0:00:05 > 0:00:06'Adult trauma call...'
0:00:06 > 0:00:09Just move yourselves over to the side for a minute.
0:00:09 > 0:00:12This winter, one of Britain's busiest NHS trusts
0:00:12 > 0:00:14opened its doors...
0:00:14 > 0:00:15We have to look after the patients
0:00:15 > 0:00:19whether they come from 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 > 0:00:23We've got lots of patients now
0:00:23 > 0:00:27competing for an unknown number of beds.
0:00:27 > 0:00:31Every week, more than 20,000 people are treated here.
0:00:31 > 0:00:34- The pressure's just gone. - What?! Has it completely gone?
0:00:35 > 0:00:38And 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 > 0:00:46At some point,
0:00:46 > 0:00:48somebody will be telling us whether we're allowed to do any work.
0:00:48 > 0:00:52This is a place with some of the best specialists in the world...
0:00:52 > 0:00:53The tumour's out. Job done.
0:00:53 > 0:00:55..where lives are transformed.
0:00:55 > 0:00:58This is saving his life. It has to work.
0:00:58 > 0:01:00But they're operating at a time when the NHS
0:01:00 > 0:01:02has never been under more pressure.
0:01:02 > 0:01:06- Any beds?- No. - No beds for anyone?- No.- OK.
0:01:06 > 0:01:11It does feel to me like the elastic's a bit nearer
0:01:11 > 0:01:14to breaking now than it ever was.
0:01:15 > 0:01:17Its very future under scrutiny.
0:01:17 > 0:01:19All right, I think we will go out on red,
0:01:19 > 0:01:22because we're under real pressure in the emergency department.
0:01:22 > 0:01:23We're aware of the problems.
0:01:23 > 0:01:25Anybody got a solution(?)
0:01:25 > 0:01:27Following the patients from the moment they are admitted...
0:01:27 > 0:01:32Anything I've done up to this point means nothing compared to when
0:01:32 > 0:01:36you can literally give a bit of yourself to save someone else.
0:01:36 > 0:01:37..to the moment they leave.
0:01:37 > 0:01:40It's all good news. The cancer's gone.
0:01:40 > 0:01:42You don't need any more treatment.
0:01:42 > 0:01:44- Fantastic!- Thank you so much.
0:01:46 > 0:01:50Week by week, we reveal the complex decisions the staff must make
0:01:50 > 0:01:52about 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 > 0:02:01they're going to die.
0:02:06 > 0:02:08SIRENS WAIL
0:02:11 > 0:02:13PHONE RINGS
0:02:13 > 0:02:15This is main theatre admissions.
0:02:15 > 0:02:16One can do 12...
0:02:16 > 0:02:22Imperial College Healthcare NHS Trust performs over 500 operations
0:02:22 > 0:02:25across 19 different surgical specialities every week.
0:02:25 > 0:02:27How long after MRSA...?
0:02:27 > 0:02:29Got probably about...
0:02:29 > 0:02:32- 12 hours' worth of operating on this list.- At least.
0:02:34 > 0:02:36- 16.- Yep.
0:02:36 > 0:02:40- OFF CAMERA:- How's your morning been? - Er, pretty stressful.
0:02:40 > 0:02:43A big case that I was supposed to be doing this afternoon
0:02:43 > 0:02:48we've had to move and cancel because of this trauma patient
0:02:48 > 0:02:50that we've got to get done.
0:02:50 > 0:02:53Hip and pelvic specialist Angus Lewis
0:02:53 > 0:02:56works across two of the Trust's five hospitals.
0:02:56 > 0:02:58There is only two pelvic surgeons here
0:02:58 > 0:03:01and one of those is away on annual leave at the moment,
0:03:01 > 0:03:04so it's just me.
0:03:04 > 0:03:05We are a bit stretched.
0:03:06 > 0:03:08Could do with another ten!
0:03:08 > 0:03:10But we're not going to get that.
0:03:10 > 0:03:13I've finished here at Charing Cross, I'm coming over
0:03:13 > 0:03:16so hopefully by then, the theatre's ready and we can crack on.
0:03:16 > 0:03:19I'll see you over there. All right, bye.
0:03:20 > 0:03:24Today, Angus is needed in St Mary's, five miles away,
0:03:24 > 0:03:27to operate on a man with a shattered pelvis.
0:03:29 > 0:03:33We are constantly battling with elective service
0:03:33 > 0:03:35and the trauma service
0:03:35 > 0:03:39and our trauma service is getting busier and busier by the year.
0:03:39 > 0:03:43Hopefully, timing-wise, the operating theatre at St Mary's
0:03:43 > 0:03:47is going to be vacant by the time I get there on motorcycle.
0:03:47 > 0:03:50It's a bit of a rush but it's just the way it is at the moment
0:03:50 > 0:03:54and we're just going to have to get our skates on.
0:04:05 > 0:04:06It was a rough night.
0:04:08 > 0:04:11It's-it's very painful at the moment.
0:04:13 > 0:04:17Angus's patient is 52-year-old hairdresser Reno.
0:04:17 > 0:04:19HE GROANS
0:04:19 > 0:04:21At the moment, what they're trying to do,
0:04:21 > 0:04:24to keep the bone of my leg out from the socket
0:04:24 > 0:04:28away as far as they can by putting the weights at the bottom,
0:04:28 > 0:04:32because they say if it goes up, it can cause more damage.
0:04:32 > 0:04:35I cannot move at all, just my toes I can wave a little bit,
0:04:35 > 0:04:37that's as far as it goes.
0:04:37 > 0:04:41Reno fractured his pelvis in a motorcycle accident.
0:04:41 > 0:04:44He's been waiting four days for an operation to repair it.
0:04:46 > 0:04:50The way the doctor explained to me, the whole socket,
0:04:50 > 0:04:51it's shattered,
0:04:51 > 0:04:55it's about seven, eight pieces and I'm actually sitting on it.
0:04:57 > 0:04:59Along with some other medication,
0:04:59 > 0:05:03every five minutes, I get 15ml of...
0:05:03 > 0:05:04like a morphine.
0:05:08 > 0:05:09Ooh.
0:05:10 > 0:05:12There's nothing they can do.
0:05:12 > 0:05:16I just, I can't find the right sweet angle.
0:05:17 > 0:05:19The right...
0:05:20 > 0:05:22Oh.
0:05:27 > 0:05:29To make time for Reno's surgery,
0:05:29 > 0:05:33Angus has cancelled another patient's preplanned hip operation.
0:05:35 > 0:05:37This is a very bad injury.
0:05:37 > 0:05:40The socket of his left hip joint is in quite a lot of pieces
0:05:40 > 0:05:42which need to be put back
0:05:42 > 0:05:45and it's therefore going to take quite a long operation,
0:05:45 > 0:05:51four to five hours and it's not a fracture we can leave.
0:05:51 > 0:05:56The longer you leave it, the more difficult it is to fix it.
0:05:57 > 0:05:59I don't really want to wait any longer with this gentleman.
0:06:07 > 0:06:09INAUDIBLE
0:06:15 > 0:06:17The problem we've got is the case
0:06:17 > 0:06:21that was meant to finish hasn't finished yet.
0:06:31 > 0:06:34Right, and then tomorrow, we've only got half a list.
0:06:34 > 0:06:36God, after all that.
0:06:37 > 0:06:39Oh, God.
0:06:39 > 0:06:42It is really... Yeah.
0:06:42 > 0:06:45Well, we'll talk about it when I've calmed down.
0:06:47 > 0:06:48It's none of your fault.
0:06:52 > 0:06:55It's not your fault. I'm just pissed off.
0:06:55 > 0:06:57Cos I've now got to find another slot for this guy.
0:06:57 > 0:07:00The consultant who was doing this operation, you know,
0:07:00 > 0:07:06was trying to get me into theatre on time and unfortunately we failed.
0:07:06 > 0:07:08And it's just...
0:07:08 > 0:07:12you do all these things to try and get these things slotted in,
0:07:12 > 0:07:16a lot of which is out of your control, you do what you can...
0:07:16 > 0:07:18and then it all just goes to pot.
0:07:19 > 0:07:21And that's where we are at the moment.
0:07:23 > 0:07:25OK. Erm...
0:07:25 > 0:07:26I'm going to have to go and tell him.
0:07:26 > 0:07:29I don't... Can you...? If you speak to Ian and just say,
0:07:29 > 0:07:32"Look, there's another two hours left on this list,"
0:07:32 > 0:07:34- if we can get something done.- Yeah.
