Episode 6 Hospital

'Adult trauma call...'

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 the 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?! Has it 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...

The tumour's out. Job done.

..where lives are transformed.

This is saving his life. It has to work.

But they're operating at a time when the NHS

has never been under more pressure.

-Any beds?

-No.

-No beds for anyone?

-No.

-OK.

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,

because 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's 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

PHONE RINGS

This is main theatre admissions.

One can do 12...

Imperial College Healthcare NHS Trust performs over 500 operations

across 19 different surgical specialities every week.

How long after MRSA...?

Got probably about...

-12 hours' worth of operating on this list.

-At least.

-16.

-Yep.

-OFF CAMERA:

-How's your morning been?

-Er, pretty stressful.

A big case that I was supposed to be doing this afternoon

we've had to move and cancel because of this trauma patient

that we've got to get done.

Hip and pelvic specialist Angus Lewis

works across two of the Trust's five hospitals.

There is only two pelvic surgeons here

and one of those is away on annual leave at the moment,

so it's just me.

We are a bit stretched.

Could do with another ten!

But we're not going to get that.

I've finished here at Charing Cross, I'm coming over

so hopefully by then, the theatre's ready and we can crack on.

I'll see you over there. All right, bye.

Today, Angus is needed in St Mary's, five miles away,

to operate on a man with a shattered pelvis.

We are constantly battling with elective service

and the trauma service

and our trauma service is getting busier and busier by the year.

Hopefully, timing-wise, the operating theatre at St Mary's

is going to be vacant by the time I get there on motorcycle.

It's a bit of a rush but it's just the way it is at the moment

and we're just going to have to get our skates on.

It was a rough night.

It's-it's very painful at the moment.

Angus's patient is 52-year-old hairdresser Reno.

HE GROANS

At the moment, what they're trying to do,

to keep the bone of my leg out from the socket

away as far as they can by putting the weights at the bottom,

because they say if it goes up, it can cause more damage.

I cannot move at all, just my toes I can wave a little bit,

that's as far as it goes.

Reno fractured his pelvis in a motorcycle accident.

He's been waiting four days for an operation to repair it.

The way the doctor explained to me, the whole socket,

it's shattered,

it's about seven, eight pieces and I'm actually sitting on it.

Along with some other medication,

every five minutes, I get 15ml of...

like a morphine.

Ooh.

There's nothing they can do.

I just, I can't find the right sweet angle.

The right...

Oh.

To make time for Reno's surgery,

Angus has cancelled another patient's preplanned hip operation.

This is a very bad injury.

The socket of his left hip joint is in quite a lot of pieces

which need to be put back

and it's therefore going to take quite a long operation,

four to five hours and it's not a fracture we can leave.

The longer you leave it, the more difficult it is to fix it.

I don't really want to wait any longer with this gentleman.

INAUDIBLE

The problem we've got is the case

that was meant to finish hasn't finished yet.

Right, and then tomorrow, we've only got half a list.

God, after all that.

Oh, God.

It is really... Yeah.

Well, we'll talk about it when I've calmed down.

It's none of your fault.

It's not your fault. I'm just pissed off.

Cos I've now got to find another slot for this guy.

The consultant who was doing this operation, you know,

was trying to get me into theatre on time and unfortunately we failed.

And it's just...

you do all these things to try and get these things slotted in,

a lot of which is out of your control, you do what you can...

and then it all just goes to pot.

And that's where we are at the moment.

OK. Erm...

I'm going to have to go and tell him.

I don't... Can you...? If you speak to Ian and just say,

"Look, there's another two hours left on this list,"

-if we can get something done.

-Yeah.

We've now pushed aside an elective case

which, when you look back on hindsight,

you wish you hadn't and then you end up doing nothing.

I hate doing this.

It doesn't get any easier.

Hello.

Well, I was better.

I am going to tell you that, yeah.

And I know the disappointment you're going to have.

You... I have just tried to shift mountains today

to try and get you done.

And I failed.

I'm sorry.

The case that was in that theatre has gone on longer

than the surgeon expected, which is not his fault either,

but it has run-on effects on what we need to do.

And I'm really sorry.

It's very frustrating.

Now, Friday is the next slot.

I have you top of the list.

I'm not having this again.

All right.

I'm sorry. OK.

I'll be in touch.

Reno is one of more than 300 patients at St Mary's

who have had their orthopaedic surgery delayed in the past year.

A bit frustrating.

And I do feel for the doctor,

because he was more frustrated than me.

All decisions they've got their hands tied up for.

It's not their fault. It's really the system.

It's not their fault.

Friday now, so I've got two more days of just pain.

