0:00:02 > 0:00:08This programme contains some scenes which some viewers may find upsetting
0:00:08 > 0:00:10Just move yourselves over to the side.
0:00:10 > 0:00:12This winter, one of Britain's busiest NHS trusts
0:00:12 > 0:00:13opened its doors...
0:00:13 > 0:00:16We have to look after the patients whether they come
0:00:16 > 0:00:19from Buck Palace or the park bench.
0:00:19 > 0:00:22..to show us what's really happening inside our hospitals.
0:00:22 > 0:00:25We've got lots of patients now competing
0:00:25 > 0:00:27for an unknown number of beds.
0:00:27 > 0:00:31Every week, more than 20,000 people are treated here...
0:00:31 > 0:00:35- The pressure's just gone. - What? Has it completely gone?
0:00:35 > 0:00:40..and the numbers, as well as our expectations, are rising.
0:00:40 > 0:00:42We just had our worst ten days on record.
0:00:42 > 0:00:45There's nowhere in the hospital to move anybody.
0:00:45 > 0:00:47At some point somebody will be telling us
0:00:47 > 0:00:49whether we're allowed to do any work.
0:00:49 > 0:00:52This is a place with some of the best specialists in the world...
0:00:52 > 0:00:55- Tumour's out, job done. - ..where lives are transformed.
0:00:55 > 0:00:58This is saving his life. It has to work.
0:00:58 > 0:01:01But they are operating at a time when the NHS
0:01:01 > 0:01:03has never been under more pressure...
0:01:03 > 0:01:06- Any beds?- No.- No beds for anyone? - No.- OK.
0:01:06 > 0:01:10It does feel to me like the elastic's
0:01:10 > 0:01:14a bit nearer to breaking now than it ever was.
0:01:15 > 0:01:17..its very future under scrutiny.
0:01:17 > 0:01:19All right, I think we will go out on red,
0:01:19 > 0:01:21cos we're under real pressure in the emergency department.
0:01:21 > 0:01:25We are aware of the problems - anybody got a solution?
0:01:25 > 0:01:28Following the patients from the moment they are admitted...
0:01:28 > 0:01:32Anything I've done up to this point means nothing compared to
0:01:32 > 0:01:35when you can, literally, give a bit of yourself to save someone else.
0:01:35 > 0:01:38..to the moment they leave.
0:01:38 > 0:01:40It's all good news. The cancer has gone.
0:01:40 > 0:01:43- You don't need any more treatment. - Fantastic.
0:01:43 > 0:01:46Thank you so much.
0:01:46 > 0:01:50Week by week, we reveal the complex decisions the staff must make
0:01:50 > 0:01:53about who to care for next.
0:01:53 > 0:01:56That patient is coming to me to be operated on
0:01:56 > 0:02:00and if I don't do it, then there's only one inevitable outcome -
0:02:00 > 0:02:02they're going to die.
0:02:11 > 0:02:13- OVER RADIO:- Did we trigger red overnight?
0:02:13 > 0:02:14Cos we clearly should have done.
0:02:14 > 0:02:18OK, let's go through the capacity, then, for Charing Cross.
0:02:18 > 0:02:20For surgery, we've got...
0:02:20 > 0:02:23all those patients to place, one intensive care bed.
0:02:23 > 0:02:27So we don't really have capacity at Charing Cross.
0:02:33 > 0:02:37Charing Cross is one of the five hospitals within Imperial Trust.
0:02:39 > 0:02:41It's a centre of excellence for neurosurgery
0:02:41 > 0:02:43and cancer treatment.
0:02:44 > 0:02:47Known for pioneering new technologies,
0:02:47 > 0:02:49it deals with some of the most complex
0:02:49 > 0:02:52and challenging surgery in the country.
0:02:53 > 0:02:57Demand for its services has never been higher.
0:02:57 > 0:03:01This morning, the hospital is already at 95% capacity.
0:03:01 > 0:03:06This month alone, it's been at this level for 28 days.
0:03:07 > 0:03:12It's me, yeah. Course I am, I'm on my way, I'm on my way.
0:03:13 > 0:03:17Kevin O'Neill is a world-leading brain surgeon.
0:03:17 > 0:03:19His reputation has made him one of the country's
0:03:19 > 0:03:21most in-demand specialists.
0:03:21 > 0:03:24We do like to push the boundaries a bit here.
0:03:24 > 0:03:25We've got a very good team,
0:03:25 > 0:03:28people that work together, we get very good results.
0:03:28 > 0:03:31We do stuff that sometimes other people don't want to touch.
0:03:31 > 0:03:36Stuff that we consider doing that is complicated cases
0:03:36 > 0:03:38that come for consideration from all over the country
0:03:38 > 0:03:40and all over the world.
0:03:40 > 0:03:46Today, Kevin has two scheduled operations.
0:03:46 > 0:03:50His first case, 53-year-old Valerie is particularly challenging.
0:03:53 > 0:03:57Seven years ago, she was diagnosed with multiple brain aneurysms.
0:03:57 > 0:04:02I've got five, two of them have already been operated on.
0:04:02 > 0:04:05I've had coil in, and this one has to be clipped,
0:04:05 > 0:04:10so they have to go through my head, because of where it is in my head.
0:04:10 > 0:04:11It is, I see what you mean.
0:04:11 > 0:04:14It's like a trifurcation, almost, isn't it?
0:04:14 > 0:04:16There's the actual aneurysm there, isn't it?
0:04:16 > 0:04:19The way to think of this is, it's the inner part of the vessel
0:04:19 > 0:04:22bulging through a weakness, rather like the inner tube bulging
0:04:22 > 0:04:24through a split in the tyre.
0:04:24 > 0:04:25And that poses a threat,
0:04:25 > 0:04:30because that can rupture and cause a bleed, and that can be fatal.
0:04:30 > 0:04:33So, it's a little bit of a ticking time bomb.
0:04:33 > 0:04:35It certainly does have quite a wide neck, doesn't it?
0:04:35 > 0:04:37And lots of vessels at the base.
0:04:37 > 0:04:40Got to get it clipped all the way around this.
0:04:40 > 0:04:42The difficulty we have is quite a weak-walled aneurysm
0:04:42 > 0:04:46that's going to be at risk of rupturing during surgery,
0:04:46 > 0:04:50plus there's something down here as well.
0:04:50 > 0:04:53And so, it's not straightforward.
0:04:55 > 0:04:58Valerie has been waiting for this surgery for nearly a year.
0:04:58 > 0:05:01- I'm stressed.- What's stressing you?
0:05:01 > 0:05:05Is there anything specifically that's worrying you?
0:05:05 > 0:05:08What happens if it's cancelled today?
0:05:09 > 0:05:13I can't answer that, because as far as I know it's not.
0:05:13 > 0:05:16And if it is cancelled, I think it's a discussion that's best to have
0:05:16 > 0:05:19with Mr O'Neill, cos he's the person who's doing the operation.
0:05:19 > 0:05:21- I'm not going home. - I understand, I understand.
0:05:21 > 0:05:23It's not easy.
0:05:25 > 0:05:28I think it's very unlikely at the moment
0:05:28 > 0:05:29that we're going to face that
0:05:29 > 0:05:33and I know we've said this in the past and there have been problems.
0:05:33 > 0:05:35Said it would be done January.
0:05:35 > 0:05:41Ten months on, three cancellations, so I'm hoping it'll happen today.
0:05:41 > 0:05:44- Getting worried about you. - I'm sorry, I'm sorry.
0:05:44 > 0:05:46'It's so important to her.
0:05:46 > 0:05:48'My mum puts on a brave face,
0:05:48 > 0:05:51'but knowing you've got a brain aneurysm is petrifying.
0:05:51 > 0:05:54'It's heartbreaking to see a family member,
0:05:54 > 0:05:57'especially your mum, go through something like this.'
0:05:57 > 0:06:01The one thing they stressed to my mum is not to get stressed,
0:06:01 > 0:06:06and this whole year has been nothing but a stressful period for her.
0:06:10 > 0:06:12Hello, Valerie.
0:06:12 > 0:06:15So, today, we've got you in a bed,
0:06:15 > 0:06:17so we have a head start.
