Episode 4 Keeping Britain Alive: The NHS in a Day

This programme contains scenes which some viewers may find upsetting.

18th of October, 2012.

Across Britain, 100 cameras are filming the NHS on a single day.

This change will be a disaster. CHEERING

On this day, more than 1.5 million of us will be treated.

Three days ago, you had a stroke.

1,500 of us will die.

2,000 will be born.

The NHS is the largest public healthcare system in the world.

We want that to be in your voice all the time.

-We're going to help you.

-We rely on it,

-complain about it.

-In the bin. That's because of you.

Often we take it for granted.

-Lucas!

-What we expect from the NHS is ever-increasing.

The money to pay for it isn't.

If we could see what this institution does in a single day,

what would it make us think?

This entire series tells the story of one day.

-So why isn't she waking up?

-100 cameras

capturing the NHS as you've never seen it before.

Baby born at five to three.

JAMES NAUGHTIE: 'Six o'clock on Thursday, 18th...

'Plans by the government to...'

'I have a whole world of possibilities ahead of me.

'I feel anxious, but happy to be in the hands of such a good surgeon today.

'It's one enormous step on the way'

to where I'm going, so...it's going to be... momentous, really!

I can't wait to see the outcome, actually.

Um, yeah. It's going to be quite something.

My age is 62.

Morning, Boots.

Hungry, girl? Here you are.

No? All right. Maybe later.

My daughter tells me off terribly for doing this. She says, "How can you put purple eyeliner on?!

"It's atrocious." It's not the done thing at age 14.

She knows a lot about makeup. I say, "I know nothing about makeup."

When I first became a consultant, I had a makeover. An image consultant.

We spent a lot of time doing supervised shopping and learning what to buy

and how to do one's war paint. And she just taught me ONE method of doing it,

which is probably completely wrong now because I've done it this way without supervision for too long.

Tania is a plastic surgeon.

She splits her time between working for the Army and the NHS.

So just to remind me...

My plan for today is to open up your previous scar.

You've got the two bones inside the leg, the big bone and little bone.

We're going to shorten back the little bones on both sides. They're causing the trouble.

But leave the main bone the same length. That needs filing down.

I can't be any shorter because my daughter's getting too tall!

I've got this with one of my soldiers who used to be nearly 7 foot and had to lose two inches

because the prosthetist couldn't make him balance at that height. He had to accept a shortening.

Tania's first patient of the day is Claire, who lost her legs to bacterial meningitis aged 17.

The bones in her stumps have continued to grow, making it too painful to walk on false legs.

Tania will be operating on her so that she can walk again.

Claire has two below the knee amputations and has to have a different set of legs

depending on what she's wearing. She has a pair for flat shoes

and a pair of legs for high heel shoes.

The ankle position is different. If she wants to wear heels, she has to wear a different set of legs.

Tell me about your heart. Can you tell me about your heart?

Katie was involved in a road traffic collision yesterday evening.

She was a passenger in the front seat, wearing a seatbelt.

Last night, very shortly after she arrived,

she went to theatre because she had lost a lot of blood from a ruptured liver and ruptured spleen.

Our enduring hope is that her spinal cord has not yet been damaged,

which potentially could result in paralysis.

Her mum was driving and I'm sure very innocently,

but her daughter has these distressing and potentially life-changing injuries.

I've been doing this for donkeys' years and have children her age

and I still have no idea what she feels like.

As well as her mum, Katie's twin brother was also in the car when they collided with a van.

Katie was the only one seriously injured.

Doctors put her in a medically-induced coma to keep her safe

while they investigate the damage to her spinal cord.

You all right?

'This is the last ward you want to be in. Nobody wants their family in here. Why would they?'

They only get through the doors if they have a life-threatening problem.

One thing we tend to say at the very beginning when parents arrive is that we will be brutally honest.

We will also, quite shamelessly, worry people needlessly

because things can change suddenly, but if you expect something is going to get bad,

you're not doing anybody any favours by not telling them.

Right, we're scanning her head, aren't we?

Including neck. The whole spine.

If the MRI scan reveals that Katie's spinal cord is damaged, she might never walk again.

Is everyone ready? On roll. Ready, steady...roll.

Ready, steady, roll.

We're going to go on slide. Is everyone ready? Ready, steady, slide.

Stop.

-Can we tape her eyes?

