0:00:03 > 0:00:08Where is he? You need to shout for help.
0:00:08 > 0:00:10Where is he? Which way did he go?
0:00:10 > 0:00:14One of London's biggest hospital trusts...
0:00:14 > 0:00:17He's having a heart attack, but we'll get him in straightaway and
0:00:17 > 0:00:18we'll get him sorted out.
0:00:18 > 0:00:19OK, on three. One, two, three.
0:00:19 > 0:00:22..treating more than 20,000 people every week.
0:00:22 > 0:00:24Flying over the enemy lines.
0:00:24 > 0:00:27This is a place with some of the best specialists in the world...
0:00:27 > 0:00:29I'm amazed he's alive. He had two blocked arteries.
0:00:29 > 0:00:32..where lives are transformed...
0:00:32 > 0:00:35Thank you so much.
0:00:35 > 0:00:38..but it's under intense pressure.
0:00:38 > 0:00:40We have a financial deficit of 41 million.
0:00:40 > 0:00:43With growing patient numbers...
0:00:43 > 0:00:46We are full. We're always full.
0:00:46 > 0:00:49How long has he been here? 13 hours and 46 minutes.
0:00:49 > 0:00:51I don't think that's best patient care.
0:00:51 > 0:00:55..and higher expectations.
0:00:55 > 0:00:58They're can't be nothing in this day and age.
0:00:58 > 0:00:59I want to look after him.
0:00:59 > 0:01:01First ambulance is on the ramp.
0:01:01 > 0:01:04At a time when the NHS has never been under more scrutiny...
0:01:04 > 0:01:06We're declaring a major incident at the St Mary's site.
0:01:06 > 0:01:09If this was my sister, or a friend, or anyone,
0:01:09 > 0:01:11this wouldn't be good enough.
0:01:11 > 0:01:14..week by week, we reveal the complex decisions
0:01:14 > 0:01:17the staff must make...
0:01:17 > 0:01:20Anybody else who hasn't gone knife to skin, they need to be sent home.
0:01:20 > 0:01:25..about who to care for next.
0:01:25 > 0:01:27Do you reach a point where you say, "Enough is enough"?
0:01:27 > 0:01:29Yes. The family may not like that but,
0:01:29 > 0:01:38"We are stopping and this is where it ends."
0:01:55 > 0:01:58In terms of treatment options, I'm at the end of the line.
0:01:58 > 0:02:02They've tried chemo.
0:02:02 > 0:02:05They've tried radiotherapy, surgery, and it's still coming back.
0:02:05 > 0:02:0951-year-old Glendon has a type of brain tumour
0:02:09 > 0:02:17called glioblastoma.
0:02:17 > 0:02:21He's tried every treatment his local hospital
0:02:21 > 0:02:22in Lancashire can offer.
0:02:22 > 0:02:24This is the most aggressive cancer known to man.
0:02:24 > 0:02:26You either collapse into a little pile of self-pity,
0:02:26 > 0:02:28or you carry on fighting.
0:02:28 > 0:02:33And I will carry on fighting until it kills me.
0:02:33 > 0:02:35To access a new type of therapy,
0:02:35 > 0:02:37Glendon is now under the care of Matt Williams,
0:02:37 > 0:02:42a leading oncologist at Charing Cross Hospital.
0:02:42 > 0:02:43INTERVIEWER: How did Glendon find you?
0:02:43 > 0:02:48I don't know.
0:02:48 > 0:02:49I don't know. I suspect Google!
0:02:49 > 0:02:51Matt is one of the few doctors in the country
0:02:51 > 0:03:01willing to prescribe immunotherapy for brain tumours.
0:03:01 > 0:03:04Lots of cancers are able to avoid the immune systems,
0:03:04 > 0:03:06so they kind of hide from it.
0:03:06 > 0:03:07And what the current generation of immunotherapy does,
0:03:07 > 0:03:13is allows the immune system to get active and then attack the tumours.
0:03:13 > 0:03:14It's known to work for some tumours.
0:03:14 > 0:03:16We do not know whether it works for others,
0:03:16 > 0:03:18and yet it is really expensive.
0:03:18 > 0:03:22The NHS does not offer immunotherapy to brain tumour patients because
0:03:22 > 0:03:27its benefits are unproven, but it can be accessed privately.
0:03:27 > 0:03:31So we're going up to the 15th floor,
0:03:31 > 0:03:37which is the private wing stuck on top of Charing Cross Hospital.
0:03:37 > 0:03:39Doors opening.
0:03:39 > 0:03:41In most cases, I think private medicine
0:03:41 > 0:03:45means a nicer room, better coffee.
0:03:45 > 0:03:49But there has been a change.
0:03:49 > 0:03:52There are cases where you'll get access to other drugs
0:03:52 > 0:03:57that aren't available on the NHS.
0:03:57 > 0:04:00And the number of people who want to access those drugs
0:04:00 > 0:04:03is definitely going up.
0:04:03 > 0:04:05OK, this is your bed.
0:04:05 > 0:04:09Lovely.
0:04:09 > 0:04:13I really fancy a refreshing Aperol Spritz!
0:04:13 > 0:04:17There must be a little bar around the corner here somewhere, surely?
0:04:17 > 0:04:20Glendon is one of Matt's NHS patients.
0:04:20 > 0:04:24Since his diagnosis a year ago, he's been exploring all treatments,
0:04:24 > 0:04:28including those only available privately.
0:04:28 > 0:04:31This is his Novocure.
0:04:31 > 0:04:33It sends a current through the brain at a certain frequency
0:04:33 > 0:04:36that's supposed to catch the cells before they split,
0:04:36 > 0:04:40so they don't set up in other areas of the brain.
0:04:40 > 0:04:43They don't have Novocure on the NHS.
0:04:43 > 0:04:47Ballpark figure, I believe they're around about ?12,000 a month.
0:04:47 > 0:04:51But I phoned them up and begged, basically.
0:04:51 > 0:04:53I got it on compassionate grounds.
0:04:53 > 0:04:54INTERVIEWER: Glendon, how much have you spent
0:04:54 > 0:04:57on trying to cure yourself?
0:04:57 > 0:04:59I've only just started.
0:04:59 > 0:05:03We've just travelled really and saw a few private...
0:05:03 > 0:05:07I'd say about 10,000, but I'm now starting to throw big wodges at it.
0:05:07 > 0:05:12What's the war chest? Half a million.
0:05:12 > 0:05:15But we haven't really got that sat there. No. Not liquid cash.
0:05:15 > 0:05:18Yeah, it's assets.
0:05:18 > 0:05:21We'd have to sell more or less everything to get hold of it.
0:05:21 > 0:05:23It will be everything else but the house.
0:05:23 > 0:05:26I'm not going to leave my family destitute by a long stretch.
0:05:26 > 0:05:28Hello. I'm one of the neurosurgical team.
0:05:28 > 0:05:32How are you doing, sir? Nice to meet you. We need to get you an MRI scan.
0:05:32 > 0:05:35Three months ago, Glendon had surgery to remove the tumour,
0:05:35 > 0:05:37but it returned and is growing.
0:05:37 > 0:05:41I thought we should talk about Mr Snape.
0:05:41 > 0:05:44He's now relapsed again. There are no standard treatment options.
0:05:44 > 0:05:45For a whole bunch of reasons,
0:05:45 > 0:05:47immunotherapy may well not be effective in
0:05:47 > 0:05:48glioblastoma by itself.
0:05:48 > 0:05:51There are good reasons to think that adding immunotherapy to a second
0:05:51 > 0:05:55course of radiotherapy may be more effective.
0:05:55 > 0:05:57And the evidence for? Poor.
0:05:57 > 0:06:01The problem is immunotherapy is quite new.
0:06:01 > 0:06:04And so far, the results have been very disappointing.
0:06:04 > 0:06:07It's ethically hard. There is no open trial for him.
0:06:07 > 0:06:10The company won't give him compassionate use.
0:06:10 > 0:06:11We're looking at self funding.
0:06:11 > 0:06:14So he would have to self fund, he is well aware of this.
0:06:14 > 0:06:16Poor chap.
0:06:16 > 0:06:19I had another patient in clinic today explicitly say,
0:06:19 > 0:06:22"I have some money, if there are extra things I can pay for,
0:06:22 > 0:06:25"then I want to know about them."
0:06:25 > 0:06:28And in that setting, you can't then not tell people about things,
0:06:28 > 0:06:31cos that's clearly the wrong thing to do.
0:06:31 > 0:06:36When I started in the NHS,
0:06:36 > 0:06:38I never thought I would have to have conversations with patients
0:06:38 > 0:06:42and ask them how wealthy they were.
0:06:42 > 0:06:46That's the first set of immunology you're going to get and you'll
0:06:46 > 0:06:48need three doses of that.