Welcome to the conference centre.

Good morning, everyone.

So, St Mary's went out on red this morning.

It's the job of site director Lesley Powls and her team

to make sure there's enough beds at St Mary's for its patients.

Unplaced electives.

This is a little bit of a movable feast this morning

and we're on hold at the moment for anything except for day cases

and inpatients in the correct beds.

An elective patient is a planned patient,

so it's a patient who knows they're coming into hospital for a surgery.

'I only called you because I've got six...'

The first thing that happens when we have bed pressures

is we review our electives, and what we tend to do is

prioritise then our urgent electives,

so our electives who need cancer surgery,

and patients who have been waiting considerable lengths of time.

So, this morning we have got only two beds in the hospital,

so all electives, I was about to ring theatres,

are going to go on hold for the time being.

I'm trying to be hopeful,

but I have a feeling they probably will be cancelled.

How's it going?

One of the surgeons hoping to operate today is

gastric bypass specialist consultant Mr Ahmed Ahmed.

Ah, Rhona, hi. How are you? Do we know what the bed status is?

-I've explained that we need two beds for the bypasses.

-Yeah.

I mean, and you're telling me that at the moment we have one bed?

-I don't have any bed at the moment.

-No beds.

41-year-old Daniel is one of five patients today on Mr Ahmed's list.

There's a little bit of me in the back of my mind which is anxious.

But fingers crossed we've got a bed and we can get this done.

I don't think I can go through another being sent away

and having to wait for another appointment again.

Daniel has been waiting a year and a half for his weight-loss surgery.

I am 27 stone,

and I have a BMI of just short of 50.

The family history has not been great,

so all our parents are no longer with us,

so they've all passed away through one ill health or another, so...

If I can sort of increase my chances of a longer life

and a healthier life, it's got to be good.

I don't want to be another statistic,

where my girls are growing up without their dad.

I don't want them to be saying goodbye to me at 45.

Daniel's surgery is scheduled to take place in

St Mary's £10 million Surgical Innovation Centre.

It has its own dedicated weight loss operating theatre and

oversized beds for clinically obese patients.

Hi, Mandy, how are you? Do you have any questions...?

When St Mary's is close to capacity, the weight loss beds are regularly

redeployed to higher priority patients from across the hospital.

-INTERVIEWER:

-Where does bariatric surgery kind of sit

in the pecking order at St Mary's, in terms of who gets cancelled?

Well, unfortunately it's low down on the priority list.

It's often our patients that, you know, get cancelled,

because there's a lack of beds.

The beds will first go to patients that are coming in through

accident and emergency and then lastly there will be

elective surgery like bariatric surgery and...

Other specialties as well.

I mean, I don't want to say that mine is the only one

that's suffering this problem.

Any kind of elective noncancerous surgery, you know, gets hit.

When the centre opened in 2012,

Mr Ahmed and his team performed 750 operations.

Last year, they completed just 150.

If you look at the number of patients who meet our

national NHS criteria for bariatric surgery,

we should be doing about 1.5 million operations

a year in this whole country.

But I can tell you, last year we probably only did about 9,000.

The last time it got cancelled was one of the most difficult days

that I've had in quite a long time.

We have this endless number of patients that's building up

that don't get their surgery

because there is actually no beds in the hospital.

That is our 82nd complaint from a lady patient of ours.

"I was referred for bariatric surgery at St Mary's in April 2015.

"On calling the team at Mary's, I was informed I would only

"possibly get a date February next year, 2017.

"Putting aside the growing desperation to get my surgery done

"and the stress this is causing, this is influencing

"my ability to make decisions on my career because I am in limbo.

"This journey has taken the better part of four years.

"Can you please help?"

The waiting list for bariatric surgery

is one of the longest in the Trust.

I think generally there's a feeling that we're victimising them

and not giving them...

We're withholding surgery, and what I try to get across is that

it's not personal, but that there is...

I think there is a stigmatisation against obesity and that that's

part of the problem, that we're not prioritising these operations.

Because in general there's a perception

that obesity is not as big a problem,

or somehow a lifestyle problem that people have caused themselves.

It's sad to say but we get a fair amount of complaints,

and there is a common theme,

which is basically that people who struggle with this disease

have to wait so long to get treatment.

How many patients do we have tomorrow coming for surgery?

All right.

Fourth time?

Third time coming in.

So that's two three-time cancellations and

a fourth-time cancellation, so that's ten cancellations

on the list tomorrow already happened previously.

Unbelievable. All right.

If Daniel's operation goes ahead today,

he'll need to recover for two days afterwards on the ward.

We're going to just pop over to The Lindo Wing,

which is the private unit of St Mary's Hospital.

