Episode 4 Hospital

This programme contains some scenes which some viewers may find upsetting

Just move yourselves over to the side for a minute.

This winter,

one of Britain's busiest NHS trusts opened its doors...

We have to look after patients,

whether they come from Buck Palace or the park bench.

..to show us what's really happening inside our hospitals.

We've got lots of patients now

competing for an unknown number of beds.

Every week, more than 20,000 people are treated here.

The pressure's just gone. What? Completely gone?

And the numbers, as well as our expectations, are rising.

We just had our worst ten days on record.

There's nowhere in the hospital to move anybody.

At some point somebody will be telling us whether we're

allowed to do any work.

This is a place with some of the best specialists in the world...

Tumour's out. Job done.

..where lives are transformed.

This is saving his life. It has to work.

But they are operating at a time when the NHS

has never been under more pressure...

Need beds? No.

Got beds for anyone? No.

It does feel to me like the elastic's

a bit nearer to breaking now than it ever was.

..its very future under scrutiny.

All right, I think we will go out on red cos we're under real pressure

in the emergency department.

We're aware of the problems. Anybody got a solution?

Following the patients from the moment they are admitted...

Anything I've done up to this point means nothing compared to

when you can literally give a bit of yourself to save someone else.

..to the moment they leave.

It's all good news. The cancer has gone.

You don't need any more treatment.

Fantastic. Thank you so much.

Week by week, we reveal the complex decisions the staff must make

about who to care for next.

That patient is coming to me to be operated on and if I don't do it

then there's only one inevitable outcome - they're going to die.

SIRENS WAIL

Imperial College Healthcare NHS Trust has five hospitals

spread across Central London.

Right, good morning, everybody. It's 8:30 on Monday morning.

Let's go to St Mary's.

We've let the majority of surgery go ahead.

Electives for today, we've got one for Charles Pannett,

three for the SIC, two vascular, two gynae and two orthopaedic.

As you've can see, we've got 22 in the department, a large amount

of patients, which are red, and have been over four hours...

After a busy weekend of admissions, St Mary's A is already full.

Don't worry, we'll sort you out.

Our door through ED is always open,

irrespective of where someone comes from

and irrespective of how they get here.

We cover all of Northwest London.

Obviously we've got Paddington Station, Heathrow Airport,

Oxford Street - so it's a huge area

and we will pick up anybody passing through.

We don't have that ability to stop people and turn them away -

you come to us and we will treat you.

INDISTINCT CHATTER THROUGHOUT

Morning.

A regular visitor to the trust's emergency department is Terry

from the Overseas Office.

He's responsible for checking the list of overnight admissions

to assess who is and who isn't eligible for free NHS care.

There's hand-written sheets with all the patients that have

been admitted over the last 24 hours.

NHS trusts are obliged by law to identify overseas patients

and charge them for their treatment.

There is this assumption that it's free of charge

but that isn't the case.

The main criteria to receive free medical treatment in the UK

is residency.

You have to be resident here.

My name is Terry. I'm from the Overseas Patient Office, sir.

Just need a quick word with you.

What, Officer? I'm from the Overseas Patient Office.

The Overseas Patient Office.

The Overseas Patient Office.

Can you finish your conversation?

Stay in the bed, sir.

Stay in the bed.

No, stay in the bed, sir.

You don't need to get up.

No, just stay in the bed.

Because you're on a tourist visa,

you're not entitled to free medical treatment.

'We use ATMs, card reader,'

very effective in being able to take a payment on the spot.

?800 a day.

I understand that but that's what we have to charge, sir.

In an emergency,

Imperial staff won't ask to see a person's identification

before treating them.

The first thing I'm looking for

is to make sure they've got an NHS number.

If the patient doesn't have an NHS number then it can be an indication

that actually they're not resident.

Also I'm looking for overseas addresses.

It's a quick sweep of picking up patients who have come in.

There's a patient here without an NHS number.

Moved to Italy two weeks ago and now suddenly he's returned.

But he's got no GB registration that we can see.

The patient arrived in A yesterday.

Hello, sir.

Sorry to wake you.

He came in complaining of kidney problems.

Sorry to wake you. I need to speak with you.

Yeah, yeah. Yeah?

How are you? Give yourself a moment to wake up.

OK. Yeah?

What's your nationality?

Sorry?

You're from Palestine.

So you arrived back in the UK yesterday, you said.

Sorry?