0:06:48 > 0:06:51But it's actually going to be more like 6,000, I think,
0:06:51 > 0:06:53because he's having a bit less of the drug.
0:06:53 > 0:06:56So that'll be kind of 24,000 to start with.
0:06:56 > 0:06:59If that doesn't work, we move onto these two drugs,
0:06:59 > 0:07:02and that's ?31,840.
0:07:02 > 0:07:06That's two immunology drugs that he might need,
0:07:06 > 0:07:11and I don't know how many treatments he'll need of that.
0:07:11 > 0:07:15You know, you live once.
0:07:15 > 0:07:19Life is precious. And I do feel like I'm being asset stripped
0:07:19 > 0:07:23for a cancer which is not my fault.
0:07:23 > 0:07:26But by doing the immunology, it should,
0:07:26 > 0:07:32touch wood, buy me more months.
0:07:34 > 0:07:36If you go back 10 or 15 years,
0:07:36 > 0:07:40the NHS essentially provided all the treatment that was available.
0:07:40 > 0:07:43There is now a gap, particularly in terms of drugs,
0:07:43 > 0:07:47where the NHS will not pay because funding is flat,
0:07:47 > 0:07:49the demand is rising,
0:07:49 > 0:07:53we're all looking at things we can stop doing.
0:07:53 > 0:07:56And so that the gap between what is potentially available
0:07:56 > 0:08:05and what the NHS will provide, is unfortunately going to get bigger.
0:08:13 > 0:08:16Since the NHS was formed, consultants have had the right to do
0:08:16 > 0:08:21private work in addition to their NHS responsibilities.
0:08:21 > 0:08:23The NHS does encourage private practice because
0:08:23 > 0:08:25they get revenue from it.
0:08:25 > 0:08:31And all hospitals in the NHS have to look for their revenue.
0:08:31 > 0:08:35To enable Imperial College Trust to benefit from private work,
0:08:35 > 0:08:41each of its five hospitals has a private ward.
0:08:41 > 0:08:46At Hammersmith Hospital, it's the Robert and Lisa Sainsbury Wing.
0:08:46 > 0:08:47It's where private patients come.
0:08:47 > 0:08:49Occasionally we use it for the NHS,
0:08:49 > 0:08:51if we're short of beds on the NHS side.
0:08:51 > 0:08:54They're all individual rooms with en suite bathrooms.
0:08:54 > 0:08:58I feel like a salesman!
0:08:58 > 0:09:01Today, cardiothoracic surgeon Rex Stanbridge
0:09:01 > 0:09:04has one private patient on his operating list.
0:09:04 > 0:09:06Nice bed.
0:09:06 > 0:09:09You've got Sky Movies.
0:09:09 > 0:09:13And Sky Sports, your favourite! Star treatment!
0:09:13 > 0:09:1887-year-old Mary is having surgery to remove
0:09:18 > 0:09:20a suspicious lump on her lung.
0:09:20 > 0:09:22Oh, I can see the prison!
0:09:22 > 0:09:24Look!
0:09:24 > 0:09:27There! That's the highlight of Mum's visit to the hospital!
0:09:27 > 0:09:28Yeah, it is. I've been to Scrubs!
0:09:28 > 0:09:31It is a very attractive building, I think so anyway.
0:09:31 > 0:09:34Right, I'll go and see her for the consent. 11.
0:09:34 > 0:09:37Good morning. Good morning.
0:09:37 > 0:09:41Right. OK.
0:09:41 > 0:09:44As you know, they were following you and they found that you had a lump
0:09:44 > 0:09:46in your lung, on the left side,
0:09:46 > 0:09:49and that over a period of a few months, six months, I think,
0:09:49 > 0:09:53that lump has grown. Yes. I hope you're going to take it out.
0:09:53 > 0:09:56Yes. Well, we'll take out the cancer but also it's the upper lobe
0:09:56 > 0:09:58of the lung that we may take out as well,
0:09:58 > 0:10:02which is our gold standard procedure for lung cancer.
0:10:02 > 0:10:04I know as you get a bit older people might argue,
0:10:04 > 0:10:06"Why bother?"
0:10:06 > 0:10:09SHE LAUGHS
0:10:09 > 0:10:12However, I tend to like to think that it's not the age
0:10:12 > 0:10:15from the cradle but the age from the grave that we're looking at.
0:10:15 > 0:10:18Yeah!
0:10:18 > 0:10:21Right, so this is the consent form for you.
0:10:21 > 0:10:25Mum has medical insurance and she has this certain amount
0:10:25 > 0:10:27of cancer care, so we've done...
0:10:27 > 0:10:30all the scans and all the different tests
0:10:30 > 0:10:35that she's had to have - we've done all that on the National Health.
0:10:35 > 0:10:41Thank you very much. OK. Good luck!
0:10:41 > 0:10:45And the only thing that she asked is after the operation that she has her
0:10:45 > 0:10:47own room, so that's why she wanted to do that privately.
0:10:47 > 0:10:52My husband, he's been dead 28 years so he set it up
0:10:52 > 0:10:58and we've been paying ?800 per month.
0:10:58 > 0:11:01I think I get a little more peace when you've got your own room.
0:11:01 > 0:11:04You don't get people coming in and out and in and out,
0:11:04 > 0:11:07and a nice, big window, blue sky.
0:11:07 > 0:11:11INTERVIEWER: Do you feel like you've kind of earned it?
0:11:11 > 0:11:15Well, I paid for it, let's put it that way!
0:11:15 > 0:11:19Mr Stanbridge said he would do it on the same day whether she came in on
0:11:19 > 0:11:21the NHS or she came in privately.
0:11:21 > 0:11:25It would have been equally as fast from the diagnosis to now.
0:11:25 > 0:11:28She pays a lot of money in every month
0:11:28 > 0:11:30and doesn't get much out of it,
0:11:30 > 0:11:34and she can have the same operation but in a slightly nicer environment.
0:11:34 > 0:11:37They get a bit more personal care from the consultant.
0:11:37 > 0:11:40I just wanted to check on the bloods on this patient.
0:11:40 > 0:11:44Private one? Yeah. Lovely.
0:11:44 > 0:11:48INTERVIEWER: If you have a procedure, would it be private?
0:11:48 > 0:11:52I haven't got private insurance.
0:11:52 > 0:11:54I don't know if I should have to start now,
0:11:54 > 0:11:58but I believe it's very expensive.
0:11:58 > 0:12:02Next to Hammersmith Hospital is...
0:12:03 > 0:12:06It's the trust's centre of excellence
0:12:06 > 0:12:08for gynaecological medicine.
0:12:08 > 0:12:10Hello. They're ready for you to go to theatre now.
0:12:10 > 0:12:13OK.
0:12:13 > 0:12:16I'll walk down. We'll take a pillow with us as well.
0:12:16 > 0:12:2144-year-old Nicky has ovarian cancer that's relapsed.
0:12:21 > 0:12:26I've been given 6-12 months if I don't have any treatment.
0:12:26 > 0:12:29In addition to her NHS care, Nicky's crowdfunding to raise money
0:12:29 > 0:12:34for a cancer drug.
0:12:34 > 0:12:38"My surgical team in Devon have only proposed chemo and I do not believe
0:12:38 > 0:12:41"this is my only hope."
0:12:41 > 0:12:43Don't be nervous, it's fine. I'm really nervous.
0:12:43 > 0:12:46"So I've needed to find out if I can find any other treatment."
0:12:46 > 0:12:49We're going to follow the blue corridor.
0:12:49 > 0:12:52"I've done much research and the most immediate chance to live a bit
0:12:52 > 0:12:54"longer is a large surgery plus ideally
0:12:54 > 0:12:57"a new maintenance drug called Olaparib."
0:12:57 > 0:13:03You're in good hands, OK?
0:13:03 > 0:13:06It has to be paid for privately.
0:13:06 > 0:13:11The cost is approximately ?4,000-5,000 a month.
0:13:11 > 0:13:15I'm sort of fighting, fighting my corner as much as I can.
0:13:15 > 0:13:19Are you all right? Yeah, I'm just really nervous.
0:13:19 > 0:13:22At times, it's an uphill battle.
0:13:22 > 0:13:28OK, I'm just going to flush your drip here.
0:13:28 > 0:13:30No-one talks about the cost of cancer
0:13:30 > 0:13:38and I'm determined to try and find a way to stay alive.
0:13:46 > 0:13:49The NHS gives patients the right to choose their consultant.
0:13:49 > 0:13:51When her cancer returned, Nicky sought a second opinion
0:13:51 > 0:13:55from Christina Fotopoulou,
0:13:55 > 0:13:56a renowned gynaecological cancer surgeon
0:13:56 > 0:14:01who's at the forefront of new surgical techniques.