0:06:17 > 0:06:19But it has been a bit of a struggle.
0:06:19 > 0:06:22It's the fourth time I've been here.
0:06:22 > 0:06:25We feel your emotion, we feel your pain...
0:06:25 > 0:06:28I don't think there's any way we're going to cancel you.
0:06:28 > 0:06:29I'm not going home.
0:06:29 > 0:06:32You will have priority today,
0:06:32 > 0:06:35we will go ahead, we won't cancel your case.
0:06:35 > 0:06:36Even if we've got bed issues today,
0:06:36 > 0:06:39we will really do everything possible.
0:06:39 > 0:06:42- OK, so we'd better get cracking.- OK.
0:06:44 > 0:06:47- Any questions?- No. - Just get it over with!
0:06:53 > 0:06:56Before Kevin can start Valerie's procedure,
0:06:56 > 0:07:00the intensive care team must prepare for the worst-case scenario.
0:07:03 > 0:07:07- Specialist surgery, and she needs a level 3 bed.- A level 3 bed?
0:07:07 > 0:07:09A level 3 bed, post op.
0:07:09 > 0:07:12If her operation runs into serious complications,
0:07:12 > 0:07:14Valerie will need a bed with life-support
0:07:14 > 0:07:16and one-to-one nursing.
0:07:16 > 0:07:19- How many nurses have we got? - We've got 17.
0:07:21 > 0:07:23We might be able to.
0:07:23 > 0:07:25One, two, three, four, five, six,
0:07:25 > 0:07:27seven, eight, nine, ten...
0:07:27 > 0:07:2912,
0:07:29 > 0:07:3213, 14, 15.
0:07:32 > 0:07:34SHE SIGHS
0:07:34 > 0:07:37- It's a bit tricky. - Cos we've got no emergency bed.
0:07:37 > 0:07:39No, no, no, exactly.
0:07:39 > 0:07:41I just don't think there's any way
0:07:41 > 0:07:44- that we're going to be able to do it.- No.
0:07:46 > 0:07:50Apparently she'd been cancelled a couple of times before.
0:07:50 > 0:07:52OK.
0:07:52 > 0:07:54Yes.
0:07:58 > 0:08:02- But if you haven't got the nurses to do it, it's irrelevant.- Yeah.
0:08:03 > 0:08:05OK.
0:08:05 > 0:08:08We don't like cancelling patients and, you know...
0:08:08 > 0:08:11but sometimes that decision is out of our hands.
0:08:11 > 0:08:15Every sort of decision impacts on somebody else, really.
0:08:22 > 0:08:26Availability of intensive care beds is constantly changing.
0:08:26 > 0:08:29The demand for the beds comes from departments including
0:08:29 > 0:08:33neurosurgery, ear, nose and throat, or ENT, and stroke.
0:08:33 > 0:08:36This morning, there is just one bed available,
0:08:36 > 0:08:39and competition for it is already high.
0:08:39 > 0:08:43Have you heard what's happening upstairs?
0:08:43 > 0:08:44Yeah, I heard.
0:08:44 > 0:08:47I think we're competing for the same ITU bed.
0:08:47 > 0:08:51- Yeah.- Is yours a hot aneurysm?
0:08:51 > 0:08:53I think mine trumps yours.
0:08:54 > 0:08:57She's been cancelled four times this month.
0:08:57 > 0:08:59Mine's been cancelled twice, so...
0:08:59 > 0:09:02It's a game of trumps, isn't it?
0:09:02 > 0:09:04Because we all want to do the best for our patients.
0:09:04 > 0:09:07- Absolutely.- Best of luck.
0:09:07 > 0:09:09Thank you.
0:09:11 > 0:09:14Dr Kyriakos Lobotesis also has a patient
0:09:14 > 0:09:17with a brain aneurysm who may need
0:09:17 > 0:09:19the intensive care bed after surgery.
0:09:21 > 0:09:24So, we're just waiting to hear.
0:09:24 > 0:09:27I have every confidence that they will do the best they can.
0:09:27 > 0:09:30Somehow, we need to fit our patients in.
0:09:30 > 0:09:33- PHONE RINGS - Hello, intensive care, can I help?
0:09:33 > 0:09:38Hi, intervention, how are you? Good.
0:09:38 > 0:09:41So, as soon as I know, I will give you guys a call back on 30777.
0:09:41 > 0:09:43Let's see what the situation is.
0:09:45 > 0:09:47- Hi, guys.- Hi.
0:09:47 > 0:09:48Any news?
0:09:48 > 0:09:50Yeah. I spoke to sister Nicky.
0:09:50 > 0:09:53She's saying I need to speak to Sarah Gordon.
0:09:53 > 0:09:56Got to create beds for these patients.
0:10:01 > 0:10:04Neither aneurysm operation can start until Sarah and Nicky
0:10:04 > 0:10:08move patients out of intensive care onto a general ward.
0:10:08 > 0:10:10But the general wards are full.
0:10:13 > 0:10:16OK. Maybe if you can let us know.
0:10:16 > 0:10:18PHONE RINGS
0:10:18 > 0:10:19Hello.
0:10:19 > 0:10:23Until a decision is made, two theatres are inactive.
0:10:23 > 0:10:26Yes, right, OK.
0:10:27 > 0:10:30In an ideal world, everybody would get their own bed
0:10:30 > 0:10:32and everybody would get done, but it's not an ideal world.
0:10:32 > 0:10:34PHONE RINGS
0:10:34 > 0:10:36Hello, intensive care, can I help?
0:10:36 > 0:10:38Oh, right, OK.
0:10:38 > 0:10:43They will keep calling until we've got a bed available, really.
0:10:43 > 0:10:46Cos they've got, obviously, so many people that they need
0:10:46 > 0:10:49to proceed with. The longer the delay is,
0:10:49 > 0:10:51you know, you worry about them not being able to do
0:10:51 > 0:10:53all of the cases on the list.
0:10:53 > 0:10:55Ten calls from IR there.
0:10:55 > 0:10:58- Oh, yeah. They're texting me as well.- God.
0:10:58 > 0:11:01- Shall we just say yeah? - I'm tempted just to say yes.
0:11:03 > 0:11:05Rather than cancel patients,
0:11:05 > 0:11:09Sarah gives the go-ahead for both operations to proceed.
0:11:09 > 0:11:12I think just do it, because otherwise, you know,
0:11:12 > 0:11:15it ends up later and later and, you know,
0:11:15 > 0:11:17then there are other problems.
0:11:17 > 0:11:20It's quite a common thing.
0:11:20 > 0:11:22What you tend to end up doing is, you know,
0:11:22 > 0:11:24we'll accept two patients when we've got one bed
0:11:24 > 0:11:27and hope that one doesn't need to come and if, at the end of the day,
0:11:27 > 0:11:28they do need to come,
0:11:28 > 0:11:30then we have to work out another strategy.
0:11:30 > 0:11:34So it makes things quite tough, doesn't it?
0:11:34 > 0:11:37It's no fun at our end, but, you know,
0:11:37 > 0:11:39otherwise patients get cancelled.
0:11:43 > 0:11:45Valerie is called to theatre.
0:11:46 > 0:11:50It's the end of a year-long wait for her operation.
0:11:51 > 0:11:55They don't even know if they've got a bed for her after the operation,
0:11:55 > 0:11:58which is so worrying, because if she needs to go to ITU after,
0:11:58 > 0:12:00and they're saying there isn't a bed available,
0:12:00 > 0:12:02who's going to look after her?
0:12:02 > 0:12:05Who's going to give her that one-to-one care that she needs?
0:12:07 > 0:12:10It's a big, invasive operation that she's having done.
0:12:11 > 0:12:13It's scary.
0:12:13 > 0:12:15It really is. It's scary.
0:12:18 > 0:12:20It's a serious business.
0:12:20 > 0:12:21We do have many challenges
0:12:21 > 0:12:25and, I mean, Mr O'Neill is much more qualified than me
0:12:25 > 0:12:28to speak about these issues, you know, the NHS is facing.