-Yeah.

OK. zero. >

-Just try the temperature of this on your head.

-OK, that's good.

-Is that all right?

-Yeah.

-Is that a nice feeling, Steven?

-Having my hair washed? Oh, yeah.

It's lovely. That's two advantages of being a tetraplegic.

I never have to wash my hair again and I'll never have to shave again.

Scratch the top of my head as well, please.

Yeah, there. Oh, yeah.

That must be the worst thing, having an itch and not being able to do anything about it.

9 months ago, Steven fell down the stairs and damaged his spinal cord. He's been in hospital ever since.

He's paralysed from the neck down and fed through a tube in his stomach.

I can swallow,

but there's something deflecting what I swallow into my lungs.

-Have you given up eating olives, then?

-I've given up olives, yeah.

We call it Olivegate.

My mother was eating olives with garlic in them and I begged her for an olive.

So she reluctantly gave me one and I ate it.

It came up one day when they were doing some physio. He coughed it up and they kept it in a little tube.

The smell just comes wafting over you and you're not in a good space.

You think if you eat an olive it will change the way you feel for a couple of seconds.

It's just that.

Take a deep breath. One, two, three.

OK, ready?

-Time for a fag soon!

-I'll pretend I didn't hear that!

Ready? One, two, three.

In a month, Steven will leave the spinal injuries unit and move to a new home

with the 24-hour care he'll need for the rest of his life.

-Now go to Skype.

-Yeah, yeah.

-OK.

-OK.

-Got it?

-Yeah.

-Double click that.

Hello, baby! How are you?

-I can't see you. Can you see me?

-Yeah, I can see you.

How's Johnny been? Johnny's the rabbit.

-He's been good?

-Yeah.

-We're going out of the hospital today.

Caroline's going to pick you up, and we'll do a bit of shopping. I'll see you about 11.30, 12 o'clock.

OK? Is that a little heart you put for me, was it?

-Yeah.

-It's beating as well.

Is it beating? I love you to pieces, baby.

-Bye-bye, darling.

-Close it?

-Yeah.

WHISTLES CALMLY

Sally is one of more than 3,000 people in Britain who are in the process of changing their gender.

The NHS spends around £2 million a year on gender reassignment surgery,

but before an operation, patients must live as their preferred sex for two years, undergo assessment

-and have hormone treatment.

-I'm Iffy. Pleased to meet you.

-I've heard all about you.

Have you? It's all lies.

-What are you currently taking?

-Oestradiol valerate, Progynova.

-Yeah.

-And Decapeptyl.

-OK.

-Once every three months.

-OK.

And I don't take medicines. I'm from the pharmaceutical industry!

-OK.

-I avoid them if I can possibly...!

OK, on a scale of 1-10,

1 being terrible, 10 fantastic, where are your energy levels at the moment?

-I would say probably 3-4.

-OK.

And your sex drive, what's that like on a good day and a bad day?

-I was going to say zero!

-You can say zero if you like.

-Between zero and 2.

-OK.

-Horrible question, but do you see any erections any more?

-No.

-OK.

Now, from a surgical point of view, referral through, hopefully,

-for the labiaplasty. Is that correct? For the cosmetic...

-That's right.

-Lovely.

-So the next thing I'm going to do is put you on the weigh-in scales. OK?

-Yes.

-OK.

-My blood pressure's fine.

-I will be doing that as well.

-Good.

Yes, I will.

Hello.

I'm all right. How are you?

I'm going to start at the beginning.

Current medicines?

'On my very first appointment here, something very funny happened.'

There were a couple of trans women and a lady said, "Is this your first time here?"

I was like, "Yes." I thought maybe I seem really nervous.

She said, "I feel you could have made a bit more effort with your appearance."

Was I dressed too casually or something like that?

But then she added, "It's good to start looking more feminine at some point when you go outside."

I realised that she thought I was born male and was trying to transition to be female.

I politely pointed out that actually I was female transitioning to be male!

I think I hide it well, but I have double D breasts.

-How's your general health?

-I'm just getting used to my face changing.

I saw some photographs of myself a year ago, before the testosterone.

I suddenly looked at a picture now and I was like, "Wow!"

And now I'm getting body hair everywhere. I'm getting it on the face, my belly at the bottom.

That's good news that you're getting it where you should be getting it.

-It's nice to see it here, isn't it?