You were living in Italy? OK.

Do you hold Italian nationality, sir?

Hm? Do you hold Italian nationality?

You don't.

So, have you claimed asylum here?

Hm? Have you claimed asylum in the UK? Mm-hm. You have?

Yeah? And when you claimed asylum,

have the Home Office given you a residency in the UK? In England?

Right. So what sort of travel documents do you have?

Hm? What travel document do you have?

Oh, you don't have any documents?

What I need to understand is whether you have a legal right

to live in the UK.

Mm-hm. If we can't confirm that you're resident here

then we will charge you for your treatment.

I'm going to have to do some checks

and we'll come back to you.

Yeah.

'It's very frustrating because I cannot confirm his residency here

'and he's telling me that he has gone through the asylum process,'

but what's frustrating is he cannot give me a straight answer as to what

documents he does have and what he doesn't have, which would enable me

to make a judgment on his entitlement to health care.

If a patient can demonstrate that they are a refugee or a registered

asylum seeker, they will be entitled to free NHS care.

So what I will do is put a request through to Immigration

to find out what his immigration status is.

INTERVIEWER: How do you get from Italy to the UK without any papers?

Really?

Across London, a woman is being transferred from A at St Mary's

to its sister hospital Hammersmith

for an urgent operation.

You need to be positive.

All right? You'll be going off to the anaesthetic room

where you're going to go off to sleep. OK?

Cardiologists have discovered 56-year-old Sonia

has dangerous narrowing of the arteries and could have

a heart attack at any moment.

This is my youngest sister. She's on holiday here from the Philippines,

she wasn't feeling well,

she was shivering and she's having chest pain.

She's shaking and she's worried, so I tried to reassure her.

I said everything will be OK.

I hope the operation...goes well

and she'll be OK.

Fingers crossed.

INTERVIEWER: Did she have travel insurance?

Erm...

unfortunately, she didn't have one.

Sonia's operation will be conducted

by the hospital's world-renowned cardiac team.

Hammersmith Hospital is a specialist cardiac hospital.

It does not have an acute accident and emergency department.

However, any patient in the region who presents with chest pain

will be brought here immediately by ambulance.

In charge of the operation

is veteran heart surgeon Rex Stanbridge.

The heart scan showed narrowing of all the important arteries

of her heart. Effectively, it's like a blockage in the high street -

the cars can't go through and the blood's not getting through

to the muscle of the heart.

What we're doing is making a bypass round the high street.

It's going fine, very well.

Quite anxious for her, as well as you,

and we think might be nice of you to sit down outside.

So I'll wait there? You can wait out there, yes.

Go and do a bit of retail therapy.

Thank you, bye-bye.

It's not good to sit right outside the theatres. If anything were to

happen or something, you can imagine a relative might get wind of it

and they'd sort of go hysterical and come rushing in and screaming

and stuff and that would put everybody off.

Also, the patient is probably aware of her and that makes the patient

more concerned.

Cos the patient is worried about the relative and the relative

is worried about the patient, and so on.

What do you think?

Sonia needs a quadruple bypass.

The surgeons must take veins from her leg

to make new blood vessels to replace her blocked arteries.

So you've got just the length of this much at the moment.

We'll go in your...this bit. Can I have a swab, please?

Rex must decide whether to stop Sonia's heart mid-surgery

using a pump to keep her alive while the bypass is completed.

The standard method is to attach the patient

to a heart-lung bypass machine, take the blood out of the heart,

put it into a machine, circulate it, warm it,

oxygenate it as you need, put it back in.

The way of doing it without using the heart-lung machine

is called off-pump surgery and it is a benefit to the patient.

Not circulating blood through machines,

the blood doesn't get damaged in the same way.

Conducting Sonia's bypass off-pump could reduce her recovery time

after the operation, but it will mean keeping her heart beating

throughout the delicate procedure.

It's a practice I've been doing regularly for 20 years,

but not all the surgeons like doing it that way.

It's technically a tiny bit more difficult and it can go wrong.

You know when you've got one heart

and you think something might go wrong,

you realise you haven't got another one as backup,

so everyone's a little bit aware in heart operations.

Before beginning Sonia's operation off-pump,

Rex tests whether her heart will be strong enough

to be moved around during surgery.

Will the heart tolerate being lifted? It's beating quite nicely.

If we look at the blood pressure, it's 120

and if we do this very gently, we can lift the heart up.

