0:00:02 > 0:00:05- Where is he?- I thought...- You need to shout for help. Where is he?
0:00:05 > 0:00:06Which way did he go?
0:00:06 > 0:00:08One of London's biggest hospital trusts...
0:00:08 > 0:00:11He's having a heart attack, but we'll get him in straightaway
0:00:11 > 0:00:12and we'll get him sorted out.
0:00:12 > 0:00:14OK, on three. One, two, three...
0:00:14 > 0:00:18..treating more than 20,000 people every week.
0:00:18 > 0:00:20Flying over the enemy lines.
0:00:20 > 0:00:24This is a place with some of the best specialists in the world...
0:00:24 > 0:00:26I'm amazed he's alive. He had two blocked arteries.
0:00:26 > 0:00:29..where lives are transformed.
0:00:29 > 0:00:32Oh, thank you so much.
0:00:32 > 0:00:34But it's under intense pressure.
0:00:34 > 0:00:37We have a financial deficit of 41 million.
0:00:37 > 0:00:39With growing patient numbers...
0:00:39 > 0:00:41We are full. We're always full.
0:00:41 > 0:00:43How long has he been here?
0:00:43 > 0:00:4513 hours and 46 minutes.
0:00:45 > 0:00:47I don't think that's best patient care.
0:00:47 > 0:00:49..and higher expectations...
0:00:49 > 0:00:51There can't be nothing in this day and age.
0:00:51 > 0:00:54I want to look after him.
0:00:54 > 0:00:56First ambulance is on the ramp.
0:00:56 > 0:01:00..at a time where the NHS has never been under more scrutiny.
0:01:00 > 0:01:03We're declaring a major incident at the St Mary's site.
0:01:03 > 0:01:05If this was my sister, or a friend, or anyone,
0:01:05 > 0:01:07this wouldn't be good enough.
0:01:07 > 0:01:11Week by week, we reveal the complex decisions the staff must make...
0:01:11 > 0:01:16Anybody else who hasn't gone knife to skin, they need to be sent home.
0:01:16 > 0:01:18..about who to care for next.
0:01:20 > 0:01:23Do you reach the point where you say, "Enough is enough"?
0:01:23 > 0:01:26Yes. The family may not like that,
0:01:26 > 0:01:28but we are stopping and this is where it ends.
0:01:29 > 0:01:32This programme contains some strong language
0:01:32 > 0:01:35and some scenes which some viewers may find upsetting.
0:01:37 > 0:01:40- Good morning. Hammersmith? - 'Yeah, I'm here.'
0:01:40 > 0:01:42Charing Cross, good morning to you.
0:01:42 > 0:01:44'Morning, Judy.'
0:01:44 > 0:01:47St Mary's, we have A&E with us.
0:01:47 > 0:01:50Good morning. I think we've got 15 patients in the department.
0:01:50 > 0:01:53Six are over four hours. Three of those are waiting for a psych bed.
0:01:53 > 0:01:56One's been allocated, but she's waiting for transport.
0:01:56 > 0:01:57Just to highlight,
0:01:57 > 0:01:59the first psych patient has now been in A&E for 22 hours.
0:01:59 > 0:02:01That patient has caused lots of disruption overnight,
0:02:01 > 0:02:03has assaulted various members of staff.
0:02:03 > 0:02:05The police have been called.
0:02:08 > 0:02:11A woman is being cared for in Room Q -
0:02:11 > 0:02:15a dedicated space in A&E for psychiatric patients.
0:02:15 > 0:02:17She arrived in an agitated state
0:02:17 > 0:02:18yesterday morning.
0:02:22 > 0:02:25I'm just concerned about this mental health patient in A&E for 22 hours
0:02:25 > 0:02:29who is difficult to handle because she's so aggressive and violent.
0:02:29 > 0:02:30Going through the notes,
0:02:30 > 0:02:33they've assaulted five members of staff throughout the night shift.
0:02:33 > 0:02:36She's a very big lady and she's difficult to handle.
0:02:36 > 0:02:39She...got seen by the mental health team,
0:02:39 > 0:02:41they booked a normal mental health bed.
0:02:41 > 0:02:44Eventually, she got so aggressive, when the crew turned up to take her,
0:02:44 > 0:02:47they decided she needed a psychiatric intensive care bed,
0:02:47 > 0:02:49which is in, like, a locked room.
0:02:49 > 0:02:51There's very few of them in London.
0:02:51 > 0:02:54The new bed was then identified, but now we're waiting on transport.
0:02:54 > 0:02:57There has to be a secure vehicle that she can be secured in.
0:02:57 > 0:03:00We've been waiting for that since 4:30, I believe.
0:03:00 > 0:03:02I'll chase that up.
0:03:02 > 0:03:04Does the patient need any cages or anything like that?
0:03:08 > 0:03:11St Mary's, like most general hospitals,
0:03:11 > 0:03:14doesn't have its own psychiatric beds on site.
0:03:14 > 0:03:18We've got this lady - assaulted staff last night,
0:03:18 > 0:03:21quite aggressive verbally and physically.
0:03:21 > 0:03:24A liaison psychiatry team based at St Mary's
0:03:24 > 0:03:27but employed by a separate NHS Trust
0:03:27 > 0:03:29must assess and transfer mental health patients
0:03:29 > 0:03:31to off-site psychiatric units
0:03:31 > 0:03:34or arrange treatment for them in the community.
0:03:34 > 0:03:37- She needed to be restrained as well? - Yeah.
0:03:37 > 0:03:40- Security or police? - Security AND police.
0:03:41 > 0:03:44It's the job of the team's deputy manager, Million Moyo,
0:03:44 > 0:03:47to secure a bed for the patient.
0:03:47 > 0:03:49The problem is the logistics,
0:03:49 > 0:03:51because we don't have wards on site.
0:03:54 > 0:03:56They need to be transferred elsewhere.
0:03:56 > 0:04:00Where we transfer them, quite often there are no beds.
0:04:00 > 0:04:05It's very unusual that we've got a bed ready for a psychiatric patient.
0:04:07 > 0:04:09Hello.
0:04:17 > 0:04:21We are giving her medication so that the transfer can go smoothly.
0:04:23 > 0:04:26- Is she safe? Is she safe?- Yeah.
0:04:26 > 0:04:27OK. That's fine.
0:04:32 > 0:04:34Oh, you're at St Mary's Hospital.
0:04:41 > 0:04:44You came to the hospital yesterday.
0:04:44 > 0:04:48When we met you, you seemed quite confused.
0:04:50 > 0:04:51Do you drink alcohol?
0:04:53 > 0:04:55Do you use any substances?
0:04:56 > 0:04:59Crystal. When is the last time you used crystal?
0:05:01 > 0:05:03You don't know.
0:05:04 > 0:05:05Are you feeling sleepy?
0:05:09 > 0:05:14Last year, 2,300 mental health patients attended St Mary's A&E,
0:05:14 > 0:05:18an 8% rise on 2015.
0:05:19 > 0:05:21Compared to maybe even six, eight years ago,
0:05:21 > 0:05:24we're seeing more people showing up to our A&E departments in crisis.
0:05:24 > 0:05:28It seems people don't know where to go to if they've newly become
0:05:28 > 0:05:31homeless or are living on the streets or have newly been diagnosed
0:05:31 > 0:05:34with a mental health issue, they might not always know where to go.
0:05:34 > 0:05:37But everyone knows if you turn up to an Accident and Emergency department
0:05:37 > 0:05:39that we will see you, regardless.
0:05:39 > 0:05:41If they don't come to us, they're not going to get help,
0:05:41 > 0:05:44and then things will turn out a lot worse for them.
0:05:48 > 0:05:52It's getting to over 24 hours now. This is a very long breach.
0:05:52 > 0:05:5612-hour breaches are considered very serious.
0:05:56 > 0:05:58The Chief Executive gets informed.
0:05:58 > 0:06:03The Government sets targets to prevent long waits in A&E.
0:06:03 > 0:06:05If these are breached repeatedly,
0:06:05 > 0:06:09the hospital can face financial penalties.
0:06:09 > 0:06:10We do take breaches seriously.
0:06:10 > 0:06:13We do strive to try and get our patients into beds
0:06:13 > 0:06:14where we can, as possible.
0:06:14 > 0:06:17Our mental health breaches, that's very difficult
0:06:17 > 0:06:18to try and actually do anything about them,
0:06:18 > 0:06:20because they're out of our control.
0:06:20 > 0:06:22She's just as ill as our other patients.
0:06:22 > 0:06:24She's iller than our other patients.
0:06:24 > 0:06:26We can help them and look after them.
0:06:27 > 0:06:30We can't do anything, other than wait and wait.