0:07:38 > 0:07:40We've now pushed aside an elective case
0:07:40 > 0:07:42which, when you look back on hindsight,
0:07:42 > 0:07:45you wish you hadn't and then you end up doing nothing.
0:07:46 > 0:07:48I hate doing this.
0:07:50 > 0:07:51It doesn't get any easier.
0:07:54 > 0:07:55Hello.
0:08:00 > 0:08:01Well, I was better.
0:08:04 > 0:08:06I am going to tell you that, yeah.
0:08:08 > 0:08:10And I know the disappointment you're going to have.
0:08:10 > 0:08:12You... I have just tried to shift mountains today
0:08:12 > 0:08:14to try and get you done.
0:08:14 > 0:08:15And I failed.
0:08:15 > 0:08:16I'm sorry.
0:08:19 > 0:08:22The case that was in that theatre has gone on longer
0:08:22 > 0:08:26than the surgeon expected, which is not his fault either,
0:08:26 > 0:08:30but it has run-on effects on what we need to do.
0:08:33 > 0:08:34And I'm really sorry.
0:08:36 > 0:08:38It's very frustrating.
0:08:40 > 0:08:43Now, Friday is the next slot.
0:08:43 > 0:08:46I have you top of the list.
0:08:46 > 0:08:48I'm not having this again.
0:08:48 > 0:08:50All right.
0:08:50 > 0:08:51I'm sorry. OK.
0:08:53 > 0:08:54I'll be in touch.
0:08:56 > 0:09:00Reno is one of more than 300 patients at St Mary's
0:09:00 > 0:09:03who have had their orthopaedic surgery delayed in the past year.
0:09:06 > 0:09:08A bit frustrating.
0:09:08 > 0:09:09And I do feel for the doctor,
0:09:09 > 0:09:12because he was more frustrated than me.
0:09:13 > 0:09:15All decisions they've got their hands tied up for.
0:09:15 > 0:09:18It's not their fault. It's really the system.
0:09:20 > 0:09:21It's not their fault.
0:09:27 > 0:09:32Friday now, so I've got two more days of just pain.
0:09:45 > 0:09:48Welcome to the conference centre.
0:09:48 > 0:09:50Good morning, everyone.
0:09:50 > 0:09:54So, St Mary's went out on red this morning.
0:09:54 > 0:09:57It's the job of site director Lesley Powls and her team
0:09:57 > 0:10:01to make sure there's enough beds at St Mary's for its patients.
0:10:01 > 0:10:02Unplaced electives.
0:10:02 > 0:10:04This is a little bit of a movable feast this morning
0:10:04 > 0:10:07and we're on hold at the moment for anything except for day cases
0:10:07 > 0:10:10and inpatients in the correct beds.
0:10:10 > 0:10:13An elective patient is a planned patient,
0:10:13 > 0:10:16so it's a patient who knows they're coming into hospital for a surgery.
0:10:16 > 0:10:19'I only called you because I've got six...'
0:10:19 > 0:10:21The first thing that happens when we have bed pressures
0:10:21 > 0:10:24is we review our electives, and what we tend to do is
0:10:24 > 0:10:28prioritise then our urgent electives,
0:10:28 > 0:10:30so our electives who need cancer surgery,
0:10:30 > 0:10:34and patients who have been waiting considerable lengths of time.
0:10:35 > 0:10:42So, this morning we have got only two beds in the hospital,
0:10:42 > 0:10:44so all electives, I was about to ring theatres,
0:10:44 > 0:10:47are going to go on hold for the time being.
0:10:47 > 0:10:48I'm trying to be hopeful,
0:10:48 > 0:10:51but I have a feeling they probably will be cancelled.
0:11:00 > 0:11:01How's it going?
0:11:01 > 0:11:04One of the surgeons hoping to operate today is
0:11:04 > 0:11:08gastric bypass specialist consultant Mr Ahmed Ahmed.
0:11:08 > 0:11:11Ah, Rhona, hi. How are you? Do we know what the bed status is?
0:11:11 > 0:11:16- I've explained that we need two beds for the bypasses.- Yeah.
0:11:16 > 0:11:20I mean, and you're telling me that at the moment we have one bed?
0:11:20 > 0:11:22- I don't have any bed at the moment. - No beds.
0:11:26 > 0:11:3141-year-old Daniel is one of five patients today on Mr Ahmed's list.
0:11:31 > 0:11:33There's a little bit of me in the back of my mind which is anxious.
0:11:33 > 0:11:36But fingers crossed we've got a bed and we can get this done.
0:11:36 > 0:11:38I don't think I can go through another being sent away
0:11:38 > 0:11:41and having to wait for another appointment again.
0:11:41 > 0:11:46Daniel has been waiting a year and a half for his weight-loss surgery.
0:11:46 > 0:11:49I am 27 stone,
0:11:49 > 0:11:54and I have a BMI of just short of 50.
0:11:54 > 0:11:56The family history has not been great,
0:11:56 > 0:12:00so all our parents are no longer with us,
0:12:00 > 0:12:06so they've all passed away through one ill health or another, so...
0:12:06 > 0:12:09If I can sort of increase my chances of a longer life
0:12:09 > 0:12:11and a healthier life, it's got to be good.
0:12:11 > 0:12:14I don't want to be another statistic,
0:12:14 > 0:12:17where my girls are growing up without their dad.
0:12:19 > 0:12:22I don't want them to be saying goodbye to me at 45.
0:12:23 > 0:12:26Daniel's surgery is scheduled to take place in
0:12:26 > 0:12:29St Mary's £10 million Surgical Innovation Centre.
0:12:30 > 0:12:33It has its own dedicated weight loss operating theatre and
0:12:33 > 0:12:36oversized beds for clinically obese patients.
0:12:36 > 0:12:39Hi, Mandy, how are you? Do you have any questions...?
0:12:39 > 0:12:43When St Mary's is close to capacity, the weight loss beds are regularly
0:12:43 > 0:12:48redeployed to higher priority patients from across the hospital.
0:12:48 > 0:12:51- INTERVIEWER:- Where does bariatric surgery kind of sit
0:12:51 > 0:12:56in the pecking order at St Mary's, in terms of who gets cancelled?
0:12:56 > 0:13:00Well, unfortunately it's low down on the priority list.
0:13:01 > 0:13:05It's often our patients that, you know, get cancelled,
0:13:05 > 0:13:07because there's a lack of beds.
0:13:07 > 0:13:10The beds will first go to patients that are coming in through
0:13:10 > 0:13:13accident and emergency and then lastly there will be
0:13:13 > 0:13:16elective surgery like bariatric surgery and...
0:13:16 > 0:13:17Other specialties as well.
0:13:17 > 0:13:19I mean, I don't want to say that mine is the only one
0:13:19 > 0:13:20that's suffering this problem.
0:13:20 > 0:13:24Any kind of elective noncancerous surgery, you know, gets hit.
0:13:26 > 0:13:28When the centre opened in 2012,
0:13:28 > 0:13:32Mr Ahmed and his team performed 750 operations.
0:13:33 > 0:13:36Last year, they completed just 150.
0:13:37 > 0:13:40If you look at the number of patients who meet our
0:13:40 > 0:13:45national NHS criteria for bariatric surgery,
0:13:45 > 0:13:48we should be doing about 1.5 million operations
0:13:48 > 0:13:50a year in this whole country.
0:13:50 > 0:13:53But I can tell you, last year we probably only did about 9,000.
0:13:53 > 0:13:57The last time it got cancelled was one of the most difficult days
0:13:57 > 0:13:59that I've had in quite a long time.
0:13:59 > 0:14:04We have this endless number of patients that's building up
0:14:04 > 0:14:06that don't get their surgery
0:14:06 > 0:14:09because there is actually no beds in the hospital.
0:14:17 > 0:14:22That is our 82nd complaint from a lady patient of ours.
0:14:22 > 0:14:27"I was referred for bariatric surgery at St Mary's in April 2015.
0:14:27 > 0:14:29"On calling the team at Mary's, I was informed I would only
0:14:29 > 0:14:33"possibly get a date February next year, 2017.
0:14:33 > 0:14:36"Putting aside the growing desperation to get my surgery done
0:14:36 > 0:14:39"and the stress this is causing, this is influencing
0:14:39 > 0:14:44"my ability to make decisions on my career because I am in limbo.
