrhage are causing unnecessary harm, a study has found.
The National Confidential Enquiry into Patient Outcome, a charitable body that works to improve professional standards funded largely by the government, said the situation was exacerbated at weekends and after patients had had surgery and been discharged.
The study focused on patients suffering a brain haemorrhage as a result of an aneurysm, a ballooning in an artery wall, which causes it to thin and become weak. Such haemorrhages account for about 5% of strokes in the UK and, in contrast to more common types of stroke, most people affected are of a relatively young age, with half younger than 60 years old.
NCEPOD said there had been significant advances in care for patients with aneurysmal brain haemorrhage but that in 41.5% of cases they examined, there was room for improvement or the care was unsatisfactory.
The report said almost a third of patients' care could have been adversely affected by a failure of their GP to recognise symptoms of aneurysmal brain haemorrhage when they went to them with a severe headache and other warning signs.Haroon Siddique
Regulator's review says patients more likely to suffer poor care as avoidable emergency admissions of older people increase
Hospitals have made no improvement in patient safety or treating the ill with dignity and respect despite the concerns triggered by the Mid Staffordshire scandal, according to the independent healthcare regulator.
The Care Quality Commission (CQC) also found no improvement in hospitals monitoring and assessment of the quality of care they are providing.
About 47% of problems identified by the CQC had a major or moderate impact on patients, a deterioration from the previous year, when the figure was 39%. Inspectors found poor care in about 10% of all hospitals they visited.
The damning findings came in the regulator's first annual report since it was overhauled by the health secretary, Jeremy Hunt, in an attempt to restore public confidence in the wake of Mid Staffordshire and other scandals, which saw its senior staff replaced and the hospital inspections regime beefed up.
The report said: "In the aftermath of the failures of care at Mid Staffordshire NHS foundation trust, our inspectors' biggest concern in 2012-13 was that acute hospitals made no improvement in assessing and monitoring the quality of care they provided. We also found no improvement in safety and safeguarding, or in hospital patients being treated with dignity and respect."
Among the problems identified were staff "talking over" patients as though they were not there and patients not always being able to reach call bells, or staff not responding to them in a reasonable time.
The CQC report also found that 530,000 people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in 2012-13, compared with 374,000 in 2007-08. More than 9% of people aged 75 and over experienced at least one emergency hospital admission for an avoidable condition last year compared with 7.1% six years ago. Over the same period, there was a 64% increase in admissions for pneumonia, 52% for inhalation of food or liquid, and 45% for urinary tract infections - conditions that many argue should usually be managed by GPs.
There were significant regional variations in the numbers of older people going to hospital with avoidable conditions, with the north-east having the highest rate of avoidable emergency admissions (for people 65 and over per head of population) and the south-west having the lowest.
The report reflects concerns about poor care that ministers have been highlighting recently and say they are determined to address. On Tuesday, responding to the Francis report into Mid Staffordshire, the government announced that hospitals could be hit with financial penalties for hospitals if they covered up mistakes that caused injury, and that patients would be given a named consultant and nurse during their stay in an attempt to improve the safety of care. Last week, the health secretary announced changes to the GP contract, including a named, accountable GP for over 75s, which Hunt said would reduce pressure on accident and emergency departments.
Norman Lamb, the health minister, said: "This report shows why we are right to be changing the NHS in patients' interests.
"Many more people are living longer with complex care needs. That is why we are transforming the way health and social care is given across the country through a joined-up and integrated approach."
Liz Kendall, shadow minister for care and older people, said the report showed "the full scale of David Cameron's care crisis".
Mother claims Bristol children's hospital could have done more to save seven-year-old, after coroner records narrative verdict
The mother of a seven-year-old boy who died after suffering catastrophic bleeding a week after a heart operation has said the hospital where he was treated could have done more to save him.
Faye Valentine claimed that the ward at Bristol Royal Hospital for Children where her son Luke Jenkins was recovering from surgery was understaffed and that nurses and doctors had ignored her concerns.
Speaking at the end of Luke's inquest, Valentine said: "We weren't being listened to. They thought we were being over-anxious and asking too many questions. They ignored us. We weren't asking stuff for the fun of it. We had serious issues and they ignored us."
Luke's inquest heard claims about staff shortages on the bank holiday weekend when he died, and was given conflicting accounts about whether vital emergency equipment was close at hand when he suffered massive bleeding.
It emerged that the hospital has made numerous changes, including boosting the staff-patient ratio and instigating improvements to record-taking and how families' concerns are dealt with.
After hearing from more than 30 witnesses over seven days, the inquest at Flax Bourton, near Bristol, could not establish what had caused the fatal haemorrhaging. Experts said it was unusual that severe bleeding had begun so long after an operation. In a narrative verdict, the Avon coroner, Maria Voisin, said the bleeding had led to a cardiac arrest and brain damage. She said there had been no "gross failure" by the hospital.
Valentine said she and her partner, Stephen Jenkins, would continue to fight for answers. They are likely to launch a civil action against the hospital.
She said: "Some of our questions have been answered but we have many more, which we will take forward to the next stage. We still have a lot of concerns. We still think his death was preventable. There are others like us out there. We know of a few we are in touch with." About 10 families are believed to have taken legal advice over deaths at the hospital and some are calling for a public inquiry.
The staffing on ward 32, where Luke was treated, came in for strong criticism from the Care Quality Commission. Following Luke's death, it found there were insufficient well-qualified nurses for the number of patients being treated, and issued a warning notice requiring University Hospitals Bristol NHS foundation trust to take immediate action.
The trust's own "root cause analysis" report also highlighted concerns about staffing levels. After the inquest, the trust's chief executive, Robert Woolley, said Luke had been cared for by the "right people with the right skills".
He said: "It's a great regret to us that his parents believe we did not take their concerns seriously. We pride ourselves on looking after parents as well as caring for their sick children and we have introduced new procedures and training to ensure we do that to the best of our ability."
The hospital will come under scrutiny again in January when an inquest is held for four-year-old Sean Turner, who died there shortly before Luke's death. Two more inquests involving the hospital are scheduled for February and March.
Parents of children waiting for heart operations have been watching Luke's inquest before making a decision over whether to give consent for procedures to be carried out there.
Luke was born with a congenital heart defect. He underwent a series of operations, including a procedure that damaged his spinal cord and left him paralysed. He fought back and two years later was able to walk again.
In March last year he was admitted to the Bristol hospital for another heart operation. Surgeons said the procedure went well. Luke's parents claim that before the operation they were told he would spend three days on the paediatric intensive care unit after the operation. But he was quickly moved to ward 32, the children's cardiac ward.
Stephen Jenkins told the inquest that staff made only "sporadic" checks and he had to keep prompting them to make sure Luke had enough pain relief. He said: "The ward seemed short-staffed. While Luke was on ward 32 we had concerns that he was not receiving the appropriate level of care."
On 6 April Luke suffered what was described in the inquest as a "catastrophic bleed". Jenkins said: "We believe it took between six and eight minutes before any proper alarms were raised and we were left holding an oxygen mask over his face. There did not seem to be any organisation and everyone seemed to panic."
The boy underwent surgery but his heart stopped for 43 minutes and he suffered brain damage. On 9 April, Luke's parents agreed that his life support machine be switched off. Luke's mother climbed into bed with him and hugged him as he died.Steven Morris