Episode 5 Keeping Britain Alive: The NHS in a Day

This programme contains scenes which some viewers may find upsetting

18th October, 2012.

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

This change will be a disaster.

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 of the time.

Hello, we're going to help you.

-We rely on it...

-Be really brave.

-..complain about it...

-In the bin, that's because of you!

..often we take it for granted.

Lucas! 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.

RADIO: 'A top temperature today of 12 degrees...'

'Tayside and Fife have been badly affected...'

'Sunshine and showers today...

'Eastern parts of England...'

'Clockwise between 23...'

'Later on this afternoon we will see some showery outbreaks of rain

'just spreading into East Anglia and the south-east of England.'

'Why brains?

'Well, first of all brains are beautiful, I have got to say that.

'My father is a neurosurgeon

'but I was quite keen on becoming an engineer.

'Then there was a big tragedy'

in Malta, which is where I grew up,

there was a hijack and the hijacked plane was forced to land

in Malta, and the terrorists were shooting passengers in the head

every hour and demanding that the plane be refuelled.

'But I remember quite vividly my father going into hospital

'and coming back after two or three days,

'having operated on five of these people who had suffered

'horrific injuries and that three of them had survived.'

So I just decided that I wanted to become a neurosurgeon.

Today, Ludvic has two patients booked in for surgery.

He specialises in deep brain stimulation,

a surgical procedure used to treat extreme tremors.

His first patient, 70-year-old Agnes, has a neurological disorder

called dystonia and 67-year-old Rose has Parkinson's disease.

Although both conditions are incurable,

surgery could make a significant difference to the symptoms.

Deep brain stimulation involves placing electrodes

deep within the brain, so, just to give you a demonstration,

this is the sort of thing that we are implanting,

it's a very thin lead,

which is about the size of an uncooked spaghetti,

with four little contacts at the end.

So, what we end up with is a lead that we put in the brain,

connected to a battery which is implanted either underneath

the collarbone or in the tummy.

For some patients, like Agnes and Rose, it is less risky to have

two separate operations, one for each side of the body.

I had it done before because my right hand had a severe tremor.

I just can't wait for the end result.

I'm hoping it will be as successful as last year's operation.

Agnes uses a remote control to switch on the electrode

already implanted in her brain.

That's on.

When it goes on, I can feel a shot of electricity go into my brain.

And this is the difference.

In the last two years, Rose's tremors have become

so violent she has lost two-and-a-half stone in weight.

What are you most looking forward to after you have had the operation?

Being able to slice and move a pan

over to the other side without burning myself.

Carrying a cup of tea and things like that, you know.

She couldn't...

Sometimes she might get there with it and sometimes she'll spill it.

Then when I go to the post office and get my pension,

I can't sign that.

All the staff do it for me.

Just simple things like that.

It's going to be a new beginning. I am sure.

Karen, it is lying breach at the minute, bottom down, OK?

Mornings are good towards the end of the week

but I quite like doing lates on a Monday, straight after the weekend.

I think there's an element of putting a bit of a face on,

yes, cos you don't want to, sort of, be blubbering all day

and things like that.

You have got to put a bit of a face on, like a bit of a smiley face,

because you know, everyone has got issues, everyone has got their own

problems that they have to come into work with and stuff like that, like,

you know if you have had an argument in the morning you've still

got to go in and smile at everyone when really you don't want to but...

You know, it's just the way it is. It's just nursing, that.

But that's like any job, though, isn't it?

Giving chemo for the very first time is horrible for all involved

really, just because this is...you're starting them off.

They are always going to remember you, they are always going to

remember you as the first person that ever gave them the chemo,

which most of the time is a good thing, but sometimes,

you know, you are always going to have that stigma of,

"Oh, you were the first one, when I came to the Christie, you were the

"first one that gave me treatment and made me feel really sick."

Right, come on!

Right, out.

Now, come on.

Move, come on!

-A nice red colour for you.

-That'll be lovely, that, won't it?

That is a change, isn't it?

-This is the one that makes your hair come out.

-Right.

-All right?

I had a haircut last week because I said it was less to drop out.

Yes, it looks nice.

-RADIO:

-'Rangers fans were going to buy these tickets...'

Right, through we go then.

Well done. You are doing really well.

I have a patient on the island of Islay who has got schizophrenia.

THEY SPEAK IN GAELIC

Like all surgical patients,

Agnes has been screened for superbugs such as MRSA.