0:14:44 > 0:14:48"This journey has taken the better part of four years.
0:14:48 > 0:14:50"Can you please help?"
0:14:50 > 0:14:53The waiting list for bariatric surgery
0:14:53 > 0:14:55is one of the longest in the Trust.
0:14:55 > 0:14:58I think generally there's a feeling that we're victimising them
0:14:58 > 0:14:59and not giving them...
0:14:59 > 0:15:03We're withholding surgery, and what I try to get across is that
0:15:03 > 0:15:06it's not personal, but that there is...
0:15:06 > 0:15:10I think there is a stigmatisation against obesity and that that's
0:15:10 > 0:15:14part of the problem, that we're not prioritising these operations.
0:15:14 > 0:15:15Because in general there's a perception
0:15:15 > 0:15:17that obesity is not as big a problem,
0:15:17 > 0:15:21or somehow a lifestyle problem that people have caused themselves.
0:15:21 > 0:15:25It's sad to say but we get a fair amount of complaints,
0:15:25 > 0:15:28and there is a common theme,
0:15:28 > 0:15:33which is basically that people who struggle with this disease
0:15:33 > 0:15:36have to wait so long to get treatment.
0:15:36 > 0:15:38How many patients do we have tomorrow coming for surgery?
0:15:40 > 0:15:41All right.
0:15:44 > 0:15:45Fourth time?
0:15:49 > 0:15:50Third time coming in.
0:15:50 > 0:15:53So that's two three-time cancellations and
0:15:53 > 0:15:56a fourth-time cancellation, so that's ten cancellations
0:15:56 > 0:15:58on the list tomorrow already happened previously.
0:15:58 > 0:16:00Unbelievable. All right.
0:16:05 > 0:16:07If Daniel's operation goes ahead today,
0:16:07 > 0:16:11he'll need to recover for two days afterwards on the ward.
0:16:13 > 0:16:16We're going to just pop over to The Lindo Wing,
0:16:16 > 0:16:20which is the private unit of St Mary's Hospital.
0:16:20 > 0:16:22With no beds available,
0:16:22 > 0:16:26Mr Ahmed has a plan to ensure Daniel's operation can happen.
0:16:26 > 0:16:30We were able to have a negotiation
0:16:30 > 0:16:34which has allowed the NHS part of our hospital
0:16:34 > 0:16:40to buy two beds for after surgery for two of my patients.
0:16:41 > 0:16:44The Lindo Wing is a 39-bed private hospital
0:16:44 > 0:16:47owned and operated by Imperial Trust.
0:16:47 > 0:16:50Profits from The Lindo are reinvested into the Trust
0:16:50 > 0:16:52and used to support its NHS services.
0:16:54 > 0:16:58It's one of the primary private units in London.
0:16:58 > 0:17:00I mean, it's very popular.
0:17:00 > 0:17:02I mean, you obviously remember, you know,
0:17:02 > 0:17:05Prince George and Princess Charlotte were born here not so long ago.
0:17:05 > 0:17:08So, yes, it's very important.
0:17:11 > 0:17:15Good morning, Reception. Dorika speaking. How can I help you?
0:17:16 > 0:17:18Hello. Oh, there she is!
0:17:18 > 0:17:21- Are you going to take two of my patients today?- Yes, I am.
0:17:21 > 0:17:23- We're ready for you. - Thank you. All right, perfect.
0:17:23 > 0:17:27The Lindo can accommodate Mr Ahmed's NHS patients today because
0:17:27 > 0:17:30it's not currently full of private clients.
0:17:30 > 0:17:32The costs of nursing them in the private Lindo
0:17:32 > 0:17:36during their recovery from surgery will be borne by Mr Ahmed's
0:17:36 > 0:17:38NHS bariatrics budget.
0:17:38 > 0:17:41The alternative, which is not to use these private beds,
0:17:41 > 0:17:44would be for us not to do any surgery.
0:17:44 > 0:17:47And that would be a complete waste of money because it costs the NHS
0:17:47 > 0:17:50I think roughly about £20 a minute to run an operating room.
0:17:50 > 0:17:54So you can imagine, with all the team and the staff that's there,
0:17:54 > 0:17:55and if we don't operate,
0:17:55 > 0:17:58that's costing a lot of money and a lot of wastage.
0:17:58 > 0:18:01So at least by paying a little bit and getting these extra beds,
0:18:01 > 0:18:04at least two of our cases don't get cancelled.
0:18:04 > 0:18:07You know, I think that's a great idea.
0:18:08 > 0:18:10What have you got, elective-wise, Linda?
0:18:10 > 0:18:12Oh, we've got nine for surgery.
0:18:12 > 0:18:15We use The Lindo Wing beds when they have free capacity,
0:18:15 > 0:18:18but what that means is when we do that,
0:18:18 > 0:18:21we in effect stop Lindo being able to use those beds
0:18:21 > 0:18:24for a paying private patient.
0:18:24 > 0:18:29The Lindo Wing is part of Imperial and the money that the Lindo
0:18:29 > 0:18:32bring in we use to fund NHS work.
0:18:33 > 0:18:39For me, if we've got an empty bed anywhere on this site
0:18:39 > 0:18:41I will make sure that we use it,
0:18:41 > 0:18:44because it's really important to get our patients treated,
0:18:44 > 0:18:47irrespective of how the money for that bed comes in.
0:18:51 > 0:18:54Which two of these beds can I have?
0:18:54 > 0:18:57Colorectal surgeon George Reese is also scheduled
0:18:57 > 0:18:58to operate this morning.
0:19:00 > 0:19:01Hi, good morning.
0:19:01 > 0:19:04So, there's two patients on my list today, two ladies,
0:19:04 > 0:19:08who should have been booked for HDU, I think.
0:19:08 > 0:19:12- Are you likely to have any discharges, do you know?- Erm...
0:19:12 > 0:19:15- They haven't done the round yet but...- Well, we'll wait.
0:19:15 > 0:19:20Before he can start, Mr Reese needs to find an HDU,
0:19:20 > 0:19:25or a high dependency unit, bed for his patient, 84-year-old Betty.
0:19:26 > 0:19:30- Were you up very early?- Yes.
0:19:30 > 0:19:32Crack of doom.
0:19:33 > 0:19:36Betty was diagnosed with bowel cancer a month ago.
0:19:36 > 0:19:39She's accompanied by her two sons.
0:19:39 > 0:19:45I think the worst thing is not hearing the news yourself
0:19:45 > 0:19:49but telling your relatives, and those close to you.
0:19:51 > 0:19:55I can't quite believe that...
0:19:55 > 0:19:56that I've actually got it.
0:19:56 > 0:19:59It doesn't seem possible.
0:20:01 > 0:20:02I don't know.
0:20:02 > 0:20:07You expect to have some feeling that there's that beast in you.
0:20:07 > 0:20:10But there's, apart from having an occasional pain,
0:20:10 > 0:20:14there's nothing extraordinary about it.
0:20:14 > 0:20:19- Quite tough. Are you quite brave? - No, no! I'm a registered coward!
0:20:23 > 0:20:26But pull the plug if I'm going to be...
0:20:28 > 0:20:31As soon as they stop filming, we'll do that, yeah.
0:20:39 > 0:20:41HE SIGHS
0:20:50 > 0:20:53HE SIGHS
0:20:53 > 0:20:56We're going to do a day case whilst we find out if we're going to be
0:20:56 > 0:21:00allowed to do any operating at all today because the bed
0:21:00 > 0:21:02situation is worse than we had first thought.
0:21:02 > 0:21:06And we may not even get a bed for our cancer case, apparently.
0:21:17 > 0:21:21Any help in negotiating a bed would be appreciated.
0:21:21 > 0:21:26I'm texting our divisional manager.
0:21:26 > 0:21:29And I'm also going to send the same message to his boss.
0:21:29 > 0:21:31Just, really, for some leverage.
0:21:31 > 0:21:34Everyone's doing what they can, but I don't like being in the dark.
0:21:34 > 0:21:38Because things were so bad for such a long time
0:21:38 > 0:21:42that all of the previous ways
0:21:42 > 0:21:46we had of negotiating beds have been exhausted.
0:21:46 > 0:21:49And...there isn't a way any more.
0:21:49 > 0:21:52The site manager says there's a bed, there's a bed.
0:21:52 > 0:21:54Or they don't, and then there isn't.
0:22:03 > 0:22:05OK. Daniel, good to see you, how are you?