With no beds available,

Mr Ahmed has a plan to ensure Daniel's operation can happen.

We were able to have a negotiation

which has allowed the NHS part of our hospital

to buy two beds for after surgery for two of my patients.

The Lindo Wing is a 39-bed private hospital

owned and operated by Imperial Trust.

Profits from The Lindo are reinvested into the Trust

and used to support its NHS services.

It's one of the primary private units in London.

I mean, it's very popular.

I mean, you obviously remember, you know,

Prince George and Princess Charlotte were born here not so long ago.

So, yes, it's very important.

Good morning, Reception. Dorika speaking. How can I help you?

Hello. Oh, there she is!

-Are you going to take two of my patients today?

-Yes, I am.

-We're ready for you.

-Thank you. All right, perfect.

The Lindo can accommodate Mr Ahmed's NHS patients today because

it's not currently full of private clients.

The costs of nursing them in the private Lindo

during their recovery from surgery will be borne by Mr Ahmed's

NHS bariatrics budget.

The alternative, which is not to use these private beds,

would be for us not to do any surgery.

And that would be a complete waste of money because it costs the NHS

I think roughly about £20 a minute to run an operating room.

So you can imagine, with all the team and the staff that's there,

and if we don't operate,

that's costing a lot of money and a lot of wastage.

So at least by paying a little bit and getting these extra beds,

at least two of our cases don't get cancelled.

You know, I think that's a great idea.

What have you got, elective-wise, Linda?

Oh, we've got nine for surgery.

We use The Lindo Wing beds when they have free capacity,

but what that means is when we do that,

we in effect stop Lindo being able to use those beds

for a paying private patient.

The Lindo Wing is part of Imperial and the money that the Lindo

bring in we use to fund NHS work.

For me, if we've got an empty bed anywhere on this site

I will make sure that we use it,

because it's really important to get our patients treated,

irrespective of how the money for that bed comes in.

Which two of these beds can I have?

Colorectal surgeon George Reese is also scheduled

to operate this morning.

Hi, good morning.

So, there's two patients on my list today, two ladies,

who should have been booked for HDU, I think.

-Are you likely to have any discharges, do you know?

-Erm...

-They haven't done the round yet but...

-Well, we'll wait.

Before he can start, Mr Reese needs to find an HDU,

or a high dependency unit, bed for his patient, 84-year-old Betty.

-Were you up very early?

-Yes.

Crack of doom.

Betty was diagnosed with bowel cancer a month ago.

She's accompanied by her two sons.

I think the worst thing is not hearing the news yourself

but telling your relatives, and those close to you.

I can't quite believe that...

that I've actually got it.

It doesn't seem possible.

I don't know.

You expect to have some feeling that there's that beast in you.

But there's, apart from having an occasional pain,

there's nothing extraordinary about it.

-Quite tough. Are you quite brave?

-No, no! I'm a registered coward!

But pull the plug if I'm going to be...

As soon as they stop filming, we'll do that, yeah.

HE SIGHS

HE SIGHS

We're going to do a day case whilst we find out if we're going to be

allowed to do any operating at all today because the bed

situation is worse than we had first thought.

And we may not even get a bed for our cancer case, apparently.

Any help in negotiating a bed would be appreciated.

I'm texting our divisional manager.

And I'm also going to send the same message to his boss.

Just, really, for some leverage.

Everyone's doing what they can, but I don't like being in the dark.

Because things were so bad for such a long time

that all of the previous ways

we had of negotiating beds have been exhausted.

And...there isn't a way any more.

The site manager says there's a bed, there's a bed.

Or they don't, and then there isn't.

OK. Daniel, good to see you, how are you?

Welcome back to the hospital for attempt number two.

At the moment, in the hospital,

we are having a huge problem with beds on the NHS side.

So, in fact, we don't have any beds for you.

But I have got a bed for you in the private side.

So you're going to be looked after after the surgery not in this

building but the one across the street,

which is the private building, for private patients.

And we've actually done a deal so we basically bought

a bed for you there so the operation doesn't get cancelled.

You'll have your own private room, and, you know, en-suite bathroom.

You know, it's a bit more luxurious.

Daniel's obesity has led to Type 2 diabetes,

sleep apnoea and high blood pressure.

And the amazing thing we will hopefully see, and we see

that in 80% of cases,

is your diabetes will begin to melt away within hours of the operation.

All these drugs you're on at the moment, hopefully,

we'll be able to switch them all off, one after the other.

'You can take Daniel's case.'

Poor guy's suffering from diabetes and on five different drugs.

How much money does that cost the NHS?