0:06:30 > 0:06:34If this was my sister, or my mum, or a friend, or anyone,
0:06:34 > 0:06:36this wouldn't be good enough.
0:06:36 > 0:06:37It's not good enough.
0:06:37 > 0:06:41We have had patients here for 36, 48 hours -
0:06:41 > 0:06:45young, vulnerable patients and elderly, vulnerable patients.
0:06:45 > 0:06:46It is disgusting.
0:06:46 > 0:06:49Sometimes we just feel like our hands are tied
0:06:49 > 0:06:50and we can't do anything else.
0:06:50 > 0:06:52All we can do is do our best for them.
0:06:53 > 0:06:56Hi, it's Million. I've got a dilemma.
0:06:57 > 0:07:00A bed has not been identified for this lady.
0:07:00 > 0:07:02They actually refused the patient.
0:07:03 > 0:07:05A few minutes ago.
0:07:08 > 0:07:10Yeah, I know. I've been calling everybody.
0:07:10 > 0:07:14We may be lucky to get a bed in the next few minutes.
0:07:14 > 0:07:16I will call you back in the next 20 minutes.
0:07:16 > 0:07:20Hopefully we can hold on to the transport.
0:07:20 > 0:07:23A private ambulance is booked to take the patient to
0:07:23 > 0:07:25an off-site psychiatric unit.
0:07:25 > 0:07:27We're authorising hundreds of pounds worth of transport
0:07:27 > 0:07:30for these people to go to a safe place.
0:07:32 > 0:07:37Hi. I'm doing my best. We're just waiting for the go-ahead.
0:07:37 > 0:07:43How long's that going to be? Cos we got told 10:30.
0:07:43 > 0:07:48I think let's wait those ten minutes and see how it pans out.
0:07:48 > 0:07:49Are you happy with that?
0:07:49 > 0:07:51We're going to have to tell our controller,
0:07:51 > 0:07:53cos we go straight in, straight out.
0:07:53 > 0:07:57Transport are just waiting and they are just about to cancel.
0:07:57 > 0:07:59Have you got a place for her yet?
0:07:59 > 0:08:03- Not just yet. It is actually this phone call.- He's on the phone now.
0:08:03 > 0:08:07Can we leave it five minutes and then call you back?
0:08:07 > 0:08:09Is that all right?
0:08:09 > 0:08:13OK, they're standing here, so... All right, thank you. Bye.
0:08:15 > 0:08:17Another five minutes...
0:08:18 > 0:08:23I just want to check about this lady you're expecting.
0:08:23 > 0:08:24What time we can transfer?
0:08:27 > 0:08:282:30?
0:08:40 > 0:08:42Bad? It's not acceptable.
0:08:44 > 0:08:47Why is it going to take two and a half hours?
0:08:51 > 0:08:53But that takes two and a half hours, why?
0:08:53 > 0:08:55I know it's not your fault, but I need an answer.
0:08:55 > 0:08:57Everyone asks me why, and two and a half hours is...
0:09:01 > 0:09:03OK, so this patient leaves here at two o'clock.
0:09:08 > 0:09:11INTERVIEWER: What do people think of psych liaison in the hospital?
0:09:11 > 0:09:16Those who understand how we work, they appreciate us a lot.
0:09:16 > 0:09:21Those who don't, Um...are sort of...
0:09:21 > 0:09:23lose confidence with us.
0:09:23 > 0:09:26But I understand the pressure that they'll be going through.
0:09:28 > 0:09:32It's not fair on her, ultimately, or anybody else here either.
0:09:32 > 0:09:33We need a definite time for a bed,
0:09:33 > 0:09:37and they can't keep changing it, so I'll rebook transport now.
0:09:37 > 0:09:40A new crew for two o'clock. The patient goes at two, regardless.
0:09:40 > 0:09:43They'll have staff and a bed at two o'clock.
0:09:43 > 0:09:45- All right, two o'clock, yeah? - Yeah, please.
0:09:45 > 0:09:48I need to speak to someone regarding the mental health transfer.
0:09:48 > 0:09:50INTERVIEWER: Whose fault is this?
0:09:59 > 0:10:01- I have to let you guys leave.- OK.
0:10:01 > 0:10:05The possibility is that you might get a call back on it later,
0:10:05 > 0:10:08but for now, I'm afraid we're going to have to cancel it.
0:10:08 > 0:10:11No problem at all. Have you spoken to our office, or do you want me
0:10:11 > 0:10:15- to do it?- Yes, that's all been done, so we've made the contacts...
0:10:15 > 0:10:17- Excellent.- I am so sorry.
0:10:17 > 0:10:21Hey, don't worry about it, things happen, don't they?
0:10:21 > 0:10:24I had a lovely cup of coffee.
0:10:24 > 0:10:27It's so frustrating and it becomes so ridiculous sometimes that we can
0:10:27 > 0:10:30spend 12 hours of a shift, and then my colleague can spend
0:10:30 > 0:10:32the next 12 hours of a shift trying to help these people,
0:10:32 > 0:10:35trying to find them a bed where they can go to
0:10:35 > 0:10:37so they can get the correct care that they need.
0:10:37 > 0:10:39In the meantime, they're sitting in a cubicle
0:10:39 > 0:10:41in a busy A&E department
0:10:41 > 0:10:43with all hell breaking loose around them sometimes.
0:10:50 > 0:10:54Three hours later, after 29 hours in A&E,
0:10:54 > 0:10:58a bed in a psychiatric unit is found for the patient.
0:10:58 > 0:11:00INTERVIEWER: Do you ever feel undervalued?
0:11:00 > 0:11:04Occasionally I have felt undervalued...
0:11:06 > 0:11:08..but not by patients.
0:11:11 > 0:11:13I think let's leave that at that!
0:11:19 > 0:11:21Get her mum's number.
0:11:21 > 0:11:24Ask your colleague to get her her mum's number.
0:11:26 > 0:11:28There's been just so many cuts in all areas
0:11:28 > 0:11:30of our social care in this country.
0:11:30 > 0:11:32It's just so frustrating that anyone in society that doesn't know
0:11:32 > 0:11:34where to turn, they will come to us.
0:11:34 > 0:11:36It's fine, that's what we're here for.
0:11:36 > 0:11:39It just makes our job very, very frustrating.
0:11:39 > 0:11:41It's also very frustrating for them and their families,
0:11:41 > 0:11:44cos we're not the right people to help sometimes.
0:11:44 > 0:11:47But in their eyes, we're seen as the only people that can help them.
0:11:58 > 0:12:02We've got four patients with mental health issues in our department.
0:12:02 > 0:12:04They've been here for rather a long time,
0:12:04 > 0:12:08but they do all need a formal mental state examination
0:12:08 > 0:12:11via our psychiatric liaison team, so...
0:12:11 > 0:12:14INTERVIEWER: Referrals have been made, have they?
0:12:14 > 0:12:16Yeah, yeah, they've been made. Many hours ago.
0:12:18 > 0:12:21I've already had a barney with the A&E staff this morning.
0:12:21 > 0:12:24I just basically told them, you can't keep bleeping
0:12:24 > 0:12:26and asking about every single case.
0:12:26 > 0:12:31I said I've come in to five cases, one of them's absconded already.
0:12:34 > 0:12:3675-year-old Carl has dementia.
0:12:36 > 0:12:40His family brought him to A&E after he became aggressive at home.
0:12:42 > 0:12:44Yesterday morning, he walked out of the hospital
0:12:44 > 0:12:47and was missing for 13 hours.
0:12:47 > 0:12:49The police found him wandering the streets alone
0:12:49 > 0:12:52and brought him back to A&E.
0:12:52 > 0:12:54Three people to look after him at the moment,
0:12:54 > 0:12:57he's needing security because he's in an unfamiliar environment,
0:12:57 > 0:13:02it's noisy, it's bright, there's lots going on.
0:13:02 > 0:13:06I suspect that that's really playing into his underlying diagnosis
0:13:06 > 0:13:09and making things much worse for him.
0:13:09 > 0:13:12For his own safety, Carl is being held in Room Q,
0:13:12 > 0:13:16the space reserved for psychiatric patients.
0:13:16 > 0:13:20- So we've just been asked to come and see that you're OK.- Me?
0:13:20 > 0:13:25Do you know where you are at the moment? Do you know where you are?
0:13:25 > 0:13:28- Yeah.- Yeah? Can you tell me?
0:13:28 > 0:13:30Won't say anything.
0:13:30 > 0:13:33He's very confused at the moment. He's got a history...
0:13:33 > 0:13:36He's got a diagnosis of dementia already,
0:13:36 > 0:13:38but it sounds like, from his presentation,
0:13:38 > 0:13:42he's really deteriorated in the last month, really.
0:13:42 > 0:13:43Where is he?