-So you know that your GP did a swab for you.

-Yes.

That came back as negative.

-Yes, I was clear.

-That was clear.

-But the swap that they did yesterday came back as positive.

-MRSA?

I don't think we should be taking risks with your health.

-You are not going to do it?

-Not now.

-Oh!

-Sorry.

-I had it last year.

-But we cleared it before the operation.

-No!

-We did, we did.

When it come back from the ward they put me in isolation.

But we cleared it beforehand.

-It doesn't make sense to do it now and take that extra risk.

-Yes.

Rather than postponing it by a few weeks. So, I'm really sorry.

-You were psyched up for this.

-I know. I'm very disappointed.

-You have had a bit of an audience, as well.

-Yes.

But I think we should do what is best for your health

because the last thing... You won't thank me

if we do the operation and the hardware gets infected...

-That's right.

-..and we have to take both sides out.

-I forget about that. I forgot.

-Do you understand?

-Yes, I do.

-We've got to do the best for you, all right?

-Thank you.

-I'll come back and have a chat.

-Thank you anyway.

-No worries.

-See you later.

-OK, bye.

I wasn't expecting that.

-No?

-No.

-I'm really sorry.

-I'm trying to keep brave about it.

I was so hyped up.... to have this operation.

As I said, I was looking forward to the end result

and now to have to go through it all again...

Just one of these things.

But I just feel like crying.

Now Agnes is going home, Rose is moved up the operating list.

-Hi there.

-Hi there.

-How are you?

-Very well, thank you.

-All set?

-All set.

How long has it been since we did the first operation?

-17th of August last year.

-So just over a year.

-Yes.

Let's have a look, how are we getting on? So what about the tremor here?

Very good. Are you happy with that?

-What are we going to do for you today?

-You are going to do this side.

Absolutely. So we are going to put an electrode on this side of the head

because it's this side of the brain that controls that side of the body.

-But you are happy for us to go ahead.

-Oh, yes.

-Perfect.

-I have to do.

-So we will see you downstairs very shortly.

-Please, God.

-Thanks a million.

-We will do the very best for you.

-Thank you.

-Take care.

Hi, Fred.

How are you?

BABY CRIES

Ladies and gentlemen, if you are here for chemotherapy today,

please be aware there is a slight delay in getting blood results...

Although cancer remains Britain's biggest killer,

survival rates are better than ever.

Two million people are now living with or beyond the disease.

Hello there, Mike Whitaker. Thank you.

Around 130 of them will come here today for chemotherapy.

Some are hoping to be cured.

Others know it can only buy them time.

To get as far as the chemo treatment is absolutely brilliant.

Because from what was said at the beginning, it wasn't looking good.

-It wasn't looking good. I was going for... Is it the EMR scan?

-Yes.

If that showed anything up then there was nothing he could do.

Well, I have had so many tests since and I am down

and I am here, so that is brilliant.

Yes, that's the best thing, that's the best news, isn't it,

that anyone can ask for?

'The reasons I came into this job are still the same, you know,

'cancer is always going to be there and I think, you know,'

it's something, if you've got the chance to be on

the other side of it and help, for as long as possible,

then, why wouldn't you?

'You know?

'I want to be on this side of it so that I can see and help people'

and, you know, make them smile a little bit, maybe.

Sometimes.

-Right, so this is your steroid.

-Okey-doke.

Now this can give you a bit of a prickly bottom.

Oh, right, OK.

It only lasts for a couple of seconds.

Don't make me laugh!

Sorry!

-Oh, dear.

-Some people say it feels like nettles.

-Oh, right.

So that is pleasant for you(!)

Barry has cancer of the oesophagus.

He was first diagnosed two months ago.

'This is my first treatment.'

I've got three months' treatment, then an operation,

and then a rest, and then three months' treatment after

what they call mopping up.

So, um, yes, I was wary about this morning but so far so good.

He seems to be pretty straightforward. He knew

exactly what he was doing, he knew what to expect and things like that.

The only thing that he was worried about was his son.

-How old is Liam then?

-24 in December, and a star.

He is a magic lad, special needs, he is profoundly handicapped,

-but he is like...

-Will you do anything for his birthday?

We've nothing planned as yet because it has thrown things

but we are fortunate, we've got a place in Wales

so we can walk down the beach

and because it's concrete you can walk about three miles

in his wheelchair so that's brilliant.

He just loves it down there.

Especially when the tide's in, and it's coming over.