I would say just tablet treatment for diabetes

will probably be costing the NHS close to £8,000-£9,000 every year

for the rest of his life.

So, people who have diabetes will get heart disease,

they'll get strokes, they'll get problems with their eyes,

they'll get amputations, they'll get kidney damage.

And I'm not even costing in the cost of treating those health

problems from diabetes.

So, one operation that's going to cost the NHS close

to £6,000 will, in fact, pay for itself within a year or two.

-All right, thank you, see you in a bit. Goodbye.

-Thank you.

-Oh, I'm sorry it's such a long time.

-That's all right.

I thought you'd be going.

Betty needs a post-operative high dependency bed,

which is still not available.

There is one potential short-term solution.

We can do the cancer if we're prepared for her

to stay in recovery.

Let me check the number on your band.

Although I've got permission to send,

she's going to have to spend...

you know, probably at least a couple of days in recovery.

Of all the ladies I've had for these cancers,

this is really not a good person to leave in recovery indefinitely.

Recovery is a 12-bay holding area

adjacent to the main operating theatres.

It's designed for patients to wake up from their anaesthetic,

before being moved and cared for on the appropriate ward.

What it means is that because our recovery isn't set up as a ward,

it's supposed to be somewhere that people spend no more than

four hours, there are not the normal facilities you need

to get people up and going after an operation, and it's not staffed

to nurse unwell, post-operative patients for long periods of time.

We know that there are some operations where we just

really struggle to be able to postpone them.

And we look for what's the next best option.

And, often, the next best option, for that patient is recovery.

A last resort is cancelling.

It's the next best option.

Hi, sorry to disturb you.

Thank you and everyone said that I'm allowed to do the cancer case

and she can stay here and stuff, but I'm not totally sure

if she's the right person to stay here.

She's 84, she's quite frail,

and it might not be the nicest or safest place for her to recover

for more than a minimum period of time.

How are we staffed, if we do decide to do this now?

So, today, the only patient I know that's going to stay overnight...

-Would be her?

-..is her.

If you're well staffed, and she'll be the only one,

then that should be OK. OK, thank you.

We'll go ahead with Betty's operation.

After only...

..3.5 hours of wrangling.

So, we're going to send for Betty.

Oh, right, OK.

Thank you.

-See you later.

-Yep.

-Goodbye for now.

Thank you.

-Hi, sorry about the delay.

-Hello.

I think you've witnessed a lot of the frustration we've had

this morning, trying to do operations and being told,

"No, you can't start in case there's no bed later," and, then,

after hours of not doing anything, they find a bed.

Bowel cancer is the fourth most common cancer in the UK,

with over 100 new diagnoses each day.

Bowel cancer is curable.

And if people report symptoms to their doctors early,

then they have better results.

Let's orientate it.

So, this is the ascending colon and the caecum coming down here.

And then off the bottom of the caecum, this is going to be the

appendix here, which has tailed back on itself.

The cancer's all in here.

It's very hard here.

Until we've got the final pathology, I can't...

I can never say never,

but I would imagine that we will consider it definitive...

..treatment.

Betty will stay in recovery until an HDU bed becomes available.

After 18 months of waiting,

Daniel is having his gastric bypass surgery.

It's only going ahead because the Trust's private Lindo Wing

is providing him with a bed.

This is the first time we've done this.

Is it a long-term solution? I don't know.

That's something you'd have to ask the managers.

How long can the carry on...

you know...

funding these private beds? Hard to know.

But, you know, it's one way to, you know, get through the work,

and make sure our patients get the surgery they need so much.

Mr Ahmed will use keyhole surgery to reduce the size of Daniel's

stomach by 80%.

So, this is the size of his new stomach, his neo-stomach.

We're joining on the lower bowel.

So, this is the small intestine being pulled up,

so his initial weight loss will come all internally.

All this fat we see here will melt away in the next few weeks.

Start to go very, very quickly for him.

The surgery, it returns life expectancy back to normal.

It reduces the risk of getting cancer by 40%.

People who were previously perhaps not working or on unemployment

benefit will, hopefully, after losing weight and getting

their health back, will go back to work.

So, I can't think of any other surgery that's as beneficial,

both to the individual and to society.

Daniel's operation is completed.

He'll spend two nights recovering in St Mary's private Lindo Wing.

Ah, there she is!

Not quite what I expected when I came up. They're just waiting

for a bed in the high-dependency.

Yeah.

She's always been the one that looks after us rather than

anyone else looking after her.

You go back to sleep, if you can.

After seven hours in recovery,

a bed becomes available for Betty in the high-dependency unit.

It's Lesley at St Mary's. Have we got Hammersmith?