The pressure's now 76, put the heart down, the pressure will come up.

So it looks like we will be able to do all the arteries off-pump,

so we should be able to do this procedure as planned.

Can I have the table up a little bit, please? Yes. Thank you. Stop.

Sonia's surgery will take five hours and cost a minimum of ?5,000.

We'll go in your...this bit. Can I have a swab, please?

In the Philippines, before they can operate on you...

..you have to...have money...

See how it's all going.

So if you're poor there, you don't have the capacity to pay...

..you'll die.

Well, I've been doing this job about 12 years now.

INTERVIEWER: What did you do before it?

My background is photography, in fact, but unfortunately I wasn't

really able to make a sufficient living out of it, so we jumped ship.

Yeah, travel photography.

That sort of ties in with what I do now really.

I mean, I applied for the job,

not fully understanding, you know, what the job entailed,

but I've grown into the role

cos there's so many difficulties in the role,

not least, you know, very contentious communication,

not only with the patient but with the patient's relatives.

Under NHS regulations, treatment in A is free to all.

It's only when an overseas patient

is admitted onto a ward that charges begin.

When did he arrive in the UK? I think it was maybe a month ago.

They're visiting me. I live here.

So he's travelling with his wife? Yes. OK.

Mahir is also under the care of the heart team.

He had a heart attack while on holiday from Turkey

visiting his daughter in the UK.

So he's just visiting from Turkey.

OK, because we do charge for treatment

and I think possibly discussing surgery. That's right, yes.

I'm waiting for the surgeons. They haven't discussed it with me.

They haven't discussed it with you? OK.

At the moment the charge is going to be ?800.

Now, if he stays and has surgery,

he could be here for about ten days,

this could be costing ?15,000-?20,000.

?15,000-?20,000? Yeah, if he was to have his surgery here. OK.

This is what we call an agreement to pay

because we're going to be charging the patient for treatment

and we ask the patient or a relative to sign it. OK.

Would you be happy to sign it?

This is the only way to proceed with, you know, his surgery,

the doctors won't talk to us if there's...

if I've not agreed to pay? No, no, no, no.

They will...they will decide whether to pursue treatment... OK.

..based on the clinical need.

OK. OK. So this will not inter...

If he needs surgery, then it will go ahead... OK. ..regardless.

It's a question of informing people

that we're going to be charging them,

on the one hand, but also reassuring them

that they are going to be treated appropriately on the other hand

and that if the treatment is absolutely necessary,

it will go ahead.

The worst case scenario is that the patient wants to leave the hospital

immediately because of the charges.

Most of the patients we deal with

I would not define as health tourists.

They're not here specifically for... to access free medical treatment,

they're here on holiday usually

and they've fallen ill or they have an accident.

You know, here at this moment, we just...

At night my father had a heart attack and we came here.

The most important is his health,

so I would sign any paper, right? So...

INTERVIEWER: Has your father been made aware of the costs yet

or anything like that?

No, I told him I'll deal with it, you know, he doesn't need to...

You know, he already has a very serious condition,

so I just want my father to be healthy and well

and this is a good hospital.

I hope the surgeons and the doctors are good

and that's the most important thing for me right now.

Before the Palestinian man's immigration status can be checked,

he leaves the hospital.

So he had his procedure and he was discharged

and there is a possibility that, you know,

he will disappear into the community

and we won't see him again here any time soon.

Does that happen often?

Yes, it does, it happens quite a lot, yeah,

and it's more pertinent with, you know, illegal immigrants

or people who have overstayed their visas

because we know that they're not likely to come back

if they can help it, basically.

If it does turn out that he's not entitled,

or that he doesn't have a residency in the UK,

then all we can do is send out an invoice through the home address.

What more can you do?

You know, it's a wider issue than just accessing healthcare.

The trust's neo-natal intensive care unit

is one of Britain's leading centres for premature babies.

What's it like to take blood from a baby so young?

Amongst the most vulnerable,

three siblings born more than three months before their due date.

Hello, I've come to find out how Priscilla's babies are doing.

Oh, naturally they are still in very critical state,

so they all need

continuous support and monitoring,

so, yeah. OK. It is very difficult.

We have to be honest with her.

The baby's mother, Priscilla,

is recovering nearby in the adult intensive care unit.

Her life was at risk and, at one moment in time,

we were very, very worried about her.

She had collapsed, she wasn't breathing very well.