We just have great fun.

# Well they talk about me

# But people don't really care... #

Today, one in six of us is living with some kind of mental illness.

# ..We're going to keep on going... #

Terry is a patient in a secure psychiatric unit in Blackpool.

As part of a programme to prepare patients for their return

to the community they are sent on a supervised visit to the zoo.

..bipolar yourself, I tell you, you're off your head!

I will!

'I think, just going outside, in the normal environment,'

which they will be spending most of their life,

see how they interact with people,

see how they interact with the staff there,

'how they manage their money,

'basic safety measures like, you know, crossing the road,'

whether they are able to

handle themselves safely throughout the visit.

Thanks, everybody, for sticking to road safety.

THEY ALL LAUGH

'You cannot cure mental illness,'

but what we can do is there are different treatment regimes

pharmacological, psychological and, you know, social treatments

which would help to contain these symptoms.

Terry has bipolar disorder. He's been at the unit for six weeks

but is due to released at the end of today.

Just grabbing hold of your fingers, that's what they want.

Would you expect at some point you'll come back to the hospital?

I can never really tell. If I go a bit high and I go too much,

-I might have to.

-Yeah.

But sometimes I remain all right for two years.

Giraffes! Go and see my giraffes! I've seen the lions now so...

And the tigers, so we are going to go and see the giraffes.

Chris has a personality disorder,

he's bipolar and suffers from delusions.

He's been known to mental health services since he was 13.

Mother, daddy and a baby.

It is amazing, they are beautiful creatures, so, so sensitive.

Wow!

Oh!

I was...

I was a difficult child and I was abrupt and I was disobedient

and very, very unsettled as a child.

Apple.

'I left my mother's home at the age of 14'

and won the lottery at the age of 25...

I'm 27 now so I won the lottery when I was 23.

Wow.

'I'm hoping the authorities have got it.

'It was £10.7 million'

and it was a lot of money -

could have changed my life and many more lives.

I wouldn't be here now,

I'd maybe be travelling in Asia or travelling in America,

on business, entrepreneurial business.

What do you do with £10.7 million, what do you do with all that money?

Buy a dog.

I'd buy a dog, and buy a car

and buy a home, somewhere nice.

Dog first, I always wanted a dog.

-TERRY:

-That's what they all say in Blackpool, they all call me Elvis.

They say there is nobody as fluent as you singing Elvis.

He said, "I always liked Elvis songs but you can sing exactly like him."

-Christopher!

-Chris!

-Christopher!

-Chris!

-TERRY:

-Christopher! Christopher!

-You can get here this way.

-Christopher! Chris!

-Chris, are you going that way?

-He reckons this way is quicker.

No, we're not.

SIRENS WAIL

RADIO: 'Two accidents in West Yorkshire on the A1.

'M1 northbound, lane out at junction 13 because of an accident.

'If you are heading out of London, the A13 is closed eastbound.'

Rose is about to undergo deep brain stimulation.

Shall we come straight in?

Hello.

Fewer than one in ten Parkinson's patients

are considered suitable for this life-changing treatment.

'She started tremoring about May, 2006.'

'It got worse all the time.

'I couldn't walk from the sink'

to the table.

Oh, it was horrible. It really was horrible.

Rose has really exhausted all the medical options

for trying to help with the tremor.

The tremor is becoming so bad,

it really has progressed over the last year or so.

It's become so bad that her whole body shakes

and I think if we can diminish that tremor,

of course it would be lovely to get rid of it, but if we can improve it,

then I think it would make a big effect on her quality of life.

'I think if we didn't have this operation

'she would have to cope as best she can with the symptoms.'

The arduous procedure will take four hours,

and Rose will be awake throughout.

I'll take good care of her.

-So, you remember this little fella?

-I do.

-We are going to put that on the head.

-Yes.

These little bars will go in your ears.

You'll feel a bit of pressure for five minutes or so.

If that becomes unbearable,

-you let us know and we'll pull it out.

-Right.

-Then we'll numb these four areas and put those little screws in.

-Right.

-Then the frame will be on.

-Right.

-All right?

-Yes.

Let's get it over and done with.

This is the worst bit, you remember that.

-In for a penny... TOGETHER:

-..in for a pound.

Good luck. OK. Here we go.

'To start the procedure requires putting a frame on the head

'and getting an MRI scan which will be a personal map to Rose's brain.