-'Yes.'

-Renal, are you on the line?

-'Yes. No problems.

-'We have two beds.'

-Marvellous.

Three miles west of St Mary's

is the Trust's renal unit at Hammersmith Hospital.

Renal will work really hard to ensure that there is

a bed if they have something like a transplant coming up.

And they're protected, because what they do is very, very special.

Surgeons here are specialists in live kidney transplants,

where organs are harvested from healthy donors.

You are seeing the best of the best.

It's kind of the jewel in Imperial's crown, really.

Can we do a group hug?

-Yep!

-So, busy day today. We have...

Head of transplantation Frank Dor

conducts around 35 live donations a year.

People are still not aware that they can save a life by donating

a kidney. It is one of the most beautiful things to do.

As you will see, it's just lovely to do an operation knowing that people

will actually get a second life and knowing that the donor will

do well, as well.

-So, let's concentrate on the live donor first...

-Yep.

..and everything else according to the protocol.

BELL PINGS

-Hi!

-How are you?

-I'm fine! How are you?

-Yeah, I'm all right.

-Good!

How are you?

31-year-old Jen, a mother of two,

is donating one of her kidneys to save her husband's life.

In my mind, it's very black and white to give my kidney away.

For me, it's not a selfless thing that I'm doing.

We are ready.

My husband gets his life back, my kids get their father back.

Jen's husband Elliot has a rare autoimmune disease which has

left him with just 5% kidney function.

I had kidney failure and I had to go straight onto dialysis.

He is kept alive by regular four-hour dialysis sessions.

The last eight months have been pretty tough,

you know, not being able to work full time and going to

dialysis three times a week.

We've got a young family, and we've got kids,

and we explained to them that everybody has two kidneys and both

of Daddy's kidneys weren't working and that he needed a new one.

At Imperial, without a live donor,

kidney patients typically wait three to five years for an organ to

become available from the deceased donor list.

There's great studies that show that overall,

50% of dialysis patients don't survive five years, so this is very

serious, and a kidney transplant can prolong life with decades.

Forget about the whole circus and focus on each other,

-and we will take care of the rest.

-OK.

-Yeah?

-Thank you.

-Excellent!

-See you round.

-See you later.

-Bye-bye.

I knew I wanted to be a donor.

There was never a second of doubt in my mind.

This is something I wanted to do.

We're both going to have an operation on the same day,

so it's quite nice to go through that together, I think.

They're a very close, tight little unit and just there for each other.

It's not like Elliot would have said to her, "Will you do this for me?"

It was just right away, "Right, I will give you my kidney,"

as anyone that you love would do.

Where's my dad?

OK, love you.

-Bye.

-Be good.

Love you.

-Tough, isn't it?

-JEN LAUGHS

You know, this is about him and this is saving his life.

I love you. Good luck.

His operation means a lot more to me than my operation,

because his HAS to be OK, it has to work, he needs that kidney to work.

And, Jennifer, what operation are we doing?

-Kidney transplant.

-So what operation are you having?

-A donor. Sorry.

-Can I just make the famous arrow...

-You can!

..so that you're still awake and still remember that we're going to

take your left kidney out?

As soon as Frank Dor harvests Jen's kidney,

an intricate chain of events will be set in motion.

I was unable to donate directly to him as I wasn't a blood type match.

And when I found out, that was devastating.

Jen's blood type means she can't donate directly to Elliot,

so the couple are taking part in a pioneering kidney-sharing scheme.

Jen will donate to someone else in the UK,

and Elliot actually gets a kidney from somewhere else in the UK.

She ensures he gets a kidney transplant.

Four times a year, a group of specialist renal centres,

including Hammersmith, unites in a kidney swap initiative

called Paired and Pooled.

So, I'll be co-ordinating for the day with my other colleagues

in the other centres and making sure

everything is OK with our donor recipient pair

and we're happy to proceed.

And everything has to happen at the same time, basically,

putting the patient to sleep at the same time and the operations

starting at the same time

and there's no problem, so we communicate constantly for the day.

Hoping that everything goes smoothly,

there's no last-minute cock-ups.

One mistake, you know, can screw up or mess up the whole thing.

All the pre-transplant work is anonymous.

For now, no-one knows to whom

he's donating and from whom she is receiving.

You know, to help improve someone else's life is really important,

having been through and seen how Elliot suffers.

No-one should be suffering like that.

For Jen to be able to do that for a complete stranger

is, you know, admirable.

OK, so are you happy for us to put our donor to sleep?

-Thank you. Bye.

-So it's a yes?

-Yes.

-Great. I'll get started!

-Good news! We can start!