0:14:01 > 0:14:04Nicky's initial diagnosis was a few years ago.
0:14:04 > 0:14:07When she had this surgery back then
0:14:07 > 0:14:09the ovaries and the tubes were removed.
0:14:09 > 0:14:12So when ovarian cancer comes back,
0:14:12 > 0:14:16it comes back on the skin inside the abdomen, it's called the peritoneum.
0:14:16 > 0:14:17But you can see here,
0:14:17 > 0:14:20all this is being covered by little lesions there
0:14:20 > 0:14:25that are common to be there at relapse.
0:14:25 > 0:14:29However, she has a larger tumour that goes a bit deeper
0:14:29 > 0:14:30into the liver.
0:14:30 > 0:14:31Good morning.
0:14:31 > 0:14:33Christina will perform a radical operation to remove the cancer
0:14:33 > 0:14:37that's spread to the lining of Nicky's abdomen and liver.
0:14:37 > 0:14:40She's a young woman. We are doing everything in order
0:14:40 > 0:14:46to try to prolong her life.
0:14:46 > 0:14:49We know from retrospective data that overall survival
0:14:49 > 0:14:52can be high if you can get the patient tumour free.
0:14:52 > 0:14:55Whether we will be able to get her tumour free,
0:14:55 > 0:15:01this is something that we can answer only during the operation.
0:15:01 > 0:15:05OK, if you need anything, give us a call. Yeah, all right, thanks.
0:15:05 > 0:15:09All right, take care.
0:15:09 > 0:15:10Nicky was in remission for a year.
0:15:10 > 0:15:13We had no sign of anything for 12 months
0:15:13 > 0:15:17and I think probably we got a little bit complacent...
0:15:17 > 0:15:23..until we got the second diagnosis.
0:15:23 > 0:15:28It feels like your world's just collapsed again.
0:15:28 > 0:15:31INTERVIEWER: Do you ever talk about the end?
0:15:31 > 0:15:33No, we haven't done yet.
0:15:33 > 0:15:36I know we'll have to at some point.
0:15:36 > 0:15:38We know it's real, we know what's going to happen.
0:15:38 > 0:15:41There's no reluctance to talk about it.
0:15:41 > 0:15:51We will talk about it, I think, when the time comes.
0:15:58 > 0:16:00Yeah, stick him on the end there, can't we?
0:16:00 > 0:16:03Glendon, who wants to top up his NHS treatment
0:16:03 > 0:16:04with a self-funded course of immunotherapy
0:16:04 > 0:16:08is seeing Matt Williams in his NHS clinic.
0:16:08 > 0:16:11This is...
0:16:11 > 0:16:15..now post re-resection.
0:16:15 > 0:16:16Glendon has already had two surgeries,
0:16:16 > 0:16:18chemotherapy and radiotherapy
0:16:18 > 0:16:23at hospitals in Preston and Liverpool.
0:16:23 > 0:16:30He's obviously got that cavity but he's got this new tumour...
0:16:30 > 0:16:33..which might benefit from some of that coming out.
0:16:33 > 0:16:36I have another treatment which I am intending to give him
0:16:36 > 0:16:39which he's come today to see me about,
0:16:39 > 0:16:42but I think an operation first might be a good idea.
0:16:42 > 0:16:44My only concern is this is then his third operation.
0:16:44 > 0:16:48The main risk I would worry about in him would be
0:16:48 > 0:16:54a paralysis on the left side.
0:16:54 > 0:16:58What I'm looking for at the moment is obviously to stay alive.
0:16:58 > 0:17:00I've got to kill it
0:17:00 > 0:17:02and immunology, as far as I'm aware,
0:17:02 > 0:17:06is the only chance I have of actually bringing
0:17:06 > 0:17:10this nightmare to an end.
0:17:10 > 0:17:13I think we are in a difficult place.
0:17:13 > 0:17:17There's a significant amount of abnormal tumour
0:17:17 > 0:17:22and we feel that if we're going to advance the case, then we should try
0:17:22 > 0:17:27and remove as much of that to get as small a target as possible.
0:17:27 > 0:17:30How do you feel about the idea...?
0:17:30 > 0:17:33I'm fine because I haven't got really an option.
0:17:33 > 0:17:37Is there anything else that you want to ask?
0:17:37 > 0:17:40The main thing is can we do this so that I'm alive?
0:17:40 > 0:17:42SHE LAUGHS Cos I don't want to die.
0:17:42 > 0:17:45I don't want to do all this and die at the last hurdle,
0:17:45 > 0:17:49that would be infuriating for me cos I've worked so bloody hard
0:17:49 > 0:17:51to get to this stage. Sure.
0:17:51 > 0:17:53I mean, it really has.
0:17:53 > 0:17:57I mean, I've done...
0:17:57 > 0:18:03..ten hours research every day since the day I've been diagnosed.
0:18:03 > 0:18:06I will spend whatever it takes.
0:18:06 > 0:18:12And I know this sounds daft - when I got diagnosed I thought,
0:18:12 > 0:18:16"There can't be nothing in this day and age." So that's where I am.
0:18:16 > 0:18:20Sorry, rant over. OK. That's all right.
0:18:20 > 0:18:24I'll leave you with that audience and I'll see you next week.
0:18:24 > 0:18:25Thank you very much.
0:18:25 > 0:18:29The point of us offering you treatment to keep you alive
0:18:29 > 0:18:32is so you can enjoy your life and spending your time till...
0:18:32 > 0:18:34Spending your time till three in the morning
0:18:34 > 0:18:35looking up brain tumour treatments...
0:18:35 > 0:18:37Thank you so much. ..on the internet,
0:18:37 > 0:18:43that's not much quality of life.
0:18:43 > 0:18:46Do I know it! You've just made my life so much easier.
0:18:46 > 0:18:48OK, but only if you go and spend your time
0:18:48 > 0:18:51doing something more interesting.
0:18:51 > 0:18:54Traditionally, you used to be able to say to patients,
0:18:54 > 0:18:56"I think you should have treatment X
0:18:56 > 0:18:59"and you will be having treatment X," and now there's the internet,
0:18:59 > 0:19:01so it's much easier to see what is the standard treatment
0:19:01 > 0:19:03for your disease in America, Germany,
0:19:03 > 0:19:07Norway and our cancer survival rates
0:19:07 > 0:19:10are worse than almost everywhere in Europe.
0:19:10 > 0:19:13And how we deal with that as a profession,
0:19:13 > 0:19:23how we deal with that as a society, is a difficult question.
0:19:26 > 0:19:28Katie Urch is the divisional director
0:19:28 > 0:19:32overseeing all cancer services for the trust.
0:19:32 > 0:19:34INTERVIEWER: How does a drug get approval?
0:19:34 > 0:19:39Usually a drug has been developed by a company
0:19:39 > 0:19:41and gone through various clinical trial phases.
0:19:41 > 0:19:44It is then put forward in this country for NICE approval.
0:19:44 > 0:19:48NICE approval means it has been independently assessed
0:19:48 > 0:19:53as having some degree of benefit.
0:19:53 > 0:19:56NICE is the body responsible for deciding
0:19:56 > 0:20:01which new treatments should be available on the NHS.
0:20:01 > 0:20:04We are certainly in a golden era of more and more drugs available but
0:20:04 > 0:20:13the amount of added life benefit perhaps is quite minimum.
0:20:13 > 0:20:15And so the jury is still out on many of them,
0:20:15 > 0:20:22of exactly what benefit we're going to see.
0:20:30 > 0:20:34Christina is halfway through a two and a half hour operation to remove
0:20:34 > 0:20:39cancerous tissue from Nicky's abdomen.
0:20:39 > 0:20:44So the disease is stuck on the right urethra on the right pelvic vessels,
0:20:44 > 0:20:47and on the right muscle that goes to the leg.
0:20:47 > 0:20:50If you dissect it in the way it should be dissected,
0:20:50 > 0:20:54then it easily comes off.
0:20:54 > 0:20:57I'm stripping it away like you would strip away your gloves
0:20:57 > 0:20:59or your tights.
0:20:59 > 0:21:05In cancer medicine, for advanced stages,
0:21:05 > 0:21:07we talk about prolongation of life, not about a cure.
0:21:07 > 0:21:10If we only want to cure people, then we will have to treat
0:21:10 > 0:21:13only patients with very early stages of favourable tumours
0:21:13 > 0:21:16and let everybody else die.
0:21:16 > 0:21:26That's not possible and that's not ethical to do that.
0:21:26 > 0:21:27INTERVIEWER: What would have happened if you guys
0:21:27 > 0:21:31had stayed back in Devon?
0:21:31 > 0:21:39We probably would have started chemotherapy this coming Thursday.