0:12:28 > 0:12:31But, yeah, it is very stressful for us as well,
0:12:31 > 0:12:33it's extremely stressful.
0:12:36 > 0:12:40Giulio Anichini from Italy came to London to train under Kevin.
0:12:42 > 0:12:45Giulio is basically my right-hand man.
0:12:45 > 0:12:48Suction. Excellent.
0:12:48 > 0:12:50Eccellente, Ambassador.
0:12:50 > 0:12:53EQUIPMENT WHIRS
0:12:53 > 0:12:56What's good is that we can share the struggle.
0:12:56 > 0:12:57Get things done.
0:12:57 > 0:12:59She's a lovely lady.
0:12:59 > 0:13:01She's a very nice lady.
0:13:01 > 0:13:03EQUIPMENT WHIRS
0:13:04 > 0:13:08It can't be easy, knowing you've got all these aneurysms in your head.
0:13:15 > 0:13:18The number of elective operations performed at Imperial
0:13:18 > 0:13:20has grown 50% in five years.
0:13:20 > 0:13:24Each month, at least 10,000 procedures are carried out.
0:13:35 > 0:13:38John is the second patient on Kevin's list today.
0:13:38 > 0:13:42For two years, he's suffered from a spinal disorder
0:13:42 > 0:13:44which causes acute leg pain.
0:13:44 > 0:13:48Yeah, exactly. Yeah. Hang on.
0:13:48 > 0:13:52His operation requires four hours' theatre time.
0:13:52 > 0:13:56It can only start once Valerie's is safely completed.
0:13:58 > 0:14:00I'm a patient man.
0:14:00 > 0:14:04The only reason I'm here is because of Kevin O'Neill.
0:14:04 > 0:14:06He certainly could not guarantee that the operation
0:14:06 > 0:14:08was going to take place today.
0:14:08 > 0:14:11However, he's very conscious the operation has been already
0:14:11 > 0:14:15cancelled once, so we'll wait and see.
0:14:16 > 0:14:19The stats are just unbelievable.
0:14:20 > 0:14:23"How long do Germans wait after seeing a specialist?
0:14:23 > 0:14:25"Two to three weeks."
0:14:25 > 0:14:29How does this compare to your waiting time?
0:14:29 > 0:14:31Mine, what, here?
0:14:31 > 0:14:32Yeah...
0:14:32 > 0:14:34I've been waiting since March.
0:14:34 > 0:14:38You know, the time it took to get the appointments done,
0:14:38 > 0:14:41the time it took to get the MRI scans,
0:14:41 > 0:14:45the time it took to get those things done was just ridiculous.
0:14:47 > 0:14:51It's still a good system, I suppose, compared with lots of countries.
0:14:51 > 0:14:53What, Third World or...
0:14:53 > 0:14:55- HE LAUGHS - ..Western world?
0:14:55 > 0:14:57- Western world.- Western world.
0:15:01 > 0:15:04Looks very, very unstable.
0:15:17 > 0:15:21The problem is that she's got a very fragile-looking aneurysm
0:15:21 > 0:15:23that's about to pop.
0:15:25 > 0:15:28To get that requires some complex clip.
0:15:32 > 0:15:35It's more complicated than we thought.
0:15:38 > 0:15:41Valerie's surgery is into its fourth hour.
0:15:41 > 0:15:43The longer the operation runs on,
0:15:43 > 0:15:46the more impact it has on other patients.
0:15:48 > 0:15:49Hi, Sarah.
0:15:51 > 0:15:55This is not as straightforward as these things can be.
0:15:57 > 0:16:01How long is it going to take? ..Right.
0:16:02 > 0:16:06The chances of Valerie needing an intensive care bed are rising.
0:16:10 > 0:16:12A clip across here.
0:16:15 > 0:16:16Yeah.
0:16:27 > 0:16:29OK. We need the bed.
0:16:36 > 0:16:38Right.
0:16:49 > 0:16:52The situation with the bed is, there is one ITU bed available,
0:16:52 > 0:16:54two complex cases, including ours,
0:16:54 > 0:16:57and I'm in the middle of a complex operation.
0:16:59 > 0:17:02Yes, it's constantly juggling, actually. Yeah.
0:17:02 > 0:17:05Although your focus is here, and has to be here,
0:17:05 > 0:17:08there are things going on in the background.
0:17:12 > 0:17:14OK.
0:17:16 > 0:17:18So the neuro case does need a bed.
0:17:18 > 0:17:20- Valerie?- Yeah.
0:17:20 > 0:17:23Do they try and put pressure on you?
0:17:23 > 0:17:26They do a little bit, but it's swings and roundabouts, you know.
0:17:26 > 0:17:29We put pressure on them, they put pressure on us.
0:17:29 > 0:17:34So, it can be a little stressful, but it's OK.
0:17:34 > 0:17:35Yeah.
0:17:37 > 0:17:40So, we were thinking about this one, weren't we?
0:17:40 > 0:17:43Because I was thinking more of something like this.
0:17:44 > 0:17:46That's very curved, isn't it?
0:17:46 > 0:17:50Kevin must fasten a metal clip around Valerie's aneurysm,
0:17:50 > 0:17:53a procedure that could cause a bleed on her brain.
0:17:53 > 0:17:56It's the most dangerous stage of her operation.
0:17:59 > 0:18:01- Let's just see what this looks like. - OK.
0:18:25 > 0:18:26Aneurysm clipped.
0:18:30 > 0:18:34And the clip is all over, right across the neck, you can see it.
0:18:36 > 0:18:37Good.
0:18:37 > 0:18:39Everything is preserved.
0:18:39 > 0:18:42Perfect, very happy with that result. Very good.
0:18:46 > 0:18:49The operation is a success.
0:18:50 > 0:18:54They don't want the case...the bed for the clipping, no? OK.
0:18:57 > 0:18:59It's all changed again.
0:19:10 > 0:19:12NURSE CALLS JOHN
0:19:12 > 0:19:14Thank you, ladies.
0:19:14 > 0:19:17John has been waiting nine hours for the operation
0:19:17 > 0:19:20to release trapped nerves in his back.
0:19:22 > 0:19:26So, decompression bilaterally here
0:19:26 > 0:19:30and then extend the spaces down to here.
0:19:30 > 0:19:34After being cancelled once before, his operation will now go ahead.
0:19:36 > 0:19:38Everything under control?
0:19:43 > 0:19:45All right, mate? Very well.
0:19:45 > 0:19:47Sorry about the wait.
0:19:47 > 0:19:51No, it's not your fault, it's Mr O'Neill's fault, probably.
0:19:51 > 0:19:52THEY LAUGH
0:19:52 > 0:19:58Cancellations, you know, we don't do these things lightly.
0:19:58 > 0:20:01Cancellations in themselves create their own problems.
0:20:01 > 0:20:05But our department is under a lot of demand and that comes from
0:20:05 > 0:20:08the good service that we offer and the good results that we get.
0:20:09 > 0:20:11Valerie...
0:20:11 > 0:20:14You're just waking up from the anaesthetic.
0:20:16 > 0:20:18Everything is done. The operation is done.
0:20:18 > 0:20:21We will keep a close eye on her to make sure she's fine.
0:20:21 > 0:20:24- I'm so pleased that we managed to do that.- Thank you so much.
0:20:27 > 0:20:30There's just such a high demand for the NHS.
0:20:30 > 0:20:33We've been waiting for this since January, so it's a big relief.
0:20:35 > 0:20:38The system is under strain. What do you do?
0:20:38 > 0:20:41There's only so much you can do in a week.
0:20:41 > 0:20:43You know, you can't beat the laws of physics
0:20:43 > 0:20:45and the time-space continuum.
0:20:48 > 0:20:50PHONE RINGS
0:20:53 > 0:20:55Good afternoon, neurosurgery.
0:20:57 > 0:20:59Yes.
0:20:59 > 0:21:01What I'll do is, I've sent the letter out to you,
0:21:01 > 0:21:03so you'll get the letter instead.
0:21:03 > 0:21:07Demand on Kevin's neurosurgery department is especially high.
0:21:07 > 0:21:09It's increased by a third in the past year.
0:21:09 > 0:21:12He has so many patients, it's never-ending.
