0:00:03 > 0:00:07This programme contains some scenes which some viewers may find upsetting
0:00:07 > 0:00:10Just move yourselves over to the side for a minute.
0:00:10 > 0:00:12This winter,
0:00:12 > 0:00:15one of Britain's busiest NHS trusts opened its doors...
0:00:15 > 0:00:17We have to look after patients,
0:00:17 > 0:00:20whether they come from Buck Palace or the park bench.
0:00:20 > 0:00:23..to show us what's really happening inside our hospitals.
0:00:23 > 0:00:26We've got lots of patients now
0:00:26 > 0:00:29competing for an unknown number of beds.
0:00:29 > 0:00:32Every week, more than 20,000 people are treated here.
0:00:32 > 0:00:36The pressure's just gone. What? Completely gone?
0:00:36 > 0:00:40And the numbers, as well as our expectations, are rising.
0:00:42 > 0:00:45We just had our worst ten days on record.
0:00:45 > 0:00:47There's nowhere in the hospital to move anybody.
0:00:47 > 0:00:49At some point somebody will be telling us whether we're
0:00:49 > 0:00:50allowed to do any work.
0:00:50 > 0:00:53This is a place with some of the best specialists in the world...
0:00:53 > 0:00:55Tumour's out. Job done.
0:00:55 > 0:00:57..where lives are transformed.
0:00:57 > 0:01:00This is saving his life. It has to work.
0:01:00 > 0:01:02But they are operating at a time when the NHS
0:01:02 > 0:01:04has never been under more pressure...
0:01:04 > 0:01:06Need beds? No.
0:01:06 > 0:01:08Got beds for anyone? No.
0:01:08 > 0:01:12It does feel to me like the elastic's
0:01:12 > 0:01:16a bit nearer to breaking now than it ever was.
0:01:16 > 0:01:19..its very future under scrutiny.
0:01:19 > 0:01:22All right, I think we will go out on red cos we're under real pressure
0:01:22 > 0:01:23in the emergency department.
0:01:23 > 0:01:27We're aware of the problems. Anybody got a solution?
0:01:27 > 0:01:30Following the patients from the moment they are admitted...
0:01:30 > 0:01:33Anything I've done up to this point means nothing compared to
0:01:33 > 0:01:37when you can literally give a bit of yourself to save someone else.
0:01:37 > 0:01:39..to the moment they leave.
0:01:39 > 0:01:42It's all good news. The cancer has gone.
0:01:42 > 0:01:44You don't need any more treatment.
0:01:44 > 0:01:47Fantastic. Thank you so much.
0:01:47 > 0:01:52Week by week, we reveal the complex decisions the staff must make
0:01:52 > 0:01:55about who to care for next.
0:01:55 > 0:01:59That patient is coming to me to be operated on and if I don't do it
0:01:59 > 0:02:03then there's only one inevitable outcome - they're going to die.
0:02:08 > 0:02:13SIRENS WAIL
0:02:13 > 0:02:17Imperial College Healthcare NHS Trust has five hospitals
0:02:17 > 0:02:20spread across Central London.
0:02:20 > 0:02:23Right, good morning, everybody. It's 8:30 on Monday morning.
0:02:23 > 0:02:26Let's go to St Mary's.
0:02:26 > 0:02:28We've let the majority of surgery go ahead.
0:02:28 > 0:02:30Electives for today, we've got one for Charles Pannett,
0:02:30 > 0:02:34three for the SIC, two vascular, two gynae and two orthopaedic.
0:02:34 > 0:02:38As you've can see, we've got 22 in the department, a large amount
0:02:38 > 0:02:41of patients, which are red, and have been over four hours...
0:02:41 > 0:02:47After a busy weekend of admissions, St Mary's A is already full.
0:02:47 > 0:02:51Don't worry, we'll sort you out.
0:02:51 > 0:02:55Our door through ED is always open,
0:02:55 > 0:02:58irrespective of where someone comes from
0:02:58 > 0:03:00and irrespective of how they get here.
0:03:00 > 0:03:02We cover all of Northwest London.
0:03:02 > 0:03:05Obviously we've got Paddington Station, Heathrow Airport,
0:03:05 > 0:03:08Oxford Street - so it's a huge area
0:03:08 > 0:03:11and we will pick up anybody passing through.
0:03:11 > 0:03:15We don't have that ability to stop people and turn them away -
0:03:15 > 0:03:18you come to us and we will treat you.
0:03:18 > 0:03:21INDISTINCT CHATTER THROUGHOUT
0:03:24 > 0:03:25Morning.
0:03:25 > 0:03:29A regular visitor to the trust's emergency department is Terry
0:03:29 > 0:03:31from the Overseas Office.
0:03:31 > 0:03:34He's responsible for checking the list of overnight admissions
0:03:34 > 0:03:39to assess who is and who isn't eligible for free NHS care.
0:03:39 > 0:03:43There's hand-written sheets with all the patients that have
0:03:43 > 0:03:45been admitted over the last 24 hours.
0:03:45 > 0:03:50NHS trusts are obliged by law to identify overseas patients
0:03:50 > 0:03:53and charge them for their treatment.
0:03:53 > 0:03:56There is this assumption that it's free of charge
0:03:56 > 0:03:58but that isn't the case.
0:03:58 > 0:04:01The main criteria to receive free medical treatment in the UK
0:04:01 > 0:04:03is residency.
0:04:03 > 0:04:04You have to be resident here.
0:04:04 > 0:04:08My name is Terry. I'm from the Overseas Patient Office, sir.
0:04:08 > 0:04:10Just need a quick word with you.
0:04:10 > 0:04:13What, Officer? I'm from the Overseas Patient Office.
0:04:15 > 0:04:17The Overseas Patient Office.
0:04:17 > 0:04:19The Overseas Patient Office.
0:04:19 > 0:04:22Can you finish your conversation?
0:04:25 > 0:04:27Stay in the bed, sir.
0:04:29 > 0:04:31Stay in the bed.
0:04:31 > 0:04:33No, stay in the bed, sir.
0:04:33 > 0:04:35You don't need to get up.
0:04:35 > 0:04:38No, just stay in the bed.
0:04:38 > 0:04:41Because you're on a tourist visa,
0:04:41 > 0:04:44you're not entitled to free medical treatment.
0:04:46 > 0:04:49'We use ATMs, card reader,'
0:04:49 > 0:04:54very effective in being able to take a payment on the spot.
0:04:56 > 0:04:58?800 a day.
0:05:00 > 0:05:03I understand that but that's what we have to charge, sir.
0:05:06 > 0:05:08In an emergency,
0:05:08 > 0:05:11Imperial staff won't ask to see a person's identification
0:05:11 > 0:05:13before treating them.
0:05:13 > 0:05:14The first thing I'm looking for
0:05:14 > 0:05:16is to make sure they've got an NHS number.
0:05:16 > 0:05:20If the patient doesn't have an NHS number then it can be an indication
0:05:20 > 0:05:21that actually they're not resident.