0:21:39 > 0:21:40They offered us just chemotherapy,
0:21:40 > 0:21:41they didn't think surgery was indicated
0:21:41 > 0:21:43and that's why we thought we'd look around
0:21:43 > 0:21:52just to make sure that what we were being offered was the right thing.
0:21:52 > 0:21:57But each trust has its own rules and they do vary quite dramatically.
0:21:57 > 0:21:59The specialists here just finished a research project
0:21:59 > 0:22:01that your chances of living longer are higher
0:22:01 > 0:22:03if you have surgery before your second set of chemo
0:22:03 > 0:22:05rather than just chemo on its own.
0:22:05 > 0:22:07Queen Charlotte's and Chelsea offers specialist surgical treatment not
0:22:07 > 0:22:10available at most local hospitals.
0:22:10 > 0:22:12Around a third of their gynaecological cancer patients
0:22:12 > 0:22:17are from outside London.
0:22:17 > 0:22:19INTERVIEWER: My understanding is there's drug that could
0:22:19 > 0:22:23prolong life expectancy.
0:22:23 > 0:22:26As far as I know it's a maintenance drug.
0:22:26 > 0:22:30It's something to do with altering the replication of the cancer's gene
0:22:30 > 0:22:35and it's supposed to increase the length of time before it comes back.
0:22:35 > 0:22:37It doesn't treat the cancer,
0:22:37 > 0:22:39it just tries to maintain the situation as it is.
0:22:39 > 0:22:43That's the drug that we're hoping to go on in the autumn.
0:22:43 > 0:22:46INTERVIEWER: Is this available on the NHS? Yeah, it is after a third
0:22:46 > 0:22:49session of chemotherapy so your cancer has got
0:22:49 > 0:22:53to come back two times after the first one for you to qualify under,
0:22:53 > 0:22:56I think, current NICE guidelines.
0:22:56 > 0:23:02It doesn't seem fair. It's available after two sessions of chemotherapy
0:23:02 > 0:23:09in some countries in Europe and they've had some success
0:23:09 > 0:23:16with it in France and Germany, I think.
0:23:16 > 0:23:19Patients will come to you in the clinic and they have read many
0:23:19 > 0:23:21things about new drugs. Often they will tell you,
0:23:21 > 0:23:22"Why can't I have this?"
0:23:22 > 0:23:23So we're finished.
0:23:23 > 0:23:26We have to be cost-effective but we also have to balance
0:23:26 > 0:23:27very carefully the benefits for the patient.
0:23:27 > 0:23:31If we give all this money for a new drug for a few months longer,
0:23:31 > 0:23:34we have to take this money from patients in screening programmes,
0:23:34 > 0:23:36in early detection of disease that can be cured.
0:23:36 > 0:23:46So, it's tricky.
0:23:46 > 0:23:47Hey.
0:23:47 > 0:23:53Perfect. Really? Perfect.
0:23:53 > 0:24:00Everything as expected, no problems, she's tumour free and fine.
0:24:00 > 0:24:03So well done. OK? It's all good. Thanks very much.
0:24:03 > 0:24:04Some disease on the pelvic sidewall,
0:24:04 > 0:24:07some disease on the liver but on the liver, not inside the liver. OK.
0:24:07 > 0:24:09Some disease on the diaphragm, like we discussed. Yeah.
0:24:09 > 0:24:13That's that. Thank you, Christina. It's all fine. Thank you.
0:24:13 > 0:24:16By the sounds of things, it couldn't have gone any better.
0:24:16 > 0:24:18There was nothing unexpected there
0:24:18 > 0:24:26and she managed to get everything out, which is fantastic.
0:24:26 > 0:24:29You hope for that in the beginning but you don't want to hope too much
0:24:29 > 0:24:39in case it doesn't happen.
0:24:42 > 0:24:50All the best. Take care.
0:24:58 > 0:25:04She said you'd be sitting up tomorrow.
0:25:05 > 0:25:07INTERVIEWER: Do you ever feel you're being held to ransom?
0:25:07 > 0:25:12Held to ransom in that I can't give the drugs that we want to give.
0:25:12 > 0:25:17I think we have, in our health service,
0:25:17 > 0:25:20an amazing access to drugs and to new therapies,
0:25:20 > 0:25:23new surgical techniques.
0:25:23 > 0:25:26But there is a balance of which drugs,
0:25:26 > 0:25:30which interventions we fund and which we don't.
0:25:30 > 0:25:33And every single economy will struggle.
0:25:33 > 0:25:36We struggle and come up with a certain answer.
0:25:36 > 0:25:39If you're in Europe, you would come up with a different answer.
0:25:39 > 0:25:42In America, you'd come up with an answer based on what you can afford,
0:25:42 > 0:25:43rather than what you need.
0:25:43 > 0:25:47I don't think there is a perfect solution.
0:25:47 > 0:25:53I think it's a very difficult balancing across a whole population.
0:25:55 > 0:25:59Bye. Good luck. Thank you. See you. See you later.
0:25:59 > 0:26:0387-year-old private patient Mary is called to theatre.
0:26:03 > 0:26:08It's no good feeling all worried and uptight and stuff like that.
0:26:08 > 0:26:15If it goes wrong, well, I've had a good life.
0:26:15 > 0:26:18The hospital will recoup the cost of Mary's operation
0:26:18 > 0:26:22and stay in hospital from her insurance company.
0:26:22 > 0:26:25Nice big breath for me. A nice big breath.
0:26:25 > 0:26:27On average, the trust charges a third more
0:26:27 > 0:26:31for private work than the NHS tariff for equivalent treatment.
0:26:31 > 0:26:34INTERVIEWER: Do you think the public view private work differently?
0:26:34 > 0:26:36Yes. They do have misconceptions.
0:26:36 > 0:26:40What's the most common?
0:26:40 > 0:26:42The most common one is,
0:26:42 > 0:26:47"Oh, he's in Harley Street, he must be the best."
0:26:47 > 0:26:52This may be true and it may not be true.
0:26:52 > 0:26:55Are there cowboys there?
0:26:55 > 0:27:00Let's just say that not everything that goes on in Harley Street
0:27:00 > 0:27:01is wonderful.
0:27:01 > 0:27:04Private work is largely carried in NHS operating theatres
0:27:04 > 0:27:07with an NHS surgical team.
0:27:07 > 0:27:09Only the anaesthetist and surgeon are being paid separately
0:27:09 > 0:27:13by the insurance company.
0:27:13 > 0:27:15She's a relatively fit woman, actually.
0:27:15 > 0:27:18She's a lifelong smoker. Does that change anything?
0:27:18 > 0:27:21No, it doesn't change anything at all. No.
0:27:21 > 0:27:23Would the NHS still choose to operate on somebody...?
0:27:23 > 0:27:27Yes. Yes. Do you think it should?
0:27:27 > 0:27:35Yes. Yes, definitely. Yes.
0:27:35 > 0:27:41Flying over the enemy lines.
0:27:41 > 0:27:45I'll take a knife to this and then I'll come back
0:27:45 > 0:27:46and put the camera in.
0:27:46 > 0:27:49Black is soot and it's a sign of smoking,
0:27:49 > 0:27:53it's a sign of pollution in the air from all the motor vehicles we use.
0:27:53 > 0:27:54She's got a mass on her lung.
0:27:54 > 0:27:58A mass has been growing for six months
0:27:58 > 0:28:00and is highly suspicious of a cancer,
0:28:00 > 0:28:05but we haven't proven it is cancer yet.
0:28:05 > 0:28:09This bag just pops the specimen in.
0:28:09 > 0:28:14So we're going to do that by taking a segment of the lung.
0:28:14 > 0:28:17Pop one wedge into the bag.
0:28:17 > 0:28:21Sending it off to the laboratory.
0:28:21 > 0:28:23And they'll give us a phone call back
0:28:23 > 0:28:28to tell us what they think it is.
0:28:28 > 0:28:31If it is cancer, we take out the upper lobe of the lung.
0:28:31 > 0:28:32PHONE RINGS
0:28:32 > 0:28:37Hello, Stanbridge here.
0:28:37 > 0:28:38That's fine. Thank you very much.
0:28:38 > 0:28:40And we have a result.
0:28:40 > 0:28:41It's a non-small cell carcinoma,
0:28:41 > 0:28:44so the biopsy is positive and malignant.
0:28:44 > 0:28:46INTERVIEWER: How important do you think private work
0:28:46 > 0:28:48is for the future of the NHS?
0:28:48 > 0:28:51The NHS is making some money out of it.
0:28:51 > 0:28:54A big bag and then we're going to take the specimen out.
0:28:54 > 0:28:56And that helps to keep them going,
0:28:56 > 0:28:59because they need all the funds they can get.
0:28:59 > 0:29:01England is lucky, it's the only country that does have an NHS
0:29:01 > 0:29:04quite like it is.