0:13:44 > 0:13:48You need to shout for help. Where is he? Which way did he go?
0:13:48 > 0:13:51- That way.- Right, chase him. - Where is he?
0:13:54 > 0:13:58Carl, look... Let's go into this room here where there's comfy seats.
0:13:58 > 0:14:01Come and have a sit down, Carl. Please.
0:14:01 > 0:14:03Come and have a sit down, please.
0:14:03 > 0:14:06He's taking up quite a lot of resource in the A&E department
0:14:06 > 0:14:08whilst we try and stop him from leaving,
0:14:08 > 0:14:11because obviously, he doesn't really want to be here.
0:14:11 > 0:14:12Carl.
0:14:14 > 0:14:15Carl.
0:14:16 > 0:14:20I'm Dr Matras, I'm a psychiatrist. How are you doing, sir?
0:14:22 > 0:14:23Are you OK?
0:14:25 > 0:14:27Are you OK? Are you doing well?
0:14:27 > 0:14:30- Yeah.- Perfect. Do you know where you are?
0:14:32 > 0:14:33- Yeah.- Could you tell me?
0:14:36 > 0:14:37Say again.
0:14:41 > 0:14:44Sober? I am sober, yes. I'm a doctor. I'm sober, sir.
0:14:46 > 0:14:47We're finding it hard.
0:14:47 > 0:14:49It is hard. It's stressful.
0:14:49 > 0:14:50Just seeing him today
0:14:50 > 0:14:52is just heartbreaking.
0:14:52 > 0:14:54Really heartbreaking.
0:14:54 > 0:14:56My mum's on respite.
0:14:56 > 0:14:57She's gone on a two-week respite,
0:14:57 > 0:15:01so myself and my partner are actually caring for Carl.
0:15:01 > 0:15:04That's when we started finding more changes with him.
0:15:04 > 0:15:07I don't know if it's the circumstances
0:15:07 > 0:15:11that his routine's kind of changed, compared to when my mum's around.
0:15:11 > 0:15:15I think that might be the cause of why he's in here today.
0:15:15 > 0:15:20- Are you looking for your wife? - Yeah.- Yeah.
0:15:20 > 0:15:22- Do you think he's missing her? - He's definitely missing her.
0:15:22 > 0:15:25He's definitely missing her, because he tries to ask for her.
0:15:25 > 0:15:30He normally lives with his wife, who is away now.
0:15:30 > 0:15:32She's due to return quite soon.
0:15:32 > 0:15:34He doesn't have the history of aggression,
0:15:34 > 0:15:36but he has become aggressive.
0:15:36 > 0:15:39The daughter thinks that is has deteriorated over the last
0:15:39 > 0:15:43three or four days. He's much more confused, he's much more jumbled.
0:15:43 > 0:15:46He went to visit his daughter, but he confused the addresses
0:15:46 > 0:15:49and tried to force entry to somebody else's home.
0:15:49 > 0:15:53- That's not good.- My concern is having him on this busy ward.
0:15:53 > 0:15:56- Yeah, he needs to go somewhere else. - I think he's getting agitated
0:15:56 > 0:15:58- with all the people around him, the noise.- Yeah.
0:15:58 > 0:16:02The main problem will be he's wanting to leave and go,
0:16:02 > 0:16:04because it's what he normally does.
0:16:06 > 0:16:07INTERVIEWER: Can you just tell me
0:16:07 > 0:16:09what's going on with this guy, what the dilemmas are?
0:16:09 > 0:16:11First of all,
0:16:11 > 0:16:13we are not entirely clear why there was a change in his behaviour.
0:16:13 > 0:16:15The investigations that have been
0:16:15 > 0:16:17carried out don't show the evidence
0:16:17 > 0:16:20of a medical cause that could be attributable,
0:16:20 > 0:16:23but, at the same time, it doesn't exclude that.
0:16:23 > 0:16:27So there'll be a question whether he could be admitted medically
0:16:27 > 0:16:28for further investigations.
0:16:28 > 0:16:30That's something that I want to discuss with the medical team,
0:16:30 > 0:16:33because they may say that, unfortunately,
0:16:33 > 0:16:35it's not necessary for him to be admitted.
0:16:35 > 0:16:38So then there'll be the question of who will be arranging
0:16:38 > 0:16:41the increased package of care, because he's unlikely to be
0:16:41 > 0:16:43able to return home without an increased package of care.
0:16:49 > 0:16:53Psychiatrist Bart works for a different NHS Trust,
0:16:53 > 0:16:56so he can't admit patients to St Mary's.
0:16:56 > 0:17:00Instead, he must ask one of the duty doctors to find Carl a bed.
0:17:09 > 0:17:14- Hi, how are you?- Hi. - There's a chap here called Carl.
0:17:14 > 0:17:17He was brought in last night with increased confusion.
0:17:17 > 0:17:19He normally lives with his wife, but she's away.
0:17:19 > 0:17:21Communication with him was difficult,
0:17:21 > 0:17:23but according to the daughter, he's even more jumbled up.
0:17:23 > 0:17:26You know what I'm trying to say.
0:17:26 > 0:17:29There's a Q on chronic confusion, there's a safeguarding issue
0:17:29 > 0:17:32- and possibly... - Well, not necessarily.
0:17:32 > 0:17:37But might need an increased package of care or something.
0:17:37 > 0:17:39He won't be capable of going back home at the moment.
0:17:39 > 0:17:44- We'll get him admitted to AMU.- AMU? - AMU. There will be beds.
0:17:44 > 0:17:47We'll get the whole story and we'll see what's chronic and what's new
0:17:47 > 0:17:51and what's reversible and what's not.
0:17:51 > 0:17:54- Awesome. Thank you.- No problem. - Thanks again.
0:18:01 > 0:18:04Our longest waiting patient is going to go to the medical ward now,
0:18:04 > 0:18:06so he's going to the Acute Medical Unit.
0:18:06 > 0:18:08INTERVIEWER: How long has he been here?
0:18:08 > 0:18:0913 hours and 46 minutes.
0:18:11 > 0:18:13What do you think of that?
0:18:13 > 0:18:17I don't think that's best patient care.
0:18:17 > 0:18:20Is mental health given the priority that physical health is?
0:18:22 > 0:18:26Yes, in terms of the care delivery within this hospital,
0:18:26 > 0:18:31but no in terms of the budget that is has across the whole country.
0:18:31 > 0:18:32- It doesn't have parity?- No.
0:18:39 > 0:18:44Get her away! Move away! No hands on me.
0:18:44 > 0:18:45Please.
0:18:45 > 0:18:49- Stanley, that's not nice. - Please, don't let her touch me.
0:18:49 > 0:18:50No!
0:18:50 > 0:18:51OK.
0:18:51 > 0:18:5485-year-old Stanley has vascular dementia.
0:18:54 > 0:18:56This is his fourth admission in three months.
0:18:56 > 0:19:02Push me back. About two feet backwards and then right.
0:19:02 > 0:19:03OK, we're going now.
0:19:03 > 0:19:06Around 25% of medical patients
0:19:06 > 0:19:09treated annually by the Trust have dementia.
0:19:09 > 0:19:11They're accommodated in a specialist ward
0:19:11 > 0:19:13until their social care can be arranged.
0:19:17 > 0:19:19STANLEY GROANS
0:19:19 > 0:19:22Stanley, he remains medically fit.
0:19:22 > 0:19:24In terms of discharge, actually,
0:19:24 > 0:19:26the only thing that we need is the package of care.
0:19:26 > 0:19:27What are we waiting for?
0:19:27 > 0:19:30As he can no longer cope living alone, Stanley's family,
0:19:30 > 0:19:32along with hospital staff,
0:19:32 > 0:19:35have decided he needs a place in a care home.
0:19:35 > 0:19:37He's under the care of the complex discharge team.
0:19:37 > 0:19:40So I've spoken to the CCG.
0:19:40 > 0:19:45They said that they still haven't heard from the commissioner,
0:19:45 > 0:19:47so by midday tomorrow,
0:19:47 > 0:19:53we'll hopefully get the answer for the funding that we're asking.
0:19:53 > 0:19:55- Good stuff.- Then we'll start looking for a care home.
0:19:55 > 0:19:58If you get unwell, this is where you come,
0:19:58 > 0:19:59and that's what we expect,
0:19:59 > 0:20:03but I think there's probably more that we're seeing of people
0:20:03 > 0:20:06whose social situation has just reached a breaking point.
0:20:06 > 0:20:11I think, you know, we're just seeing more people in worse crises
0:20:11 > 0:20:14as it gets more difficult to access social care
0:20:14 > 0:20:17or to have your problems met in the community.
0:20:17 > 0:20:23No, don't turn me right. Ahead. Ahead. No, you're turning.
0:20:23 > 0:20:26- Stanley...- I mustn't be turned.