0:22:05 > 0:22:08Welcome back to the hospital for attempt number two.
0:22:08 > 0:22:10At the moment, in the hospital,
0:22:10 > 0:22:13we are having a huge problem with beds on the NHS side.
0:22:13 > 0:22:15So, in fact, we don't have any beds for you.
0:22:15 > 0:22:18But I have got a bed for you in the private side.
0:22:18 > 0:22:22So you're going to be looked after after the surgery not in this
0:22:22 > 0:22:24building but the one across the street,
0:22:24 > 0:22:27which is the private building, for private patients.
0:22:27 > 0:22:30And we've actually done a deal so we basically bought
0:22:30 > 0:22:33a bed for you there so the operation doesn't get cancelled.
0:22:33 > 0:22:37You'll have your own private room, and, you know, en-suite bathroom.
0:22:37 > 0:22:40You know, it's a bit more luxurious.
0:22:40 > 0:22:44Daniel's obesity has led to Type 2 diabetes,
0:22:44 > 0:22:47sleep apnoea and high blood pressure.
0:22:47 > 0:22:51And the amazing thing we will hopefully see, and we see
0:22:51 > 0:22:52that in 80% of cases,
0:22:52 > 0:22:57is your diabetes will begin to melt away within hours of the operation.
0:22:57 > 0:23:00All these drugs you're on at the moment, hopefully,
0:23:00 > 0:23:04we'll be able to switch them all off, one after the other.
0:23:04 > 0:23:06'You can take Daniel's case.'
0:23:06 > 0:23:09Poor guy's suffering from diabetes and on five different drugs.
0:23:09 > 0:23:10How much money does that cost the NHS?
0:23:10 > 0:23:14I would say just tablet treatment for diabetes
0:23:14 > 0:23:18will probably be costing the NHS close to £8,000-£9,000 every year
0:23:18 > 0:23:20for the rest of his life.
0:23:20 > 0:23:22So, people who have diabetes will get heart disease,
0:23:22 > 0:23:25they'll get strokes, they'll get problems with their eyes,
0:23:25 > 0:23:28they'll get amputations, they'll get kidney damage.
0:23:28 > 0:23:30And I'm not even costing in the cost of treating those health
0:23:30 > 0:23:32problems from diabetes.
0:23:32 > 0:23:34So, one operation that's going to cost the NHS close
0:23:34 > 0:23:38to £6,000 will, in fact, pay for itself within a year or two.
0:23:38 > 0:23:41- All right, thank you, see you in a bit. Goodbye.- Thank you.
0:23:44 > 0:23:47- Oh, I'm sorry it's such a long time. - That's all right.
0:23:47 > 0:23:49I thought you'd be going.
0:23:49 > 0:23:51Betty needs a post-operative high dependency bed,
0:23:51 > 0:23:53which is still not available.
0:23:54 > 0:23:57There is one potential short-term solution.
0:23:58 > 0:24:01We can do the cancer if we're prepared for her
0:24:01 > 0:24:02to stay in recovery.
0:24:02 > 0:24:04Let me check the number on your band.
0:24:04 > 0:24:07Although I've got permission to send,
0:24:07 > 0:24:09she's going to have to spend...
0:24:09 > 0:24:13you know, probably at least a couple of days in recovery.
0:24:15 > 0:24:18Of all the ladies I've had for these cancers,
0:24:18 > 0:24:22this is really not a good person to leave in recovery indefinitely.
0:24:23 > 0:24:26Recovery is a 12-bay holding area
0:24:26 > 0:24:29adjacent to the main operating theatres.
0:24:31 > 0:24:35It's designed for patients to wake up from their anaesthetic,
0:24:35 > 0:24:39before being moved and cared for on the appropriate ward.
0:24:39 > 0:24:44What it means is that because our recovery isn't set up as a ward,
0:24:44 > 0:24:47it's supposed to be somewhere that people spend no more than
0:24:47 > 0:24:51four hours, there are not the normal facilities you need
0:24:51 > 0:24:54to get people up and going after an operation, and it's not staffed
0:24:54 > 0:24:58to nurse unwell, post-operative patients for long periods of time.
0:24:58 > 0:25:03We know that there are some operations where we just
0:25:03 > 0:25:06really struggle to be able to postpone them.
0:25:06 > 0:25:09And we look for what's the next best option.
0:25:09 > 0:25:14And, often, the next best option, for that patient is recovery.
0:25:14 > 0:25:15A last resort is cancelling.
0:25:15 > 0:25:18It's the next best option.
0:25:19 > 0:25:21Hi, sorry to disturb you.
0:25:21 > 0:25:24Thank you and everyone said that I'm allowed to do the cancer case
0:25:24 > 0:25:27and she can stay here and stuff, but I'm not totally sure
0:25:27 > 0:25:29if she's the right person to stay here.
0:25:29 > 0:25:32She's 84, she's quite frail,
0:25:32 > 0:25:37and it might not be the nicest or safest place for her to recover
0:25:37 > 0:25:40for more than a minimum period of time.
0:25:40 > 0:25:44How are we staffed, if we do decide to do this now?
0:25:44 > 0:25:50So, today, the only patient I know that's going to stay overnight...
0:25:50 > 0:25:52- Would be her?- ..is her.
0:25:52 > 0:25:54If you're well staffed, and she'll be the only one,
0:25:54 > 0:25:58then that should be OK. OK, thank you.
0:26:00 > 0:26:02We'll go ahead with Betty's operation.
0:26:03 > 0:26:05After only...
0:26:07 > 0:26:09..3.5 hours of wrangling.
0:26:09 > 0:26:11So, we're going to send for Betty.
0:26:11 > 0:26:13Oh, right, OK.
0:26:13 > 0:26:16Thank you.
0:26:20 > 0:26:23- See you later.- Yep.- Goodbye for now.
0:26:26 > 0:26:28Thank you.
0:26:29 > 0:26:31- Hi, sorry about the delay.- Hello.
0:26:31 > 0:26:33I think you've witnessed a lot of the frustration we've had
0:26:33 > 0:26:37this morning, trying to do operations and being told,
0:26:37 > 0:26:42"No, you can't start in case there's no bed later," and, then,
0:26:42 > 0:26:46after hours of not doing anything, they find a bed.
0:26:48 > 0:26:52Bowel cancer is the fourth most common cancer in the UK,
0:26:52 > 0:26:54with over 100 new diagnoses each day.
0:26:56 > 0:26:58Bowel cancer is curable.
0:26:58 > 0:27:04And if people report symptoms to their doctors early,
0:27:04 > 0:27:06then they have better results.
0:27:08 > 0:27:10Let's orientate it.
0:27:10 > 0:27:13So, this is the ascending colon and the caecum coming down here.
0:27:13 > 0:27:17And then off the bottom of the caecum, this is going to be the
0:27:17 > 0:27:20appendix here, which has tailed back on itself.
0:27:20 > 0:27:22The cancer's all in here.
0:27:22 > 0:27:23It's very hard here.
0:27:23 > 0:27:27Until we've got the final pathology, I can't...
0:27:27 > 0:27:28I can never say never,
0:27:28 > 0:27:31but I would imagine that we will consider it definitive...
0:27:32 > 0:27:34..treatment.
0:27:36 > 0:27:41Betty will stay in recovery until an HDU bed becomes available.
0:27:47 > 0:27:50After 18 months of waiting,
0:27:50 > 0:27:53Daniel is having his gastric bypass surgery.
0:27:53 > 0:27:57It's only going ahead because the Trust's private Lindo Wing
0:27:57 > 0:27:59is providing him with a bed.
0:28:01 > 0:28:04This is the first time we've done this.
0:28:04 > 0:28:06Is it a long-term solution? I don't know.
0:28:06 > 0:28:09That's something you'd have to ask the managers.
0:28:09 > 0:28:11How long can the carry on...
0:28:11 > 0:28:13you know...
0:28:13 > 0:28:16funding these private beds? Hard to know.
0:28:16 > 0:28:21But, you know, it's one way to, you know, get through the work,
0:28:21 > 0:28:24and make sure our patients get the surgery they need so much.
0:28:25 > 0:28:29Mr Ahmed will use keyhole surgery to reduce the size of Daniel's
0:28:29 > 0:28:31stomach by 80%.
0:28:33 > 0:28:35So, this is the size of his new stomach, his neo-stomach.
0:28:35 > 0:28:38We're joining on the lower bowel.