'But if you look at any map,'

in order to navigate accurately,

you have to place a reference grid over it

and that is exactly what the frame does.

It allows us to have what we call coordinates, that guide us

to very precise locations within the brain

'with millimetric accuracy.'

-Just going into the ears, they'll feel a bit uncomfortable.

-Yes.

Do let us know if it becomes unbearable.

-The right one's a bit...

-It's a bit painful already, is it?

-Is it tight?

-Yes, very.

-Is it unbearable?

-Yes.

-Which side is worse?

-Left.

-The left?

-Top right is hurting.

-On the forehead?

-Yes.

OK, let that out a little bit.

Rob, could you hold her hand a little bit?

Just maybe help control the tremor a bit.

-It's really hurting me.

-The right? Here? Hold on.

-I'm sorry.

-You are being very good.

-The frame's moved this side.

-Are you all right, Rose?

-Yes.

Close your eyes for me.

A sharp scratch above your right eye. A little bit of burning.

Just behind your right ear again.

-And just behind your left.

-Yes.

-Have you got any pain anywhere at the moment?

-No.

-Good.

Get you lying down in just a second, OK?

Just going to tighten those things up a little bit more.

Good.

-I right deserve a brew.

-That does deserve a brew, absolutely!

We need something stronger in it!

-THEY LAUGH

-A wee drop of something!

OK. Take it easy.

Can you remember this plastic box that we put on top of everything?

-You can hear a bit of a click.

-Yes.

OK.

Good.

Good.

-OK, this is just going to come over you.

-OK.

All right? You can close your eyes if you want to.

-It's entirely up to you.

-ROSE'S COMMENT INDISTINCT

And then up a little bit.

'A lot of what doctors do is thought be life-saving'

and a lot of it is, of course it is an important part of what we do,

but I think quality of life is increasingly being recognised

over the decades as being one of the most important things

that we can do other than saving lives.

'The more technology that we have, the more we are spending

'to provide people with these increases in quality of life.

'So it is a big challenge,

'a big economic health challenge for the society at large to say,'

all right, how much are we prepared to invest

in a National Health Service, that is going to provide

quality of life which is important for us as human beings?

And what's that cut-off? Where do we have to say,

these are the resources that we have got and above that resource

we can't afford it and below that resource, we can?

There we go.

Mental health is one of the most complex challenges facing the NHS.

Treating mental health disorders

costs the NHS more than any other illness.

# He has the strength to move the tide

# Without his love you won't survive

# I'm singing praise together

# Sing together

# Pray with one mighty roar... #

This evening, Terry is due to be discharged from the unit

and will return to the care home he has lived in for nearly two years.

# ..Rejoice. #

Over the last week, the psychiatric team have been meeting to discuss

whether or not he is ready and safe to leave the unit.

Terry is around 63-years-old and more than half of his life

he has been dealing with this bipolar illness.

He has a 37 year history of this and he has had plenty of admissions.

When he came to us on this particular instance, Terry was demanding

and aggressive and agitated on the ward

'and he was singing lots of songs of Elvis Presley.'

-How do you cope with that? How do you cope when you are low?

-Well...

You know the best thing to do about it, when you are lying in bed

and you can't even motivate yourself to get up?

Force yourself to get up

and just make yourself get up and take up walking.

And as you're walking, look at the sea going out or coming in.

Walking is the best thing for depression.

'What tends to happen is Terry will come onto the ward

'and his physical health problems will be looked after.

'We sort of look into his medications'

and then he gradually starts to improve

and then he is at a point where all his abnormal beliefs,

they tend to retreat and his normal self

comes more and more into the front.

Shall we get Terry in then? Yes.

-Hello.

-Sorry.

-Morning, Terry.

-Morning.

-You know all of us in the room here.

-Yes.

And, I get, you know, you think you are getting better now,

-you are on your road to recovery at the moment.

-I am, yes.

And I think we all share the same thing that Terry is showing

improvement. How do you feel about your medication?

It's done right. It's levelled out.

It is helping me, um, just be normal.

You know when you have not been well in the past,

-you have sometimes felt like life is not worth living.

-Yes.

-Has it happened recently when you have had such thoughts?

-No, no.

How would you feel about going back to this residential

accommodation you were at previously?

-Yes, I want to go back there. I think I am all right.

-Absolutely.

We are all in agreement of that, Terry.

I'll be all right in my care home anyway.

-Yes, you will.

-AROKIA:

-Well done, Terry.