0:05:21 > 0:05:24Also I'm looking for overseas addresses.
0:05:24 > 0:05:27It's a quick sweep of picking up patients who have come in.
0:05:27 > 0:05:30There's a patient here without an NHS number.
0:05:30 > 0:05:35Moved to Italy two weeks ago and now suddenly he's returned.
0:05:35 > 0:05:39But he's got no GB registration that we can see.
0:05:44 > 0:05:47The patient arrived in A yesterday.
0:05:47 > 0:05:49Hello, sir.
0:05:49 > 0:05:51Sorry to wake you.
0:05:51 > 0:05:54He came in complaining of kidney problems.
0:05:54 > 0:05:56Sorry to wake you. I need to speak with you.
0:05:56 > 0:05:58Yeah, yeah. Yeah?
0:05:59 > 0:06:02How are you? Give yourself a moment to wake up.
0:06:02 > 0:06:04OK. Yeah?
0:06:04 > 0:06:05What's your nationality?
0:06:07 > 0:06:08Sorry?
0:06:08 > 0:06:10You're from Palestine.
0:06:10 > 0:06:13So you arrived back in the UK yesterday, you said.
0:06:15 > 0:06:17Sorry?
0:06:17 > 0:06:19You were living in Italy? OK.
0:06:19 > 0:06:22Do you hold Italian nationality, sir?
0:06:22 > 0:06:25Hm? Do you hold Italian nationality?
0:06:25 > 0:06:27You don't.
0:06:27 > 0:06:30So, have you claimed asylum here?
0:06:30 > 0:06:33Hm? Have you claimed asylum in the UK? Mm-hm. You have?
0:06:34 > 0:06:37Yeah? And when you claimed asylum,
0:06:37 > 0:06:42have the Home Office given you a residency in the UK? In England?
0:06:46 > 0:06:49Right. So what sort of travel documents do you have?
0:06:49 > 0:06:51Hm? What travel document do you have?
0:06:53 > 0:06:54Oh, you don't have any documents?
0:06:54 > 0:06:57What I need to understand is whether you have a legal right
0:06:57 > 0:06:59to live in the UK.
0:06:59 > 0:07:02Mm-hm. If we can't confirm that you're resident here
0:07:02 > 0:07:05then we will charge you for your treatment.
0:07:05 > 0:07:07I'm going to have to do some checks
0:07:07 > 0:07:10and we'll come back to you.
0:07:10 > 0:07:11Yeah.
0:07:11 > 0:07:17'It's very frustrating because I cannot confirm his residency here
0:07:17 > 0:07:21'and he's telling me that he has gone through the asylum process,'
0:07:21 > 0:07:25but what's frustrating is he cannot give me a straight answer as to what
0:07:25 > 0:07:29documents he does have and what he doesn't have, which would enable me
0:07:29 > 0:07:34to make a judgment on his entitlement to health care.
0:07:35 > 0:07:39If a patient can demonstrate that they are a refugee or a registered
0:07:39 > 0:07:44asylum seeker, they will be entitled to free NHS care.
0:07:44 > 0:07:49So what I will do is put a request through to Immigration
0:07:49 > 0:07:53to find out what his immigration status is.
0:07:55 > 0:08:00INTERVIEWER: How do you get from Italy to the UK without any papers?
0:08:02 > 0:08:03Really?
0:08:45 > 0:08:49Across London, a woman is being transferred from A at St Mary's
0:08:49 > 0:08:51to its sister hospital Hammersmith
0:08:51 > 0:08:53for an urgent operation.
0:08:57 > 0:08:59You need to be positive.
0:08:59 > 0:09:02All right? You'll be going off to the anaesthetic room
0:09:02 > 0:09:05where you're going to go off to sleep. OK?
0:09:06 > 0:09:10Cardiologists have discovered 56-year-old Sonia
0:09:10 > 0:09:13has dangerous narrowing of the arteries and could have
0:09:13 > 0:09:15a heart attack at any moment.
0:09:17 > 0:09:20This is my youngest sister. She's on holiday here from the Philippines,
0:09:20 > 0:09:22she wasn't feeling well,
0:09:22 > 0:09:26she was shivering and she's having chest pain.
0:09:26 > 0:09:31She's shaking and she's worried, so I tried to reassure her.
0:09:31 > 0:09:33I said everything will be OK.
0:09:39 > 0:09:43I hope the operation...goes well
0:09:43 > 0:09:46and she'll be OK.
0:09:46 > 0:09:48Fingers crossed.
0:09:48 > 0:09:51INTERVIEWER: Did she have travel insurance?
0:09:51 > 0:09:53Erm...
0:09:53 > 0:09:56unfortunately, she didn't have one.
0:09:56 > 0:09:58Sonia's operation will be conducted
0:09:58 > 0:10:02by the hospital's world-renowned cardiac team.
0:10:02 > 0:10:05Hammersmith Hospital is a specialist cardiac hospital.
0:10:05 > 0:10:09It does not have an acute accident and emergency department.
0:10:09 > 0:10:13However, any patient in the region who presents with chest pain
0:10:13 > 0:10:16will be brought here immediately by ambulance.
0:10:20 > 0:10:22In charge of the operation
0:10:22 > 0:10:25is veteran heart surgeon Rex Stanbridge.
0:10:25 > 0:10:29The heart scan showed narrowing of all the important arteries
0:10:29 > 0:10:34of her heart. Effectively, it's like a blockage in the high street -
0:10:34 > 0:10:38the cars can't go through and the blood's not getting through
0:10:38 > 0:10:39to the muscle of the heart.
0:10:39 > 0:10:43What we're doing is making a bypass round the high street.
0:10:47 > 0:10:50It's going fine, very well.
0:10:50 > 0:10:52Quite anxious for her, as well as you,
0:10:52 > 0:10:56and we think might be nice of you to sit down outside.
0:10:56 > 0:10:59So I'll wait there? You can wait out there, yes.
0:10:59 > 0:11:03Go and do a bit of retail therapy.
0:11:03 > 0:11:05Thank you, bye-bye.
0:11:05 > 0:11:08It's not good to sit right outside the theatres. If anything were to
0:11:08 > 0:11:11happen or something, you can imagine a relative might get wind of it
0:11:11 > 0:11:15and they'd sort of go hysterical and come rushing in and screaming
0:11:15 > 0:11:16and stuff and that would put everybody off.
0:11:16 > 0:11:20Also, the patient is probably aware of her and that makes the patient
0:11:20 > 0:11:22more concerned.
0:11:22 > 0:11:25Cos the patient is worried about the relative and the relative
0:11:25 > 0:11:28is worried about the patient, and so on.
0:11:30 > 0:11:31What do you think?
0:11:34 > 0:11:36Sonia needs a quadruple bypass.
0:11:36 > 0:11:39The surgeons must take veins from her leg
0:11:39 > 0:11:42to make new blood vessels to replace her blocked arteries.
0:11:43 > 0:11:46So you've got just the length of this much at the moment.