0:20:26 > 0:20:28- Stanley...- What, darling?
0:20:28 > 0:20:31Remember, I told you, no screaming.
0:20:31 > 0:20:34I was assigned to look after only him,
0:20:34 > 0:20:39cos he's quite confused and he's very demanding as well.
0:20:39 > 0:20:43He's off and on, screaming, shouting.
0:20:43 > 0:20:45Flip, flop...
0:20:45 > 0:20:47STANLEY GROANS
0:20:47 > 0:20:49Careful.
0:20:52 > 0:20:56Asking for so many things that you can't really figure out sometimes.
0:20:56 > 0:20:59Well, that's our job.
0:21:01 > 0:21:02- Are you waving to everybody?- What?
0:21:02 > 0:21:04Are you waving to everybody?
0:21:06 > 0:21:09INTERVIEWER: Do you think he knows where he is, Peter?
0:21:09 > 0:21:12I've not got a clue. I can ask him.
0:21:12 > 0:21:14Do you know where you are?
0:21:14 > 0:21:15No.
0:21:15 > 0:21:17- In St Mary's Hospital.- Yeah.
0:21:17 > 0:21:20- Do you know where you're going to after?- Where?
0:21:20 > 0:21:22Do you know where you're going to go to after?
0:21:22 > 0:21:24No.
0:21:24 > 0:21:25A nursing home.
0:21:25 > 0:21:26- STANLEY GROANS - My back!
0:21:28 > 0:21:30Ohh!
0:21:30 > 0:21:32- Thank you.- It's cool, cool, cool.
0:21:32 > 0:21:34Do you know where you are?
0:21:34 > 0:21:35Me? I'm with you.
0:21:35 > 0:21:38- Where? - St Mary's Hospital, Paddington.
0:21:38 > 0:21:41Dementia is not an illness, per se,
0:21:41 > 0:21:43it's a series of different illnesses.
0:21:43 > 0:21:47Like Alzheimer's, people tend to notice things like the memory loss,
0:21:47 > 0:21:49but dementia is more than just memory,
0:21:49 > 0:21:52it's also how you think, how you behave.
0:21:52 > 0:21:55It can completely change someone's personality,
0:21:55 > 0:21:57massively affect how they function.
0:21:57 > 0:22:00Dementia is one of the worst things that can happen to you
0:22:00 > 0:22:02or someone you care about.
0:22:02 > 0:22:06He had about ten weeks in and out of this place,
0:22:06 > 0:22:10because he keeps walking around the area - occasionally semi-clad,
0:22:10 > 0:22:12shall we call it - on his electric scooter.
0:22:12 > 0:22:14He broke down on the Westway once.
0:22:14 > 0:22:17My brother Tony got a phone call to say, could he come and pick him up?
0:22:17 > 0:22:19When he got there, he realised he was actually
0:22:19 > 0:22:20in his electric wheelchair.
0:22:20 > 0:22:26There's a rather large traffic jam, so he's just... He gets confused.
0:22:26 > 0:22:28Three to six months ago, he would not have been like this at all.
0:22:28 > 0:22:31He'd be totally, totally different.
0:22:31 > 0:22:33Two years ago, he'd be like you and me, normal.
0:22:33 > 0:22:35I don't know what normal is these days.
0:22:35 > 0:22:38Because of the illness, he shouldn't be at home.
0:22:38 > 0:22:40They're going to find you a nice home.
0:22:40 > 0:22:43- Can't hear.- They're going to find you a nice nursing home.
0:22:46 > 0:22:50It'd be nice if you could find somewhere tomorrow.
0:22:50 > 0:22:53But sometimes he actually thinks that he's already in a home.
0:22:53 > 0:22:55The last time we came in here, he said,
0:22:55 > 0:22:57"I should have come in here a long while ago," not actually
0:22:57 > 0:23:01realising he's already three or four times in the last six weeks.
0:23:03 > 0:23:04I don't know where he's going to end up.
0:23:04 > 0:23:07They said there's a home for him eventually.
0:23:07 > 0:23:09It's just when they can find a place.
0:23:10 > 0:23:15Stanley is your patient. He's waiting nursing home placement,
0:23:15 > 0:23:19I noticed that. He had all his documentation sent down to the CCG.
0:23:19 > 0:23:22He was granted continuing care.
0:23:24 > 0:23:25Yeah.
0:23:26 > 0:23:29'Sometimes, patients that are challenging'
0:23:29 > 0:23:32take a while to be placed.
0:23:32 > 0:23:33Cos in the wrong place,
0:23:33 > 0:23:37they will be back in A&E with people not able to manage them.
0:23:41 > 0:23:43I think this is called acting natural.
0:23:45 > 0:23:48The stocks for nursing homes are low
0:23:48 > 0:23:51and the demands for people to go into them are high.
0:23:52 > 0:23:55They may not... You see, like Stanley,
0:23:55 > 0:23:58he has to be placed where they can meet his needs,
0:23:58 > 0:24:01where his risks can be managed and where his challenges can be
0:24:01 > 0:24:06managed, and also to protect him from harm and neglect.
0:24:06 > 0:24:09He needs somebody around all the time to help him
0:24:09 > 0:24:11and to provide some guidance and reassurance
0:24:11 > 0:24:14and to make sure he doesn't get upset and agitated and angry.
0:24:14 > 0:24:17Potentially, he's going to need a member of staff looking
0:24:17 > 0:24:21after him quite a lot of the time. That's really, really expensive.
0:24:37 > 0:24:38He's shattered, isn't he?
0:24:44 > 0:24:48Remembering what he was like before and now is just...
0:24:48 > 0:24:54It's heartbreaking. He's been like a dad to me, practically all my life.
0:24:54 > 0:24:56He taught me how to do many things.
0:24:56 > 0:24:58Taught me how to drive, that was one of the great things,
0:24:58 > 0:25:00learning how to drive.
0:25:00 > 0:25:02- Learning how to play cricket. - Play cricket.
0:25:05 > 0:25:07- He's always been there. - Yeah, he's always been there.
0:25:07 > 0:25:09It's quite sad seeing him in this condition.
0:25:09 > 0:25:13INTERVIEWER: When he was a younger man, what was Carl like?
0:25:13 > 0:25:17He loved his cricket. He always played cricket. He's a bus driver.
0:25:17 > 0:25:20Even up to today, he talks about the buses.
0:25:20 > 0:25:23- Those are his two main passions. - Which route was it?- 182.
0:25:23 > 0:25:26That's his bus. 182 to Harrow and Wealdstone.
0:25:28 > 0:25:29So what's happening now?
0:25:29 > 0:25:32It's going to be day by day, see how he gets on day by day.
0:25:32 > 0:25:34Then we have to decide what we're going to do,
0:25:34 > 0:25:35if he's going to come home.
0:25:35 > 0:25:38My mum is the main carer. She's on respite.
0:25:38 > 0:25:40She wanted to come back home straightaway,
0:25:40 > 0:25:44but I tried to persuade her that it's in hand, we're dealing with it.
0:25:44 > 0:25:47She's very upset. She'll be back soon.
0:25:47 > 0:25:49Yeah, it's very sad.
0:25:51 > 0:25:52I don't think she's come to terms
0:25:52 > 0:25:54with what's happened to Carl, actually.
0:25:54 > 0:25:57I think sometimes, she maybe tries to block it out.
0:25:57 > 0:26:01Do you think she can continue to look after him?
0:26:01 > 0:26:04To be quite honest, I don't think she can.
0:26:04 > 0:26:08I think she'd like to believe she can, but I don't think she can.
0:26:08 > 0:26:11Once he sleeps and revives, they'll just see how he gets on.
0:26:13 > 0:26:15'She's not the same person as what she was.
0:26:15 > 0:26:18'That's one of the reasons why she had to go on respite.
0:26:18 > 0:26:19'She was drained.'
0:26:21 > 0:26:22Do you have a tough decision to make?
0:26:22 > 0:26:25I don't really want to make any decision, cos that'll be
0:26:25 > 0:26:29in the hands of my mother when she comes back on Saturday.
0:26:29 > 0:26:31I don't want to make wrong decisions,
0:26:31 > 0:26:35so I'd rather just wait for my mum to decide what she wants to do.
0:26:36 > 0:26:37OK, thank you.
0:26:38 > 0:26:40Thank you. Thank you. Bye.
0:26:54 > 0:26:57So, he was working four years ago, working as a bus driver.
0:26:57 > 0:26:58They said it's been more like a year,
0:26:58 > 0:27:00but the last two months have been worse.
0:27:19 > 0:27:21Carl, come and wait here, please.
0:27:24 > 0:27:26INAUDIBLE
0:27:30 > 0:27:31There is no way out.