0:28:38 > 0:28:40So, this is the small intestine being pulled up,
0:28:40 > 0:28:44so his initial weight loss will come all internally.
0:28:44 > 0:28:48All this fat we see here will melt away in the next few weeks.
0:28:48 > 0:28:50Start to go very, very quickly for him.
0:28:51 > 0:28:56The surgery, it returns life expectancy back to normal.
0:28:56 > 0:28:59It reduces the risk of getting cancer by 40%.
0:28:59 > 0:29:03People who were previously perhaps not working or on unemployment
0:29:03 > 0:29:06benefit will, hopefully, after losing weight and getting
0:29:06 > 0:29:08their health back, will go back to work.
0:29:08 > 0:29:11So, I can't think of any other surgery that's as beneficial,
0:29:11 > 0:29:14both to the individual and to society.
0:29:16 > 0:29:18Daniel's operation is completed.
0:29:18 > 0:29:23He'll spend two nights recovering in St Mary's private Lindo Wing.
0:29:37 > 0:29:39Ah, there she is!
0:29:43 > 0:29:46Not quite what I expected when I came up. They're just waiting
0:29:46 > 0:29:48for a bed in the high-dependency.
0:29:52 > 0:29:53Yeah.
0:29:53 > 0:29:56She's always been the one that looks after us rather than
0:29:56 > 0:29:58anyone else looking after her.
0:30:00 > 0:30:03You go back to sleep, if you can.
0:30:09 > 0:30:11After seven hours in recovery,
0:30:11 > 0:30:15a bed becomes available for Betty in the high-dependency unit.
0:30:23 > 0:30:26It's Lesley at St Mary's. Have we got Hammersmith?
0:30:26 > 0:30:30- 'Yes.'- Renal, are you on the line? - 'Yes. No problems.
0:30:30 > 0:30:33- 'We have two beds.' - Marvellous.
0:30:33 > 0:30:35Three miles west of St Mary's
0:30:35 > 0:30:38is the Trust's renal unit at Hammersmith Hospital.
0:30:40 > 0:30:43Renal will work really hard to ensure that there is
0:30:43 > 0:30:46a bed if they have something like a transplant coming up.
0:30:46 > 0:30:51And they're protected, because what they do is very, very special.
0:30:51 > 0:30:55Surgeons here are specialists in live kidney transplants,
0:30:55 > 0:30:58where organs are harvested from healthy donors.
0:30:59 > 0:31:02You are seeing the best of the best.
0:31:02 > 0:31:05It's kind of the jewel in Imperial's crown, really.
0:31:07 > 0:31:09Can we do a group hug?
0:31:09 > 0:31:13- Yep!- So, busy day today. We have...
0:31:13 > 0:31:16Head of transplantation Frank Dor
0:31:16 > 0:31:19conducts around 35 live donations a year.
0:31:21 > 0:31:25People are still not aware that they can save a life by donating
0:31:25 > 0:31:28a kidney. It is one of the most beautiful things to do.
0:31:28 > 0:31:31As you will see, it's just lovely to do an operation knowing that people
0:31:31 > 0:31:36will actually get a second life and knowing that the donor will
0:31:36 > 0:31:37do well, as well.
0:31:37 > 0:31:41- So, let's concentrate on the live donor first...- Yep.
0:31:41 > 0:31:45..and everything else according to the protocol.
0:31:45 > 0:31:47BELL PINGS
0:31:49 > 0:31:53- Hi!- How are you?- I'm fine! How are you?- Yeah, I'm all right.- Good!
0:31:53 > 0:31:55How are you?
0:31:55 > 0:31:5731-year-old Jen, a mother of two,
0:31:57 > 0:32:01is donating one of her kidneys to save her husband's life.
0:32:01 > 0:32:05In my mind, it's very black and white to give my kidney away.
0:32:05 > 0:32:09For me, it's not a selfless thing that I'm doing.
0:32:09 > 0:32:10We are ready.
0:32:10 > 0:32:14My husband gets his life back, my kids get their father back.
0:32:15 > 0:32:19Jen's husband Elliot has a rare autoimmune disease which has
0:32:19 > 0:32:22left him with just 5% kidney function.
0:32:23 > 0:32:27I had kidney failure and I had to go straight onto dialysis.
0:32:28 > 0:32:33He is kept alive by regular four-hour dialysis sessions.
0:32:33 > 0:32:36The last eight months have been pretty tough,
0:32:36 > 0:32:39you know, not being able to work full time and going to
0:32:39 > 0:32:40dialysis three times a week.
0:32:42 > 0:32:44We've got a young family, and we've got kids,
0:32:44 > 0:32:48and we explained to them that everybody has two kidneys and both
0:32:48 > 0:32:52of Daddy's kidneys weren't working and that he needed a new one.
0:32:52 > 0:32:54At Imperial, without a live donor,
0:32:54 > 0:32:58kidney patients typically wait three to five years for an organ to
0:32:58 > 0:33:01become available from the deceased donor list.
0:33:01 > 0:33:04There's great studies that show that overall,
0:33:04 > 0:33:1050% of dialysis patients don't survive five years, so this is very
0:33:10 > 0:33:14serious, and a kidney transplant can prolong life with decades.
0:33:15 > 0:33:18Forget about the whole circus and focus on each other,
0:33:18 > 0:33:22- and we will take care of the rest. - OK.- Yeah?- Thank you.- Excellent!
0:33:22 > 0:33:25- See you round. - See you later.- Bye-bye.
0:33:27 > 0:33:28I knew I wanted to be a donor.
0:33:28 > 0:33:31There was never a second of doubt in my mind.
0:33:31 > 0:33:33This is something I wanted to do.
0:33:36 > 0:33:39We're both going to have an operation on the same day,
0:33:39 > 0:33:42so it's quite nice to go through that together, I think.
0:33:45 > 0:33:50They're a very close, tight little unit and just there for each other.
0:33:50 > 0:33:54It's not like Elliot would have said to her, "Will you do this for me?"
0:33:54 > 0:33:57It was just right away, "Right, I will give you my kidney,"
0:33:57 > 0:34:00as anyone that you love would do.
0:34:02 > 0:34:04Where's my dad?
0:34:04 > 0:34:07OK, love you.
0:34:07 > 0:34:09- Bye.- Be good.
0:34:11 > 0:34:13Love you.
0:34:13 > 0:34:15- Tough, isn't it? - JEN LAUGHS
0:34:21 > 0:34:24You know, this is about him and this is saving his life.
0:34:26 > 0:34:29I love you. Good luck.
0:34:29 > 0:34:32His operation means a lot more to me than my operation,
0:34:32 > 0:34:37because his HAS to be OK, it has to work, he needs that kidney to work.
0:34:37 > 0:34:39And, Jennifer, what operation are we doing?
0:34:39 > 0:34:43- Kidney transplant.- So what operation are you having?- A donor. Sorry.
0:34:43 > 0:34:46- Can I just make the famous arrow... - You can!
0:34:46 > 0:34:50..so that you're still awake and still remember that we're going to
0:34:50 > 0:34:51take your left kidney out?
0:34:53 > 0:34:56As soon as Frank Dor harvests Jen's kidney,
0:34:56 > 0:34:59an intricate chain of events will be set in motion.
0:34:59 > 0:35:04I was unable to donate directly to him as I wasn't a blood type match.
0:35:04 > 0:35:07And when I found out, that was devastating.
0:35:07 > 0:35:11Jen's blood type means she can't donate directly to Elliot,
0:35:11 > 0:35:15so the couple are taking part in a pioneering kidney-sharing scheme.
0:35:15 > 0:35:17Jen will donate to someone else in the UK,
0:35:17 > 0:35:22and Elliot actually gets a kidney from somewhere else in the UK.
0:35:22 > 0:35:27She ensures he gets a kidney transplant.
0:35:27 > 0:35:30Four times a year, a group of specialist renal centres,
0:35:30 > 0:35:34including Hammersmith, unites in a kidney swap initiative
0:35:34 > 0:35:35called Paired and Pooled.
0:35:37 > 0:35:41So, I'll be co-ordinating for the day with my other colleagues
0:35:41 > 0:35:43in the other centres and making sure
0:35:43 > 0:35:47everything is OK with our donor recipient pair
0:35:47 > 0:35:49and we're happy to proceed.