Thank you very much. Thank you.

'Every time we turn around a patient's life I think that's

'the biggest satisfaction we get in our jobs.'

So I am really pleased that Terry has got better

and is able to go home today. I wish him well.

Sorry, just excuse me.

Unlike Terry, Chris is not ready to leave the unit.

Oh! Oh!

Excuse me.

Go on!

'Christopher was known to mental health services as a child.

'When he is low he is very depressed and when he is high,

'which he experiences a lot, he can experience delusions,'

you know,

mostly of a grandiose nature.

This is it.

This is my computer where I am doing all my work on at the moment.

I have got a dossier to type up, a couple of dossiers.

This is Bonnie Prince Charlie, he is a relative of mine,

back in the olden days, Culloden,

and he's now buried with the Pope in the Vatican City.

Charles Edward Stuart.

There is some issues I'd like to get off my chest

whilst you are filming within the NHS.

The services could be a lot better, given the better Government funding

and a lot of people miss out on the potential the NHS could reach.

The National Health Service of this nation could be an awful lot better

and Jeremy Hunt of the member of the Parliament...

Member of Parliament for Healthcare,

he knows that he has the money to transform the NHS,

the National Health Service of Great Britain,

and unfortunately he just won't.

Jeremy Hunt, Secretary of State for Health,

is in charge of the £105 billion NHS budget.

Now that over 15 million of us are living with long-term illness,

Jeremy Hunt has to find a way to finance the growing demand

this makes on the NHS.

At the moment demand in the NHS is rising by around 4% a year,

in some parts of the system it's more.

Admissions to A&E are going up by about 5% a year

and that is an increasing burden on public finances

which is why it's so important to have a strong economy,

because the public want us to be able to carry on investing

and it's top of their priorities in terms of the area

that they want to see the Government focusing on.

Today, Jeremy is visiting a cancer centre in central London

-which is partly charity funded.

-Thank you for coming.

-Pleasure.

-Robert Naylor, Chief Executive.

-Nice to meet you.

-Geoff Bellingan.

-Hello, Jeremy.

-Nice to meet you.

-Katherine Fenton.

Katherine, very nice to meet you.

-Right.

-All right?

-Yes.

I will take you to our ambulatory care unit,

so this is really a way in which we can treat patients with

complex chemotherapy regimes without needing to keep them in hospital.

-Is chemotherapy normally an injection?

-Well, it's a variety...

It is usually infusions.

Sometimes tablets, sometimes injections,

but usually it's a series of infusions maybe lasting an hour,

maybe a bit longer.

What do you mean by an infusion?

-Claire, do you have somebody who is having an infusion?

-Um, yes. I do.

No cuts in services!

Morning.

When we was going to the toilet, blood,

you have seen the adverts, diagnosed with bowel cancer.

Had the op in February, put me on the old chemo.

Then they tell me the chemo hasn't worked.

Then they tell me you have five or ten years left,

then I saw my main doctor a fortnight later,

she tells me, "No, it's not, it's one or two years."

I said, "Thanks!"

-Bottom line is, I say, you don't know.

-No.

-You don't know.

You don't know, you've just got to stay positive and, you know,

trying just keep plodding away.

Yes. Without doubt.

-Angela Newnan, please.

-See you in a bit.

-That other nurse, on here, she's got them...

-Chinchillas.

-That's it, yes.

-How many chinchillas has she got?

-I think she had five, one died.

-Oh, did it die?

-Yes, and then she got another one.

-Oh, bless.

-Now she is thinking...

-She is thinking of getting one.

-Yeah, I want one.

-Are you?

He is holding his head. THEY LAUGH

-You got another one to go?

-Yes, I've got another hour to go. Yes.

-No, you haven't.

-Serious!

No, no, no, no. This is the last. Don't have me on.

-We have got another hour to go.

-We haven't.

-We have.

'It's always there, isn't it?

'It's always at the back of your mind.

'How many people have cancer, but I think when you are faced with it

'on a day-to-day basis'

it does make you think a little bit more.

'I can't do this job and not spot signs or symptoms

'or things like that

'I think it makes you more aware of things that maybe aren't

'really there and you think, "Oh, well,'

-"I'll just go and check it out."

-Where do you go?

-GP.

Definitely. I think he has seen me more since I have started here

'than he's ever seen me before.

'He's never nasty. They're just sort of,'

"Where do you work?" "Christie's." "Right."

Hello! Good afternoon.