0:11:49 > 0:11:52We'll go in your...this bit. Can I have a swab, please?
0:11:53 > 0:11:57Rex must decide whether to stop Sonia's heart mid-surgery
0:11:57 > 0:12:01using a pump to keep her alive while the bypass is completed.
0:12:04 > 0:12:07The standard method is to attach the patient
0:12:07 > 0:12:10to a heart-lung bypass machine, take the blood out of the heart,
0:12:10 > 0:12:12put it into a machine, circulate it, warm it,
0:12:12 > 0:12:15oxygenate it as you need, put it back in.
0:12:15 > 0:12:18The way of doing it without using the heart-lung machine
0:12:18 > 0:12:22is called off-pump surgery and it is a benefit to the patient.
0:12:22 > 0:12:27Not circulating blood through machines,
0:12:27 > 0:12:29the blood doesn't get damaged in the same way.
0:12:31 > 0:12:35Conducting Sonia's bypass off-pump could reduce her recovery time
0:12:35 > 0:12:39after the operation, but it will mean keeping her heart beating
0:12:39 > 0:12:40throughout the delicate procedure.
0:12:46 > 0:12:50It's a practice I've been doing regularly for 20 years,
0:12:50 > 0:12:53but not all the surgeons like doing it that way.
0:12:53 > 0:12:58It's technically a tiny bit more difficult and it can go wrong.
0:12:58 > 0:12:59You know when you've got one heart
0:12:59 > 0:13:01and you think something might go wrong,
0:13:01 > 0:13:03you realise you haven't got another one as backup,
0:13:03 > 0:13:07so everyone's a little bit aware in heart operations.
0:13:07 > 0:13:10Before beginning Sonia's operation off-pump,
0:13:10 > 0:13:13Rex tests whether her heart will be strong enough
0:13:13 > 0:13:15to be moved around during surgery.
0:13:16 > 0:13:20Will the heart tolerate being lifted? It's beating quite nicely.
0:13:20 > 0:13:22If we look at the blood pressure, it's 120
0:13:22 > 0:13:27and if we do this very gently, we can lift the heart up.
0:13:28 > 0:13:33The pressure's now 76, put the heart down, the pressure will come up.
0:13:33 > 0:13:37So it looks like we will be able to do all the arteries off-pump,
0:13:37 > 0:13:40so we should be able to do this procedure as planned.
0:13:42 > 0:13:46Can I have the table up a little bit, please? Yes. Thank you. Stop.
0:13:46 > 0:13:50Sonia's surgery will take five hours and cost a minimum of ?5,000.
0:13:50 > 0:13:53We'll go in your...this bit. Can I have a swab, please?
0:13:53 > 0:13:57In the Philippines, before they can operate on you...
0:13:58 > 0:14:03..you have to...have money...
0:14:03 > 0:14:04See how it's all going.
0:14:06 > 0:14:11So if you're poor there, you don't have the capacity to pay...
0:14:13 > 0:14:14..you'll die.
0:14:31 > 0:14:34Well, I've been doing this job about 12 years now.
0:14:34 > 0:14:36INTERVIEWER: What did you do before it?
0:14:36 > 0:14:41My background is photography, in fact, but unfortunately I wasn't
0:14:41 > 0:14:45really able to make a sufficient living out of it, so we jumped ship.
0:14:46 > 0:14:47Yeah, travel photography.
0:14:47 > 0:14:50That sort of ties in with what I do now really.
0:14:53 > 0:14:55I mean, I applied for the job,
0:14:55 > 0:14:58not fully understanding, you know, what the job entailed,
0:14:58 > 0:15:00but I've grown into the role
0:15:00 > 0:15:03cos there's so many difficulties in the role,
0:15:03 > 0:15:07not least, you know, very contentious communication,
0:15:07 > 0:15:10not only with the patient but with the patient's relatives.
0:15:11 > 0:15:16Under NHS regulations, treatment in A is free to all.
0:15:16 > 0:15:18It's only when an overseas patient
0:15:18 > 0:15:20is admitted onto a ward that charges begin.
0:15:23 > 0:15:27When did he arrive in the UK? I think it was maybe a month ago.
0:15:27 > 0:15:29They're visiting me. I live here.
0:15:29 > 0:15:31So he's travelling with his wife? Yes. OK.
0:15:32 > 0:15:35Mahir is also under the care of the heart team.
0:15:35 > 0:15:38He had a heart attack while on holiday from Turkey
0:15:38 > 0:15:39visiting his daughter in the UK.
0:15:43 > 0:15:46So he's just visiting from Turkey.
0:15:46 > 0:15:49OK, because we do charge for treatment
0:15:49 > 0:15:53and I think possibly discussing surgery. That's right, yes.
0:15:53 > 0:15:55I'm waiting for the surgeons. They haven't discussed it with me.
0:15:55 > 0:15:57They haven't discussed it with you? OK.
0:15:57 > 0:16:00At the moment the charge is going to be ?800.
0:16:00 > 0:16:02Now, if he stays and has surgery,
0:16:02 > 0:16:04he could be here for about ten days,
0:16:04 > 0:16:08this could be costing ?15,000-?20,000.
0:16:08 > 0:16:12?15,000-?20,000? Yeah, if he was to have his surgery here. OK.
0:16:13 > 0:16:15This is what we call an agreement to pay
0:16:15 > 0:16:17because we're going to be charging the patient for treatment
0:16:17 > 0:16:21and we ask the patient or a relative to sign it. OK.
0:16:21 > 0:16:24Would you be happy to sign it?
0:16:24 > 0:16:28This is the only way to proceed with, you know, his surgery,
0:16:28 > 0:16:30the doctors won't talk to us if there's...
0:16:30 > 0:16:33if I've not agreed to pay? No, no, no, no.
0:16:33 > 0:16:38They will...they will decide whether to pursue treatment... OK.
0:16:38 > 0:16:41..based on the clinical need.
0:16:41 > 0:16:44OK. OK. So this will not inter...
0:16:44 > 0:16:48If he needs surgery, then it will go ahead... OK. ..regardless.
0:16:50 > 0:16:51It's a question of informing people
0:16:51 > 0:16:53that we're going to be charging them,
0:16:53 > 0:16:55on the one hand, but also reassuring them
0:16:55 > 0:16:59that they are going to be treated appropriately on the other hand
0:16:59 > 0:17:02and that if the treatment is absolutely necessary,
0:17:02 > 0:17:03it will go ahead.
0:17:03 > 0:17:07The worst case scenario is that the patient wants to leave the hospital
0:17:07 > 0:17:09immediately because of the charges.
0:17:10 > 0:17:12Most of the patients we deal with
0:17:12 > 0:17:14I would not define as health tourists.
0:17:14 > 0:17:19They're not here specifically for... to access free medical treatment,
0:17:19 > 0:17:20they're here on holiday usually
0:17:20 > 0:17:22and they've fallen ill or they have an accident.
0:17:22 > 0:17:25You know, here at this moment, we just...