0:35:49 > 0:35:51And everything has to happen at the same time, basically,
0:35:51 > 0:35:54putting the patient to sleep at the same time and the operations
0:35:54 > 0:35:56starting at the same time
0:35:56 > 0:36:01and there's no problem, so we communicate constantly for the day.
0:36:02 > 0:36:04Hoping that everything goes smoothly,
0:36:04 > 0:36:07there's no last-minute cock-ups.
0:36:07 > 0:36:10One mistake, you know, can screw up or mess up the whole thing.
0:36:11 > 0:36:16All the pre-transplant work is anonymous.
0:36:16 > 0:36:19For now, no-one knows to whom
0:36:19 > 0:36:23he's donating and from whom she is receiving.
0:36:25 > 0:36:29You know, to help improve someone else's life is really important,
0:36:29 > 0:36:32having been through and seen how Elliot suffers.
0:36:32 > 0:36:34No-one should be suffering like that.
0:36:34 > 0:36:39For Jen to be able to do that for a complete stranger
0:36:39 > 0:36:40is, you know, admirable.
0:36:42 > 0:36:46OK, so are you happy for us to put our donor to sleep?
0:36:49 > 0:36:54- Thank you. Bye.- So it's a yes? - Yes.- Great. I'll get started!
0:36:55 > 0:36:59- Good news! We can start!- Oh, my God! - Jennifer, squeeze my hand.
0:36:59 > 0:37:01- I don't mind.- He's really strong.
0:37:01 > 0:37:03You'll feel a little bit light-headed.
0:37:03 > 0:37:05We'll do some arm wrestling.
0:37:18 > 0:37:21Hello! Are you OK? Do you know which room my patients are in?
0:37:21 > 0:37:25Weight-loss patient Daniel is recovering from yesterday's
0:37:25 > 0:37:27operation to reduce the size of his stomach.
0:37:27 > 0:37:29Right, there he is. How are you?
0:37:29 > 0:37:31- I'm good, thank you. - Good to see you.
0:37:31 > 0:37:33How about the drinks? Are they going down OK?
0:37:33 > 0:37:35I've had a small mouthful,
0:37:35 > 0:37:38and I think for one occasion it actually felt like it was too much.
0:37:38 > 0:37:42So there's a feeling of fullness you're getting as part of
0:37:42 > 0:37:44a consequence of the surgery we did.
0:37:44 > 0:37:47When was the last meal you ate before the surgery? Sunday night?
0:37:47 > 0:37:52It was Sunday night. It was around... It finished about 6:30.
0:37:52 > 0:37:55- Do you feel hungry today? - Not particularly.- No.
0:37:55 > 0:37:58So isn't that amazing? We went through all of Sunday night,
0:37:58 > 0:38:01all of Monday, yesterday, with nothing to eat,
0:38:01 > 0:38:04and then till now all you've been having is a bit of water and soup.
0:38:04 > 0:38:08- Yeah.- So for most of us, we'd be famished right now.
0:38:08 > 0:38:10But the amazing thing is that you don't feel hungry,
0:38:10 > 0:38:13- and that's the effect of the surgery.- Yeah, yeah.- OK?- Definitely.
0:38:13 > 0:38:16- Thank you.- Take care. Bye-bye. - Cheers. Right, thank you.
0:38:21 > 0:38:22What, bring them in the private sector?
0:38:22 > 0:38:24I didn't ask Daniel what he thought of the ward,
0:38:24 > 0:38:26but he seems really happy.
0:38:26 > 0:38:30Well, we'll see. At the moment, we have no beds on the NHS.
0:38:30 > 0:38:34And this is one practical solution so that, you know,
0:38:34 > 0:38:37my surgeons can do their work and we don't get any...
0:38:37 > 0:38:39it'll minimise the cancellations.
0:38:48 > 0:38:53So, this is a nice anatomy lesson, guys, for the students.
0:38:53 > 0:38:56And of course, what you see is a bit magnified.
0:38:56 > 0:39:00Transplant surgeon Frank Dor is about to remove Jen's healthy
0:39:00 > 0:39:03kidney as part of a unique kidney swap scheme.
0:39:03 > 0:39:07Can we zoom in there some? This is the kidney, still covered,
0:39:07 > 0:39:10but you can see the shape of a kidney bean.
0:39:10 > 0:39:12That's why it's a "kidney bean".
0:39:12 > 0:39:15And it's a beautiful, beautiful kidney that we see.
0:39:15 > 0:39:18And of course, it makes it beautiful because we know that
0:39:18 > 0:39:21it's going to save Elliot's life.
0:39:25 > 0:39:31I'm just going to expose the kidney. It's an operation with finesse.
0:39:31 > 0:39:35And that's what's necessary. There is a small risk.
0:39:35 > 0:39:39There is no operation without any risk. The risk of dying is about...
0:39:39 > 0:39:41is reported to be one in 3,000.
0:39:43 > 0:39:45If something goes wrong,
0:39:45 > 0:39:47obviously - and I can't stress it enough - this is
0:39:47 > 0:39:52a person that doesn't need this operation, and basically we
0:39:52 > 0:39:57only can do things wrong, because she's perfect now, in good health.
0:39:57 > 0:39:59I'm going to make a few small incisions in her.
0:39:59 > 0:40:02That's going to change her body forever,
0:40:02 > 0:40:07and of course she's taking some risk by having a vital organ removed.
0:40:07 > 0:40:09So, the kidney is almost free.
0:40:10 > 0:40:12Stapler ready?
0:40:12 > 0:40:16- On...- Shh, shh, shh. Please. Just let me think a second.
0:40:16 > 0:40:19Staplers did not fire, and we have a thing there.
0:40:22 > 0:40:26Can we please all be quiet? Sam, if you hold this...
0:40:32 > 0:40:39OK, another stapler now. Scissors. Thank you. Just cut it.
0:40:40 > 0:40:42Ahhh...
0:40:45 > 0:40:51OK, kidney back. Nothing wrong with the kidney.
0:40:51 > 0:40:55And nothing wrong with Jen, which is of course most important.
0:40:55 > 0:40:59- OK.- It's like delivering a newborn baby. That's how I see it!
0:40:59 > 0:41:01This kidney's coming out, and we look at it and think,
0:41:01 > 0:41:03"Wow, this is so brilliant."
0:41:03 > 0:41:06Science has evolved, and eventually this is going to save
0:41:06 > 0:41:08someone's life and give them a good quality of life.
0:41:08 > 0:41:10So it's all exciting now.
0:41:10 > 0:41:12OK, lights on.
0:41:12 > 0:41:16It's a beautiful kidney, and you know it's going to change
0:41:16 > 0:41:20someone's life in another centre, so that is a good feeling.
0:41:22 > 0:41:23Jen's healthy kidney is one of many
0:41:23 > 0:41:27that have been harvested simultaneously across the country.
0:41:29 > 0:41:32As hers is couriered to its recipient, her husband
0:41:32 > 0:41:35Elliot's new kidney should now be on its way to Hammersmith.
0:41:37 > 0:41:42Jennifer, you've got another bump coming.
0:41:44 > 0:41:45I'm so proud of her as a mother.
0:41:45 > 0:41:49I just think what she's doing is just incredible.
0:41:49 > 0:41:51And you couldn't ask for a bigger
0:41:51 > 0:41:53show of love, could you, to somebody?
0:41:55 > 0:41:58- Stay asleep. - You saved someone's life.
0:41:58 > 0:42:00It's gone to a very good place.
0:42:03 > 0:42:05Love you.
0:42:05 > 0:42:09- Nearly there.- Nearly there. One down, one to go.
0:42:09 > 0:42:12- Go back to sleep. Rest. - Yeah.
0:42:12 > 0:42:14- INTERVIEWER:- What's it like to see
0:42:14 > 0:42:18your daughter-in-law give away a kidney for your son?
0:42:18 > 0:42:21It's going to cost him a lot of Chanel handbags!
0:42:21 > 0:42:22For sure!
0:42:24 > 0:42:27- Your eyelashes look good.- Mm.
0:42:27 > 0:42:29Two people, two members of your closest family,
0:42:29 > 0:42:31to be operated on on the same day is just...
0:42:33 > 0:42:34..really, really tough.
0:42:36 > 0:42:38- All yours.- Thank you. - Perfect.
0:42:39 > 0:42:43Elliot's new kidney arrives from its anonymous donor.
0:42:43 > 0:42:45If the transplant is a success,
0:42:45 > 0:42:48he will be able to come off dialysis immediately.