-I like my little wolf patch that I sort of get here.

Good morning, Sally. My name is Helena. Nice to meet you.

I'll be helping your anaesthetist.

-Can you just confirm your name and date of birth?

-Sally Rivers.

BIRTH DATE BLEEPED OUT

And you are coming for cricothyroid approximation and thyroid chondroplasty?

-You understand the operation?

-I do.

-Have you signed the consent?

Today Sally is having an operation to change the pitch of her voice

and reduce the size of her Adam's apple.

Hello. Good morning. Can I come in?

If I could just have a little peep at your neck.

-There's a nice skin crease there so we'll use that.

-OK.

Afterwards, you're going to rest your voice completely.

The odd word's not the end of the world, but rest your voice.

-In two or three weeks, you'll meet with Speech Therapy?

-Yes.

-OK.

'I was, in many respects, a normal child, but something started to happen.

'I just began to relate more to what girls were doing than what boys were doing.

'And it utterly horrified me.

'You are a prisoner in your own body.

'There are plenty of other people who have illnesses where they're trapped in their own body,

'but it's almost like I'm giving myself permission now to lead a full and proper life as other women do

'and rather than it being a dream, it's now becoming a reality.'

All the way.

I want big, slow breaths.

We're just reducing the laryngeal prominence, the Adam's apple.

We've exposed the larynx completely at the front and I'm going to do a little bit of a trim here.

15 blade, thank you.

Sally's vocal cord surgery costs around £2,000.

I'm probably the third generation of surgeon doing this procedure. The pioneers were in the early '70s.

We've been doing between 50 and 70 cases a year.

It's probably the largest number I know of any unit in the world.

But we're getting less referrals for this surgery through the NHS

and that relates to the current economic environment we live in,

but times change and I'm sure they'll rediscover its value.

In a moment, we'll tighten the sutures

and they should tension the cords.

-The analogy of a guitar string.

-My colleague's just said the analogy is a guitar string.

If you tension a string, the pitch gets higher.

This is probably the most crucial part of the whole operation. Get the mosquito.

-Have we not got a mosquito rather than...?

-No.

OK, go ahead.

-Got it?

-Mm-hm.

-OK?

-Yeah.

So basically the gap here was much, much larger a few minutes ago.

What the effect of this is is that inside the larynx, it's tensioning the cords.

I've got scissors here.

Most of the patients with gender dysphoria are of a working age.

Now if you are born the wrong sex,

you're uncomfortable going out, you're uncomfortable socialising, being involved.

'And some of these patients do not work.

'The simple fact is that if you're not working and paying your taxes, that is money lost to everyone.'

There are other ill health issues. Going to the doctor's with depression or they attempt suicide

and end up being treated on the Intensive Care Unit.

One day in there will cost far more than this whole procedure,

so if you think about it like that, it does pay for itself.

Let's get this. Follow that car, catch up with him.

Foetus inside, so the students can get a feel for where the baby is.

I'm not sure. I think it's here that's fractured.

-On both sides. Is that right?

-There is spinal trauma. The rest is C2, isn't it?

-Yeah.

-The cord looks fine.

-That's good.

Greatly relieved. The spinal cord isn't damaged and she's not paralysed.

If you're going to break your neck, that's the way to do it - in a way that can be fixed in a safe manner

and also is not going to impact too much on the way we look after the rest of her injuries.

-I'll go and get Mum and Dad.

-OK. Thanks.

No, I'll get the nurse to go and get them or they'll think something terrible.

Do you mind getting Mum and Dad round so the guys...?

-I can come round as well.

-Or we talk to them there.

We had a discussion with the neurosurgeons.

She's got a fracture which is colloquially called a hangman's fracture, which isn't very nice,

but it's the one you get when basically her neck's done that.

What is good is that the spinal cord has plenty of room, nice and free.

So...

she's unlikely to have any kind of neurological injury.

We'd quite like to keep her asleep. It gives a little bit of time for the other injuries to settle down.

At the moment, we're looking at about Monday to wake her up.

I know you have a 16-year-old daughter with a broken neck,

-but it's a bit better this afternoon than it was this morning.

-OK.

Thank you.

Look...

You might be having a heart attack.

Before I had my surgery, I weighed 25 stone.

I'm half the person I used to be!

For three months, Steven's been having daily therapy to help him cope.