0:17:25 > 0:17:28At night my father had a heart attack and we came here.
0:17:28 > 0:17:31The most important is his health,
0:17:31 > 0:17:32so I would sign any paper, right? So...
0:17:33 > 0:17:38INTERVIEWER: Has your father been made aware of the costs yet
0:17:38 > 0:17:39or anything like that?
0:17:39 > 0:17:43No, I told him I'll deal with it, you know, he doesn't need to...
0:17:43 > 0:17:47You know, he already has a very serious condition,
0:17:47 > 0:17:50so I just want my father to be healthy and well
0:17:50 > 0:17:52and this is a good hospital.
0:17:52 > 0:17:54I hope the surgeons and the doctors are good
0:17:54 > 0:17:57and that's the most important thing for me right now.
0:18:02 > 0:18:06Before the Palestinian man's immigration status can be checked,
0:18:06 > 0:18:08he leaves the hospital.
0:18:09 > 0:18:12So he had his procedure and he was discharged
0:18:12 > 0:18:15and there is a possibility that, you know,
0:18:15 > 0:18:17he will disappear into the community
0:18:17 > 0:18:20and we won't see him again here any time soon.
0:18:20 > 0:18:22Does that happen often?
0:18:22 > 0:18:24Yes, it does, it happens quite a lot, yeah,
0:18:24 > 0:18:30and it's more pertinent with, you know, illegal immigrants
0:18:30 > 0:18:33or people who have overstayed their visas
0:18:33 > 0:18:36because we know that they're not likely to come back
0:18:36 > 0:18:39if they can help it, basically.
0:18:39 > 0:18:41If it does turn out that he's not entitled,
0:18:41 > 0:18:45or that he doesn't have a residency in the UK,
0:18:45 > 0:18:49then all we can do is send out an invoice through the home address.
0:18:49 > 0:18:50What more can you do?
0:18:50 > 0:18:56You know, it's a wider issue than just accessing healthcare.
0:19:11 > 0:19:14The trust's neo-natal intensive care unit
0:19:14 > 0:19:18is one of Britain's leading centres for premature babies.
0:19:18 > 0:19:20What's it like to take blood from a baby so young?
0:19:37 > 0:19:39Amongst the most vulnerable,
0:19:39 > 0:19:42three siblings born more than three months before their due date.
0:19:42 > 0:19:47Hello, I've come to find out how Priscilla's babies are doing.
0:19:47 > 0:19:53Oh, naturally they are still in very critical state,
0:19:53 > 0:19:55so they all need
0:19:55 > 0:19:57continuous support and monitoring,
0:19:57 > 0:20:01so, yeah. OK. It is very difficult.
0:20:01 > 0:20:04We have to be honest with her.
0:20:06 > 0:20:08The baby's mother, Priscilla,
0:20:08 > 0:20:11is recovering nearby in the adult intensive care unit.
0:20:11 > 0:20:16Her life was at risk and, at one moment in time,
0:20:16 > 0:20:19we were very, very worried about her.
0:20:19 > 0:20:23She had collapsed, she wasn't breathing very well.
0:20:23 > 0:20:25She needed to be intubated.
0:20:25 > 0:20:27Thank you.
0:20:28 > 0:20:33Priscilla lives in Nigeria, where she works in health care.
0:20:54 > 0:20:57After receiving the treatment in Nigeria,
0:20:57 > 0:21:00Priscilla became pregnant with quadruplets.
0:21:35 > 0:21:39Priscilla boarded a plane from Nigeria to America.
0:22:02 > 0:22:04Priscilla boarded a flight back to Nigeria
0:22:04 > 0:22:07with a scheduled connection at London Heathrow.
0:22:33 > 0:22:35Soon after arrival,
0:22:35 > 0:22:41she was in labour and we delivered one of her babies.
0:22:41 > 0:22:44The baby was of a very low birth weight, less than a bag of sugar.
0:22:44 > 0:22:48Unfortunately, that baby died.
0:23:09 > 0:23:11She's gone from thinking that she was going to America
0:23:11 > 0:23:13to family and friends to finding herself
0:23:13 > 0:23:16in a hospital she doesn't know in a country she doesn't know
0:23:16 > 0:23:17with nobody she knows nearby,
0:23:17 > 0:23:19not knowing how long she's going to be there
0:23:19 > 0:23:21or how things are going to turn out.
0:23:21 > 0:23:25It's a pretty daunting, pretty terrifying situation
0:23:25 > 0:23:27to find yourself in, I think.
0:23:32 > 0:23:34Can I have the table up a little bit, please?
0:23:38 > 0:23:44After five hours in theatre, Sonia's quadruple heart bypass is complete.
0:23:46 > 0:23:49The operation has been done with a full graft
0:23:49 > 0:23:52using the off-pump technique.
0:23:52 > 0:23:56Her blood vessels were actually very small, so quite difficult.
0:24:00 > 0:24:02And although there were times when the blood pressures
0:24:02 > 0:24:06were not as robust as I'd like,
0:24:06 > 0:24:10nothing really bad has happened.
0:24:20 > 0:24:21Hello!
0:24:21 > 0:24:24OK, sit down, sit down.
0:24:24 > 0:24:29She's OK. She's fine. The operation went all right.
0:24:29 > 0:24:32She had the full graft, which she wanted to do.
0:24:32 > 0:24:33I think she'll be fine.
0:24:33 > 0:24:37I'm very pleased! We're going to keep her in asleep tonight
0:24:37 > 0:24:40and wake her up tomorrow morning cos they often do that
0:24:40 > 0:24:44when it's a slightly more difficult operation.
0:24:44 > 0:24:48We're very grateful... Not at all, not at all.
0:24:52 > 0:24:56Hello! Hi, how's it going? My name's Michael, I'm looking after her.
0:24:56 > 0:24:59So, she's just come out about 20 minutes ago. OK.
0:24:59 > 0:25:01At the moment, she's fine. We'd just like to monitor her,
0:25:01 > 0:25:05make sure she's not bleeding and her blood pressure's stable.
0:25:20 > 0:25:22She's on very, very minimal anaesthetic
0:25:22 > 0:25:23so she's doing really well so far.
0:25:23 > 0:25:25All right?
0:25:25 > 0:25:28But it's scary, isn't it?
0:25:31 > 0:25:34I love my sister very much.
0:25:34 > 0:25:36We are a very close-knit family.
0:25:36 > 0:25:39We love each other. We care for each other.
0:25:39 > 0:25:42That's why I asked her to come over here
0:25:42 > 0:25:46to have a holiday and I'm working here as much as possible.
0:25:46 > 0:25:50If I have the money, I can take her on holiday.
0:25:51 > 0:25:53Because she lost her husband 12 years ago
0:25:53 > 0:25:56and she's living there alone.
0:25:58 > 0:26:03But this kind of surgery, you have to pay a lot of money.
0:26:05 > 0:26:08Do you think it'll be OK, though? Yeah, it's good.