0:27:36 > 0:27:37Don't open the door.
0:27:50 > 0:27:52Why do you hit me?
0:27:56 > 0:27:57I won't, don't worry. I'll be fine.
0:27:59 > 0:28:02Can I get backup? Backup, please. Backup, please.
0:28:03 > 0:28:05OK.
0:28:21 > 0:28:22It may look heavy-handed,
0:28:22 > 0:28:24but patients like Carl are very unpredictable.
0:28:24 > 0:28:29The security is there, really, for his own protection.
0:28:29 > 0:28:32Carl, look at me. It's all right.
0:28:32 > 0:28:33- Carl.- Be careful.- Don't worry.
0:28:42 > 0:28:45Yeah.
0:28:45 > 0:28:46We need to find an assigned room.
0:28:58 > 0:28:59INTERVIEWER: Did he hit you?
0:28:59 > 0:29:01Yeah, he hit me.
0:29:01 > 0:29:02Are you all right?
0:29:02 > 0:29:04I'm OK. I'm OK.
0:29:04 > 0:29:06Is this one of the risks of your job?
0:29:06 > 0:29:10That's it. You must expect this.
0:29:10 > 0:29:14You have to expect all that aggression, so...
0:29:14 > 0:29:16You have to.
0:29:16 > 0:29:18You can't blame him at all.
0:29:20 > 0:29:25So, now they've put the care on two to one.
0:29:25 > 0:29:29It's going to be two to one now, not just one person.
0:29:30 > 0:29:31It's very difficult,
0:29:31 > 0:29:34he just tried to kick the consultant in the face twice.
0:29:34 > 0:29:36Yeah, yeah, yeah.
0:29:36 > 0:29:39I mean, we're giving him more antibiotics now.
0:29:39 > 0:29:42His inflammatory markers are non-exciting,
0:29:42 > 0:29:47so there's no systemic illness going on, so, you know,
0:29:47 > 0:29:52were it not for his deterioration, you know, we'd be discharging him.
0:29:52 > 0:29:55There is nothing being done here that couldn't be done anywhere else.
0:29:55 > 0:29:59Is there anywhere more appropriate on a different, you know,
0:29:59 > 0:30:01within the mental health set-up?
0:30:01 > 0:30:06Cos he's going to end up harming himself or someone else, you know.
0:30:08 > 0:30:12He's medically fit, isn't he? There's no need to be in hospital.
0:30:12 > 0:30:18We're making a guess, really, that he's got a unitary tract infection.
0:30:18 > 0:30:21But the evidence for that is poor.
0:30:21 > 0:30:24But, right now, he's someone who could come to harm
0:30:24 > 0:30:27if he's not around people who can care for him.
0:30:27 > 0:30:31His main carer is taking some respite care.
0:30:31 > 0:30:35Quite clear that he needs to stay somewhere where he's safe,
0:30:35 > 0:30:38and that place right now is a quieter a bit of the hospital.
0:30:38 > 0:30:41So, we're not in a situation where we can send him home straightaway.
0:30:43 > 0:30:45OK. Well, all the best.
0:30:45 > 0:30:47- OVER PHONE:- Thank you, bye-bye.- Bye.
0:30:51 > 0:30:54Carl's wife, Patricia, has returned from a respite break
0:30:54 > 0:30:56visiting relatives in the Caribbean.
0:30:56 > 0:30:58- Do you know where you are?- Yeah.
0:30:58 > 0:31:00Yes or no?
0:31:00 > 0:31:02Where is there?
0:31:02 > 0:31:03St Mary's Hospital.
0:31:03 > 0:31:05- VOICEOVER:- When I got the call,
0:31:05 > 0:31:09everything just drained from my body. I started to cry.
0:31:09 > 0:31:13I said to Sandra, "I'm going to try to get a flight to come back home."
0:31:13 > 0:31:16She said, "Don't come, Mum," there's nothing I can do.
0:31:16 > 0:31:18I felt so bad, you know?
0:31:21 > 0:31:23You're... Hi.
0:31:23 > 0:31:26- Hello. Hi.- Kiss me.
0:31:26 > 0:31:27Mmm! The other one.
0:31:29 > 0:31:31Do you remember who I am?
0:31:31 > 0:31:33Who? Tell... Hm?
0:31:33 > 0:31:36No, I'm not Peter. I'm your wife.
0:31:36 > 0:31:37I'm your wife.
0:31:38 > 0:31:40Did you forget me?
0:31:40 > 0:31:41Pat?
0:31:43 > 0:31:44You remember me now?
0:31:44 > 0:31:46You remember me?
0:31:46 > 0:31:51Before I took the two weeks, I was at the edge.
0:31:51 > 0:31:53I was at the edge of me breaking down.
0:31:53 > 0:31:55Been a good boy last night?
0:31:55 > 0:31:56No fighting?
0:31:59 > 0:32:01I know you don't fight, I know. So that's what...
0:32:03 > 0:32:06I did need a holiday because I can hardly cope.
0:32:08 > 0:32:10Because his features changes.
0:32:10 > 0:32:13In what way?
0:32:13 > 0:32:15In a way like...
0:32:15 > 0:32:16aggressive way.
0:32:16 > 0:32:18In an aggressive way.
0:32:18 > 0:32:20I can see when his features changes.
0:32:20 > 0:32:23I have to tell him, "Let's go for a walk,"
0:32:23 > 0:32:25because I get scared at home.
0:32:25 > 0:32:28All right... You miss me? Kiss me.
0:32:30 > 0:32:33- How many years have you been married?- 25.
0:32:36 > 0:32:37Yes.
0:32:40 > 0:32:41Good boy.
0:32:43 > 0:32:46Do you think you can take Carl home?
0:32:47 > 0:32:51Carl is still mobile. He's strong.
0:32:51 > 0:32:54It is hard for me to put him in a residential home.
0:32:55 > 0:32:58And at home, I cannot cope.
0:32:58 > 0:33:01I don't know what's going to happen.
0:33:01 > 0:33:04THEY LAUGH
0:33:04 > 0:33:09I'll see you, yeah? We have to go now. Don't get upset.
0:33:09 > 0:33:13They're looking after you and they care for you. Carl, please!
0:33:13 > 0:33:15You stay inside. You're making me feel sad.
0:33:15 > 0:33:18- You have to stay... You have to stay here.- Who?
0:33:18 > 0:33:20You. You cannot come out now.
0:33:20 > 0:33:23- Just relax, watch some cricket, we'll come back.- Yeah.
0:33:23 > 0:33:27Watch some cricket. Cricket... You know cricket? West Indies?
0:33:27 > 0:33:30- The West Indies.- Yeah. - Yeah. Watch them.
0:33:30 > 0:33:32Watch them do bad again.
0:33:41 > 0:33:43SHE SNIFFS
0:33:48 > 0:33:52I don't know. I don't know what's going to happen.
0:33:53 > 0:33:58Because he's talking about places he wants to go. I don't know...
0:34:15 > 0:34:19Carl's case is passed to the complex discharge team,
0:34:19 > 0:34:22who will assess his needs to see if he's able to return home.
0:34:28 > 0:34:30Have you left my side up?
0:34:30 > 0:34:32Yes, I'll do that. No problem.
0:34:34 > 0:34:37Stanley has now been in hospital for 21 days.
0:34:37 > 0:34:41His family are waiting for the results of a care home assessment.
0:34:41 > 0:34:45All patients going into nursing homes have an assessment,
0:34:45 > 0:34:46especially with complex needs.
0:34:46 > 0:34:48What do you think they're going to say?
0:34:48 > 0:34:52It would depend on the clients they have already got on board
0:34:52 > 0:34:57in their nursing home, and would Stanley fit into their home?
0:34:57 > 0:35:02Stanley's care home will cost £1,700 a week, plus,
0:35:02 > 0:35:04because of his complex needs,
0:35:04 > 0:35:07an additional 2,300 for one-to-one care.
0:35:07 > 0:35:11It will be funded by the NHS continuing health care scheme.
0:35:11 > 0:35:12Peter!
0:35:12 > 0:35:14You all right?
0:35:14 > 0:35:16STANLEY STUTTERS
0:35:16 > 0:35:18Elizabeth!
0:35:20 > 0:35:21You all right?
0:35:21 > 0:35:23What a surprise!
0:35:24 > 0:35:26I've got something for you, Dad.
0:35:26 > 0:35:27Oh, what is that, eh?
0:35:28 > 0:35:30I think that goes there.
0:35:31 > 0:35:35We went... We went to view the home.
0:35:35 > 0:35:37- What home?- For you.
0:35:37 > 0:35:39A different place for you to go in, with your own room.
0:35:41 > 0:35:43It was nice.
0:35:43 > 0:35:45Your own room.