This intensive therapy will end when he leaves the unit,

but his care will still cost the NHS £80,000 a year.

That sort it?

That feels good. As it runs past wherever it does,

-I'm more aware of...

-Absolutely. It's about waking up all those senses, really.

-Is it nice to taste something?

-Lovely. This is the highlight of my day. Definitely the highlight.

-Having a glass of orange.

-Who'd have thought?

-I know.

-I've actually brought some yoghurt.

-OK.

-Which will come in handy.

-Wow.

-This is the big treat.

-A big day today, eh?

-Ready?

-OK.

-OK?

-I felt good.

-But that swallow is tiring. It's taking more effort to trigger.

I think I'm going to stop, actually. Everything's getting really tired.

-I'll just get you into trouble.

-OK.

-You won't thank me for that.

-OK.

Do you want some suction?

-No, it's OK.

-See? That's what I suspect is the yoghurt sliding down.

No, it's all right. No.

We'll get a SATs monitor on.

I think it's fair to say he'll probably never eat a full meal again.

For pleasure purposes, it would be really valuable to take a small amount so on any social occasion

he may be able to sit down and have a drink with some friends or coffee.

Eating, drinking is the glue of life, quite often.

If he can have something, he can be a part of the party.

-Hello.

-Hello, Karma! Hello, baby.

Am I going to have a kiss? Am I going to get a kiss?

-Oh, I can't reach you.

-Can't reach.

-Come round here and see if you can.

You must be able to. Stand on the bed, then.

Oh...so close!

Ah, thank you, darling.

-Oh...

-All right?

-A bit chilly.

-Do you want...?

-No, it's OK.

-Do you want a rug or something?

-No, no, no.

Looks uncool in a rug. It's bad enough being in a wheelchair.

As part of his rehab, Steven is taken out to help him get used to life in a wheelchair.

Steven's separated from his partner and sees his daughter once a week.

Today's the first time he's left the hospital with her since the accident.

I miss you.

-I miss you, too.

-I miss you very much, Karma.

I miss you very much, too.

I miss... going swimming with you.

Do you know that? Probably that's the most... the most...the most missed anything.

Going swimming.

-Yeah?

-Yeah.

Yeah, me, too.

What we see here, this is the right leg

and you can see that the fibula and tibia are fairly similar in length.

I would like to achieve 2cm difference between the fibula and the tibia.

I think the NHS's role is about making you function.

With the improvement in prostheses that we've seen over the last few decades, there are very few things

that an amputee can't actually do.

The only real thing you can't do is easily leap out of bed in the night to go to the loo

because you've got to put your leg on, but other than that, with a well-fitted below-knee prosthesis,

you can do an awful lot of the things that used to be considered to be impossible for amputees.

She's twitching.

It's not causing me concern. It was interesting that she was doing it.

I wasn't sure it was significant or anything.

Oh, that's why I wear a visor!

-Shall I take it off?

-If you like. I don't mind.

-Will it be easier to clean that way?

-Hmm.

I'm just having a quick clean.

And then we're going to need the saw in a minute.

LOUD DRILLING

OK, and the nail file.

SCRAPING SOUND

OK. The nice thing about having new instruments is they're all sharp.

So that's now quite a lot shorter than the main bone here.

We're just going to take a quick short cut.

I think a lot of what we do is about the whole patient, rather than just this operation.

I expect that I will need to do modifications to Claire for many, many years to come

and there may be other treatments that are more cosmetic,

but that's not cosmetic, i.e, making you look more like a film star.

That's bringing you in line with what is normal for the population as a whole.

My feeling is that what the NHS should be allowed to do is normalise people.

-Aaagh!

-Just there. Sorry.

-It's all right.

-How's that?

-No, that's numb. That feels quite numb.

You've just had a special birthday.

40, plus VAT. That's what I was.

-Where did you go?

-Marbella. Me and the girls and it was absolutely fabulous.

-God, you see the sights there!

-Oh, yeah.

-We've done the lap-dancing clubs and the poles.

-What? Did you?

-I struggled with that pole though, Ann.

-You didn't, really?

-I did, yeah, Puerto Banus.

You've got to go to Puerto Banus when you're in Marbella.

Oh, yeah, it's fabulous.

For the past ten years, the NHS has been offering nipple tattoos

to patients who have had breast reconstruction as a result of cancer.