0:42:53 > 0:42:55- PETER:- Please, God, if the kidney works,
0:42:55 > 0:42:57then it'll be a new life for him.
0:42:59 > 0:43:02See you. Love you.
0:43:02 > 0:43:04See you later.
0:43:04 > 0:43:09You can't really plan, you know, five, ten, fifteen years in advance.
0:43:09 > 0:43:11You just have to take this one and live
0:43:11 > 0:43:15a completely normal life and hope it lasts a long time.
0:43:18 > 0:43:20Elliot's operation will be performed
0:43:20 > 0:43:23by Imperial's head of renal surgery, Vassilios Papalois.
0:43:26 > 0:43:29The kidney looks beautiful, actually, very nicely procured.
0:43:29 > 0:43:32The anatomical structures have been protected,
0:43:32 > 0:43:34so this is a very good start.
0:43:34 > 0:43:39The clock is ticking, and we cannot wait. We can't simply wait.
0:43:39 > 0:43:41It's an amazing feeling,
0:43:41 > 0:43:44I mean, to be able to help people that are in this very difficult
0:43:44 > 0:43:47situation, and especially the living donor operation is
0:43:47 > 0:43:50absolutely amazing, actually, because not the life of an
0:43:50 > 0:43:54individual but the life of a whole family changes dramatically.
0:43:54 > 0:43:57But it's equally important to remember that the kidney transplants
0:43:57 > 0:44:00add years of life, as well.
0:44:01 > 0:44:05So, we are basically ready to start. As you can see,
0:44:05 > 0:44:08the kidney's grey because all the blood has been flushed out and
0:44:08 > 0:44:12has been replaced by a very expensive preservation solution.
0:44:12 > 0:44:15But it's a nice and healthy kidney.
0:44:15 > 0:44:18You put your hand in here to protect the kidney.
0:44:18 > 0:44:20Here.
0:44:20 > 0:44:22Must not go on the floor.
0:44:30 > 0:44:32Quite soon we're going to be coming up to
0:44:32 > 0:44:35a fairly crucial part of the operation,
0:44:35 > 0:44:39when we take off the clamps on the vessels which supply
0:44:39 > 0:44:42the transplanted kidney and the transplanted kidney will
0:44:42 > 0:44:44fill up with blood.
0:44:47 > 0:44:49It's a miracle and it's happening in front of your eyes.
0:44:49 > 0:44:51It's something that was practically dead,
0:44:51 > 0:44:55an organ in an ice box without blood, and it's coming back to life.
0:44:56 > 0:44:59You can see it start making urine. See that?
0:45:01 > 0:45:04It's urine, it's already working.
0:45:04 > 0:45:07That's the transplant section.
0:45:07 > 0:45:11It looks good, actually. Nice and pink and both arteries are buzzing,
0:45:11 > 0:45:15which is excellent news. I think it went very well, very pleased.
0:45:26 > 0:45:29All I thought about was what it's going to be like, you know,
0:45:29 > 0:45:32spending time with the kids normally, being able to go
0:45:32 > 0:45:36swimming and all those things that you take for granted.
0:45:41 > 0:45:44Elliot will be monitored closely over the next few days
0:45:44 > 0:45:47to make sure his body doesn't reject the donor kidney.
0:45:57 > 0:46:00It's a lovely morning today. The operation day.
0:46:02 > 0:46:04I feel much better, had a good night rest.
0:46:06 > 0:46:09This young lady here is my beloved wife, Marina.
0:46:09 > 0:46:12Without her I don't think I would be where I am now.
0:46:14 > 0:46:18It is quite excessive damage that he's done to his pelvis and
0:46:18 > 0:46:21it'll be a while before he's better.
0:46:21 > 0:46:23I'm sure he thought he was going to be up and about in
0:46:23 > 0:46:27a couple of weeks, going back to his dancing and his cross-fit and
0:46:27 > 0:46:31standing up ten hours a day at work.
0:46:31 > 0:46:35I think the surgeon kind of made him realise that he won't be doing
0:46:35 > 0:46:38a lot of that stuff for maybe a year.
0:46:38 > 0:46:41The problem will be probably when I get him home, but then
0:46:41 > 0:46:44hopefully his mother will come and she'll look after him at home
0:46:44 > 0:46:47and I'll just be out of the house working all day!
0:46:49 > 0:46:52See you later. Thank you.
0:46:52 > 0:46:55Two days after the operation to repair his shattered pelvis
0:46:55 > 0:46:59was postponed, Reno is finally called to theatre.
0:47:18 > 0:47:19This is a very bad injury.
0:47:21 > 0:47:25You can see the number of fragments that we're now dealing with.
0:47:32 > 0:47:35There is one assistant who is pulling on the leg,
0:47:35 > 0:47:39which is actually one of the most important jobs.
0:47:39 > 0:47:44It helps the surgeon to hold the fracture in the position
0:47:44 > 0:47:46he wants it.
0:47:46 > 0:47:49Then, once we've worked out how it's all going to go back together again,
0:47:49 > 0:47:53the next stage of the operation is trying to hold it there
0:47:53 > 0:47:54with plates and screws.
0:48:00 > 0:48:03Screwdriver, please.
0:48:03 > 0:48:05That's fantastic, that looks great.
0:48:05 > 0:48:10It's reconstituted his socket, which was just in pieces earlier.
0:48:14 > 0:48:16We're now going to close up.
0:48:16 > 0:48:21And we're done so, you know, this guy's got his operation. Brilliant.
0:48:32 > 0:48:35- So, shall we go and see her?- Yes.
0:48:36 > 0:48:38Good morning, very nice to see you again.
0:48:38 > 0:48:40How are you feeling this morning?
0:48:44 > 0:48:46Yes, I'm not surprised you feel a little ropey.
0:48:46 > 0:48:49Betty has spent the past three days recovering from her bowel
0:48:49 > 0:48:53cancer surgery on a high-dependency ward.
0:48:53 > 0:48:55It's very important to sit you out of bed and to get you out and
0:48:55 > 0:48:58moving and to get you breathing deeply, OK?
0:48:58 > 0:48:59We'll keep a very close eye on you.
0:48:59 > 0:49:02- All right, bye-bye.- Thank you.
0:49:02 > 0:49:05She's obviously had her confidence hit a bit, which is perfectly
0:49:05 > 0:49:08natural, perfectly expected, given the circumstances.
0:49:08 > 0:49:11So I'm trying to build up that confidence and try to get
0:49:11 > 0:49:14into her head that she's going to be going home after the weekend.
0:49:14 > 0:49:17I think that's probably roughly when she'll be fit.
0:49:19 > 0:49:23We think it's going to be the middle of next week.
0:49:23 > 0:49:25It seemed pretty fast to us,
0:49:25 > 0:49:28but she's got a good support network,
0:49:28 > 0:49:32so someone will always be with her once she does come home.
0:50:19 > 0:50:21Good morning, Jen.
0:50:22 > 0:50:25- Hi.- Good morning.- Good morning. Sleeping in today?
0:50:27 > 0:50:30Elliot and his wife Jen are recovering well,
0:50:30 > 0:50:33following their respective kidney operations.
0:50:33 > 0:50:38People probably think you've done an amazing thing, I hope.
0:50:38 > 0:50:41I don't know about that but just making sure Ell was OK.
0:50:41 > 0:50:44I was in contact with the transplant surgeon in the other centre
0:50:44 > 0:50:45- yesterday...- Yeah.
0:50:45 > 0:50:49..and even up till late in the evening we texted each other.
0:50:49 > 0:50:53- Good.- So he was very happy with your kidney.
0:50:53 > 0:50:58- And your kidney turned out to be a perfect match.- Oh, my God!
0:50:58 > 0:50:59So this is a one-off event.
0:50:59 > 0:51:02- Oh, I'm really happy to hear that! - Yeah?
0:51:02 > 0:51:03That's what I thought.
0:51:03 > 0:51:04- Really happy.- Yeah.
0:51:04 > 0:51:05OK, good.
0:51:05 > 0:51:11She is not a patient. I normally don't call live donors a patient.
0:51:11 > 0:51:15She is healthy, she comes in, she feels a bit worse, of course,
0:51:15 > 0:51:18afterwards, by having one kidney and having had an operation
0:51:18 > 0:51:20that she didn't need.
0:51:20 > 0:51:23The most important thing is that Jen can live with one kidney
0:51:23 > 0:51:25for the rest of her life,
0:51:25 > 0:51:28and we know that there is a slight increased risk
0:51:28 > 0:51:32for getting end-stage renal disease herself.