She needed to be intubated.

Thank you.

Priscilla lives in Nigeria, where she works in health care.

After receiving the treatment in Nigeria,

Priscilla became pregnant with quadruplets.

Priscilla boarded a plane from Nigeria to America.

Priscilla boarded a flight back to Nigeria

with a scheduled connection at London Heathrow.

Soon after arrival,

she was in labour and we delivered one of her babies.

The baby was of a very low birth weight, less than a bag of sugar.

Unfortunately, that baby died.

She's gone from thinking that she was going to America

to family and friends to finding herself

in a hospital she doesn't know in a country she doesn't know

with nobody she knows nearby,

not knowing how long she's going to be there

or how things are going to turn out.

It's a pretty daunting, pretty terrifying situation

to find yourself in, I think.

Can I have the table up a little bit, please?

After five hours in theatre, Sonia's quadruple heart bypass is complete.

The operation has been done with a full graft

using the off-pump technique.

Her blood vessels were actually very small, so quite difficult.

And although there were times when the blood pressures

were not as robust as I'd like,

nothing really bad has happened.

Hello!

OK, sit down, sit down.

She's OK. She's fine. The operation went all right.

She had the full graft, which she wanted to do.

I think she'll be fine.

I'm very pleased! We're going to keep her in asleep tonight

and wake her up tomorrow morning cos they often do that

when it's a slightly more difficult operation.

We're very grateful... Not at all, not at all.

Hello! Hi, how's it going? My name's Michael, I'm looking after her.

So, she's just come out about 20 minutes ago. OK.

At the moment, she's fine. We'd just like to monitor her,

make sure she's not bleeding and her blood pressure's stable.

She's on very, very minimal anaesthetic

so she's doing really well so far.

All right?

But it's scary, isn't it?

I love my sister very much.

We are a very close-knit family.

We love each other. We care for each other.

That's why I asked her to come over here

to have a holiday and I'm working here as much as possible.

If I have the money, I can take her on holiday.

Because she lost her husband 12 years ago

and she's living there alone.

But this kind of surgery, you have to pay a lot of money.

Do you think it'll be OK, though? Yeah, it's good.

You can find the money, but for her health, you know,

you can't so it's a blessing that she had surgery here.

Terry from the overseas office

has been made aware of Priscilla from Nigeria.

The care of her babies and her own treatment in intensive care

could run into hundreds of thousands of pounds.

She was an emergency and that's why she came to the hospital.

If you accept quads,

then you are looking at your neo-natal unit probably being full.

The neo-natal intensive care unit has ten cots,

each offering life-preserving breathing support

and body temperature control for pre-term babies.

Many of the babies treated here must stay on the unit

for extended periods of time.

The largest invoice I've raised for a single individual

was just under ?200,000.

I do know that the family have paid, to date, ?75,000 on that.

Where is the patient? Isolation four.

In this room. She's in there, is she? Yeah. OK, that's wonderful.

Hello, Priscilla?

Priscilla, my name is Terry. I'm from the overseas patients office.

So, really, I'm here today just to introduce myself

because I cover this hospital.

The thing is, Priscilla,

the hospital bills are going to be quite high.

No, I understand that.

You're going to be in England for a while, aren't you?

Do you understand that?

Erm...

So, your husband, is your husband in Nigeria? Mm-hmm. He is.

Will he be coming over at all,

under these circumstances?

He won't.

When you're a bit more steady and you've come out of ITU,

I'll come and see you again, OK?

I do understand that it's a very difficult time for you,

you know, but we do need to talk about the charges for the treatment.

I do appreciate it's hard and, as I said, I do understand,

you know, it's a very difficult time for you.

Take this steady, a day at a time, OK?

OK, you take care.

The next stage, really,

is to let her know that we have to start raising invoices

on a regular basis, so it'll be a weekly basis,

and those invoices are going to be huge

because she's got three babies in ITU, you know,

so that's, like, 20 grand a week for each baby.

Sonia's condition is deteriorating.

She's in the intensive care unit,

receiving treatment for a suspected blood infection.

She had the operation and then she was getting ready

to go back to the ward. They took everything off.

They sat her out on the chair,

then later on, she became ill again.

Apparently, they think it might be sepsis, so that's why

they're treating her with antibiotics and blood transfusion.

It is difficult, very difficult, thinking that she is very ill

and we're just hoping and praying that she's going to pull through.