0:21:12 > 0:21:14What kind of numbers are we talking about?
0:21:16 > 0:21:17Easily...
0:21:19 > 0:21:20Easily over 500.
0:21:22 > 0:21:24So there is quite a long wait.
0:21:24 > 0:21:26Many patients choose Imperial
0:21:26 > 0:21:29because of the reputation of its surgeons.
0:21:31 > 0:21:35We had to cancel a clinic today so he could do a theatre list
0:21:35 > 0:21:38and he's doing a clinic tomorrow in his own time
0:21:38 > 0:21:41to see the patients, because we don't have the capacity
0:21:41 > 0:21:43to move them elsewhere.
0:21:43 > 0:21:44Along with routine patients,
0:21:44 > 0:21:47Kevin also deals with emergency cases.
0:21:49 > 0:21:50Giulio, have you seen Mr Marson?
0:21:50 > 0:21:53We're going to see Mr Marson now. I've seen him this morning.
0:21:53 > 0:21:57Today, he's concerned about the health of Phil, a crane driver.
0:21:59 > 0:22:01Phillip. So, how does this arm feel? Is it quite weak?
0:22:01 > 0:22:06- Yeah, it's very weak.- Yeah. - And my leg.- And your leg as well.
0:22:06 > 0:22:09So, when was the last time you were able to walk?
0:22:09 > 0:22:11- Can you walk now or...- No.- No.
0:22:11 > 0:22:15Mr Marson came to the brain tumour clinic about a week or two ago
0:22:15 > 0:22:20with a history of... Well, you were falling over a bit, weren't you?
0:22:20 > 0:22:24And some weakness on the left side, which did actually...
0:22:24 > 0:22:27was discovered after attending his local casualty
0:22:27 > 0:22:31and they did a scan and found a brain tumour.
0:22:32 > 0:22:34It looks like a benign brain tumour,
0:22:34 > 0:22:37it's right over the sensory motor cortex.
0:22:37 > 0:22:40But the only way to really deal with it is to get this thing out.
0:22:40 > 0:22:43So, as he's been getting weak, progressively,
0:22:43 > 0:22:46over the last four, five days, we're going to move his surgery
0:22:46 > 0:22:49forward and try and do it urgently tomorrow.
0:22:49 > 0:22:52So I'm hoping this is just what we think it is
0:22:52 > 0:22:54and that's the end of it.
0:23:03 > 0:23:05The tumour on the scan looks benign,
0:23:05 > 0:23:09but the way it is behaving from a clinical point of view
0:23:09 > 0:23:13is making me worry whether it's something more malignant.
0:23:13 > 0:23:18Phillip, I've seen him on Monday, has been deteriorating more,
0:23:18 > 0:23:19which is very unusual.
0:23:19 > 0:23:23It's peculiar about this case, because usually it's not so quick.
0:23:23 > 0:23:25These are slow-growing lesions.
0:23:26 > 0:23:31Phil's fast-growing tumour has already reached six centimetres.
0:23:31 > 0:23:34There's a possibility it could be cancerous.
0:23:38 > 0:23:43I'm a tail crane driver. I see a lot of the sights of London.
0:23:43 > 0:23:45Don't go up the London Eye too much.
0:23:45 > 0:23:48I see it every day, mate.
0:23:50 > 0:23:52Yeah, I've got a partner, Chloe, yeah.
0:23:52 > 0:23:55Lots of friends and family have rallied round to help
0:23:55 > 0:23:59and come and see me, and a big support network, which is good.
0:24:01 > 0:24:04What can I do? Can't change what's happened.
0:24:04 > 0:24:07Well, hopefully he can.
0:24:09 > 0:24:12Phil is on the emergency operating list for tomorrow.
0:24:12 > 0:24:17We haven't got any choice. The sooner, the better.
0:24:17 > 0:24:19That's the best course of action for him.
0:24:26 > 0:24:28- Good evening.- Hiya.
0:24:28 > 0:24:31So, as I said, the operation is going to be done under
0:24:31 > 0:24:34general anaesthetic, so you'll be completely asleep.
0:24:34 > 0:24:35This lump is here,
0:24:35 > 0:24:39it's here, and we're going to expose this side of your head.
0:24:39 > 0:24:41What are the risks of this operation?
0:24:41 > 0:24:43I mean, we talk about that.
0:24:43 > 0:24:46There is a risk of potentially life-threatening complications.
0:24:46 > 0:24:48These include a number of awful things.
0:24:48 > 0:24:51Risk of coma, risk of neurological impairment,
0:24:51 > 0:24:53stroke, heart attack.
0:24:53 > 0:24:56Even dying from the operation, I'm afraid, is one of the risks.
0:24:56 > 0:24:58I'm telling you, because this is quite unpredictable.
0:24:58 > 0:25:00Some people just have them and we don't know why.
0:25:00 > 0:25:03But it is my duty to tell you that it is brain surgery,
0:25:03 > 0:25:05so any of these are potentially possible.
0:25:05 > 0:25:07Yeah, I understand that. Start messing about with it...
0:25:07 > 0:25:09- Is this happening tomorrow? - Tomorrow.
0:25:09 > 0:25:11So, I booked you for emergency theatre tomorrow.
0:25:11 > 0:25:13And, so, what? Just go down first thing in the morning?
0:25:13 > 0:25:16Hopefully, yes. 8.30, 9.00, something like that.
0:25:16 > 0:25:17All right, yeah.
0:25:23 > 0:25:25And these risks that I've mentioned to this gentleman,
0:25:25 > 0:25:28they're actually not far from happening.
0:25:28 > 0:25:30Sometimes we do see them, I'm afraid.
0:25:30 > 0:25:32This is a very serious operation.
0:25:32 > 0:25:35They need to be aware of everything
0:25:35 > 0:25:38that can potentially happen, and face it.
0:25:38 > 0:25:40Some of these are quite...
0:25:42 > 0:25:46Takes over a little bit...when somebody tells you all that.
0:25:46 > 0:25:48- It's the realisation, isn't it?- >
0:25:48 > 0:25:51Yeah, I could die.
0:25:52 > 0:25:54Thanks for that one(!)
0:26:07 > 0:26:11It's the morning of Phil's operation.
0:26:12 > 0:26:14SIRENS WAIL
0:26:16 > 0:26:2011 floors down, a man is admitted to A&E
0:26:20 > 0:26:22with a life-threatening bleed on the brain.
0:26:22 > 0:26:24Can you squeeze my hand?
0:26:27 > 0:26:30PHONE RINGS
0:26:32 > 0:26:36So, we've got a gentleman, known alcoholic,
0:26:36 > 0:26:41who has a very large left intracerebral haematoma.
0:26:41 > 0:26:44He's been intubated, ventilated and he's coming across.
0:26:46 > 0:26:49Charing Cross has ten operating theatres.
0:26:49 > 0:26:52Each one is booked out to different specialties.
0:26:52 > 0:26:56Theatre 8 is for emergencies.
0:26:56 > 0:26:58It's where Phil's brain tumour operation
0:26:58 > 0:27:01is scheduled to take place.
0:27:03 > 0:27:07But the new emergency case is also heading to theatre 8.
0:27:08 > 0:27:10I mean, this isn't...
0:27:10 > 0:27:12If it's superficial, it shouldn't take too long, isn't it?
0:27:12 > 0:27:15So we still might have time to do the other case, potentially.
0:27:15 > 0:27:18We're going to decompress, we're not going to chase
0:27:18 > 0:27:19all the last bit of clot.
0:27:19 > 0:27:21No, no, sure. Absolutely. Yeah, yeah. Fine.
0:27:29 > 0:27:32- I mean, this haematoma has priority. - Exactly, yes.- OK.- Yeah.
0:27:39 > 0:27:41Phillip, how are you?
0:27:41 > 0:27:45- Listen. We were just about to go... - Yeah.
0:27:45 > 0:27:48..and then there is a crashing emergency,
0:27:48 > 0:27:50undelayable emergency, that came through the door.
0:27:50 > 0:27:52But I don't want to fear now,
0:27:52 > 0:27:55because we might have an arrangement for this afternoon.