0:35:46 > 0:35:48Meet some nice new people.
0:35:51 > 0:35:53Hello, is that the...home?
0:35:53 > 0:35:56We came this morning regarding my father, Stanley.
0:35:58 > 0:36:00She said there'd been an assessment done,
0:36:00 > 0:36:02and she said she can't say anything to us until they hear back
0:36:02 > 0:36:06from your person who came and assessed him this morning.
0:36:10 > 0:36:11Would you like to get there?
0:36:11 > 0:36:13Yeah.
0:36:13 > 0:36:15It would... It wouldn't cost a lot?
0:36:15 > 0:36:18No, it doesn't cost us anything.
0:36:18 > 0:36:22I was just wondering if I can sort of pre-empt things a little bit
0:36:22 > 0:36:24and wondered if there'd been a decision made.
0:36:24 > 0:36:26It's just, we're sitting with my father and, obviously,
0:36:26 > 0:36:29it would be good if we could give him some good news.
0:36:29 > 0:36:31Thank you. Oh!
0:36:37 > 0:36:38OK, then. Thank you very much.
0:36:40 > 0:36:41She said...
0:36:41 > 0:36:44It's all looking fine. As far as they're concerned, it's a yes,
0:36:44 > 0:36:45but because he needs extra funding,
0:36:45 > 0:36:49because he needs more one-to-one care than they are willing to
0:36:49 > 0:36:53give him with the resources they've got, it has to be funded by the NHS.
0:36:53 > 0:36:55And you won't know that until Monday.
0:36:55 > 0:36:58You just have a man in the middle who has to say yes about funding.
0:36:58 > 0:37:01Even though the funding's been agreed, but not for the additional care.
0:37:01 > 0:37:04- OK, so the fact is we still don't know.- No.
0:37:04 > 0:37:09Everybody was full of, sort of, hope this morning.
0:37:09 > 0:37:12You know, there's been a lot, a lot of stress over this.
0:37:12 > 0:37:15People travelling from hundreds and hundreds of miles regularly
0:37:15 > 0:37:19to come down and try and sort it and help it out and we're still here.
0:37:19 > 0:37:21We still don't know.
0:37:21 > 0:37:23And, erm...what if they say no?
0:37:23 > 0:37:27Then we've got to find another place and start again next week.
0:37:29 > 0:37:32And then, will we still have the same issues?
0:37:36 > 0:37:38- Do you remember this?- Hm?
0:37:38 > 0:37:40- Your sideburn.- Mm-hm.
0:37:40 > 0:37:43See? Your sideburn.
0:37:43 > 0:37:45Very proud of it.
0:37:45 > 0:37:47Yeah, when you had your sideburn.
0:37:47 > 0:37:51- And this one, I think we went away for a weekend.- Yes.
0:37:51 > 0:37:53I can't remember if it's... Yeah.
0:37:53 > 0:37:57All right, let's start with Carl. So, he remains medically fit.
0:37:57 > 0:37:59I think he seems a little better today.
0:37:59 > 0:38:02We had a bit of a conversation about the cricket,
0:38:02 > 0:38:04which was sustained, which was nice.
0:38:04 > 0:38:08I haven't met his wife yet, but I think she's around this afternoon,
0:38:08 > 0:38:10so I'll have a chat with her after the meeting.
0:38:10 > 0:38:13In terms of discharge, the only thing we need is a package of care.
0:38:13 > 0:38:16Yeah, it's all just social services we're waiting on,
0:38:16 > 0:38:21and they want to make sure that there's something in place before he goes home.
0:38:21 > 0:38:23Well, I'll have a chat and we can talk about various things.
0:38:23 > 0:38:26- But, either way, should be getting out of here soon.- Yeah.- Good.
0:38:28 > 0:38:30- Oh, we had our good times together. - We used to...
0:38:30 > 0:38:33Yeah, we had our good times together.
0:38:37 > 0:38:42I know he would look after me. He would look after me the same way.
0:38:42 > 0:38:47And I'm prepared to look after him as well.
0:38:47 > 0:38:52But, in his condition, all I am asking for is a little support.
0:38:52 > 0:38:56You know? Just to ease the pressure off me. That's all.
0:39:00 > 0:39:02- Hello.- Hello.- Yes?
0:39:02 > 0:39:06- Dr Mitchell. Nice to meet you. - And you, yes.- How are you?
0:39:06 > 0:39:07I'm good, thank you.
0:39:07 > 0:39:12So I've heard that there's been obviously quite a lot of challenge,
0:39:12 > 0:39:17let's say, in terms of being able to cope and keep things going at home.
0:39:17 > 0:39:21- Sounds like you've done a pretty remarkable job, frankly.- Oh, I try!
0:39:21 > 0:39:24We need another carer being there either during the day or at some
0:39:24 > 0:39:28points during the week, so at least there's somebody around for a while so you can get out of the house.
0:39:28 > 0:39:30- Yeah.- Would that be of some use?
0:39:30 > 0:39:33Well, yes, if I can get out, you know...
0:39:33 > 0:39:36for even a day in the week.
0:39:36 > 0:39:40You know, I could say, "Well, today's... Wednesday's my day."
0:39:40 > 0:39:42- You know what I mean?- Yeah.
0:39:42 > 0:39:44I'll be honest with you - that's going to be difficult.
0:39:44 > 0:39:47You won't get somebody there for a whole day.
0:39:47 > 0:39:50Typically, what social services will do is they will get you a carer
0:39:50 > 0:39:52for half an hour in the morning, half an hour in the afternoon.
0:39:52 > 0:39:53Seven days a week.
0:39:53 > 0:39:56It's not going to be able to do everything that you've been doing,
0:39:56 > 0:39:59because what you've been doing, frankly, is incredible.
0:39:59 > 0:40:03It's potentially going to be an ongoing challenge, I'm afraid.
0:40:05 > 0:40:09If Patricia had known months ago that she could get some support,
0:40:09 > 0:40:11then maybe it wouldn't have got to the stage where she is
0:40:11 > 0:40:15so exhausted she can hardly imagine how she'll carry on.
0:40:15 > 0:40:18But I guess that's what people often do.
0:40:18 > 0:40:22They just sort of soldier on as long as they possibly can.
0:40:22 > 0:40:26Listen... If you want to come home, you have to behave yourself.
0:40:26 > 0:40:28Come here.
0:40:28 > 0:40:30Are we set up to help somebody in her shoes?
0:40:30 > 0:40:33No, these things are incredibly complicated.
0:40:33 > 0:40:36I've been doing this, as a consultant, for five years,
0:40:36 > 0:40:40and I still get baffled as to how some of these things get sorted out.
0:40:54 > 0:40:58Are you OK? Are you OK?
0:40:58 > 0:40:59Are you comfortable here?
0:40:59 > 0:41:01Yes, thank you.
0:41:06 > 0:41:07It's quite busy.
0:41:07 > 0:41:10We came in this morning, there had been patients
0:41:10 > 0:41:11in the apartment for over 12 hours.
0:41:11 > 0:41:13Mostly psychiatric.
0:41:13 > 0:41:17The problem with that is it takes up a quarter of the department.
0:41:17 > 0:41:20Keeping an eye on them, keeping them safe, making sure
0:41:20 > 0:41:22they don't abscond, making sure they're not too distressed,
0:41:22 > 0:41:26looking after all the other patients in the department at the same time.
0:41:28 > 0:41:32- RADIO:- Trauma team to adult A&E resus.
0:41:35 > 0:41:3856-year-old Stephen has been brought to St Mary's
0:41:38 > 0:41:42by London Ambulance Service after self-harming with a knife.
0:41:42 > 0:41:45He needs emergency surgery to repair his arm.
0:41:49 > 0:41:52This is the psychiatric nurse.
0:41:54 > 0:41:57She's basically explaining why he's done it.
0:41:57 > 0:41:59Da, da, da, da, da...
0:41:59 > 0:42:02He stated he deliberately did self-harm because his benefit,
0:42:02 > 0:42:04he said, has been stopped.
0:42:04 > 0:42:06According to him, he was unable to get support,
0:42:06 > 0:42:10to have his voice heard, and this is the trigger, if you like.
0:42:10 > 0:42:13How awful, if that's the only way you feel you can get attention.
0:42:13 > 0:42:14Yeah.
0:42:16 > 0:42:20Mental health patients are more likely to encounter trauma.
0:42:20 > 0:42:23Illness that affects your behaviour and impairs your judgment makes them
0:42:23 > 0:42:27more prone to accidents or, occasionally, self-harm.
0:42:27 > 0:42:30So it does represent a significant proportion of our workload.
0:42:32 > 0:42:37We're quite busy and we're quite stretched as it is, so in order to cover this,
0:42:37 > 0:42:43I've had to take a very senior doctor out of another list to cover.