We love her very much.

Once they remove the tube there,

she's going to have a tracheostomy, but the recovery is...

The rehabilitation is long,

but I don't mind as long as she gets better.

Yeah, so she's in good hands. Everybody is doing good for her.

An intensive care bed costs the trust around ?2,000 a night.

It's unclear how long Sonia will have to stay on the unit.

Now, I'm asking the doctor to give us a letter

so that we can cancel her flight.

Definitely not going, she's not ready to go home.

I want them to take her alive and well so she has to get better.

Having given birth eight days ago, today is the first time

Priscilla has been well enough to go and see her babies.

Right, so we'll now take this, just in case. Yes, that's good.

Hey! How are you?

Good to see you. You've come to see your little ones?

So, your two little girls, numbers two and three,

are on this side by the window

and then your little boy's just there by the door.

I'll come out of your way and you can come in and then we'll swap over

and say hello to the others in a second.

Did you say you've decided names for them?

Is this Deborah? Is that the name you've picked for her, yeah?

That's a nice name. I like that.

She's another one who knows Mummy, doesn't she?

She knows Mummy.

This is your baby boy.

I'll double-check the spellings before you go,

just so we've got all the names right.

It's a good day, yeah? A good day.

First day you get to hold your babies' hands.

Have you been waiting for this day?

Thank you all. Thank you so much.

You guys are great, good job!

All three babies have a serious infection

and their condition remains unstable.

The babies were obviously born very prematurely.

They were born at 24 weeks.

The chances of survival are pretty limited, born that early.

They're by no means out of the woods.

They definitely need time to grow and develop.

To nurse the three babies in intensive care

costs the trust ?6,000 a day.

Funds in the NHS are very, very finite.

I think we would all feel that if you haven't put into the pot,

you don't have an entitlement to take out of the pot,

but then you look at somebody like Priscilla, who...

It's not that straightforward always.

What do you say?

Do you pack her back on a plane to Nigeria

in the condition she's in, where she's herself really unwell?

Do you drag her away from those very, very tiny babies,

who, you know, are still really fighting for their lives?

Do you say to those tiny children who've had nothing to do with it,

"Sorry, you're not entitled"?

You know, the reality in individual cases

is very, very different to the kind of big headlines of, you know,

people taking what's rightfully ours, you know,

people taking what they're not entitled to.

It's really hard to make those decisions

and I'm glad it's not my job to do it.

The NHS's annual budget is around ?100 billion.

It has been estimated that around ?450 million is spent each year

treating overseas patients who have no entitlement

to free UK health care.

Terry is preparing an invoice for Filipino heart patient, Sonia.

The cost of her treatment so far is ?18,000.

This is Sonia's invoice, who's had open-heart surgery.

She took a turn for the worse in terms of her recovery,

so she's very poorly.

She's from the Philippines.

You know, she doesn't have that kind of money.

And that's not the end of it. Her total now could reach...

you know, ?40,000, I suspect.

That will impact on her sister in this case and on other relatives,

and so it really does bring my sort of role and the idea of

presenting a huge bill and demanding payment...

brings it into sharp focus.

I'm here to see Sonia. So, which bed is she in? She's in bed five.

Bed five, is she? OK.

Rowena! Hi.

Hi, Rowena. I just want to have a quick chat, if that's all right.

Do you mind? No, no, no, not at all. So, erm, Rowena, erm...

this is the invoice, which, as you know, we have to present. Of course.

Yeah. OK? Now, clearly Sonia's been in ITU for a while now.

By law, we have to present these. OK?

So, er, I also need to ask you, are you able to make

a small payment, a deposit, today, do you think?

Er... At the moment, I...

You know I'm retired?

You're retired, yeah. I am. And a big mortgage, as well.

I do understand. Yeah, yeah. So, at the moment, erm...

My son is unemployed, as well, so... Right. OK. OK.

That's another worry for me. OK. So, er...

I'm not going to press you for that. OK? So, what I will say is,

you know, there will be further invoices.

You know, I think you need to look at the possibility of...

you know, making a small payment on a monthly basis rather than

paying the whole amount. OK? Mm-hm.

But, erm, this won't disrupt your sister's treatment.

You just need to know that, as well. Mm. OK? Mm.

That's the first time I've seen Sonia myself.

You know, she's very poorly.

When you visually see a patient in that condition,

then that has its own impact on me.