0:27:55 > 0:27:58- We really would like to push for today.- Yeah.
0:27:58 > 0:28:01Sorry for that. As soon as I've got news, I will let you know.
0:28:01 > 0:28:04- Yeah, if you'll just keep me informed.- Absolutely, absolutely.
0:28:08 > 0:28:10We need to do this chap today.
0:28:10 > 0:28:14He's becoming paralysed, that's our problem.
0:28:14 > 0:28:17So, they tell you you're on the emergency list
0:28:17 > 0:28:20and then, obviously, the other person is more of an emergency,
0:28:20 > 0:28:22so it's fair enough, you know.
0:28:22 > 0:28:25They don't just put people in front of you for no reason,
0:28:25 > 0:28:27do they? It's not...
0:28:27 > 0:28:29It's a selfish thing on my part.
0:28:38 > 0:28:41The surgery on Phil's brain tumour must wait.
0:28:41 > 0:28:44His life's on hold, and there's a big uncertainty
0:28:44 > 0:28:48about his future, so, he's putting a brave face on it,
0:28:48 > 0:28:50you know, he's a big, strong guy.
0:28:50 > 0:28:53Crane driver, you know, putting a brave face on it,
0:28:53 > 0:28:55but underneath that, you can see
0:28:55 > 0:28:57the concern and worry in his eyes,
0:28:57 > 0:29:00so that's part of the reason we're trying to get on with this.
0:29:00 > 0:29:02It's just hard.
0:29:02 > 0:29:05Emotions go up and down, you know.
0:29:05 > 0:29:08You think, "Oh, what's happening, what's happening?"
0:29:08 > 0:29:12People have been ringing me saying, "Oh, what's happening?"
0:29:15 > 0:29:17But it is what it is, and what can you do?
0:29:17 > 0:29:21Nature of the beast, really, isn't it?
0:29:28 > 0:29:32The Government committed that NHS trusts must treat patients
0:29:32 > 0:29:35within 18 weeks of GP referral.
0:29:38 > 0:29:42At Imperial, 10,000 patients have been waiting for treatment
0:29:42 > 0:29:44for over 18 weeks.
0:29:44 > 0:29:47We've found, because of administrative problems
0:29:47 > 0:29:50and our increased demand, we had more patients
0:29:50 > 0:29:52on the waiting list than we realised.
0:29:53 > 0:29:57475 have waited for more than a year.
0:30:02 > 0:30:06Waiting lists is probably the single top priority in my job,
0:30:06 > 0:30:09is to get this problem sorted.
0:30:09 > 0:30:11Is the problem going to go away?
0:30:11 > 0:30:14Er, so we've got a plan to meet...
0:30:14 > 0:30:18to get back to meeting the Government targets by next year.
0:30:18 > 0:30:21That priority is shared by the
0:30:21 > 0:30:25Divisional Director and the Chief Executive and the Medical Director,
0:30:25 > 0:30:27and we meet every week about it.
0:30:29 > 0:30:31So, by the end of November, that 475,
0:30:31 > 0:30:33what will that number be down to?
0:30:33 > 0:30:37- Six have already been treated.- And we're at the end of November now.
0:30:37 > 0:30:41- Yes.- So I would expect more than 6 of the 475 to have been treated.
0:30:41 > 0:30:44But some of these specialities sort of legitimately have too much
0:30:44 > 0:30:46going to be able to get this sorted out.
0:30:46 > 0:30:49Neurosurgery, it's an increase in referrals.
0:30:49 > 0:30:52- Yeah, it's a lot of theatre time, isn't it?- Theatre time, yeah.
0:30:52 > 0:30:56A number of strategies are being introduced to cut waiting times.
0:30:56 > 0:31:01At Imperial, like other trusts, these include outsourcing.
0:31:01 > 0:31:06So outsourcing is when we take a small number of patients, usually
0:31:06 > 0:31:09the routine ones, not the very complicated operations,
0:31:09 > 0:31:11and we phone the patient and ask them if they'd be happy
0:31:11 > 0:31:14to have their operation done at a private hospital.
0:31:14 > 0:31:16And we do that if we don't have the capacity to treat them
0:31:16 > 0:31:19quickly enough, within the Government's 18-week target.
0:31:19 > 0:31:21They reckon that'll take them 10 weeks
0:31:21 > 0:31:23from when we send them out, to see them in out-patients,
0:31:23 > 0:31:26arrange a date, do them in out-patients, discharge them.
0:31:26 > 0:31:2810 weeks is a lot quicker than we do it.
0:31:28 > 0:31:30Really, a private provider?
0:31:30 > 0:31:33Yeah. From our point of view,
0:31:33 > 0:31:36it's a short-term solution because our waiting lists were longer
0:31:36 > 0:31:39than we'd realised and we needed to do something fairly quickly.
0:31:41 > 0:31:45Outsourcing team, yeah. So if you have any concerns, give us a call.
0:31:45 > 0:31:48A dedicated outsourcing team is up and running.
0:31:48 > 0:31:51They are two weeks into the proposed six-month programme.
0:31:51 > 0:31:54It should all go smoothly. So best of luck.
0:31:54 > 0:31:56I hope everything goes well and you'll hopefully hear from them
0:31:56 > 0:31:58very soon with your appointment.
0:31:58 > 0:32:01OK, you're very welcome. Thanks for your time.
0:32:01 > 0:32:02Thanks. Bye.
0:32:05 > 0:32:10So far, 200 patients have agreed to be treated at private hospitals.
0:32:10 > 0:32:12Hi, there. I understand that you're waiting
0:32:12 > 0:32:16for an appointment under neurosurgery, is that right?
0:32:18 > 0:32:22'The private providers have agreed to do this for the same price
0:32:22 > 0:32:26'as the NHS pays, so it's financially neutral to the NHS.'
0:32:27 > 0:32:32So, ideologically, there's no difference between you being
0:32:32 > 0:32:36seen by the NHS or a private provider, paid for by the NHS?
0:32:36 > 0:32:40I'm not answering that question. What does "ideologically" mean?
0:32:41 > 0:32:45I'm just trying to get patients treated, OK?
0:32:45 > 0:32:47So, waiting lists are not an administrative thing.
0:32:47 > 0:32:50They're people, actually, who are waiting for operations.
0:32:50 > 0:32:52They find it very stressful,
0:32:52 > 0:32:54and we need to get them done in a reasonable level of time.
0:32:54 > 0:32:58Is that something you are happy to do?
0:32:59 > 0:33:03On the whole, people are kind of surprised to hear
0:33:03 > 0:33:06about the option, but usually fairly happy to go ahead,
0:33:06 > 0:33:09but there are some who are concerned.
0:33:09 > 0:33:13No, you don't need to pay, it's all covered.
0:33:13 > 0:33:15Where...
0:33:16 > 0:33:20Well, she wouldn't want it any sooner, so... She's declined.
0:33:29 > 0:33:32At Charing Cross Hospital, all ten theatres are in use.
0:33:34 > 0:33:38It is now too late to start the operation on Phil's brain tumour.
0:33:38 > 0:33:40Quite frustrating, when you're sitting around all day.
0:33:40 > 0:33:43You can't eat, you can't drink, from midnight last night.
0:33:43 > 0:33:46Messes with your head a little bit, cos you're hoping to get in
0:33:46 > 0:33:48and then you're not and then you are and then you're not.
0:33:50 > 0:33:53Kevin and Giulio are not scheduled to operate again
0:33:53 > 0:33:55until after the weekend.
0:33:55 > 0:33:58Phil's brain tumour continues to grow.
0:33:59 > 0:34:02Either we wait, which is frustrating for everybody,
0:34:02 > 0:34:05or we re-designate and re-plan
0:34:05 > 0:34:08and so we're going to have to find another way.
0:34:08 > 0:34:12- Here we go.- I'm tired. So the juggling continues.- Yeah.- Yeah.
0:34:12 > 0:34:14It's going on and on, isn't it?
0:34:14 > 0:34:18So I think we've got to do it, at least over the weekend.
0:34:18 > 0:34:20We could start first thing in the morning,
0:34:20 > 0:34:22I could come in, and I know it's a Saturday,
0:34:22 > 0:34:24but we can come in and...