0:29:04 > 0:29:06But it's not funded properly.
0:29:06 > 0:29:09It's underfunded.
0:29:09 > 0:29:12So we could do a lot more with a lot better equipment,
0:29:12 > 0:29:20a lot more stuff, if it had more funding.
0:29:20 > 0:29:25My headlight batteries have died, so that means I have to leave.
0:29:25 > 0:29:27The team are going to close up.
0:29:27 > 0:29:28INTERVIEWER: Can I ask a cheeky question?
0:29:28 > 0:29:30How different is your invoice for this
0:29:30 > 0:29:34compared to if it was on the NHS? Not silly money.
0:29:34 > 0:29:38For two or three hours private operating...
0:29:38 > 0:29:42..seeing the patient for 15 minutes every day...
0:29:42 > 0:29:44..I don't know what you think it should be.
0:29:44 > 0:29:49Do you want me to throw a figure out? Throw a figure out.
0:29:49 > 0:29:52?1,000. Yup, well, it's not far off.
0:29:52 > 0:29:57It's a little more than that. But it's less than two.
0:30:00 > 0:30:01Hello. Hello.
0:30:01 > 0:30:02It's all over, the operation.
0:30:02 > 0:30:05It's good. OK. OK, do you want to sit down?
0:30:05 > 0:30:08It's fine. Sure, sure. It's easier, you don't have to stand up.
0:30:08 > 0:30:11All right.
0:30:11 > 0:30:16She's OK. The result was that the frozen section that we did the wedge
0:30:16 > 0:30:20showed that she had cancer, which wasn't a big surprise.
0:30:20 > 0:30:25No. So I proceeded to do the full lobectomy.
0:30:25 > 0:30:29It's all out. And I'm sure she won't need further treatment for it,
0:30:29 > 0:30:33and I'm sure that's a relief.
0:30:33 > 0:30:36Thank you. Thank you very much. Thank you.
0:30:36 > 0:30:44Thanks. Thank you.
0:30:44 > 0:30:49She's OK.
0:30:49 > 0:30:53God, she's tough!
0:30:53 > 0:30:58I'm sure they were quite nervous that they'd done the right thing
0:30:58 > 0:31:01because she's elderly and it's their mum
0:31:01 > 0:31:07and they've helped to advise her.
0:31:07 > 0:31:09Is she asking anything? Yeah, no, she's speaking, yeah.
0:31:09 > 0:31:10She's awake. Yes.
0:31:10 > 0:31:12Does she want to know what's happened?
0:31:12 > 0:31:14I don't know if she'd be that awake.
0:31:14 > 0:31:20You can ask her.
0:31:20 > 0:31:22Hello.
0:31:22 > 0:31:29Good - everything's good. The operation's done, all right?
0:31:29 > 0:31:35Just relax and we'll just look after you for the next day or two.
0:31:35 > 0:31:43Good.
0:31:46 > 0:31:49Mary will spend up to 24 hours
0:31:49 > 0:31:54recovering in the hospital's cardiac intensive care unit.
0:31:54 > 0:31:58INTERVIEWER: The people with cancer who have private health care,
0:31:58 > 0:32:04do they live longer? I've absolutely no information on that.
0:32:04 > 0:32:10In private care, I don't think you can buy life.
0:32:14 > 0:32:15Welcome, everyone.
0:32:15 > 0:32:18So let's move on to the first item on the agenda,
0:32:18 > 0:32:20which is the income report.
0:32:20 > 0:32:23In the five years from 2010 to 2015,
0:32:23 > 0:32:26the trust's income from private work increased by 40% -
0:32:26 > 0:32:31from ?31 million to ?43 million.
0:32:31 > 0:32:35So April, the first month of the new year,
0:32:35 > 0:32:37was actually a pretty good month for us again.
0:32:37 > 0:32:40So it followed the strong trend of the last three or four months.
0:32:40 > 0:32:42I think, in terms of highlights,
0:32:42 > 0:32:45our cancer business continued to show strong growth.
0:32:45 > 0:32:47If you can grow more private patient income,
0:32:47 > 0:32:50that will actually help out with the
0:32:50 > 0:32:53rest of the national health business.
0:32:53 > 0:32:56There's a lot of enthusiasm for working closer with you and finding
0:32:56 > 0:32:58the growth. I think there's a bigger understanding of how private works
0:32:58 > 0:33:03in the trust - that we need to get those very clear messages going on.
0:33:03 > 0:33:06INTERVIEWER: Are there any downsides to doing private work?
0:33:06 > 0:33:08I think people think that we make more compromises
0:33:08 > 0:33:11than we actually do.
0:33:11 > 0:33:17We know that it doesn't compromise our NHS care, but, nonetheless,
0:33:17 > 0:33:20it's very easy to write a story that says because there's money in there,
0:33:20 > 0:33:21because the NHS needs money,
0:33:21 > 0:33:24surely they must be disadvantaging NHS patients in some way,
0:33:24 > 0:33:26whereas the truth is that the money
0:33:26 > 0:33:29does flow back in to NHS patient care.
0:33:29 > 0:33:32And the proposal is to kind of take that income and directly allocate
0:33:32 > 0:33:34it down to divisional positions.
0:33:34 > 0:33:38Is it possible to say what percentage goes back to NHS?
0:33:38 > 0:33:41All of it. It doesn't go anywhere else.
0:33:41 > 0:33:44It could go into private facilities.
0:33:44 > 0:33:48It doesn't in our case, cos we own all the facilities.
0:33:48 > 0:33:51We need all of the things to be flying...
0:33:51 > 0:33:57..and I think we need to just keep doing what we're doing.
0:33:57 > 0:33:59We have a financial deficit of 41 million,
0:33:59 > 0:34:02so if we can make money treating private patients,
0:34:02 > 0:34:05then it's better that we address our deficit that way than that we have
0:34:05 > 0:34:08to cut back on NHS services, which, to be honest,
0:34:08 > 0:34:11is the only other way we can address the deficit.
0:34:11 > 0:34:14OK. Great. Keep up the good work.
0:34:14 > 0:34:16We've got to get smarter, we've got get more efficient
0:34:16 > 0:34:19and we've got to do the best with the money we've got.
0:34:19 > 0:34:21I don't think that's a particularly difficult argument.
0:34:21 > 0:34:23I think it's reasonably well understood,
0:34:23 > 0:34:30it's just not very popular.
0:34:30 > 0:34:32Another five big deep breaths, there, for me.
0:34:32 > 0:34:36You're doing really well.
0:34:36 > 0:34:39Starting to feel a little bit woozy.
0:34:39 > 0:34:43Glendon's undergoing three hours of brain surgery on the NHS to remove
0:34:43 > 0:34:44as much tumour as possible.
0:34:44 > 0:34:47Wow, wow, wow...
0:34:47 > 0:34:49Just getting off to sleep now. OK.
0:34:49 > 0:34:52Drifting off to sleep.
0:34:52 > 0:34:57The operation carries a risk of paralysis on his left-hand side.
0:34:57 > 0:35:00OK to start.
0:35:00 > 0:35:01Thank you.
0:35:01 > 0:35:04That's the skull. He's had a previous opening here.
0:35:04 > 0:35:06The opening, the craniotomy,
0:35:06 > 0:35:11has been secured with metal screws and plates.
0:35:11 > 0:35:14Elevate this.
0:35:14 > 0:35:18And we have plainly abnormal tissue under here.
0:35:18 > 0:35:22I suspect this will be part of the tumour, this grey,
0:35:22 > 0:35:28jelly-like substance here.
0:35:28 > 0:35:32Sometimes they're terribly soft and it would be like resecting
0:35:32 > 0:35:35creme brulee. But, um...
0:35:35 > 0:35:39in this case, as you can see, as we grab the tumour, it's very firm.
0:35:39 > 0:35:49It's like almost a hard lychee, or a rock-hard kiwi fruit.
0:35:49 > 0:35:52This tumour would be about the size of a tangerine.
0:35:52 > 0:36:02It's almost five centimetres across.
0:36:03 > 0:36:07When was that? That was... I think that was about four years ago.
0:36:07 > 0:36:10Yeah.
0:36:10 > 0:36:15Hm! That's the same time.
0:36:15 > 0:36:17We went to Cambodia and Vietnam.
0:36:17 > 0:36:18We were planning on doing lots more travelling.
0:36:18 > 0:36:21We used to walk quite a bit, as well.
0:36:21 > 0:36:23Just a picture walking, there.
0:36:23 > 0:36:26How did you meet? Through a friend, actually, that I worked with.
0:36:26 > 0:36:27Yeah.
0:36:27 > 0:36:30She introduced us. She actually did a reading at the wedding,
0:36:30 > 0:36:33which was really nice.