0:26:08 > 0:26:13You can find the money, but for her health, you know,
0:26:13 > 0:26:19you can't so it's a blessing that she had surgery here.
0:26:26 > 0:26:29Terry from the overseas office
0:26:29 > 0:26:32has been made aware of Priscilla from Nigeria.
0:26:32 > 0:26:37The care of her babies and her own treatment in intensive care
0:26:37 > 0:26:40could run into hundreds of thousands of pounds.
0:26:42 > 0:26:46She was an emergency and that's why she came to the hospital.
0:26:49 > 0:26:51If you accept quads,
0:26:51 > 0:26:57then you are looking at your neo-natal unit probably being full.
0:26:59 > 0:27:03The neo-natal intensive care unit has ten cots,
0:27:03 > 0:27:06each offering life-preserving breathing support
0:27:06 > 0:27:10and body temperature control for pre-term babies.
0:27:10 > 0:27:13Many of the babies treated here must stay on the unit
0:27:13 > 0:27:15for extended periods of time.
0:27:17 > 0:27:21The largest invoice I've raised for a single individual
0:27:21 > 0:27:24was just under ?200,000.
0:27:24 > 0:27:30I do know that the family have paid, to date, ?75,000 on that.
0:27:33 > 0:27:35Where is the patient? Isolation four.
0:27:35 > 0:27:38In this room. She's in there, is she? Yeah. OK, that's wonderful.
0:27:42 > 0:27:43Hello, Priscilla?
0:27:43 > 0:27:48Priscilla, my name is Terry. I'm from the overseas patients office.
0:27:48 > 0:27:51So, really, I'm here today just to introduce myself
0:27:51 > 0:27:53because I cover this hospital.
0:27:53 > 0:27:56The thing is, Priscilla,
0:27:56 > 0:27:58the hospital bills are going to be quite high.
0:27:59 > 0:28:01No, I understand that.
0:28:02 > 0:28:04You're going to be in England for a while, aren't you?
0:28:04 > 0:28:05Do you understand that?
0:28:05 > 0:28:07Erm...
0:28:07 > 0:28:12So, your husband, is your husband in Nigeria? Mm-hmm. He is.
0:28:12 > 0:28:15Will he be coming over at all,
0:28:15 > 0:28:16under these circumstances?
0:28:16 > 0:28:18He won't.
0:28:18 > 0:28:20When you're a bit more steady and you've come out of ITU,
0:28:20 > 0:28:23I'll come and see you again, OK?
0:28:23 > 0:28:27I do understand that it's a very difficult time for you,
0:28:27 > 0:28:33you know, but we do need to talk about the charges for the treatment.
0:28:33 > 0:28:38I do appreciate it's hard and, as I said, I do understand,
0:28:38 > 0:28:40you know, it's a very difficult time for you.
0:28:40 > 0:28:44Take this steady, a day at a time, OK?
0:28:44 > 0:28:46OK, you take care.
0:28:48 > 0:28:50The next stage, really,
0:28:50 > 0:28:53is to let her know that we have to start raising invoices
0:28:53 > 0:28:56on a regular basis, so it'll be a weekly basis,
0:28:56 > 0:28:58and those invoices are going to be huge
0:28:58 > 0:29:02because she's got three babies in ITU, you know,
0:29:02 > 0:29:07so that's, like, 20 grand a week for each baby.
0:29:19 > 0:29:22Sonia's condition is deteriorating.
0:29:22 > 0:29:23She's in the intensive care unit,
0:29:23 > 0:29:26receiving treatment for a suspected blood infection.
0:29:26 > 0:29:29She had the operation and then she was getting ready
0:29:29 > 0:29:32to go back to the ward. They took everything off.
0:29:32 > 0:29:36They sat her out on the chair,
0:29:36 > 0:29:40then later on, she became ill again.
0:29:43 > 0:29:48Apparently, they think it might be sepsis, so that's why
0:29:48 > 0:29:52they're treating her with antibiotics and blood transfusion.
0:29:55 > 0:29:59It is difficult, very difficult, thinking that she is very ill
0:29:59 > 0:30:03and we're just hoping and praying that she's going to pull through.
0:30:03 > 0:30:06We love her very much.
0:30:06 > 0:30:10Once they remove the tube there,
0:30:10 > 0:30:14she's going to have a tracheostomy, but the recovery is...
0:30:14 > 0:30:17The rehabilitation is long,
0:30:17 > 0:30:22but I don't mind as long as she gets better.
0:30:22 > 0:30:27Yeah, so she's in good hands. Everybody is doing good for her.
0:30:28 > 0:30:33An intensive care bed costs the trust around ?2,000 a night.
0:30:36 > 0:30:40It's unclear how long Sonia will have to stay on the unit.
0:30:40 > 0:30:43Now, I'm asking the doctor to give us a letter
0:30:43 > 0:30:45so that we can cancel her flight.
0:30:45 > 0:30:48Definitely not going, she's not ready to go home.
0:30:48 > 0:30:52I want them to take her alive and well so she has to get better.
0:31:03 > 0:31:07Having given birth eight days ago, today is the first time
0:31:07 > 0:31:10Priscilla has been well enough to go and see her babies.
0:31:10 > 0:31:13Right, so we'll now take this, just in case. Yes, that's good.
0:31:17 > 0:31:20Hey! How are you?
0:31:20 > 0:31:23Good to see you. You've come to see your little ones?
0:31:23 > 0:31:26So, your two little girls, numbers two and three,
0:31:26 > 0:31:27are on this side by the window
0:31:27 > 0:31:29and then your little boy's just there by the door.
0:31:29 > 0:31:32I'll come out of your way and you can come in and then we'll swap over
0:31:32 > 0:31:34and say hello to the others in a second.
0:31:40 > 0:31:42Did you say you've decided names for them?
0:31:44 > 0:31:46Is this Deborah? Is that the name you've picked for her, yeah?
0:31:46 > 0:31:48That's a nice name. I like that.
0:31:57 > 0:31:59She's another one who knows Mummy, doesn't she?
0:31:59 > 0:32:01She knows Mummy.
0:32:07 > 0:32:09This is your baby boy.
0:32:36 > 0:32:38I'll double-check the spellings before you go,
0:32:38 > 0:32:40just so we've got all the names right.
0:32:41 > 0:32:43It's a good day, yeah? A good day.
0:32:43 > 0:32:46First day you get to hold your babies' hands.
0:32:46 > 0:32:49Have you been waiting for this day?
0:32:49 > 0:32:51Thank you all. Thank you so much.
0:32:54 > 0:32:56You guys are great, good job!
0:32:58 > 0:33:01All three babies have a serious infection
0:33:01 > 0:33:03and their condition remains unstable.
0:33:05 > 0:33:08The babies were obviously born very prematurely.
0:33:08 > 0:33:12They were born at 24 weeks.
0:33:12 > 0:33:15The chances of survival are pretty limited, born that early.
0:33:15 > 0:33:18They're by no means out of the woods.