So, you know, pursuing hardball on financial issues at this stage,

you know, it sometimes isn't really appropriate.

I don't want to talk about the payment yet.

'I don't want to trouble myself yet, you know?

'They're not forcing me to pay at this time.'

All I'm focusing on at the moment is my sister's condition to improve.

Imperial's overall annual budget is just over ?1 billion.

In the last year, it spent over ?4 million treating overseas patients.

It has been able to recover ?1.6 million.

Shall I just phone him and find out how long it's going to be?

As a proportion, overseas patients are a tiny, tiny proportion,

much less than half a per cent

of the work that we do.

And the number of very high-value

patients is of the order of

one or two or three a year.

But I think there is certainly more that we can do to reclaim

the money from overseas patients.

With more than half of the money owed by overseas patients going

unrecovered, the trust decides to recruit a project manager

for the overseas team to help them collect more debt.

So, my understanding is we've got more money in from overseas patients

this year than last year and that the idea of this post is

that we're then going to be able to increase that further next year.

Will they be on the ground?

They need to be based on site and work from within

rather than being off site.

OK. And when do we think that post will get filled?

Ideally... Well, it really depends.

We'd be looking at six weeks at best.

The advert is currently out and closes next week.

Excellent.

These patients can end up having quite expensive care.

Obviously, we need to try and recoup that

to plough back into our NHS services.

The billing for the last financial year was, I believe,

4.2 or 4.3 million.

I recognise it is a small part in terms of the money we recoup,

but it's a part, it's an important part, and you have to look at it -

well, what would ?4 million provide in terms of treatments?

It's a no-brainer. How many nurses can you employ for ?4 million?

Again, it's a no-brainer, isn't it?

INTERVIEWER: What happens if, after repeated invoices,

someone can't pay?

So, with overseas patients, er, it...can be quite difficult.

So, patients who leave,

then obviously we would use all legal means that we have

to try and recoup the money, and the finance department will,

for patients who haven't paid,

will report that to the Government,

and on occasions that has meant

that people have not been able to come back into the country

or have been identified as they've been leaving the country

in order to recoup that money.

Terry is calculating Priscilla's latest bill.

So, I've prepared, well, four invoices, in fact, for Priscilla.

We invoice the babies under their own sort of details,

but obviously we present that to the mother.

They're just under ?100,000, these invoices.

Some people might say that I'm a bit hard-hearted,

but I wouldn't accept that at all.

I think, you know, I have a capacity to ask a difficult question,

you know, of someone in very difficult circumstances.

'And you certainly have to distance yourself emotively, you know,

'turn your emotions off, really.

'Without that, you wouldn't get the job done.'

You know? Erm, I'm not in a position to say, you know,

"I'm very sorry for your trouble, your circumstances,

"I accept that you can't afford the bill, so, hey, we won't charge you.

"OK? How about that?" I don't have that power.

Because I don't have that power, then I have no option

but to make sure that they're given the correct information,

that they will receive an invoice and that will be pursued.

I'm here to see Priscilla. OK.

Priscilla, hello. Hi.

How are you... under the circumstances?

Yes. You look a lot better today, I must say.

That's good. We've been praying for you, anyway.

Thank you. So, how are you feeling?

OK. That's good.

Well, you know, erm, obviously I've got not great news, I'm afraid,

because I've had to raise some invoices for you.

So, I've raised an invoice for you, for your treatment, OK?

That's giving birth and your time here.

And then these are the invoices for the three children.

These bills are quite high, Priscilla.

Sorry?

I'm afraid they're not negotiable, no.

You know, the trust really does not have a mandate to either cancel...

So what we do, we bill for the individual babies,

but obviously the invoices are directed to yourself. OK?

I will say this, you know, if a patient is showing willing

and is able to make a payment, then that could help...

..in reducing the charges.

Do you not think your husband

will come over and visit you whilst you're...?

I appreciate your position.

You know, it's a very difficult situation you find yourself in.

We'll have to work on these problems and, you know,

do the best we can.

Well, I understand you're coming out of ITU today,

so that's good news, and I'll come and see you next week

and we can pick this conversation up again. OK?

All right. All right, Priscilla, you take care.

And thank you for your time. OK? All right.

INTERVIEWER: Are you worried about the money?

I think at the end of the day, for her, from her perspective,

whether it's 10,000 or whether it's 200,000, you know,

I think either sum is going to be unmanageable anyway.