0:42:43 > 0:42:45So we're stretched a bit thin.
0:42:46 > 0:42:50I'm hoping for him that this is a sort of lucky escape, as it were.
0:42:51 > 0:42:54We get involved insofar as we obviously stitch them up
0:42:54 > 0:42:56and repair whatever is damaged,
0:42:56 > 0:43:01but this is clearly a manifestation of something more significant
0:43:01 > 0:43:04in this poor gentleman's mind.
0:43:06 > 0:43:08You know, I think it's no secret that we're having
0:43:08 > 0:43:12a bit of a crisis with mental health at the moment in this country,
0:43:12 > 0:43:14with the provision of care.
0:43:14 > 0:43:18They won't present to hospital until things get really out of hand.
0:43:18 > 0:43:22If they're at home, if they're having a psychosis,
0:43:22 > 0:43:26if they've got lack of insight into what's going on with
0:43:26 > 0:43:29their own health and not really taking control of it as well.
0:43:29 > 0:43:34So that's why we need more support in the community, really,
0:43:34 > 0:43:38to make sure that they get the appropriate care when they need it.
0:43:57 > 0:43:59Who wants a banana?
0:43:59 > 0:44:04After 24 days at St Mary's, Stanley is being discharged to a care home.
0:44:04 > 0:44:08- I wish you all the best, my friend. - Thank you.- Yeah.
0:44:08 > 0:44:11And you know what they say - I don't want to see you again.
0:44:11 > 0:44:14Much as I love you, hope we don't have to see you again.
0:44:14 > 0:44:16- I hope you're all right. - All the best.
0:44:16 > 0:44:17I've been hoping that this would happen
0:44:17 > 0:44:20so someone else can have this bed...
0:44:20 > 0:44:24because my dad's care could probably be taken out, done better elsewhere
0:44:24 > 0:44:26and someone else can have this bed and I'm glad of that.
0:44:26 > 0:44:30Thank you for everything and all your staff and...
0:44:30 > 0:44:32Health visitors.
0:44:32 > 0:44:34And thank you very much.
0:44:34 > 0:44:36- You're a good girl. - It's been a pleasure.
0:44:36 > 0:44:38Right...
0:44:38 > 0:44:40In a way it's sad that it takes so long
0:44:40 > 0:44:44because we were adding up the amount of cost for somebody
0:44:44 > 0:44:47like my dad to come in and out of hospital about four times.
0:44:47 > 0:44:51Wouldn't it be great if we could cut that process down
0:44:51 > 0:44:54so people could be moved more quickly
0:44:54 > 0:44:57into a place rather than hospitals?
0:44:57 > 0:45:00But we do appreciate everything the hospital have done.
0:45:01 > 0:45:05Righto, here we go. Goodbye to every little one of you.
0:45:05 > 0:45:08- Goodbye, young man. Take care.- Bye!
0:45:09 > 0:45:10See ya!
0:45:25 > 0:45:26Super, Stanley, hello.
0:45:26 > 0:45:28- We're back again.- Super.
0:45:29 > 0:45:30Are you OK, darling?
0:45:30 > 0:45:33The wheelchair that he is sitting in, he fits in.
0:45:33 > 0:45:34The wheelchair they've got
0:45:34 > 0:45:36to take him in the ambulance, he doesn't fit in.
0:45:36 > 0:45:38This wheelchair is not allowed to leave the hospital,
0:45:38 > 0:45:42and if it does, they can't fetch it back cos they say they're going to another job afterwards.
0:45:42 > 0:45:45So now they might need to find another wheelchair or change the ambulance.
0:45:45 > 0:45:46HE MUMBLES
0:45:46 > 0:45:48They're waiting for a wheelchair for you.
0:45:51 > 0:45:53The problem is, he will get irritable
0:45:53 > 0:45:55if he thinks he's not going.
0:45:55 > 0:45:56Push!
0:45:58 > 0:46:00- Push!- Hiya, Stanley!- Push.
0:46:00 > 0:46:05One minute. We're going down, we're down to one minute now.
0:46:05 > 0:46:09Right, we're going. Everybody!
0:46:09 > 0:46:11One, two, three - go!
0:46:11 > 0:46:13Excuse me.
0:46:13 > 0:46:17- Push and push!- Just got to wait for your wheelchair.
0:46:17 > 0:46:20If you're not going, I'm going.
0:46:20 > 0:46:22- You're fucking about!- We're not.
0:46:22 > 0:46:25- You've just got to wait. - No, fuck off then!
0:46:25 > 0:46:26SIREN WAILS
0:46:26 > 0:46:29Get off! Get off!
0:46:33 > 0:46:37An hour and a half later, a second ambulance arrives.
0:46:37 > 0:46:40Let's hope we don't see him back in here again!
0:46:40 > 0:46:41SHE LAUGHS
0:46:41 > 0:46:45Bye-bye! Bye-bye, Alice. Bye-bye, everyone.
0:46:58 > 0:46:59- I think... - Let's get her off the scoop.
0:46:59 > 0:47:01We can take her down and that will release you.
0:47:03 > 0:47:05- Mags, love?- Yeah?
0:47:05 > 0:47:08Uh-oh! What are you doing?
0:47:08 > 0:47:09- Huh?- What are you doing?
0:47:09 > 0:47:11MAN MUMBLES
0:47:11 > 0:47:13- No, no, no.- Oh.
0:47:13 > 0:47:15I need you to sit down.
0:47:15 > 0:47:18Cos otherwise you're going to trip up and fall over.
0:47:18 > 0:47:21Do you need the...? Do you need the toilet? OK.
0:47:21 > 0:47:23Step off the blanket.
0:47:23 > 0:47:25OK, well done, we're on the run.
0:47:25 > 0:47:27This morning we had a huge amount of psych patients.
0:47:27 > 0:47:30Patients that have been particularly difficult...
0:47:30 > 0:47:34We've got a patient in with quite advanced dementia who's needing a lot of attention.
0:47:34 > 0:47:35- INTERVIEWER: - What's he done this morning?
0:47:36 > 0:47:40He's covered my department in poo... multiple times.
0:47:40 > 0:47:42And so I now keep moving him
0:47:42 > 0:47:45and the poor domestic, he's following me around!
0:47:45 > 0:47:48So... But we're getting there.
0:47:53 > 0:47:55ALL CHAT
0:48:05 > 0:48:08How are you feeling? Are you OK?
0:48:08 > 0:48:11So, all was fine for the operation.
0:48:11 > 0:48:14Your cuts, we've stitched them up, so that's all OK.
0:48:14 > 0:48:19Um... Most of the structures were all fine. How are you feeling?
0:48:19 > 0:48:24- You feel good? Any pain in the hand at all, in the arm?- No.
0:48:32 > 0:48:33- Hello, hi.- Hi.
0:48:33 > 0:48:36I'm Dr Matras, I'm a psychiatrist.
0:48:36 > 0:48:40My understanding is that you've been feeling increasingly stressed out
0:48:40 > 0:48:42because of the problems with the benefits
0:48:42 > 0:48:46to the point that you decided to cut yourself
0:48:46 > 0:48:49because you didn't want to live any more with these problems.
0:48:51 > 0:48:53A year ago,
0:48:53 > 0:48:56Stephen lost his voice due to complications from throat cancer.
0:48:58 > 0:49:00You are the shadow of the man you used to be
0:49:00 > 0:49:04and is it because of your medical condition? OK.
0:49:04 > 0:49:07And did they tell you about your prognosis as well,
0:49:07 > 0:49:09what's going to happen in the future with your throat?
0:49:09 > 0:49:11What did they tell you?
0:49:11 > 0:49:13HE MOUTHS
0:49:13 > 0:49:15That it's going to spread?
0:49:15 > 0:49:18Now, when was the last time that you saw a psychiatrist?
0:49:21 > 0:49:23Six years ago.
0:49:23 > 0:49:27What did you see them about, about depression or about something else?
0:49:27 > 0:49:29Anger. Anger issues, OK.
0:49:29 > 0:49:33Did you have any trouble in the past, any trouble with the police?
0:49:36 > 0:49:40OK, did you end up in prison at any point? A long time?
0:49:40 > 0:49:41How long did you stay in prison?
0:49:47 > 0:49:4920 years?
0:49:49 > 0:49:5110 years? OK.
0:49:51 > 0:49:54There's a question of whether you would need to have someone with you
0:49:54 > 0:49:56all the time in the hospital.
0:49:56 > 0:49:59Because you harmed yourself, in here, they are worried that you may
0:49:59 > 0:50:02cut yourself or do something to yourself in the hospital.
0:50:02 > 0:50:04No? What would stop you from doing it?
0:50:06 > 0:50:08That's enough, that's it? OK.