0:33:18 > 0:33:20They definitely need time to grow and develop.
0:33:43 > 0:33:45To nurse the three babies in intensive care
0:33:45 > 0:33:48costs the trust ?6,000 a day.
0:33:48 > 0:33:52Funds in the NHS are very, very finite.
0:33:52 > 0:33:54I think we would all feel that if you haven't put into the pot,
0:33:54 > 0:33:56you don't have an entitlement to take out of the pot,
0:33:56 > 0:33:59but then you look at somebody like Priscilla, who...
0:33:59 > 0:34:01It's not that straightforward always.
0:34:01 > 0:34:02What do you say?
0:34:02 > 0:34:04Do you pack her back on a plane to Nigeria
0:34:04 > 0:34:08in the condition she's in, where she's herself really unwell?
0:34:08 > 0:34:10Do you drag her away from those very, very tiny babies,
0:34:10 > 0:34:13who, you know, are still really fighting for their lives?
0:34:13 > 0:34:16Do you say to those tiny children who've had nothing to do with it,
0:34:16 > 0:34:19"Sorry, you're not entitled"?
0:34:19 > 0:34:21You know, the reality in individual cases
0:34:21 > 0:34:26is very, very different to the kind of big headlines of, you know,
0:34:26 > 0:34:28people taking what's rightfully ours, you know,
0:34:28 > 0:34:30people taking what they're not entitled to.
0:34:30 > 0:34:33It's really hard to make those decisions
0:34:33 > 0:34:35and I'm glad it's not my job to do it.
0:34:40 > 0:34:44The NHS's annual budget is around ?100 billion.
0:34:44 > 0:34:48It has been estimated that around ?450 million is spent each year
0:34:48 > 0:34:51treating overseas patients who have no entitlement
0:34:51 > 0:34:54to free UK health care.
0:34:56 > 0:35:00Terry is preparing an invoice for Filipino heart patient, Sonia.
0:35:00 > 0:35:04The cost of her treatment so far is ?18,000.
0:35:06 > 0:35:11This is Sonia's invoice, who's had open-heart surgery.
0:35:11 > 0:35:14She took a turn for the worse in terms of her recovery,
0:35:14 > 0:35:16so she's very poorly.
0:35:16 > 0:35:17She's from the Philippines.
0:35:17 > 0:35:21You know, she doesn't have that kind of money.
0:35:21 > 0:35:25And that's not the end of it. Her total now could reach...
0:35:25 > 0:35:27you know, ?40,000, I suspect.
0:35:35 > 0:35:41That will impact on her sister in this case and on other relatives,
0:35:41 > 0:35:47and so it really does bring my sort of role and the idea of
0:35:47 > 0:35:50presenting a huge bill and demanding payment...
0:35:50 > 0:35:52brings it into sharp focus.
0:35:52 > 0:35:58I'm here to see Sonia. So, which bed is she in? She's in bed five.
0:35:58 > 0:36:00Bed five, is she? OK.
0:36:04 > 0:36:06Rowena! Hi.
0:36:08 > 0:36:11Hi, Rowena. I just want to have a quick chat, if that's all right.
0:36:11 > 0:36:16Do you mind? No, no, no, not at all. So, erm, Rowena, erm...
0:36:16 > 0:36:21this is the invoice, which, as you know, we have to present. Of course.
0:36:21 > 0:36:26Yeah. OK? Now, clearly Sonia's been in ITU for a while now.
0:36:26 > 0:36:30By law, we have to present these. OK?
0:36:30 > 0:36:33So, er, I also need to ask you, are you able to make
0:36:33 > 0:36:36a small payment, a deposit, today, do you think?
0:36:36 > 0:36:40Er... At the moment, I...
0:36:40 > 0:36:41You know I'm retired?
0:36:41 > 0:36:45You're retired, yeah. I am. And a big mortgage, as well.
0:36:45 > 0:36:49I do understand. Yeah, yeah. So, at the moment, erm...
0:36:49 > 0:36:52My son is unemployed, as well, so... Right. OK. OK.
0:36:52 > 0:36:56That's another worry for me. OK. So, er...
0:36:56 > 0:36:59I'm not going to press you for that. OK? So, what I will say is,
0:36:59 > 0:37:02you know, there will be further invoices.
0:37:03 > 0:37:06You know, I think you need to look at the possibility of...
0:37:06 > 0:37:09you know, making a small payment on a monthly basis rather than
0:37:09 > 0:37:13paying the whole amount. OK? Mm-hm.
0:37:13 > 0:37:17But, erm, this won't disrupt your sister's treatment.
0:37:17 > 0:37:21You just need to know that, as well. Mm. OK? Mm.
0:37:24 > 0:37:27That's the first time I've seen Sonia myself.
0:37:27 > 0:37:29You know, she's very poorly.
0:37:31 > 0:37:34When you visually see a patient in that condition,
0:37:34 > 0:37:37then that has its own impact on me.
0:37:37 > 0:37:43So, you know, pursuing hardball on financial issues at this stage,
0:37:43 > 0:37:46you know, it sometimes isn't really appropriate.
0:37:47 > 0:37:52I don't want to talk about the payment yet.
0:37:52 > 0:37:56'I don't want to trouble myself yet, you know?
0:37:56 > 0:38:00'They're not forcing me to pay at this time.'
0:38:00 > 0:38:07All I'm focusing on at the moment is my sister's condition to improve.
0:38:12 > 0:38:17Imperial's overall annual budget is just over ?1 billion.
0:38:17 > 0:38:23In the last year, it spent over ?4 million treating overseas patients.
0:38:23 > 0:38:26It has been able to recover ?1.6 million.
0:38:26 > 0:38:30Shall I just phone him and find out how long it's going to be?
0:38:30 > 0:38:34As a proportion, overseas patients are a tiny, tiny proportion,
0:38:34 > 0:38:37much less than half a per cent
0:38:37 > 0:38:39of the work that we do.
0:38:39 > 0:38:41And the number of very high-value
0:38:41 > 0:38:42patients is of the order of
0:38:42 > 0:38:45one or two or three a year.
0:38:45 > 0:38:49But I think there is certainly more that we can do to reclaim
0:38:49 > 0:38:52the money from overseas patients.
0:38:52 > 0:38:56With more than half of the money owed by overseas patients going
0:38:56 > 0:38:59unrecovered, the trust decides to recruit a project manager
0:38:59 > 0:39:02for the overseas team to help them collect more debt.
0:39:03 > 0:39:07So, my understanding is we've got more money in from overseas patients
0:39:07 > 0:39:11this year than last year and that the idea of this post is
0:39:11 > 0:39:15that we're then going to be able to increase that further next year.
0:39:15 > 0:39:18Will they be on the ground?
0:39:18 > 0:39:22They need to be based on site and work from within
0:39:22 > 0:39:24rather than being off site.
0:39:24 > 0:39:27OK. And when do we think that post will get filled?
0:39:27 > 0:39:29Ideally... Well, it really depends.