One biopsy there which is showing us the oesophagus.

This is a normal lining, perhaps a bit of inflammation,

but nothing too much to worry about.

Then we go on this higher magnification.

I've spotted

that the cells underneath the normal lining are quite worrying.

I can quite confidently say that this is a cancerous tumour.

And so what they have seen is definitely a malignancy.

Every two minutes, someone in the UK will be diagnosed with cancer.

This is a specimen from a middle-aged lady,

they did an ultrasound for her and they found that her uterus

is very big and there is a mass bulging from the uterus.

The tumour itself was 24 centimetres in maximum dimension.

The whole specimen was more than five kilograms.

-Is the patient still alive?

-Yes, she is still alive.

Michael Whitaker.

49-year-old Mike was diagnosed with bowel cancer two years ago.

-How are you today?

-Not too bad, thank you.

I have been battling through the traffic for the last hour or so.

Have you got anything planned this weekend?

The little ones are on half term

-so we will try and keep them entertained.

-Aw! Yes.

I don't go there with the, "Why me?"

Because I just like to get on with matters

and it's a case of what will be, will be. You know?

I look back on my lifestyle and think,

were there anything I could have changed? You know?

Did anything really contribute to this suddenly happening,

and no, there were nothing like that.

Never smoked all my life, drank in moderation,

never took drugs! No.

Some people say life's a lottery, you know? And what will be, will be.

Lovely, thank you.

'I have four boys I have twins at 12 and two elder guys at 21 and 23.

'They are both in the Army.'

Yes, yes.

'I have sat down with the elder two had a good chat about matters.'

The little ones are aware of my operation in February

and why Dad was going for the operation and since then,

obviously, them being 12,

we didn't want to rock the boat as such with their school life.

I'm going to let them enjoy Christmas and then, in the New Year,

probably we'll have the sit-down chat

regarding matters and my health.

When somebody tells you you've got 12 months to you left here,

you know, you've just got to stay as positive as possible

and, in a sense, in a funny sort of way, that's a challenge,

that's a challenge to me to prove people wrong.

'So I just try to live every day, you know, doing what I enjoy,

'and doing what we can do with the family, as much as possible,

'while I still have time here and that's how I look at matters.'

My wife wants the bedroom decorating for Christmas.

So she still has a little list of jobs for me, to keep me going.

I won't die of boredom if anything else.

Today, the NHS will spend over £6 million on emergency services.

The Midlands Air Ambulance is bringing in a 19-year-old girl

with burns to her face.

This is Sophie. She is 19.

She was attempting to do a poached egg in the microwave.

She opened the door of the microwave and it exploded in her face.

-Where are my glasses? Were they burning me?

-Yes.

-We'll sort out something for that.

-You all right?

-Lots of people around here.

-I know.

I know, the exciting bit now is we need to have a little look,

all right? Was the poached egg in some water in a glass jar, was it?

-Yes? Hot water.

-Boiled the kettle before I put it in the pot.

OK, so it was already going quite well?

And it exploded in your face as you opened the door, did it?

-I popped the cup out and...

-And it just exploded?

-Did the glass break at all?

-No. I didn't really look, I just ran.

-That is grand.

-Ow!

-No pressure, man.

There we go.

-That wasn't too bad, was it?

-Let me look at your face.

-Have you got any pain in your scalp at all?

-No.

-OK.

The burns look quite superficial. OK, that means it is not very deep.

That is probably why it is very painful, all right?

We are also going to have a look in your eyes

to make sure that your eyes are OK, with some special dye.

We'll shine some bright lights in your face.

Did you do any first aid?

You ran out of the room, did you put anything on it?

-I ran my face under cold water.

-For ten minutes.

-OK, and you called the ambulance?

-I fainted. They called while I was...

-Where do you live?

-Stafford.

-Stafford!

-Yeah.

-Where am I?

-You're in Birmingham.

So big, deep breaths.

By the look of you, you've been very lucky.

Nothing we need to do an operation for, I don't think. All right?

You've basically got a bad sunburn and a bit of a burny nose.

We just need to have a look at your eyes though, all right?

Can I please ring my sister because she is on the way from Stafford.

Is she? We shall give her a call, shall we? All right.

If there is a burn to a face that affects your nostrils,

your mouth, whether it be a flame burn or steam burn in this case,

then it can cause the airway to swell and therefore stop patients

from breathing so it's more of an emergency. That's why

she would have been brought in by an air ambulance in this situation.