0:51:32 > 0:51:35However, if we do a thorough follow-up
0:51:35 > 0:51:37and act upon things that arise early,
0:51:37 > 0:51:41we may actually provide her a very safe and healthy life.
0:51:41 > 0:51:44Bye-bye, dear. See you very soon.
0:51:44 > 0:51:48Last year, there were over 1,000 living kidney donations in the UK.
0:51:48 > 0:51:50Frank wants live donors like Jen
0:51:50 > 0:51:54to be able to go to the top of the transplant waiting list
0:51:54 > 0:51:58should they themselves experience kidney failure in the future.
0:51:58 > 0:52:01So, thanks to be able to present on
0:52:01 > 0:52:03an issue related to live kidney donation.
0:52:03 > 0:52:07This is more a general ethical issue
0:52:07 > 0:52:10or dilemma that I'm facing actually every day.
0:52:10 > 0:52:13He brings the issue to Imperial's ethics committee.
0:52:13 > 0:52:17Consisting of staff volunteers and members of the public,
0:52:17 > 0:52:20it meets once a month to review and debate the moral
0:52:20 > 0:52:23and ethical implications of the Trust's work.
0:52:23 > 0:52:27None of these people are actually involved in my field of expertise,
0:52:27 > 0:52:31and represent the broader public, actually,
0:52:31 > 0:52:33rather than just me talking to my colleagues,
0:52:33 > 0:52:37who might, you know, think more like me.
0:52:37 > 0:52:41First, I need to tell you that live kidney donation
0:52:41 > 0:52:45for the recipient, if you get a transplant from a live kidney donor,
0:52:45 > 0:52:49gives the best outcome, and it is spectacular.
0:52:49 > 0:52:53If this were cancer it would be Nobel-prize winning, I'm sure.
0:52:53 > 0:52:58So I think our duty as people who take out kidneys
0:52:58 > 0:53:02for the benefit of others goes for the rest of their lives,
0:53:02 > 0:53:07and that's why I think we have some obligation, at least,
0:53:07 > 0:53:11to give them at least perhaps some priority, even, if I think about it.
0:53:11 > 0:53:14Um... I'm quite conflicted
0:53:14 > 0:53:16because I had a live kidney donor, who's my brother,
0:53:16 > 0:53:19and of course on a human level I'd like to say, fantastic,
0:53:19 > 0:53:21if he suffers renal failure late in life
0:53:21 > 0:53:24he should get preference cos he's done such a wonderful thing.
0:53:24 > 0:53:27The truth is we don't give priority to anybody,
0:53:27 > 0:53:29but the reality is,
0:53:29 > 0:53:34if we are to give live donors a bonus number of points,
0:53:34 > 0:53:37how do you set that and who do you disadvantage?
0:53:37 > 0:53:42Even though I really want to see my brother have that priority,
0:53:42 > 0:53:49I'm really not sure that...that I can ethically, morally justify it.
0:53:49 > 0:53:55I'm very mindful of your relationship with these live donors,
0:53:55 > 0:54:01but I do take very seriously the idea of introducing value judgments.
0:54:01 > 0:54:05If you introduce value judgments, where does that stop?
0:54:05 > 0:54:09However admirable it is to donate a kidney,
0:54:09 > 0:54:14what you potentially describe sounds like an unequal two-tiered system.
0:54:14 > 0:54:17We do not treat people differently whether they're policemen,
0:54:17 > 0:54:21a fireman, a drug dealer, a child - it doesn't work like that.
0:54:21 > 0:54:23Everybody receives care equally
0:54:23 > 0:54:27and that's how the NHS has sort of evolved and worked to function.
0:54:27 > 0:54:30I think every time you have an ethical discussion,
0:54:30 > 0:54:32especially in a broader group,
0:54:32 > 0:54:34it helps you enormously.
0:54:34 > 0:54:37At least you can bring these dilemmas that you're facing
0:54:37 > 0:54:39every day in your job to the table.
0:54:39 > 0:54:41No-one is saying, "Oh, you're doing it wrong,"
0:54:41 > 0:54:43or, "You have the wrong opinion,"
0:54:43 > 0:54:46because everyone is giving an opinion.
0:54:46 > 0:54:49And it might be a consensus but it might not be a consensus,
0:54:49 > 0:54:53so it's just giving me input. That's really great.
0:54:59 > 0:55:03I've never come down this way until the morning of the operation.
0:55:08 > 0:55:13- Hi!- How are you?- I'm fine.- Good to see you.- How are you? I'm good.
0:55:13 > 0:55:16- How are you?- Very well.- Hi.- Alex.
0:55:16 > 0:55:19The day I came out of hospital
0:55:19 > 0:55:22felt like the world had lifted off our shoulders, instantly.
0:55:22 > 0:55:25- So, you look well, but how do you feel?- I feel well.
0:55:25 > 0:55:28- I feel really good. - Would you do it again?- Yes, I would.
0:55:28 > 0:55:31- Unfortunately, we can't. - No! Thank God for that!
0:55:31 > 0:55:35- Have you needed dialysis? - No. No dialysis,
0:55:35 > 0:55:37so I can now have a shower,
0:55:37 > 0:55:40I can go swimming, I can do normal things again.
0:55:40 > 0:55:44But having lived quite a restricted life for such a long time,
0:55:44 > 0:55:47I feel like a new person now.
0:55:47 > 0:55:49It means so much to us that not only
0:55:49 > 0:55:53did you get fixed, but someone else has got fixed as well.
0:55:53 > 0:55:57- Happy?- Very.- Very.- Very, very happy.
0:55:57 > 0:56:00Yeah, it shows.
0:56:00 > 0:56:03- So see you around! - Thank you very much.- Ah!- Good man.
0:56:11 > 0:56:14- Hi, Betty. How are you?- Hello!
0:56:14 > 0:56:17- How are you feeling? - Not too bad, thank you.
0:56:17 > 0:56:2111 days after her operation, Betty is well enough to go home.
0:56:21 > 0:56:25- I just wanted a chat about your results, which we got back. - Oh, good.
0:56:25 > 0:56:30- It's not as dramatic as it might feel at the moment.- Yeah.
0:56:30 > 0:56:34It's all good news. The general consensus is that you don't need any more treatment.
0:56:34 > 0:56:39- Oh!- It's all done.- Fantastic!- OK? - All your good work. Thank you!
0:56:39 > 0:56:40It's a pleasure.
0:56:40 > 0:56:45- So, in actual fact, we probably don't need to follow up the cancer at all.- Oh!
0:56:45 > 0:56:50- It's probably...it's probably gone. - Yes.- We're very pleased.
0:56:50 > 0:56:53- Hopefully you are, too. - I am very, very pleased.
0:56:53 > 0:56:56- What can I say but thank you? - It's a pleasure. It's a pleasure.
0:56:56 > 0:56:59You don't need to thank me at all.
0:56:59 > 0:57:01It's my pleasure.
0:57:01 > 0:57:04- I'll see you soon. I'll see you in four weeks.- Thank you.
0:57:08 > 0:57:13It's so difficult to find the words to say thank you,
0:57:13 > 0:57:19cos there aren't enough words, and he...
0:57:19 > 0:57:22I just love him, anyway!
0:57:24 > 0:57:29Across the six weeks you've been here, I think you will have seen
0:57:29 > 0:57:34the absolute best of us, and the worst of us at times.
0:57:35 > 0:57:40And I think it's really important that the public and our patients
0:57:40 > 0:57:45can see how hard we work to really try and make it right.
0:57:45 > 0:57:49I think there needs to be a shift in the expectation
0:57:49 > 0:57:52of what people want the NHS to deliver,
0:57:52 > 0:57:57because you can't keep on pulling and pulling on this system.
0:57:57 > 0:58:00We're all a bit tired,
0:58:00 > 0:58:03and we all have to dig deep within at times
0:58:03 > 0:58:06to find that extra bit of strength.
0:58:06 > 0:58:10And, you know, we're all only humans at the end of it, aren't we?
0:58:12 > 0:58:14What choices would you make
0:58:14 > 0:58:17when faced with complex healthcare decisions?
0:58:17 > 0:58:20Visit our interactive pages to find out how you would respond.
0:58:20 > 0:58:23Go to:
0:58:23 > 0:58:26Follow the links to the Open University.