-Oh, my God!

-Jennifer, squeeze my hand.

-I don't mind.

-He's really strong.

You'll feel a little bit light-headed.

We'll do some arm wrestling.

Hello! Are you OK? Do you know which room my patients are in?

Weight-loss patient Daniel is recovering from yesterday's

operation to reduce the size of his stomach.

Right, there he is. How are you?

-I'm good, thank you.

-Good to see you.

How about the drinks? Are they going down OK?

I've had a small mouthful,

and I think for one occasion it actually felt like it was too much.

So there's a feeling of fullness you're getting as part of

a consequence of the surgery we did.

When was the last meal you ate before the surgery? Sunday night?

It was Sunday night. It was around... It finished about 6:30.

-Do you feel hungry today?

-Not particularly.

-No.

So isn't that amazing? We went through all of Sunday night,

all of Monday, yesterday, with nothing to eat,

and then till now all you've been having is a bit of water and soup.

-Yeah.

-So for most of us, we'd be famished right now.

But the amazing thing is that you don't feel hungry,

-and that's the effect of the surgery.

-Yeah, yeah.

-OK?

-Definitely.

-Thank you.

-Take care. Bye-bye.

-Cheers. Right, thank you.

What, bring them in the private sector?

I didn't ask Daniel what he thought of the ward,

but he seems really happy.

Well, we'll see. At the moment, we have no beds on the NHS.

And this is one practical solution so that, you know,

my surgeons can do their work and we don't get any...

it'll minimise the cancellations.

So, this is a nice anatomy lesson, guys, for the students.

And of course, what you see is a bit magnified.

Transplant surgeon Frank Dor is about to remove Jen's healthy

kidney as part of a unique kidney swap scheme.

Can we zoom in there some? This is the kidney, still covered,

but you can see the shape of a kidney bean.

That's why it's a "kidney bean".

And it's a beautiful, beautiful kidney that we see.

And of course, it makes it beautiful because we know that

it's going to save Elliot's life.

I'm just going to expose the kidney. It's an operation with finesse.

And that's what's necessary. There is a small risk.

There is no operation without any risk. The risk of dying is about...

is reported to be one in 3,000.

If something goes wrong,

obviously - and I can't stress it enough - this is

a person that doesn't need this operation, and basically we

only can do things wrong, because she's perfect now, in good health.

I'm going to make a few small incisions in her.

That's going to change her body forever,

and of course she's taking some risk by having a vital organ removed.

So, the kidney is almost free.

Stapler ready?

-On...

-Shh, shh, shh. Please. Just let me think a second.

Staplers did not fire, and we have a thing there.

Can we please all be quiet? Sam, if you hold this...

OK, another stapler now. Scissors. Thank you. Just cut it.

Ahhh...

OK, kidney back. Nothing wrong with the kidney.

And nothing wrong with Jen, which is of course most important.

-OK.

-It's like delivering a newborn baby. That's how I see it!

This kidney's coming out, and we look at it and think,

"Wow, this is so brilliant."

Science has evolved, and eventually this is going to save

someone's life and give them a good quality of life.

So it's all exciting now.

OK, lights on.

It's a beautiful kidney, and you know it's going to change

someone's life in another centre, so that is a good feeling.

Jen's healthy kidney is one of many

that have been harvested simultaneously across the country.

As hers is couriered to its recipient, her husband

Elliot's new kidney should now be on its way to Hammersmith.

Jennifer, you've got another bump coming.

I'm so proud of her as a mother.

I just think what she's doing is just incredible.

And you couldn't ask for a bigger

show of love, could you, to somebody?

-Stay asleep.

-You saved someone's life.

It's gone to a very good place.

Love you.

-Nearly there.

-Nearly there. One down, one to go.

-Go back to sleep. Rest.

-Yeah.

-INTERVIEWER:

-What's it like to see

your daughter-in-law give away a kidney for your son?

It's going to cost him a lot of Chanel handbags!

For sure!

-Your eyelashes look good.

-Mm.

Two people, two members of your closest family,

to be operated on on the same day is just...

..really, really tough.

-All yours.

-Thank you.

-Perfect.

Elliot's new kidney arrives from its anonymous donor.

If the transplant is a success,

he will be able to come off dialysis immediately.

-PETER:

-Please, God, if the kidney works,

then it'll be a new life for him.

See you. Love you.

See you later.

You can't really plan, you know, five, ten, fifteen years in advance.

You just have to take this one and live

a completely normal life and hope it lasts a long time.

Elliot's operation will be performed

by Imperial's head of renal surgery, Vassilios Papalois.

The kidney looks beautiful, actually, very nicely procured.