Today, over 300 hospitals across the country offer the service.

Back in 1999, a long time ago now,

I didn't have a lump or anything like that, just a bit of a hard boob.

How old were you then and how old were you?

Well, that was... I was 35.

-I was 11.

-That must have been hard.

And just being on our own, a single parent, just me and Em, it was a bit...harrowing.

So, anyway, I went to see my GP, he sat me down,

stuck these X-rays, blah-blah-blah,

on this machine and said, "Yes, well, you've got ductal carcinoma in situ."

And I'm going, "Oh, that's good...

"That's great news."

"And you're going to have to have a mastectomy."

And I can remember just breaking down, crying, and saying, "Am I going to die?"

"Well," he said, "not if I can help it."

I wasn't really worried about waking up with a boob gone because...

..you don't worry about what you're going to look like.

I can remember then waking up, being very sick,

and, being the very vain person I am, looking for a mirror,

because I said, "I've got to put my lippy on. I may not have a boob, but I'm going to put my lippy on."

And looking in the mirror, I looked like I'd been knocked out.

I was violently, violently sick and I remember thinking, "No, I do want to die."

And I put that foam prosthesis in my bra, put my bra on,

put on the same black shirt that I'd come into hospital in

and I looked in that mirror and it was me.

-It's true.

-OK?

-Can I have a look in the mirror?

-Yeah.

You've got to tread carefully with how much you do in terms of tattooing

-because you do ooze a little bit.

-Yeah.

-If we get you back again to get the colour that you want to be...

-No, that looks really good.

- Yeah, chuffed. Chuffed. - It looks good.

Debbie's nips.

LAUGHTER

Dr McAllister, there's just another gentleman beside him, Mr Nelson, James Nelson.

I'll just let you pop your head in when you're here.

I'm looking at his monitor there. Everything looks normal on that.

I was tired after the operation, but I'm grand now.

And you can rotate it round and choose which prostate you would like them to examine.

So where are we going today... Start again.

Right, where's Daddy going today?

-"Hostipal".

-"Hostital".

-Why?

-To get a new hand.

-To get a new hand.

-Are you guys excited about that?

-Yes.

How much are you excited? THEY SHOUT

-If I can take that hand from you...

-Mm-hm.

Thank you.

He's programming the hand now.

On the trial hand I had various grip patterns.

And so Bruce is now taking those patterns and putting them

on to the new hand via Bluetooth, which is incredible.

It's all wireless.

-No beep when it changes, just the vibrate.

-Just the vibrate.

-They're all in the right order.

-Fantastic.

-This...

-I like your knuckles.

-A Chinese grip, yeah.

If you're going to be a robot, you need that.

-Ready?

-I am.

I think I look chubby.

I know it's just my anorexia talking. I know that that's not real.

"Chubby, chubster, whale..."

-"Big bird?"

-Oh, yeah, "big bird".

-That's not a bad day's shopping, was it, Karma?

-No.

No? "Thanks, Dad."

Did you say, "Thanks..."? Did you say, "Thanks, Dad"?

Thanks, Dad.

You're welcome, baby.

You want a children's meal - chicken nuggets,

-a double burger...

-Yeah.

-A wrap?

-Yeah.

-And a hot and cold chocolate?

-Yeah, and chips.

-And chips.

You're not talking now.

-Are you really hungry?

-Yeah.

-All right...

-You're two minutes away now.

-Let's get some food then.

OK? Have we got everything?

All right, don't drop those, Karma.

I don't think she will.

It smells delicious.

OK, right, OK...

-OK...

-Can I take them out of your pocket now?

-No, you can leave them in there.

-Right, see you later, baby.

-Bye!

Take care.

-Bye.

-Bye-bye, darling.

-Bye.

Bye. I love you.

-Karma...

-Yeah?

-Don't forget to Skype me. All right?

Skype me tomorrow.

See you later, darling.

-Bye.

-Bye.

Karma was a bit distant from me today.

Normally, she's all over me like a rash.

We were really close. I mean, you can see it in that photograph there.

She had a big grin on her face like that most of the day because we were doing such fun things.

I'm not the dad I was.

You know, I'm not the fun dad I was.

You feel yourself isolated, stuck in a wheelchair now.

And not even being able to put my arm around her,

I find it quite upsetting, really.

-What can I do with her?

-You can help her do her homework.