0:50:08 > 0:50:11How do you feel about being alive now?
0:50:12 > 0:50:15Do you feel a relief or do you feel disappointed?
0:50:19 > 0:50:22You are hopeful? OK.
0:50:25 > 0:50:26Thank you very much.
0:50:36 > 0:50:40- INTERVIEWER:- So you cut your wrist to get some attention?
0:50:40 > 0:50:45"Cos they were going to evict me from my flat -
0:50:45 > 0:50:47"what was not my fault."
0:50:47 > 0:50:49And is that what's been upsetting you?
0:50:51 > 0:50:54HE MOUTHS
0:50:58 > 0:51:02You'd rather be dead than lose your flat?
0:51:03 > 0:51:07Why... Why did you think this was the best way to make a point?
0:51:12 > 0:51:15"Cos they don't listen to reason."
0:51:16 > 0:51:19What's quite clear, had he not had the financial problems,
0:51:19 > 0:51:21we wouldn't have met today.
0:51:21 > 0:51:25Housing problems with benefits are a recurrent theme
0:51:25 > 0:51:29and quite often the major source of stress
0:51:29 > 0:51:32that leads to patients presenting in crisis.
0:51:32 > 0:51:35And quite often, yes, we have to pick up the pieces.
0:51:37 > 0:51:39Hello!
0:51:39 > 0:51:41Hello, hello!
0:51:41 > 0:51:42Hello, hello!
0:51:47 > 0:51:48Good boy!
0:51:55 > 0:51:58Hello, I'm Alice. How are you?
0:51:58 > 0:52:00I'm good, thank you.
0:52:00 > 0:52:02Hello.
0:52:02 > 0:52:04And how are you?
0:52:06 > 0:52:07How are you coping?
0:52:08 > 0:52:11Very hard, I couldn't... I can't cope.
0:52:11 > 0:52:14How long have you been looking after your husband with this condition?
0:52:14 > 0:52:17- From December 2015.- So...
0:52:17 > 0:52:19- The whole of 2016...- Yes, yes.
0:52:19 > 0:52:23And when I... I was going down... I was breaking down...
0:52:23 > 0:52:24- Right.- ..when I called my GP.
0:52:24 > 0:52:26I said I cannot do any more,
0:52:26 > 0:52:30- I feel I'm going downhill and I've got health issues as well. - Yes. Yes, yes.
0:52:30 > 0:52:32- You know?- So you felt burnt out?
0:52:32 > 0:52:36- Oh, Alice, to be honest, I was on the breaking point.- Right.
0:52:36 > 0:52:39I want to look after my husband the best I can
0:52:39 > 0:52:41and I always promised to look after him.
0:52:42 > 0:52:45But there's a limit or else I'll go down before him.
0:52:45 > 0:52:49- So I just feel I'm going down, I'm going downhill.- Of course.
0:52:49 > 0:52:51- SOBBING:- It's too much for me!
0:52:51 > 0:52:56Yes, but you just remember that we try to look after the carers.
0:52:56 > 0:52:58- I want to look after him!- Of course.
0:53:00 > 0:53:05But we do understand the stress and strain that you are under too.
0:53:05 > 0:53:08I look after him for one year, all they gave me -
0:53:08 > 0:53:14which I think is unfair - a pile of papers to read and they left me...
0:53:14 > 0:53:17- That's all they left me. I didn't know where to turn.- Yes.
0:53:17 > 0:53:19I didn't know where to go.
0:53:19 > 0:53:22So you feel that you've been in the wilderness with no support?
0:53:22 > 0:53:24- In the wilderness. No support at all.- Right.
0:53:24 > 0:53:30Well, I will try my very best to get a meeting together with
0:53:30 > 0:53:34- a social worker at the hospital here, all right?- Yeah, that's fine.
0:53:34 > 0:53:36- All right, and lovely to meet you. - Thank you, Alice.
0:53:36 > 0:53:40- Thanks for your help.- Take care. That's OK. Thank you.- OK, thanks.
0:53:40 > 0:53:42And are you all right, Carl? You've had a nice wash?
0:53:42 > 0:53:44ALICE LAUGHS
0:53:44 > 0:53:47- All right, Tricia.- Yeah, thank you, Alice.- All right.
0:53:47 > 0:53:49- Nice to meet you.- Goodbye.
0:53:50 > 0:53:54- Have you been to the toilet then? - Yeah.- Number two?
0:53:54 > 0:53:55You had a number two?
0:54:10 > 0:54:11You look nice in that, Carl.
0:54:12 > 0:54:15Carl has been in St Mary's for 11 days.
0:54:15 > 0:54:17Today, he's going home.
0:54:19 > 0:54:20Let's go.
0:54:20 > 0:54:24Social Services have agreed to fund a carer for two hours a day,
0:54:24 > 0:54:28seven days a week, to help Patricia look after Carl.
0:54:28 > 0:54:31- INTERVIEWER:- Patricia, how are you feeling this evening?
0:54:31 > 0:54:35A bit anxious, you know? Excited.
0:54:37 > 0:54:43But my concern is at night, when I'll be with him alone.
0:54:43 > 0:54:45I don't know, I might not sleep tonight.
0:54:48 > 0:54:52I'll just have to wait and see his reaction and how he behaves.
0:54:52 > 0:54:56If he wants to get out, I cannot stop him.
0:54:56 > 0:54:58Carl, stay still, please.
0:54:58 > 0:54:59You need to stay...
0:55:01 > 0:55:03You need to stay still, Carl. Please.
0:55:03 > 0:55:07Where are you going? You need to stay still, please!
0:55:07 > 0:55:10- No, no, no, don't push me, Carl. Please, please.- Wait and stay here.
0:55:10 > 0:55:11Please, don't push my shoulder.
0:55:12 > 0:55:13INAUDIBLE
0:55:13 > 0:55:15- Yeah? Yeah? - THEY CHAT
0:55:15 > 0:55:18You're welcome, sir. On you go.
0:55:18 > 0:55:20- PATRICIA:- Probably when he gets home, you know,
0:55:20 > 0:55:23he might be a bit back to himself.
0:55:23 > 0:55:24- INTERVIEWER:- You're hopeful?
0:55:24 > 0:55:27Yeah, yeah, yeah. That's all I can do, live in hope.
0:55:28 > 0:55:29Bye!
0:55:32 > 0:55:36Things are looking up. I know where to go now for help.
0:55:43 > 0:55:46- Aw, you OK?- Hello, darling. Hello, welcome home, welcome home.
0:55:46 > 0:55:48- You all right?- You're home again. - You're home again.
0:55:48 > 0:55:52- You're home again. Yeah? - You all right?- Yeah.- How are you?
0:55:52 > 0:55:55- It's this way, is it? - LAUGHTER
0:55:58 > 0:56:01- All right? - I'm all right, I'm all right.
0:56:01 > 0:56:03Happy to see me, huh?
0:56:03 > 0:56:06- INTERVIEWER:- Are you happy? - Of... Of course.
0:56:36 > 0:56:40Carl's in a mental health unit. I visit him every day.
0:56:42 > 0:56:45I wish a miracle could happen and get back to normal.
0:56:47 > 0:56:52You know? And that's all I can do, is to pray... Pray for him.
0:56:56 > 0:56:59I need some atropine, please. Quick, quick, quick!
0:56:59 > 0:57:00At Hammersmith Hospital,
0:57:00 > 0:57:04the heart attack centre is treating more people than ever before.
0:57:04 > 0:57:06We've just had an emergency call.
0:57:06 > 0:57:08We just need to get the other patient done.
0:57:08 > 0:57:10We're getting busier and busier
0:57:10 > 0:57:12and the staff are extremely stretched,
0:57:12 > 0:57:14but we have to keep going.
0:57:14 > 0:57:18There's an ongoing drive to make cost savings across the trust.
0:57:18 > 0:57:23So, last year our challenge was £2.3 million... This year, £3 million.
0:57:23 > 0:57:26It gets to a point where actually there is no more meat on the bone.
0:57:27 > 0:57:30And two young patients test the skills
0:57:30 > 0:57:32of Imperial's specialist teams.
0:57:32 > 0:57:35It's not fair, but it's happening, so get on with it.
0:57:35 > 0:57:37There's the tumour there, look.
0:57:38 > 0:57:42Well, he's going to come through it. He's still got a lot to do in life.
0:57:42 > 0:57:45It's one of the most challenging things we treat.
0:57:45 > 0:57:49If you don't get the timing of surgery right, the patient will die.
0:57:52 > 0:57:53What choices would YOU make
0:57:53 > 0:57:56when faced with complex health care decisions?
0:57:56 > 0:58:01Visit our interactive pages to find out how you would respond. Go to...
0:58:04 > 0:58:06..and follow the links to the Open University.