The anatomical structures have been protected,

so this is a very good start.

The clock is ticking, and we cannot wait. We can't simply wait.

It's an amazing feeling,

I mean, to be able to help people that are in this very difficult

situation, and especially the living donor operation is

absolutely amazing, actually, because not the life of an

individual but the life of a whole family changes dramatically.

But it's equally important to remember that the kidney transplants

add years of life, as well.

So, we are basically ready to start. As you can see,

the kidney's grey because all the blood has been flushed out and

has been replaced by a very expensive preservation solution.

But it's a nice and healthy kidney.

You put your hand in here to protect the kidney.

Here.

Must not go on the floor.

Quite soon we're going to be coming up to

a fairly crucial part of the operation,

when we take off the clamps on the vessels which supply

the transplanted kidney and the transplanted kidney will

fill up with blood.

It's a miracle and it's happening in front of your eyes.

It's something that was practically dead,

an organ in an ice box without blood, and it's coming back to life.

You can see it start making urine. See that?

It's urine, it's already working.

That's the transplant section.

It looks good, actually. Nice and pink and both arteries are buzzing,

which is excellent news. I think it went very well, very pleased.

All I thought about was what it's going to be like, you know,

spending time with the kids normally, being able to go

swimming and all those things that you take for granted.

Elliot will be monitored closely over the next few days

to make sure his body doesn't reject the donor kidney.

It's a lovely morning today. The operation day.

I feel much better, had a good night rest.

This young lady here is my beloved wife, Marina.

Without her I don't think I would be where I am now.

It is quite excessive damage that he's done to his pelvis and

it'll be a while before he's better.

I'm sure he thought he was going to be up and about in

a couple of weeks, going back to his dancing and his cross-fit and

standing up ten hours a day at work.

I think the surgeon kind of made him realise that he won't be doing

a lot of that stuff for maybe a year.

The problem will be probably when I get him home, but then

hopefully his mother will come and she'll look after him at home

and I'll just be out of the house working all day!

See you later. Thank you.

Two days after the operation to repair his shattered pelvis

was postponed, Reno is finally called to theatre.

This is a very bad injury.

You can see the number of fragments that we're now dealing with.

There is one assistant who is pulling on the leg,

which is actually one of the most important jobs.

It helps the surgeon to hold the fracture in the position

he wants it.

Then, once we've worked out how it's all going to go back together again,

the next stage of the operation is trying to hold it there

with plates and screws.

Screwdriver, please.

That's fantastic, that looks great.

It's reconstituted his socket, which was just in pieces earlier.

We're now going to close up.

And we're done so, you know, this guy's got his operation. Brilliant.

-So, shall we go and see her?

-Yes.

Good morning, very nice to see you again.

How are you feeling this morning?

Yes, I'm not surprised you feel a little ropey.

Betty has spent the past three days recovering from her bowel

cancer surgery on a high-dependency ward.

It's very important to sit you out of bed and to get you out and

moving and to get you breathing deeply, OK?

We'll keep a very close eye on you.

-All right, bye-bye.

-Thank you.

She's obviously had her confidence hit a bit, which is perfectly

natural, perfectly expected, given the circumstances.

So I'm trying to build up that confidence and try to get

into her head that she's going to be going home after the weekend.

I think that's probably roughly when she'll be fit.

We think it's going to be the middle of next week.

It seemed pretty fast to us,

but she's got a good support network,

so someone will always be with her once she does come home.

Good morning, Jen.

-Hi.

-Good morning.

-Good morning. Sleeping in today?

Elliot and his wife Jen are recovering well,

following their respective kidney operations.

People probably think you've done an amazing thing, I hope.

I don't know about that but just making sure Ell was OK.

I was in contact with the transplant surgeon in the other centre

-yesterday...

-Yeah.

..and even up till late in the evening we texted each other.

-Good.

-So he was very happy with your kidney.

-And your kidney turned out to be a perfect match.

-Oh, my God!

So this is a one-off event.

-Oh, I'm really happy to hear that!

-Yeah?

That's what I thought.

-Really happy.

-Yeah.

OK, good.

She is not a patient. I normally don't call live donors a patient.

She is healthy, she comes in, she feels a bit worse, of course,

afterwards, by having one kidney and having had an operation

that she didn't need.

The most important thing is that Jen can live with one kidney

for the rest of her life,

and we know that there is a slight increased risk

for getting end-stage renal disease herself.

However, if we do a thorough follow-up

and act upon things that arise early,

we may actually provide her a very safe and healthy life.

Bye-bye, dear. See you very soon.

Last year, there were over 1,000 living kidney donations in the UK.