-There's loads of things you can do with her.

-Yeah, I know.

-Just not active things.

-No.

This is Roger's aeroplane that he had the accident in,

obviously, before.

It's not my favourite.

And that was how it was.

The front of the aeroplane is completely devastated by fire. Roger would have been sitting about here.

Had I been a passenger, I would have been sitting there,

so I may possibly have come off worse than Roger.

Anybody in that front seat would have died. There's no question about that at all.

-Do you remember anything about the crash?

-Nothing. Nothing, I'm pleased to say.

The last recollection I have is saying "cheerio" to Kim on Thursday

and the next clear recollection I have of my own, other than from what people have told me,

is about seven weeks afterwards when I woke up from an induced coma in the Burns Unit at Chelmsford.

I see Roger as that man.

He's my first love and he always will be.

This is him at the nose wheel of an A300.

Roger's plane crash was four years ago.

He was trapped in the fire for half an hour.

Since then, he has been going to hospital every two months for reconstructive surgery.

This part of my arm here, as you can see, doesn't straighten.

I've had three operations on it already, so hopefully, with luck,

provided the tendons and muscles themselves haven't shortened, I should be able to straighten my arm.

Do you get excited about operations?

HE LAUGHS

-I'm sorry.

-Do you look forward to them?

-No.

-Not at all.

Honestly, I've had so many of the bloody things and I just want to move forward.

I'd very much sooner not look like an extra off a Hammer film,

which I do at the moment, but it's not a big priority.

The big goal is to fly again. I don't mean to fly as a passenger again, but as a pilot.

I was never, ever concerned about how he'd look.

That's never concerned me.

It was...whether or not Roger would be the same person

as he was before the accident.

If...Roger had had any brain damage,

I...I don't know how or what we'd have done.

And I can honestly say that I have absolutely no idea.

I think I'd be lying to say that there haven't been times that I wish I hadn't survived.

I suppose one of the most difficult things to bear

is losing, other than Kim, more or less everything that I enjoy doing,

losing my profession and hobbies...

..all of the things that are lost.

A lot of them are functions and bits of my body that are no longer there.

-How are you?

-Pretty good, thanks. How are you?

-Hi, Kim. How are things?

-Not bad.

-Had a busy morning?

It was slightly more interesting than it might have been. I've changed my suit. I'm clean.

The plan for today then... I'm going to do some releases on that elbow.

So how is it looking after last time?

So we've still got quite a lot of that. If we draw around that...

-That part has survived.

-Yeah.

That part is good.

-But we've lost a bit in the middle and that's contracted down a bit.

-Yeah.

We are optimistic that we'll be able to get that arm out a bit straighter.

-I don't want to cut that biceps muscle because, obviously, you need that for power to flex.

-OK.

But if we can encourage it to release some of its strands, that'll give you more movement.

-Good. You need to sign a consent form still, don't you?

-I do.

-Yeah. I shall get one.

Here.

-Oh, just there.

-There somewhere.

Roger has had 36 operations since his crash,

around half of them carried out by Tania.

I must go back and tell the boys and girls we're ready to go.

-I'll get you down and I'll see you very soon.

-Super.

-All right?

-Thanks.

Currently, we're very lucky in Burn Care. There are no specific restrictions,

so if I physically can provide an operation to improve the function,

sometimes the appearance of a burns victim, we would be allowed to do that on the NHS

and do so on a very regular basis.

OK.

Right, Roger. We're just going to give you a little bit of oxygen,

so we make sure your lungs are full of oxygen before we begin.

Can I just squeeze... Sorry.

You need a kiss first? That's fine. We're allowing that today!

See you later.

-Stay there. You might get another one.

-Oh, mightn't I?

-If you're lucky.

I'll definitely stay here then.

It's not the full anaesthetic. It's just going to make you feel nice, relaxed, chilled, drunk, happy, high.

Something like that. Most people quite like it.

We want you just to concentrate on taking some nice, long, slow, deep breaths.

The other thing is to think about something really nice to dream about.

Some people have some cracking dreams on this stuff.

Keep taking those nice, deep breaths.

There's probably time for one more kiss. One more kiss.

Before it starts going in, it can just be a little bit achy.

-All right...

-See you later.

-A little bit more of that oxygen.

So, all the time,

-if you can start really pushing on that as hard as you can...

-OK. Yeah.