0:34:24 > 0:34:26- You don't need to come. - No, no, I will, I will.
0:34:26 > 0:34:29- We've got to get these things done. - It's fine. OK.
0:34:34 > 0:34:37We are pretty much at 100% capacity. Beyond, actually.
0:34:37 > 0:34:41Ideally, what you need is a bit of leeway to deal with
0:34:41 > 0:34:46the reaction of surges in demand and emergency care.
0:34:46 > 0:34:49We just haven't got that leeway
0:34:49 > 0:34:52and that's why we spend a lot of our time, rather than operating,
0:34:52 > 0:34:56running around trying to sort things out. As you can see!
0:35:00 > 0:35:03Four floors away from the pressures of theatres,
0:35:03 > 0:35:05a clinical trial is underway.
0:35:06 > 0:35:08That's very good.
0:35:08 > 0:35:10Come over here and sit on the couch.
0:35:10 > 0:35:13As well as its five hospitals,
0:35:13 > 0:35:18Imperial Trust runs a world-leading clinical research programme.
0:35:18 > 0:35:21And now hold both hands up like that, spread the fingers.
0:35:24 > 0:35:25Fingers wide.
0:35:27 > 0:35:2952-year-old painter and decorator Selwyn
0:35:29 > 0:35:33suffers from a brain condition called essential tremor.
0:35:36 > 0:35:38And now just hold them by the nose.
0:35:39 > 0:35:43Its severity is rated on a scale of one to ten.
0:35:44 > 0:35:48- Now, this is an interesting one. - Selwyn is a nine.
0:35:54 > 0:35:57The tremors started about 20-odd years ago.
0:35:57 > 0:36:00Something to do with in your head, in your brain.
0:36:00 > 0:36:03I'm right handed, so the tremor's in my right hand,
0:36:03 > 0:36:05so it's been a bit difficult decorating.
0:36:05 > 0:36:08I've basically learnt to use my left hand over the years.
0:36:12 > 0:36:15I'm going to get you to draw from that dot, round the spiral,
0:36:15 > 0:36:17staying inside the lines.
0:36:21 > 0:36:23We're going to treat Selwyn
0:36:23 > 0:36:26in order to try and reduce the tremor in his right arm.
0:36:27 > 0:36:30The first time I actually saw non-invasive surgery,
0:36:30 > 0:36:35interestingly, was on Star Trek, 30 years ago, performed by Dr Sulu!
0:36:38 > 0:36:41Selwyn's tremor has worsened with age
0:36:41 > 0:36:43and is resistant to conventional treatment.
0:36:45 > 0:36:48I went through a load of procedures, tablets and all sorts,
0:36:48 > 0:36:50and they said the next course for me
0:36:50 > 0:36:52was just a drill drilling into my head.
0:36:53 > 0:36:57I didn't fancy that one. But this one, I'm well happy with it.
0:36:57 > 0:36:59If it works, it's brilliant.
0:36:59 > 0:37:04How it works is that an ultrasound beam, which is not powerful,
0:37:04 > 0:37:10as it's used, for example, to listen to babies in mothers' wombs,
0:37:10 > 0:37:16and therefore it doesn't damage the baby at all, is made powerful
0:37:16 > 0:37:22by the focusing of 1,004 ultrasound beams on a precise target.
0:37:24 > 0:37:27The team is preparing for next week's procedure.
0:37:28 > 0:37:32They will need a precise image of Selwyn's brain to map exactly
0:37:32 > 0:37:34where to focus the ultrasound beams.
0:37:43 > 0:37:47So contrast this with what we would have done with conventional,
0:37:47 > 0:37:49invasive surgery, drilling a hole in the skull,
0:37:49 > 0:37:54putting electrodes 15 centimetres into the brain.
0:37:54 > 0:37:57The risks are much reduced
0:37:57 > 0:38:00and the good thing is, this is just the beginning.
0:38:00 > 0:38:04In the future we look forward to using this for deep-seated
0:38:04 > 0:38:08brain tumours, where currently surgery is fraught with risk.
0:38:10 > 0:38:12So, it's quite a game-changer.
0:38:15 > 0:38:20One of the great things is that it takes this form of surgery away
0:38:20 > 0:38:26from a major operating theatre into a scanning unit.
0:38:26 > 0:38:29And of course that would allow, in principle,
0:38:29 > 0:38:34many more people to be treated, and treated effectively,
0:38:34 > 0:38:40without so much disruption or such a great wait for surgery.
0:38:46 > 0:38:49You will tell me, OK? That's the deal.
0:38:55 > 0:38:59After months of waiting and numerous cancellations,
0:38:59 > 0:39:01John and Valerie are recovering on the wards.
0:39:07 > 0:39:09Ask me, what do you want to know? How is the cut?
0:39:09 > 0:39:11- Yeah, how big is it?- OK.
0:39:12 > 0:39:15It's, in total, like that. OK?
0:39:18 > 0:39:22I'm very grateful, you know. I'm here.
0:39:22 > 0:39:25I'm alive and kicking, so, yeah, I'm very grateful.
0:39:27 > 0:39:30Very grateful for the NHS and what they've done for me.
0:39:31 > 0:39:34Take another deep breath in and out, OK?
0:39:37 > 0:39:40The thing which is noticeable, right,
0:39:40 > 0:39:43is that when you end up here in bed, it's brilliant.
0:39:43 > 0:39:45I mean, they're brilliant.
0:39:45 > 0:39:49So as soon as they sort you out in terms of, "Right, you're now going
0:39:49 > 0:39:53"into the operating room," from that moment onwards, you cannot fault it.
0:39:55 > 0:40:00The process before that is a disaster. It's an absolute disaster.
0:40:02 > 0:40:04It's just a shame it took so long,
0:40:04 > 0:40:06you know, all the messing around I've had, but, hey,
0:40:06 > 0:40:09it's done, so that's the main thing.
0:40:10 > 0:40:13So I will write to the CO, definitely.
0:40:14 > 0:40:18I'll tell her exactly what has happened to me and then
0:40:18 > 0:40:22hopefully the NHS will look at that and look at ways of changing.
0:40:23 > 0:40:25We'll wait and see.
0:40:32 > 0:40:34To deal with patient concerns,
0:40:34 > 0:40:38the trust has a dedicated patient liaison team.
0:40:38 > 0:40:41Today, they are at Kevin's weekly caseload meeting.
0:40:42 > 0:40:45This is one that the patient has made a formal complaint
0:40:45 > 0:40:49but what we're trying to do is manage it at a local level
0:40:49 > 0:40:51so that we can actually resolve it
0:40:51 > 0:40:54and the patient doesn't have to go through
0:40:54 > 0:40:56the formal complaint process.
0:40:56 > 0:40:58I do know the name.
0:40:58 > 0:41:00Thousands of patients are just coming back to me now.
0:41:00 > 0:41:01So...
0:41:01 > 0:41:03A man who needs spinal surgery
0:41:03 > 0:41:05has been waiting several months to see Kevin.
0:41:07 > 0:41:10I'd like to see him...urgently.
0:41:11 > 0:41:15What are your Christmas plans? Cos I can get him in in December.
0:41:15 > 0:41:16Without overbooking.
0:41:16 > 0:41:20- Don't have any plans at the moment, I'm just firefighting.- So you can...
0:41:20 > 0:41:23I'll stick him in, try and get him in before that.
0:41:24 > 0:41:26Try and get him in before that.
0:41:26 > 0:41:29We need to discuss this business of outsourcing and stuff.
0:41:29 > 0:41:32We promised patients that they would get treated within 18 weeks.
0:41:32 > 0:41:35I think it's a dangerous route, really, to outsource.
0:41:35 > 0:41:37My personal opinion.
0:41:38 > 0:41:40Cos it really disrupts continuity.
0:41:40 > 0:41:42The question is, whether they get the better...
0:41:42 > 0:41:45The bottom line is, whether these patients... Talk about out...
0:41:45 > 0:41:46It's not like a product.