0:39:29 > 0:39:32We'd be looking at six weeks at best.
0:39:32 > 0:39:35The advert is currently out and closes next week.
0:39:36 > 0:39:38Excellent.
0:39:39 > 0:39:44These patients can end up having quite expensive care.
0:39:44 > 0:39:47Obviously, we need to try and recoup that
0:39:47 > 0:39:49to plough back into our NHS services.
0:39:49 > 0:39:52The billing for the last financial year was, I believe,
0:39:52 > 0:39:544.2 or 4.3 million.
0:39:56 > 0:40:00I recognise it is a small part in terms of the money we recoup,
0:40:00 > 0:40:04but it's a part, it's an important part, and you have to look at it -
0:40:04 > 0:40:08well, what would ?4 million provide in terms of treatments?
0:40:08 > 0:40:14It's a no-brainer. How many nurses can you employ for ?4 million?
0:40:14 > 0:40:16Again, it's a no-brainer, isn't it?
0:40:16 > 0:40:19INTERVIEWER: What happens if, after repeated invoices,
0:40:19 > 0:40:21someone can't pay?
0:40:21 > 0:40:26So, with overseas patients, er, it...can be quite difficult.
0:40:26 > 0:40:29So, patients who leave,
0:40:29 > 0:40:33then obviously we would use all legal means that we have
0:40:33 > 0:40:37to try and recoup the money, and the finance department will,
0:40:37 > 0:40:39for patients who haven't paid,
0:40:39 > 0:40:43will report that to the Government,
0:40:43 > 0:40:44and on occasions that has meant
0:40:44 > 0:40:48that people have not been able to come back into the country
0:40:48 > 0:40:51or have been identified as they've been leaving the country
0:40:51 > 0:40:52in order to recoup that money.
0:40:57 > 0:41:01Terry is calculating Priscilla's latest bill.
0:41:01 > 0:41:06So, I've prepared, well, four invoices, in fact, for Priscilla.
0:41:06 > 0:41:09We invoice the babies under their own sort of details,
0:41:09 > 0:41:12but obviously we present that to the mother.
0:41:14 > 0:41:17They're just under ?100,000, these invoices.
0:41:21 > 0:41:26Some people might say that I'm a bit hard-hearted,
0:41:26 > 0:41:28but I wouldn't accept that at all.
0:41:28 > 0:41:31I think, you know, I have a capacity to ask a difficult question,
0:41:31 > 0:41:37you know, of someone in very difficult circumstances.
0:41:37 > 0:41:40'And you certainly have to distance yourself emotively, you know,
0:41:40 > 0:41:42'turn your emotions off, really.
0:41:42 > 0:41:46'Without that, you wouldn't get the job done.'
0:41:46 > 0:41:50You know? Erm, I'm not in a position to say, you know,
0:41:50 > 0:41:53"I'm very sorry for your trouble, your circumstances,
0:41:53 > 0:41:57"I accept that you can't afford the bill, so, hey, we won't charge you.
0:41:57 > 0:42:00"OK? How about that?" I don't have that power.
0:42:00 > 0:42:03Because I don't have that power, then I have no option
0:42:03 > 0:42:06but to make sure that they're given the correct information,
0:42:06 > 0:42:09that they will receive an invoice and that will be pursued.
0:42:11 > 0:42:15I'm here to see Priscilla. OK.
0:42:15 > 0:42:17Priscilla, hello. Hi.
0:42:17 > 0:42:21How are you... under the circumstances?
0:42:21 > 0:42:23Yes. You look a lot better today, I must say.
0:42:23 > 0:42:26That's good. We've been praying for you, anyway.
0:42:26 > 0:42:29Thank you. So, how are you feeling?
0:42:29 > 0:42:30OK. That's good.
0:42:30 > 0:42:35Well, you know, erm, obviously I've got not great news, I'm afraid,
0:42:35 > 0:42:38because I've had to raise some invoices for you.
0:42:38 > 0:42:43So, I've raised an invoice for you, for your treatment, OK?
0:42:43 > 0:42:46That's giving birth and your time here.
0:42:46 > 0:42:51And then these are the invoices for the three children.
0:42:51 > 0:42:54These bills are quite high, Priscilla.
0:42:55 > 0:42:57Sorry?
0:42:57 > 0:43:01I'm afraid they're not negotiable, no.
0:43:01 > 0:43:07You know, the trust really does not have a mandate to either cancel...
0:43:08 > 0:43:12So what we do, we bill for the individual babies,
0:43:12 > 0:43:16but obviously the invoices are directed to yourself. OK?
0:43:16 > 0:43:19I will say this, you know, if a patient is showing willing
0:43:19 > 0:43:22and is able to make a payment, then that could help...
0:43:23 > 0:43:25..in reducing the charges.
0:43:25 > 0:43:27Do you not think your husband
0:43:27 > 0:43:30will come over and visit you whilst you're...?
0:43:33 > 0:43:34I appreciate your position.
0:43:34 > 0:43:38You know, it's a very difficult situation you find yourself in.
0:43:38 > 0:43:41We'll have to work on these problems and, you know,
0:43:41 > 0:43:42do the best we can.
0:43:42 > 0:43:45Well, I understand you're coming out of ITU today,
0:43:45 > 0:43:49so that's good news, and I'll come and see you next week
0:43:49 > 0:43:52and we can pick this conversation up again. OK?
0:43:52 > 0:43:54All right. All right, Priscilla, you take care.
0:43:54 > 0:43:57And thank you for your time. OK? All right.
0:44:04 > 0:44:05INTERVIEWER: Are you worried about the money?
0:44:29 > 0:44:33I think at the end of the day, for her, from her perspective,
0:44:33 > 0:44:37whether it's 10,000 or whether it's 200,000, you know,
0:44:37 > 0:44:41I think either sum is going to be unmanageable anyway.
0:44:41 > 0:44:47We will gently push forward and, you know, do what we have to do,
0:44:47 > 0:44:51you know. We're governed by the laws and regulations.
0:44:51 > 0:44:54You know, they seem a bit fruitless at times
0:44:54 > 0:44:56but they have to be pursued.
0:44:59 > 0:45:02The team in neo-natal intensive care is concerned about
0:45:02 > 0:45:04baby Deborah's blood pressure.
0:45:04 > 0:45:09The consultant on call is neonatologist, Badr Chaban.
0:45:09 > 0:45:13They're very vulnerable. Minimum handling.
0:45:13 > 0:45:16We don't want to change anything.
0:45:18 > 0:45:21As he's examining her, her heart stops.
0:45:21 > 0:45:23What blood pressure do you have now?
0:45:26 > 0:45:30No, there is no... Get a trolley for the incubation.
0:45:30 > 0:45:33Can I have a tube? Just give me a tube.
0:45:33 > 0:45:36She's too small to be given chest compressions,
0:45:36 > 0:45:40so Dr Chaban uses a tiny pump to force air into her lungs.
0:45:40 > 0:45:42We've got the tube in.