And sort of rocking backwards and forwards a little bit, so it's starting to release...

I'm just stretching him out to see how much more extension we can get.

The idea is clearly not to break Roger's arm.

OK, your turn. Lean on there for a bit.

Another knife, please.

To ensure that Roger's arm heals properly,

Tania uses a hi-tech, artificial skin.

It's made from bovine beef collagen

and shark glycosaminoglycans

which gives it something

that is rather like the human structure.

Apparently, it needs shark in it to really become completely like the human structure.

And the idea is that it produces a scaffolding

that the blood vessels then grow into.

Right, wash hands.

All right, I'll be back fairly... Well, fairly soon. Soon-ish.

She's still on the answerphone, so we'll go this way.

-Can I ask you a few questions?

-Yeah, if we walk and talk at the same time because I'm on a mission.

Hello.

Let's go through. OK...

Yes, so it is becoming sort of second nature, so...

-Here we go.

-Perfect.

-If you just make a big leap on to the scales...

-Yeah, why not? Let's do it.

INAUDIBLE

Sally has been advised not to speak while her vocal cords recover.

Once they do, she'll join a speech therapy group at the clinic

to refine the sound of her voice.

We hear the smile in someone's voice, don't we?

We want that to be in your voice all the time, to have that smile in your voice,

not kind of that..."euh",

but that bright... "Morning!"

"On either side of the river lie long fields of barley and of rye...

"Willows whiten, aspens quiver, little breezes dusk and shiver.

"And moving through a mirror clear that hangs before her all the year...

"Sometimes a troop of damsels glad, an abbot on an ambling pad...

"She knows not what the curse may be,

"and so she weaveth steadily,

"and little other care hath she,

"the Lady of Shalott."

61.

And 113.

Which is very good.

You've got a small waist now.

And that says... What have we there? 37.

-Very good. Oh, look, she's well organised.

-Well, I was.

Hello!

It's just nice to sit here

and look at the fire.

Home at last.

What would you do if you could run the NHS?

SHE LAUGHS LOUDLY

If I could run the NHS?

Hmm...

I don't fancy running the NHS. I don't want to fly a desk. I quite like looking after patients.

One of the nice things about my job is that I do actually still look after patients.

That's what gives me a buzz.

MOBILE PHONE JINGLE Oh...

I wonder what that represents? It could be...

It's all right. It's my husband. It's not the Burns Unit.

Hello.

I'm sitting in front of the log-burner,

being filmed for the end... the end of the day shots.

It's like a reflection that I do at the end of every day.

I fancy a cigarette now.

-You're not allowed one.

-Stop it.

-I do.

-You caused trouble last time you had one.

-Who gave it to you? I'll tell them off.

-My aunt.

I managed to blackmail her.

How did you blackmail her? What did you say?

I said, "All these people ever say to me is, 'No, you can't do this, you can't do that.'"

-So I got...

-You made her feel bad.

-I did, yeah.

-That's terrible.

-I know it is, yeah.

I know.

-So did you miss me today?

-Loads.

-It's more like, "Didn't you miss us?"

-I was too busy.

OK, we're in.

-I'm feeling pretty cold now.

-OK.

-We'll get you warm in a minute.

-You're nearly there, darling.

-There you go.

Listen... Listen, did you finish all of that McDonald's that we got you?

You finished every single bit of it?

Where did you put it all?

In your stomach? Right.

'Have you had a nice day?'

I have had a nice day, although I am quite tired now.

All right? OK.

Yes, I did. I've had a very nice day, especially seeing you.

All right, are you going to bed soon?

I'm going... Do you know what? I'm in bed already.

All right, I miss you madly.

Take care, darling.

'I miss you more than you.'

No, I miss you more than what you miss me.

OK, take care of yourself, baby.

And give me a call.

All right?

Will you give me a call?

All right, take care. I love you.

-Bye-bye, darling.

-'Bye!'

-Bye-bye.

Bye.

Can you see my phone anywhere? Can you switch my phone off?

Yeah, thanks.

Just switch my phone... It's just the bottom...

Carry on going up here, then we do a right at the next bit.

To order your free copy of the Open University's booklet,

Working To Save Lives, which accompanies this series, call:

Or go to bbc.co.uk/keepingbritainalive

and follow the links to the OU.

Subtitles by Red Bee Media Ltd