0:36:33 > 0:36:35Glen hates all these wedding pictures.
0:36:35 > 0:36:37He says he looks awful on them.
0:36:37 > 0:36:39To be fair, he's probably ill, though,
0:36:39 > 0:36:40because that was only six weeks,
0:36:40 > 0:36:42probably, before he had his seizure.
0:36:42 > 0:36:45Do you feel like he's changed?
0:36:45 > 0:36:47Yeah. I mean, he's totally different.
0:36:47 > 0:36:51He'd gone manic, at one point, and he was quite aggressive.
0:36:51 > 0:36:53Literally, I'd have to walk ten paces behind,
0:36:53 > 0:36:56that kind of attitude!
0:36:56 > 0:36:59Sometimes I used to get a bit annoyed at him because I thought,
0:36:59 > 0:37:02"Well, you wouldn't be like that beforehand."
0:37:02 > 0:37:05And even when he's like in surgery now, it's kind of,
0:37:05 > 0:37:08"Is he going to come back the same person?"
0:37:08 > 0:37:10And, yeah... It's bad enough, like
0:37:10 > 0:37:12you say, that he's got this prognosis.
0:37:12 > 0:37:15I might lose him at some point, but I might lose him before I lose him.
0:37:15 > 0:37:18And to be fair, I've lost some of him already.
0:37:18 > 0:37:26That is distressing.
0:37:26 > 0:37:32On the angle.
0:37:35 > 0:37:38First day.
0:37:38 > 0:37:40Three days after surgery,
0:37:40 > 0:37:45Mary is recovering in her private room.
0:37:45 > 0:37:55I'm grateful that I can have a private room and top-hole surgeons.
0:37:55 > 0:37:59I think the kids felt, "Is she going to come out of the operation?"
0:37:59 > 0:38:02You know, because I'm old.
0:38:02 > 0:38:06I have a lot of confidence...
0:38:06 > 0:38:11..thankfully, and I didn't think of dying at all.
0:38:11 > 0:38:19I thought, "No, I'll survive."
0:38:19 > 0:38:21INTERVIEWER: So how come you're in on a bank holiday?
0:38:21 > 0:38:24She's a valued patient and I'm taking a special interest in her,
0:38:24 > 0:38:26so I thought I'd come in and see her.
0:38:26 > 0:38:28Hello, good morning, Mary.
0:38:28 > 0:38:30How are you? Fresh out the shower.
0:38:30 > 0:38:32Fresh out the shower. Fresh and lovely.
0:38:32 > 0:38:35That's fine.
0:38:35 > 0:38:38Is that different than if she was an NHS patient?
0:38:38 > 0:38:40Probably.
0:38:40 > 0:38:43Good. Did you have a good night? Very good, thank you.
0:38:43 > 0:38:45Excellent. Excellent.
0:38:45 > 0:38:48I come in because she is a private patient and I come to see her
0:38:48 > 0:38:50and I think that's basic practice for private
0:38:50 > 0:38:52to come and see your patients every day,
0:38:52 > 0:38:54if you possibly can - if it's reasonable.
0:38:54 > 0:38:58And the traffic is much lighter on a bank holiday!
0:38:58 > 0:39:01I see you've done all the Sudokus and everything.
0:39:01 > 0:39:03Oh, yeah. That's pretty good, isn't it?
0:39:03 > 0:39:05I enjoy it.
0:39:05 > 0:39:07Yeah, it means, you know...
0:39:07 > 0:39:08Brainpower. Keeps the brain ticking.
0:39:08 > 0:39:09Keeps the brain going. Yes, that's important.
0:39:09 > 0:39:12Yeah, it is. Fine.
0:39:12 > 0:39:14Well, I'll see you again in two weeks.
0:39:14 > 0:39:16A couple of weeks. Yes. That's right.
0:39:16 > 0:39:19Good. Well, thanks again.
0:39:19 > 0:39:20Very good. Thank you.
0:39:20 > 0:39:22Right, thank you very much. So, how's Mary?
0:39:22 > 0:39:24I think she's ready for discharge.
0:39:24 > 0:39:27Overall, I think she's done spectacularly well.
0:39:27 > 0:39:28What do you think of Rex?
0:39:28 > 0:39:31I think he's great. Yeah.
0:39:31 > 0:39:34I told him I loved him yesterday.
0:39:34 > 0:39:37What did he say? He didn't say anything.
0:39:37 > 0:39:43He's too shy, I think.
0:39:43 > 0:39:47Look at you. Treated like a queen.
0:39:47 > 0:39:51The trust's total revenue turnover is about a billion.
0:39:51 > 0:39:52The Imperial Private Healthcare
0:39:52 > 0:39:55part of the business is about 50 million.
0:39:55 > 0:39:59So we're currently about 5%.
0:39:59 > 0:40:01See, the sun's shining for me.
0:40:01 > 0:40:03We're an NHS Trust.
0:40:03 > 0:40:05The priority goes on the NHS patients.
0:40:05 > 0:40:08But with the big deficits that the trust faces,
0:40:08 > 0:40:12I think our chief financial officer would like me to double the size of
0:40:12 > 0:40:21the business and that may well be possible over time.
0:40:25 > 0:40:28Glen, the operation is all finished now.
0:40:28 > 0:40:30You can start breathing.
0:40:30 > 0:40:33Deep breaths, in and out.
0:40:33 > 0:40:36That's it. Well done.
0:40:36 > 0:40:40We are entering a phase of cancer survivorship where people have been
0:40:40 > 0:40:43treated and have emerged out the other end,
0:40:43 > 0:40:46that there will be people like this who are having ongoing treatment and
0:40:46 > 0:40:49you're still scanning them,
0:40:49 > 0:40:53operating on them and involving health costs.
0:40:53 > 0:41:01You then become a victim of your own success.
0:41:01 > 0:41:07Where's Kate?
0:41:07 > 0:41:11Glen? Here, darling. Hi. Hello, hi.
0:41:11 > 0:41:15Hello, sweetie.
0:41:15 > 0:41:16How are you? I'm fine.
0:41:16 > 0:41:17It was just a bog-standard one.
0:41:17 > 0:41:20Was it? Give me a kiss.
0:41:20 > 0:41:21There you are, sweetie.
0:41:21 > 0:41:24Good job on you.
0:41:24 > 0:41:29Yeah. You can still move all your left side.
0:41:29 > 0:41:33That looks good. Yeah. Yeah.
0:41:33 > 0:41:40No deficit at all... by the looks of it.
0:41:40 > 0:41:44Hello. Hello.
0:41:44 > 0:41:48When I set out to do the operation, I was aiming for 90% removal.
0:41:48 > 0:41:52Brilliant. I think we did more than that.
0:41:52 > 0:41:55Oh, thank you so much!
0:41:55 > 0:41:58You're a genius. Look at this.
0:41:58 > 0:41:59No, I'm not a genius.
0:41:59 > 0:42:00You've done brilliantly.
0:42:00 > 0:42:02You're my hero.
0:42:02 > 0:42:05Because it means that I can start living my life again.
0:42:05 > 0:42:08And that's what I haven't been able to do for a year.
0:42:08 > 0:42:12And if Dr Williams is happy, that will be the cherry on the cake.
0:42:12 > 0:42:14He's the immunologist.
0:42:14 > 0:42:17Yes. And he says, "Right, yeah,
0:42:17 > 0:42:19"we've got enough to crack on with the treatment."
0:42:19 > 0:42:22I'm happy. I'm the one who's paying all the money for this. Sure.
0:42:22 > 0:42:25Under the trust's self-pay guidelines,
0:42:25 > 0:42:29patients topping up their care with drugs not available on the NHS are
0:42:29 > 0:42:33only charged the wholesale cost and a fee to administer them.
0:42:33 > 0:42:36The NHS, quite rightly, will pay for treatments which are evidence-based.
0:42:36 > 0:42:44But there are some patients who want to go beyond that and you could say,
0:42:44 > 0:42:46"Well, they shouldn't be having non-evidence-based treatments."
0:42:46 > 0:42:50Well, maybe the evidence is there, but it is not of the best quality.
0:42:50 > 0:42:52Thank you. Bye.
0:42:52 > 0:42:57Fortunately, I'm not sitting the other side of the desk with
0:42:57 > 0:42:59a potentially life-threatening tumour
0:42:59 > 0:43:01and what would want one do if it was yourself?
0:43:01 > 0:43:04So you're ready for a cup of tea?
0:43:04 > 0:43:06Coffee. Coffee?
0:43:06 > 0:43:08All right. Cappuccino.
0:43:08 > 0:43:10That'll have to do.
0:43:10 > 0:43:11Be grateful. Say thank you.
0:43:11 > 0:43:15If he was very quiet, I'd be worried.
0:43:15 > 0:43:18Last time, you pretended I was your sister.