We will gently push forward and, you know, do what we have to do,

you know. We're governed by the laws and regulations.

You know, they seem a bit fruitless at times

but they have to be pursued.

The team in neo-natal intensive care is concerned about

baby Deborah's blood pressure.

The consultant on call is neonatologist, Badr Chaban.

They're very vulnerable. Minimum handling.

We don't want to change anything.

As he's examining her, her heart stops.

What blood pressure do you have now?

No, there is no... Get a trolley for the incubation.

Can I have a tube? Just give me a tube.

She's too small to be given chest compressions,

so Dr Chaban uses a tiny pump to force air into her lungs.

We've got the tube in.

Definitely the chest.

OK, OK. We are there.

INTERVIEWER: Did you just save that baby's life?

Yes, pretty much. Baby went asystolic completely.

There was no heart rate at all.

So, pretty much he was completely out of it.

That's one of the hardest moments you can ever get.

I mean, this 23-week-old with no heart rate whatsoever.

Practically the baby was the nearest to be dead.

Thank you very much, team. It was amazing.

It's a great relief.

You're always worried about this baby's life, whatever they are,

470g, 23 weeks or whatever age, life is life.

OK, thank you very much.

After a quadruple heart bypass and 41 days in hospital,

Sonia is returning home.

We're going to the Philippines.

I'm taking my sister home.

They've done a good job, everybody. at Hammersmith Hospital.

If she became ill and it happened in the Philippines,

she wouldn't be alive now.

It happened here and now she's...

They have done a good job.

She's alive and well. They've given a new lease of life to my sister.

INTERVIEWER: Do you know what the final cost was?

?56,000. 59, I think.

?59,000?

Mm-hm.

That's a lot of money. It is. We can't afford.

She's just a housewife and...

She hasn't got that money to pay.

Will you be able to pay any of it?

We haven't discussed yet, but we'll try and, you know...

..discuss with the family.

Priscilla is waiting to hear if she's well enough to be discharged.

Hello. You all right?

Do you want to set up a little bit?

OK.

How are you?

OK.

How are the babies?

All the infection markers have come down, so you're doing very well.

All right?

Restored, 100%.

So, we're going to be discharging you today.

All right, bye, Priscilla.

Her major problem right now is that she's got three babies

who are on the neo-natal intensive care unit, all on antibiotics.

We're not sure whether they'll survive or not.

Six weeks after she arrived in premature labour,

Priscilla is discharged.

As nurses and doctors, we will always treat the patient

that is in front of us at that time, irrespective of what their story is.

It's in your heart and I don't think you can get rid of that and I think

you'd have a huge argument trying to say to someone to stop now,

because we're not going to do this any more because this patient

isn't entitled to treatment today.

I think you get a lot of clinicians who just go, "I'm really sorry,

"they need it, so I'm going to give it to them."

In the same way that you'd want that to happen to your mother or

your father or your loved one if they weren't in this country

and they needed to be treated.

Priscilla is being housed by a charity and comes every day

to see her children.

It's ten weeks since the babies were born.

Priscilla's hospital bills continued to increase.

Terry has presented her with another set of invoices.

She's got her eyes open beautifully, look.

Yeah, after what she's gone through.

Look at that.

The babies are likely to be another two months in ITU.

We can't condemn her because she had these babies here.

It's going to be a huge financial cost to the trust.

When you're talking about these sorts of sums,

it goes well beyond the mother's ability to even address payment.

I suspect that Joe Public, as far as they're concerned, you know,

you come into a hospital, you receive treatment.

I think they probably would appreciate the NHS a lot more

if they were aware of the challenges, the cost of treatment

and perhaps they might begin to cherish it a bit more.

Jerry? Look at me. Can you see me all right?

Next time...

Just been brought in by ambulance.

..doctors race against the clock to save a stroke patient.

We called up. They said, "Come up."

OK, what do you want to do?

Every year that goes by, we're more and more stretched

and it feels like standards are slipping.

The cardiac team way up the risk of operating

on one of the hospital's oldest patients.

He's not low risk at 98.

As the population ages,

how sustainable is all of this in the current structure of the NHS?

And a 22-year-old donates his bone marrow

for a pioneering new treatment to save his sister's life.

I am very nervous because it has to work.

What choices would you make

when faced with complex health care decisions?

Visit our interactive pages to find out how you would respond.

Go to bbc.co.uk/hospital and follow the links for the Open University.