Frank wants live donors like Jen

to be able to go to the top of the transplant waiting list

should they themselves experience kidney failure in the future.

So, thanks to be able to present on

an issue related to live kidney donation.

This is more a general ethical issue

or dilemma that I'm facing actually every day.

He brings the issue to Imperial's ethics committee.

Consisting of staff volunteers and members of the public,

it meets once a month to review and debate the moral

and ethical implications of the Trust's work.

None of these people are actually involved in my field of expertise,

and represent the broader public, actually,

rather than just me talking to my colleagues,

who might, you know, think more like me.

First, I need to tell you that live kidney donation

for the recipient, if you get a transplant from a live kidney donor,

gives the best outcome, and it is spectacular.

If this were cancer it would be Nobel-prize winning, I'm sure.

So I think our duty as people who take out kidneys

for the benefit of others goes for the rest of their lives,

and that's why I think we have some obligation, at least,

to give them at least perhaps some priority, even, if I think about it.

Um... I'm quite conflicted

because I had a live kidney donor, who's my brother,

and of course on a human level I'd like to say, fantastic,

if he suffers renal failure late in life

he should get preference cos he's done such a wonderful thing.

The truth is we don't give priority to anybody,

but the reality is,

if we are to give live donors a bonus number of points,

how do you set that and who do you disadvantage?

Even though I really want to see my brother have that priority,

I'm really not sure that...that I can ethically, morally justify it.

I'm very mindful of your relationship with these live donors,

but I do take very seriously the idea of introducing value judgments.

If you introduce value judgments, where does that stop?

However admirable it is to donate a kidney,

what you potentially describe sounds like an unequal two-tiered system.

We do not treat people differently whether they're policemen,

a fireman, a drug dealer, a child - it doesn't work like that.

Everybody receives care equally

and that's how the NHS has sort of evolved and worked to function.

I think every time you have an ethical discussion,

especially in a broader group,

it helps you enormously.

At least you can bring these dilemmas that you're facing

every day in your job to the table.

No-one is saying, "Oh, you're doing it wrong,"

or, "You have the wrong opinion,"

because everyone is giving an opinion.

And it might be a consensus but it might not be a consensus,

so it's just giving me input. That's really great.

I've never come down this way until the morning of the operation.

-Hi!

-How are you?

-I'm fine.

-Good to see you.

-How are you? I'm good.

-How are you?

-Very well.

-Hi.

-Alex.

The day I came out of hospital

felt like the world had lifted off our shoulders, instantly.

-So, you look well, but how do you feel?

-I feel well.

-I feel really good.

-Would you do it again?

-Yes, I would.

-Unfortunately, we can't.

-No! Thank God for that!

-Have you needed dialysis?

-No. No dialysis,

so I can now have a shower,

I can go swimming, I can do normal things again.

But having lived quite a restricted life for such a long time,

I feel like a new person now.

It means so much to us that not only

did you get fixed, but someone else has got fixed as well.

-Happy?

-Very.

-Very.

-Very, very happy.

Yeah, it shows.

-So see you around!

-Thank you very much.

-Ah!

-Good man.

-Hi, Betty. How are you?

-Hello!

-How are you feeling?

-Not too bad, thank you.

11 days after her operation, Betty is well enough to go home.

-I just wanted a chat about your results, which we got back.

-Oh, good.

-It's not as dramatic as it might feel at the moment.

-Yeah.

It's all good news. The general consensus is that you don't need any more treatment.

-Oh!

-It's all done.

-Fantastic!

-OK?

-All your good work. Thank you!

It's a pleasure.

-So, in actual fact, we probably don't need to follow up the cancer at all.

-Oh!

-It's probably...it's probably gone.

-Yes.

-We're very pleased.

-Hopefully you are, too.

-I am very, very pleased.

-What can I say but thank you?

-It's a pleasure. It's a pleasure.

You don't need to thank me at all.

It's my pleasure.

-I'll see you soon. I'll see you in four weeks.

-Thank you.

It's so difficult to find the words to say thank you,

cos there aren't enough words, and he...

I just love him, anyway!

Across the six weeks you've been here, I think you will have seen

the absolute best of us, and the worst of us at times.

And I think it's really important that the public and our patients

can see how hard we work to really try and make it right.

I think there needs to be a shift in the expectation

of what people want the NHS to deliver,

because you can't keep on pulling and pulling on this system.

We're all a bit tired,

and we all have to dig deep within at times

to find that extra bit of strength.

And, you know, we're all only humans at the end of it, aren't we?

What choices would you make

when faced with complex healthcare decisions?

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

Go to:

Follow the links to the Open University.