0:43:18 > 0:43:20Who are you, anyway?
0:43:20 > 0:43:22Yeah, don't start that again!
0:43:22 > 0:43:27I'm glad you didn't play that trick this time.
0:43:27 > 0:43:31Is there any more water?
0:43:31 > 0:43:41My mouth's as dry as a badger's arse.
0:43:53 > 0:43:58My mother passed away from ovarian cancer about 18 years ago...
0:43:58 > 0:44:06..so I've known about ovarian cancer for a long time.
0:44:06 > 0:44:07It was really devastating.
0:44:07 > 0:44:09My mother was an amazing woman
0:44:09 > 0:44:11and she suffered terribly through her illness.
0:44:11 > 0:44:15And I was very fearful when I was first told,
0:44:15 > 0:44:17because in my mind I'd seen someone
0:44:17 > 0:44:21that I was close to go through the same thing.
0:44:21 > 0:44:23Nicky is waiting to be discharged.
0:44:23 > 0:44:26In six weeks, she'll start the standard NHS course of chemotherapy
0:44:26 > 0:44:31at her local hospital in Devon.
0:44:31 > 0:44:34Good morning. Good morning, Christina.
0:44:34 > 0:44:36How are you? You look good.
0:44:36 > 0:44:39So, we discussed yesterday that I'm happy that you go home today.
0:44:39 > 0:44:40How have things been yesterday?
0:44:40 > 0:44:44Better? Yeah, I have some good days and some not so good days,
0:44:44 > 0:44:46but then I think from Sunday, things got better.
0:44:46 > 0:44:49Excellent. I'm happy that you drink some coffee,
0:44:49 > 0:44:53that you start eating normally, normal things.
0:44:53 > 0:44:55Avoid things that could bloat you.
0:44:55 > 0:44:56Any questions or anything?
0:44:56 > 0:44:58I don't think so. Maybe just...
0:44:58 > 0:45:02Do you have any idea when I could possibly drive and get back up and
0:45:02 > 0:45:04running again? Yes. What are you doing again?
0:45:04 > 0:45:06I work with horses. Don't do that.
0:45:06 > 0:45:12OK. I'll wait a little while longer.
0:45:12 > 0:45:14Wait until six weeks, please. All right. You're very good.
0:45:14 > 0:45:16I'm very proud of you. OK? Thank you.
0:45:16 > 0:45:18Thanks, Christina. See you on the 8th. OK.
0:45:18 > 0:45:23Bye-bye. Bye-bye. Thank you.
0:45:23 > 0:45:24Hey. Hi.
0:45:24 > 0:45:27Hey, chicken. Hello.
0:45:27 > 0:45:31I've checked out of the apartment.
0:45:31 > 0:45:35Put my ring back on. How long has it been since you were able to wear
0:45:35 > 0:45:36your engagement ring?
0:45:36 > 0:45:38About a week. About a week, yes.
0:45:38 > 0:45:41It's been really hard, cos it feels really strange without it.
0:45:41 > 0:45:42It is just your fingers swell up,
0:45:42 > 0:45:45because of the amount of fluid that they pump into you.
0:45:45 > 0:45:47It feels fantastic to have it back on again.
0:45:47 > 0:45:49It was ?7 short of 11 grand.
0:45:49 > 0:45:52No way. Yes. Amazing.
0:45:52 > 0:45:55I was wondering if it might go over 11,000, last night.
0:45:55 > 0:46:03Some friends of mine that used to live in Scotland,
0:46:03 > 0:46:04they did an office cake-bake sale.
0:46:04 > 0:46:05?271.
0:46:05 > 0:46:07I know, it's absolutely amazing.
0:46:07 > 0:46:09Well, at the moment we've reached almost just shy of 11,000.
0:46:09 > 0:46:11What's the target?
0:46:11 > 0:46:15About... 66,000. ?66,000.
0:46:15 > 0:46:17Yeah.
0:46:17 > 0:46:22Even an old schoolteacher, when I was about 13,
0:46:22 > 0:46:27he's donated some money and I've not seen him for over sort of 20,
0:46:27 > 0:46:3225 years. I feel quite guilty, in a way,
0:46:32 > 0:46:35that I sort of didn't deserve this money, because I'm not very good...
0:46:35 > 0:46:38I never really ask for money and I never really ask for help.
0:46:38 > 0:46:41So, for me, this was quite a novel thing to do.
0:46:41 > 0:46:42I think crowdfunding is becoming
0:46:42 > 0:46:44quite a common platform now, I think,
0:46:44 > 0:46:46for people to raise money for cancer treatments
0:46:46 > 0:46:47that aren't available on the NHS.
0:46:47 > 0:46:49Are you ready to rock and roll?
0:46:49 > 0:46:51Yeah. I'll get you some shoes.
0:46:51 > 0:46:53What happens if you don't make 60,000?
0:46:53 > 0:46:57Whatever the money I do raise,
0:46:57 > 0:46:59I can still put towards several months of treatment.
0:46:59 > 0:47:01So if it's around ?4,000-?5,000 a month, for the Olaparib,
0:47:01 > 0:47:05I can still sign up with the drug and then just have as many months of
0:47:05 > 0:47:10the treatment as I'm able.
0:47:10 > 0:47:12With the amount that I've raised at the moment,
0:47:12 > 0:47:15that would guarantee me at least two months
0:47:15 > 0:47:16on Olaparib, which is fantastic.
0:47:16 > 0:47:19That's already about 20% of the way.
0:47:19 > 0:47:22Can you just confirm for me if you received Nicola's authorisation for
0:47:22 > 0:47:28medication? Is it a possibility we can have it ASAP?
0:47:28 > 0:47:31INTERVIEWER: Can you understand why the NHS don't fund it?
0:47:31 > 0:47:38I can understand it, but it's still very frustrating.
0:47:38 > 0:47:41Don't get me wrong, I'm eternally grateful for what's happened.
0:47:41 > 0:47:44I dread to think how much money has been spent on Nicky's treatment
0:47:44 > 0:47:48since the first diagnosis, 18 months ago.
0:47:48 > 0:47:49I understand that, yeah.
0:47:49 > 0:47:52Somebody does the sums and somebody has to do the sums.
0:47:52 > 0:47:55It's an awful job to do but somebody works out how much to spend,
0:47:55 > 0:47:57and how long to increase somebody's life by.
0:47:57 > 0:48:01Anti-sickness. OK.
0:48:01 > 0:48:02Antibiotics. OK.
0:48:02 > 0:48:06The research that is coming out now is so promising.
0:48:06 > 0:48:08Thank you so much. You've been amazing, thank you.
0:48:08 > 0:48:11It has given us a bit of hope.
0:48:11 > 0:48:14It could be a matter of months before it comes back again...
0:48:14 > 0:48:25..but no-one really knows.
0:48:27 > 0:48:32The work I do here is tightly regulated.
0:48:32 > 0:48:34I have an annual appraisal
0:48:34 > 0:48:37and people keep a fairly close eye on my work.
0:48:37 > 0:48:40Outside of places like this and other big NHS hospitals,
0:48:40 > 0:48:46if you just go and see someone privately,
0:48:46 > 0:48:48there are all manner of snake oil salesmen out there
0:48:48 > 0:48:57and I think that worries me.
0:48:57 > 0:48:58Hello!
0:48:58 > 0:49:01Matt is seeing Glendon in the NHS clinic for the first time since
0:49:01 > 0:49:04his brain surgery.
0:49:04 > 0:49:06Well, look at this.
0:49:06 > 0:49:09Can I give you a hug? I didn't do anything, mate.
0:49:09 > 0:49:12You put everything in place for me.
0:49:12 > 0:49:15I mean, I just... You know what I was down to.
0:49:15 > 0:49:17Take a seat before you fall over.
0:49:17 > 0:49:20I'm not falling over, I've been walking all day.
0:49:20 > 0:49:22OK, all right, then. Well, before you get tired, then.
0:49:22 > 0:49:25So, we need to talk about what we're going to do next.
0:49:25 > 0:49:27We had talked about having another round of radiotherapy.
0:49:27 > 0:49:32Yep. And we had talked about adding immunotherapy to it in the form
0:49:32 > 0:49:34of Pembrolizumab. Yep.
0:49:34 > 0:49:36Is that still what you want to do?
0:49:36 > 0:49:39Yes. Fine. Unless there's another combination which has come out.
0:49:39 > 0:49:41OK, this is the best I can do.
0:49:41 > 0:49:44Let's make some informed guesses.
0:49:44 > 0:49:48If it works, how long do I keep the schedule going?
0:49:48 > 0:49:50They will give you two doses of Pembrolizumab,
0:49:50 > 0:49:53one before and one after.
0:49:53 > 0:49:56But do I keep carry on taking them for the rest of my life?