0:41:46 > 0:41:49I don't think it's healthy for a patient to go
0:41:49 > 0:41:50and have another operation
0:41:50 > 0:41:52by somebody who's never seen them before.
0:41:52 > 0:41:55You know, you form a relationship with the patient,
0:41:55 > 0:41:58you create an opinion, which may be different from another doctor...
0:41:58 > 0:42:01It's just the sheer number of patients we have to get through.
0:42:01 > 0:42:02Yeah. It's true.
0:42:04 > 0:42:06What worries me is this thing about outsourcing,
0:42:06 > 0:42:11it's more of a kind of fudge than a fix. I mean...
0:42:11 > 0:42:15To a certain extent, there's a logic to it, and you can see
0:42:15 > 0:42:22that it's a fairly quick and easy win for many parties.
0:42:22 > 0:42:25But the money, rather than being invested into the system,
0:42:25 > 0:42:27is going out of the system.
0:42:28 > 0:42:30It is a form of privatisation.
0:42:30 > 0:42:34At the moment, it's being passed off as using capacity elsewhere,
0:42:34 > 0:42:37outside of the NHS, but why not build capacity in it,
0:42:37 > 0:42:42inside the NHS, er...where we can maintain standards and we can
0:42:42 > 0:42:46maintain continuity, most importantly?
0:42:46 > 0:42:48That's my main concern.
0:43:01 > 0:43:04Morning, how are you?
0:43:04 > 0:43:06They're sending for our patient, just to let you know.
0:43:06 > 0:43:08Perfect.
0:43:08 > 0:43:09Let's get this done today.
0:43:16 > 0:43:19Kevin and Giulio have come into work on a Saturday.
0:43:21 > 0:43:25It means the wait is over for brain tumour patient Phil.
0:43:39 > 0:43:41This tumour is on the surface of the brain,
0:43:41 > 0:43:43which is why Phil has this weakness.
0:43:43 > 0:43:47The difficulty with Phil's case is, it's been very aggressive
0:43:47 > 0:43:48in the way it's presented.
0:43:48 > 0:43:53Bit unusual for a benign tumour, so it may be it's cancer.
0:43:53 > 0:43:57We've done scans, but you can never be 100% sure.
0:43:57 > 0:43:59The only way is getting the thing out.
0:44:05 > 0:44:08- Right. See you later. - Right, good luck.
0:44:14 > 0:44:17Hopefully today's the first day of the recovery
0:44:17 > 0:44:19and getting back to normal.
0:44:29 > 0:44:30Go on.
0:44:37 > 0:44:41The first step is to remove part of Phil's skull, to access the tumour.
0:44:42 > 0:44:44This is a crucial part.
0:44:44 > 0:44:46The tumour can often get stuck,
0:44:46 > 0:44:48integrated into the skull a little bit.
0:44:50 > 0:44:51There's my fingernail.
0:44:51 > 0:44:54It's called the neurosurgical finger.
0:44:55 > 0:44:58See how it's all stuck? There's remnants.
0:44:58 > 0:45:01The tumour's actually invaded the bone, there.
0:45:04 > 0:45:06Fresh swab.
0:45:06 > 0:45:08There's the tumour.
0:45:08 > 0:45:13It is blending with the brain at its edges, which is a bit worrying.
0:45:18 > 0:45:20It looks kind of funny.
0:45:20 > 0:45:22- Remember we said it could be something funny?- Yeah.
0:45:29 > 0:45:33The tumour will be sent to the pathology lab for analysis.
0:45:36 > 0:45:38Do you think it's malignant, Kevin?
0:45:39 > 0:45:42Could be. It's looking more like it.
0:45:43 > 0:45:47It's a good job we persevered in getting him done, isn't it?
0:45:48 > 0:45:52Looks all right. Sometimes he can bleed from the pinpoint.
0:45:54 > 0:45:55The skin.
0:46:19 > 0:46:21So we managed to take the whole thing out.
0:46:21 > 0:46:24He should improve from the way he is now.
0:46:24 > 0:46:26I can't really tell you how much he's going to recover,
0:46:26 > 0:46:28if it's going to happen or not.
0:46:28 > 0:46:30Of course, we're going to keep an eye on him in the meantime. OK.
0:46:30 > 0:46:32- Thank you.- Cheers.
0:46:39 > 0:46:40He's waking up.
0:46:42 > 0:46:44Phil? Just relax. Just relax. Just relax.
0:46:44 > 0:46:47You're just waking up from the anaesthetic.
0:46:47 > 0:46:51Just lie back and... let it wash over you.
0:46:53 > 0:46:54How's this arm here?
0:46:56 > 0:46:59Can you move it? Oh, you can. Got a bit of tone in it.
0:46:59 > 0:47:01Can you feel me touch you?
0:47:01 > 0:47:03Yeah. Good.
0:47:05 > 0:47:10Now the tumour is out, the pressure on Phil's brain is released.
0:47:10 > 0:47:12What about your toes? Can you wiggle your toes?
0:47:13 > 0:47:17I can feel my toes. I can feel my toes better.
0:47:17 > 0:47:18Excellent. Good.
0:47:18 > 0:47:22- Well, the tumour's out.- Is it out? - Yeah, all the tumour's gone.
0:47:24 > 0:47:27When we approached it, it was just a little bit stuck and it
0:47:27 > 0:47:30looked like it was invading things.
0:47:30 > 0:47:34Overall, if that histology is good, then his prognosis is really good.
0:47:36 > 0:47:39It all really pins on what the nature of that tumour is.
0:47:41 > 0:47:45I'm hoping he's cured of this, and that's the end of the story.
0:48:05 > 0:48:08It's the morning of tremor patient Selwyn's operation.
0:48:10 > 0:48:13He's shaved his head in preparation for the procedure.
0:48:14 > 0:48:19It's strange. Didn't recognise him yesterday on the train!
0:48:19 > 0:48:20How are you feeling about it all?
0:48:20 > 0:48:25Bit anxious how he's going to be after the operation.
0:48:25 > 0:48:28Hopefully, like you said, tremor free and no side effects.
0:48:28 > 0:48:30You just don't know, do you?
0:48:37 > 0:48:40Has the patient confirmed his identity? He has.
0:48:40 > 0:48:43Has the central-imaging been reviewed? Yes.
0:48:43 > 0:48:44Anticipated blood loss? No.
0:48:47 > 0:48:49The underlying theme in all of this
0:48:49 > 0:48:51is the maximum possible safety for the patient.
0:48:51 > 0:48:53You are delivering large amounts of energy,
0:48:53 > 0:48:56in a very concentrated fashion, deep in the brain.
0:48:56 > 0:48:57Even though we don't open your head,
0:48:57 > 0:49:00even though we don't make a cut, or anything,
0:49:00 > 0:49:03it's still delivering energy inside your brain, so if it...
0:49:03 > 0:49:05So the structures around it,
0:49:05 > 0:49:07even a couple of millimetres here and there, are very important.
0:49:07 > 0:49:10So the very same thing which would control the tremor
0:49:10 > 0:49:11can also make you paralysed.
0:49:11 > 0:49:16But ballpark, overall, the risk of any of this happening is 1% risk.
0:49:16 > 0:49:19So that's me and, if you're happy, that's you. Sign here.
0:49:20 > 0:49:23And that's the other thing. Your handwriting should get better.
0:49:29 > 0:49:31A frame is bolted to Selwyn's skull
0:49:31 > 0:49:35to keep his head in place when the ultrasound beams are fired.
0:49:44 > 0:49:46Being brave, Marianna?
0:49:46 > 0:49:48Definitely being brave.
0:49:51 > 0:49:53Selwyn is one of only 20 patients
0:49:53 > 0:49:56taking part in this ground-breaking trial,
0:49:56 > 0:49:58funded by Imperial College Healthcare Charity.
0:50:04 > 0:50:06He will remain conscious throughout the procedure.
0:50:08 > 0:50:10This is a drawing of his spiral just now,
0:50:10 > 0:50:13laying in the scanner before we start operating.
0:50:13 > 0:50:16And you can see quite severe tremor.
0:50:16 > 0:50:19He could barely keep the pencil to the paper.
0:50:19 > 0:50:22We're starting with 150.