0:45:59 > 0:46:01Definitely the chest.
0:46:15 > 0:46:18OK, OK. We are there.
0:46:21 > 0:46:24INTERVIEWER: Did you just save that baby's life?
0:46:24 > 0:46:27Yes, pretty much. Baby went asystolic completely.
0:46:27 > 0:46:29There was no heart rate at all.
0:46:29 > 0:46:33So, pretty much he was completely out of it.
0:46:36 > 0:46:40That's one of the hardest moments you can ever get.
0:46:40 > 0:46:43I mean, this 23-week-old with no heart rate whatsoever.
0:46:43 > 0:46:47Practically the baby was the nearest to be dead.
0:46:47 > 0:46:50Thank you very much, team. It was amazing.
0:46:52 > 0:46:53It's a great relief.
0:46:55 > 0:46:59You're always worried about this baby's life, whatever they are,
0:46:59 > 0:47:03470g, 23 weeks or whatever age, life is life.
0:47:03 > 0:47:06OK, thank you very much.
0:47:55 > 0:47:59After a quadruple heart bypass and 41 days in hospital,
0:47:59 > 0:48:02Sonia is returning home.
0:48:02 > 0:48:04We're going to the Philippines.
0:48:06 > 0:48:08I'm taking my sister home.
0:48:26 > 0:48:31They've done a good job, everybody. at Hammersmith Hospital.
0:48:32 > 0:48:36If she became ill and it happened in the Philippines,
0:48:36 > 0:48:38she wouldn't be alive now.
0:48:41 > 0:48:44It happened here and now she's...
0:48:44 > 0:48:46They have done a good job.
0:48:46 > 0:48:51She's alive and well. They've given a new lease of life to my sister.
0:49:00 > 0:49:02INTERVIEWER: Do you know what the final cost was?
0:49:02 > 0:49:06?56,000. 59, I think.
0:49:06 > 0:49:08?59,000?
0:49:08 > 0:49:10Mm-hm.
0:49:11 > 0:49:15That's a lot of money. It is. We can't afford.
0:49:15 > 0:49:19She's just a housewife and...
0:49:21 > 0:49:25She hasn't got that money to pay.
0:49:28 > 0:49:30Will you be able to pay any of it?
0:49:31 > 0:49:36We haven't discussed yet, but we'll try and, you know...
0:49:38 > 0:49:39..discuss with the family.
0:50:10 > 0:50:15Priscilla is waiting to hear if she's well enough to be discharged.
0:50:15 > 0:50:18Hello. You all right?
0:50:20 > 0:50:22Do you want to set up a little bit?
0:50:22 > 0:50:24OK.
0:50:26 > 0:50:28How are you?
0:50:29 > 0:50:31OK.
0:50:31 > 0:50:33How are the babies?
0:50:42 > 0:50:46All the infection markers have come down, so you're doing very well.
0:50:46 > 0:50:48All right?
0:50:50 > 0:50:51Restored, 100%.
0:50:53 > 0:50:56So, we're going to be discharging you today.
0:51:00 > 0:51:02All right, bye, Priscilla.
0:51:03 > 0:51:07Her major problem right now is that she's got three babies
0:51:07 > 0:51:12who are on the neo-natal intensive care unit, all on antibiotics.
0:51:14 > 0:51:16We're not sure whether they'll survive or not.
0:51:21 > 0:51:24Six weeks after she arrived in premature labour,
0:51:24 > 0:51:26Priscilla is discharged.
0:51:32 > 0:51:36As nurses and doctors, we will always treat the patient
0:51:36 > 0:51:41that is in front of us at that time, irrespective of what their story is.
0:51:46 > 0:51:49It's in your heart and I don't think you can get rid of that and I think
0:51:49 > 0:51:53you'd have a huge argument trying to say to someone to stop now,
0:51:53 > 0:51:56because we're not going to do this any more because this patient
0:51:56 > 0:51:59isn't entitled to treatment today.
0:51:59 > 0:52:02I think you get a lot of clinicians who just go, "I'm really sorry,
0:52:02 > 0:52:05"they need it, so I'm going to give it to them."
0:52:05 > 0:52:08In the same way that you'd want that to happen to your mother or
0:52:08 > 0:52:11your father or your loved one if they weren't in this country
0:52:11 > 0:52:12and they needed to be treated.
0:52:27 > 0:52:30Priscilla is being housed by a charity and comes every day
0:52:30 > 0:52:31to see her children.
0:52:36 > 0:52:38It's ten weeks since the babies were born.
0:53:17 > 0:53:21Priscilla's hospital bills continued to increase.
0:53:21 > 0:53:24Terry has presented her with another set of invoices.
0:53:58 > 0:54:01She's got her eyes open beautifully, look.
0:54:03 > 0:54:05Yeah, after what she's gone through.
0:54:05 > 0:54:06Look at that.
0:54:16 > 0:54:19The babies are likely to be another two months in ITU.
0:54:19 > 0:54:22We can't condemn her because she had these babies here.
0:54:22 > 0:54:26It's going to be a huge financial cost to the trust.
0:54:27 > 0:54:29When you're talking about these sorts of sums,
0:54:29 > 0:54:34it goes well beyond the mother's ability to even address payment.
0:54:47 > 0:54:51I suspect that Joe Public, as far as they're concerned, you know,
0:54:51 > 0:54:54you come into a hospital, you receive treatment.
0:54:54 > 0:54:57I think they probably would appreciate the NHS a lot more
0:54:57 > 0:55:00if they were aware of the challenges, the cost of treatment
0:55:00 > 0:55:03and perhaps they might begin to cherish it a bit more.
0:56:14 > 0:56:17Jerry? Look at me. Can you see me all right?
0:56:17 > 0:56:19Next time...
0:56:19 > 0:56:20Just been brought in by ambulance.
0:56:20 > 0:56:24..doctors race against the clock to save a stroke patient.
0:56:24 > 0:56:26We called up. They said, "Come up."
0:56:26 > 0:56:28OK, what do you want to do?
0:56:28 > 0:56:31Every year that goes by, we're more and more stretched
0:56:31 > 0:56:33and it feels like standards are slipping.
0:56:33 > 0:56:36The cardiac team way up the risk of operating
0:56:36 > 0:56:38on one of the hospital's oldest patients.
0:56:38 > 0:56:40He's not low risk at 98.
0:56:40 > 0:56:42As the population ages,
0:56:42 > 0:56:46how sustainable is all of this in the current structure of the NHS?
0:56:46 > 0:56:49And a 22-year-old donates his bone marrow
0:56:49 > 0:56:53for a pioneering new treatment to save his sister's life.
0:56:53 > 0:56:56I am very nervous because it has to work.
0:57:00 > 0:57:01What choices would you make
0:57:01 > 0:57:04when faced with complex health care decisions?
0:57:04 > 0:57:08Visit our interactive pages to find out how you would respond.
0:57:08 > 0:57:13Go to bbc.co.uk/hospital and follow the links for the Open University.