0:49:56 > 0:49:58No, no, no. Two doses of Pembrolizumab.
0:49:58 > 0:49:59Right.
0:49:59 > 0:50:03Beyond that, I find it very difficult to justify continuing.
0:50:03 > 0:50:07I mean, it's not a money thing, if it works, I will carry on doing it.
0:50:07 > 0:50:08I know, I know.
0:50:08 > 0:50:10You keep saying that to me.
0:50:10 > 0:50:12INTERVIEWER: Have you made a sort of choice
0:50:12 > 0:50:14about not giving Glendon exactly what he wants?
0:50:14 > 0:50:20Are you trying not to bankrupt him?
0:50:20 > 0:50:24Well, of course I'm trying not to bankrupt him.
0:50:24 > 0:50:29One of the drugs he's interested in is just under ?30,000 a dose.
0:50:29 > 0:50:34I don't think that there is enough data to justify its use.
0:50:34 > 0:50:38Immunotherapy can be a bit funny in that...
0:50:38 > 0:50:42because it sort of takes the brakes off your immune system...
0:50:42 > 0:50:46Yep. And your immune system kicks off, it can give you lung problems,
0:50:46 > 0:50:50kidney problems, heart problems, eye problems, skin problems... Yep.
0:50:50 > 0:50:54..because essentially it depends which bit it decides.
0:50:54 > 0:50:57Yes. I heard the liver was something...
0:50:57 > 0:50:59Yes, and liver. Sign and print your name there.
0:50:59 > 0:51:02Is it the role of the doctor to say, "Stop treatment"?
0:51:02 > 0:51:06We live in a society where people are used to being able to have what
0:51:06 > 0:51:10they want, and health care is not like that.
0:51:10 > 0:51:17It's difficult because part of our job is to own the uncertainty,
0:51:17 > 0:51:20to say, "Here are the options and I will recommend A,
0:51:20 > 0:51:22"I will recommend B,"
0:51:22 > 0:51:26even when in your heart of hearts you are not entirely certain.
0:51:26 > 0:51:30In all honesty, I'm not an idiot.
0:51:30 > 0:51:33Somewhere along the line, it's going to be not treatable.
0:51:33 > 0:51:35Yes, but my aim
0:51:35 > 0:51:37is, where it's appropriate,
0:51:37 > 0:51:41is to give you treatment to keep you well for as long as possible.
0:51:41 > 0:51:44It's all we can do. That's all I want to hear.
0:51:44 > 0:51:47I'm a realist. You're a very optimistic realist.
0:51:47 > 0:51:56Thanks. Nice to see you.
0:51:56 > 0:51:58How are you feeling about the prospect
0:51:58 > 0:52:02of getting the immunotherapy drugs?
0:52:02 > 0:52:05It's like going to the bookies really, basically.
0:52:05 > 0:52:06You can't turn around and say,
0:52:06 > 0:52:10"Oh, yeah, you're on a sure-fire winner here."
0:52:10 > 0:52:14What I'm trying to do is kick this cancer further down the line.
0:52:14 > 0:52:18The further I can kick it down the line, the more studies go on,
0:52:18 > 0:52:21there's more chances of drugs being approved, which are clinically more
0:52:21 > 0:52:27effective, so that's why you do it.
0:52:27 > 0:52:31Hi, is that the 15th chemo unit?
0:52:31 > 0:52:33Hi, I'm calling from pharmacy,
0:52:33 > 0:52:34just to say that the immunotherapy
0:52:34 > 0:52:39for Glendon is ready to be collected.
0:52:39 > 0:52:47I didn't want to go to my grave without covering every angle.
0:52:47 > 0:52:48Hello.
0:52:48 > 0:52:50Hello. It's for the 15th floor.
0:52:50 > 0:52:54INTERVIEWER: You grew up expecting the NHS to always be there for you.
0:52:54 > 0:52:57Yeah. Do you feel the NHS is still there for you?
0:52:57 > 0:53:03For the everyday stuff, very much so.
0:53:03 > 0:53:10So you're staying here, yes? OK.
0:53:10 > 0:53:20Hi. Just want to pay for Glendon's treatment.
0:53:24 > 0:53:26INTERVIEWER: How does that feel?
0:53:26 > 0:53:33It's what needs to be done to get the treatments.
0:53:33 > 0:53:36Do you think the hospital, knowing that it's a bit of a gamble,
0:53:36 > 0:53:42there's no guarantee...
0:53:42 > 0:53:44Do you mean, should they offer him this?
0:53:44 > 0:53:46Yes. They've taken a lot of money from you.
0:53:46 > 0:53:47Yeah, but it's hope for him,
0:53:47 > 0:53:50and if I went home tomorrow with no treatment or forward plans,
0:53:50 > 0:53:52I don't think he would cope.
0:53:52 > 0:54:00He would give up.
0:54:00 > 0:54:02INTERVIEWER: Are you all right? SNIFFLING: Yes.
0:54:02 > 0:54:05Just that it is hope, and, you know, it might not work.
0:54:05 > 0:54:06In fact, it probably won't work.
0:54:06 > 0:54:09Well, I don't know, I don't like to get too optimistic.
0:54:09 > 0:54:12But, erm...
0:54:12 > 0:54:18You know, if it even
0:54:18 > 0:54:20gives Glen something to live for now...
0:54:20 > 0:54:25..it's serving a purpose.
0:54:25 > 0:54:28All ready, sir?
0:54:28 > 0:54:35Here we go. Here we go.
0:54:35 > 0:54:42I just want a normal life back.
0:54:42 > 0:54:43I want to live to 70.
0:54:43 > 0:54:45You know, something like that.
0:54:45 > 0:54:51I don't want to die at 50.
0:54:51 > 0:54:55Good. Fusing nicely.
0:54:55 > 0:54:58You know, you've got to put up with what
0:54:58 > 0:55:02you're given, and if I can keep it going longer,
0:55:02 > 0:55:07that's what I'm going to bloody do.
0:55:07 > 0:55:11INTERVIEWER: Are the NHS in an impossible situation?
0:55:11 > 0:55:13Yes.
0:55:13 > 0:55:16We are completely screwed.
0:55:16 > 0:55:19The NHS is caught between some demographic pressures, so we have
0:55:19 > 0:55:21a bigger population and an older population,
0:55:21 > 0:55:28but we are also caught in a really nasty wedge in other ways.
0:55:28 > 0:55:29Medical technology is developing, more treatments available,
0:55:29 > 0:55:31patient expectations are going up,
0:55:31 > 0:55:41but increasingly we are no longer able to meet them.
0:55:41 > 0:55:42And this country has
0:55:42 > 0:55:48skimped on health care for a long time.
0:55:48 > 0:55:49Sometimes people talk about a two-tier system,
0:55:49 > 0:55:52what does that mean to you?
0:55:52 > 0:56:00Well, I mean, we run a two-tier system...
0:56:00 > 0:56:02..and most of us would rather not do private health care.
0:56:02 > 0:56:05I certainly never came into medicine with any intention of doing
0:56:05 > 0:56:09any private work.
0:56:09 > 0:56:12The best example of what happens when you have a lot of
0:56:12 > 0:56:19private medicine is America.
0:56:19 > 0:56:25It gets very poor outcomes.
0:57:08 > 0:57:13ANGRY SHOUTING
0:57:13 > 0:57:16Is she safe? Is she safe?
0:57:16 > 0:57:17St Mary's A is experiencing
0:57:17 > 0:57:21a sharp rise in mental health patients...
0:57:21 > 0:57:23There are patients in the corridor at the moment
0:57:23 > 0:57:26because we don't have enough bays.
0:57:26 > 0:57:28..with one of its longest ever waiting-time breaches.
0:57:28 > 0:57:30Just to highlight, the first psych patient's
0:57:30 > 0:57:33now been in A for 22 hours.
0:57:33 > 0:57:36It's not fair on her ultimately, or anybody else here either.
0:57:36 > 0:57:38Do you know where you are? No.
0:57:38 > 0:57:43Do you know where you are?
0:57:43 > 0:57:46And the complex needs of an ageing population...
0:57:46 > 0:57:47It's too much for me.
0:57:47 > 0:57:49I want to look after him.
0:57:49 > 0:57:51..sees more people than ever attending hospital in crisis.
0:57:51 > 0:57:54Anyone in society that doesn't know where to turn, they will come to us.
0:57:54 > 0:57:59In their eyes, we're seen as
0:57:59 > 0:58:04the only people that can help them.
0:58:04 > 0:58:06What choices would you make
0:58:06 > 0:58:09when faced with complex health care decisions?
0:58:09 > 0:58:16Visit our interactive pages to find out how you would respond. Go to...
0:58:16 > 0:58:25..and follow the links to the Open University.