0:50:22 > 0:50:25150 at ten seconds.
0:50:29 > 0:50:31The ultrasound beams
0:50:31 > 0:50:33must be directed to the centre of Selwyn's brain.
0:50:35 > 0:50:37Extreme precision is essential.
0:50:37 > 0:50:39OK. Perfect.
0:50:41 > 0:50:43Each time the beams are triggered, Dr Bane
0:50:43 > 0:50:45checks there are no side effects.
0:50:46 > 0:50:48There are very many
0:50:48 > 0:50:50really important pathways
0:50:50 > 0:50:53coming close to the area we're operating on.
0:51:03 > 0:51:07It's three days since crane driver Phil's brain tumour was removed.
0:51:09 > 0:51:12This final examination will reveal if it's cancerous.
0:51:14 > 0:51:17Samples of the tumour have been
0:51:17 > 0:51:20hardened in formaldehyde
0:51:20 > 0:51:24and then put through a variety of chemicals,
0:51:24 > 0:51:26the end point of which is,
0:51:26 > 0:51:30the tumour being contained within blocks of paraffin wax.
0:51:33 > 0:51:36And very thin slices can be cut from that,
0:51:36 > 0:51:39and then stained with dyes
0:51:39 > 0:51:42which will show the nuclei,
0:51:42 > 0:51:44the centre of the cell, in one colour,
0:51:44 > 0:51:48and the cytoplasm, the rest of the cell, in another.
0:51:57 > 0:51:59The nuclei and the arrangement of the cells
0:51:59 > 0:52:01and the shape of the cells
0:52:01 > 0:52:03are issues that you examine
0:52:03 > 0:52:08when defining how good or not good this tumour might be.
0:52:20 > 0:52:22Let's have a look.
0:52:38 > 0:52:40We can get rid of that. That's the centre...
0:52:40 > 0:52:42And the adjustment, we want halfway.
0:52:42 > 0:52:45We should go back to the top and hit it again.
0:52:47 > 0:52:51Doctors have been firing ultrasound beams into Selwyn's brain
0:52:51 > 0:52:53for two hours.
0:52:53 > 0:52:55He's got no adverse effects.
0:52:55 > 0:52:58- So do you want to do a big one? - Yeah.
0:52:58 > 0:53:00Let's see how it goes.
0:53:27 > 0:53:30The effects on Selwyn are visible and immediate.
0:53:32 > 0:53:36That's a pretty magnificent achievement.
0:53:36 > 0:53:39It should make a dramatic difference to his quality of life,
0:53:39 > 0:53:40using that hand.
0:53:40 > 0:53:42Yeah. This is really fantastic.
0:53:42 > 0:53:43Just like that?
0:53:45 > 0:53:47It's absolutely amazing.
0:53:47 > 0:53:49Big smile on his face, yeah.
0:53:54 > 0:53:56Well done. That's great.
0:53:56 > 0:53:58First right-handed drink for a long time.
0:54:04 > 0:54:07The team hope to make non-invasive surgery available
0:54:07 > 0:54:09to other patients like Selwyn.
0:54:09 > 0:54:12One uses the word "game-changer" very loosely,
0:54:12 > 0:54:15but this is truly a game-changer.
0:54:15 > 0:54:18This is a much smarter way to use resources.
0:54:18 > 0:54:20It could become a day case procedure,
0:54:20 > 0:54:24so people could actually have their treatment and walk out and go home.
0:54:24 > 0:54:26So, given the full package,
0:54:26 > 0:54:29I would say this is almost a no-brainer
0:54:29 > 0:54:31for the National Health Service.
0:54:36 > 0:54:39Try and lead with your weaker leg.
0:54:42 > 0:54:45- Try and hold on with both hands, all right?- OK, sure.
0:54:46 > 0:54:47Take your time.
0:54:54 > 0:54:57Kevin has the results on Phil's tumour.
0:54:58 > 0:55:00Do you want the pre op and post op, or just the post op?
0:55:00 > 0:55:02- Pre and post op, please.- Yeah.
0:55:04 > 0:55:06We're just going to go and see Mr Marson.
0:55:06 > 0:55:08This is the tumour beforehand.
0:55:08 > 0:55:11I'm really happy for Phil,
0:55:11 > 0:55:13because it is actually a benign tumour.
0:55:13 > 0:55:16It's not the cancer we thought it might be.
0:55:19 > 0:55:20There was a little worry
0:55:20 > 0:55:22that it might have been something sinister.
0:55:22 > 0:55:23Post op.
0:55:23 > 0:55:27You can just see a little fingerprint of where the tumour was,
0:55:27 > 0:55:28so it looks really good.
0:55:28 > 0:55:31So I'm going to see him now.
0:55:31 > 0:55:32I'm excited.
0:55:32 > 0:55:34I was going to say, do you look forward to this bit?
0:55:34 > 0:55:37Yeah, this is the reward, isn't it? To see the result.
0:55:37 > 0:55:39Here he is.
0:55:39 > 0:55:41- You're doing very well, aren't you? - Yeah, I'm doing well, yeah.
0:55:41 > 0:55:44This the man who was lying in bed and couldn't walk.
0:55:44 > 0:55:46Let's have a look at your arm. Hold your arm up?
0:55:46 > 0:55:49- Wow.- It's all good. - Can you stand up?
0:55:49 > 0:55:51- Yeah.- Wow.
0:55:51 > 0:55:53I can't believe you're walking.
0:55:53 > 0:55:55I know, it's amazing.
0:55:55 > 0:55:58Been getting better by the hour. It's been very good.
0:55:58 > 0:56:00So I think we'll probably be able to get you out soon,
0:56:00 > 0:56:04- get you back home.- OK. - And we'll have an early follow-up.
0:56:04 > 0:56:06All done, all over and done with,
0:56:06 > 0:56:08and going home today, by the sounds of it,
0:56:08 > 0:56:10so it's all good news.
0:56:10 > 0:56:12You can jog down the pub now, can't you?
0:56:12 > 0:56:14Yeah, that will be the plan!
0:56:17 > 0:56:20The drive to cut waiting lists goes on.
0:56:22 > 0:56:25The outsourcing of some Imperial patients to private hospitals
0:56:25 > 0:56:28will continue until at least March.
0:56:30 > 0:56:33At the end of the day, despite all the problems,
0:56:33 > 0:56:37I still greatly believe that the NHS is a fantastic institution.
0:56:37 > 0:56:41Something that this country is recognised for around the world.
0:56:41 > 0:56:43We still manage to get great results.
0:56:43 > 0:56:45See you later.
0:56:45 > 0:56:47It's something that needs to be protected.
0:56:47 > 0:56:51Seeing people like Phil walk out, when they couldn't walk in,
0:56:51 > 0:56:52is what keeps me going.
0:56:53 > 0:56:56It's all worthwhile, when you see that.
0:57:34 > 0:57:38Overseas officer Terry tracks down foreign patients
0:57:38 > 0:57:40to bill them for their treatment.
0:57:40 > 0:57:42We use these. ATMs.
0:57:42 > 0:57:45I'm from the Overseas Patients' Office.
0:57:45 > 0:57:48- You're not entitled to free medical treatment?- No.
0:57:48 > 0:57:51In England, there is this assumption
0:57:51 > 0:57:53that it's free of charge,
0:57:53 > 0:57:55but that isn't the case.
0:57:55 > 0:57:58And he delivers one of the trust's biggest-ever bills
0:57:58 > 0:58:00to an overseas patient.
0:58:00 > 0:58:02- She's in there, is she?- Yeah. - OK, that's wonderful.
0:58:02 > 0:58:04I'm not in a position to say,
0:58:04 > 0:58:06"I accept that you can't sort the bill,
0:58:06 > 0:58:08"so, hey, we won't charge you."
0:58:08 > 0:58:10I don't have that power.
0:58:14 > 0:58:16What choices would you make
0:58:16 > 0:58:18when faced with complex health care decisions?
0:58:18 > 0:58:22Visit our interactive pages to find out how you would respond.
0:58:22 > 0:58:23Go to...
0:58:25 > 0:58:28..and follow the links to the Open University.