However, this young lady might have gone to her local hospital

which, in retrospect, would have been fine as well.

-What is this hospital called?

-Queen Elizabeth Hospital.

It's called Queen Elizabeth.

So, there we go. It is my first egg burn.

Gemma, will you come to me, I'm scared.

Do you want me to have a word with her?

Do you want the doctor to speak to you? Yeah?

You're all right, mate?

-What is your sister's name?

-Gemma.

-Hello, Gemma.

You are not allowed to cry in this hospital, OK?

-Are you all right?

-Yes.

No worries.

No, no. A bit of an injury to the face.

It is all sorted.

Any yoghurt?

She is a pickle.

There you go, love. Are you all right there? Can you manage?

Yes, I made it myself, it's gross.

-No, it's not, it's nice.

-Gross.

-It's like broccoli soup.

-It's gross.

You're going to hear a big noise now.

We're just going to make the little hole. It is very noisy,

-lots of vibration but no pain at all.

-All right.

DRILL WHIRRS

You're doing really well.

-That's it.

-I don't remember last one being like that.

No, you forget that sort of thing pretty quickly, don't you?

Ludvic needs to be sure that he doesn't damage the parts

of Rose's brain responsible for speech, movement and emotion.

-Here is the night train...

-Crossing the border.

-Crossing the border.

Bringing the cheques and the postal order.

Bringing the cheques and the postal order.

You sound like my three-year-old now, she likes copying everything

that everybody else says, she is going through that phase.

-I have a grandson.

-How old is he?

He's eight in February.

He rang me up on Sunday and said,

"Nana, has your shakes gone yet?"

And I said, "No, not yet, love." "Well, why?"

He's fabulous, he really is.

Right, can I have a new pair of gloves, please?

The electrodes, I think they cost around £2,000 each,

something like that.

I think it is important to realise that the amount of money

that's spent on medication,

the amount of money that's spent on care,

there's quite a lot of evidence out there to actually suggest,

and certainly for Parkinson's disease, if you do the surgery

in patients that are not responding to medication,

you actually start saving money after two-and-a-half years,

so it's a false economy not to offer it to people.

Of course, with the added benefit

of these people having a better quality of life.

-That is 101.

-101.

In an arc of...

66.9...

That's how the...

'The biggest risk of all is that we do the operation

'and it doesn't help.

'But at the end of the day,

'when you are doing an operation to help with function,

'the most important thing is that

'you don't leave your patients worse off.'

'Going back to the Hippocratic oath, "First, do no harm."

'But it is impossible to do any sort of surgery without risk.'

I'm 40, so I've got another 25 years plus,

if the Government gets its way, of doing this surgery,

and I hope I'm never faced with that knowledge

that I have left someone worse off than when I started.

And if I am in a position to say that I never have,

I think I'll be a very lucky man indeed.

-Rose?

-Yes.

-I don't know if you remember from last time

but do you remember we measured some of the electricity of the brain

-as we were doing the operation?

-Yes.

-Some of the music of the brain.

-Yes.

-We going to hear a little bit of that now, OK?

-Right.

-MUSICAL BEEPING

-That's fine, that's working well.

Before we do that, we want to test that all of our equipment

is working fine and ready for action.

Then once we are happy with that,

we will make a very small hole in the covering of the brain

and a very small hole on the surface and then pass that electrode

down, hopefully, to the spot that is going to affect the tremor.

'If the probe didn't end up where we wanted it to go,

'at the very least we wouldn't get the effect that we desire.

'If the probe is in the wrong place

'and you cause a bleed at that point, then you can cause a stroke.

'There's a lot that relies on us

'getting our probe at the right spot.'

-..Have you got that?

-Yes.

Thank you kindly.

-Suction here now, please.

-Suction down, please.

-There is no pain, right?

-No, no.

-Good.

MUSICAL BEEPING

Can you get that left hand out slowly...

and lift it up in the air?

Just leave it outstretched if you can. Just for about a minute.

Point to your chin. Then out again.

And then straighten your hand right out.

-Is that better?

-Yes.

Point to your chin.

Now straight out for us.

Well, do you know what? I think we have done the business.

Well done. Lovely.

-How different does it feel?

-It's very calm.

I have had it that long it doesn't seem real, it's not moving.

-So, Rose, we are just securing the electrode in place now.

-Right.

-The bed's not shaking any more.

-No! My hips aren't aching either.

-Good.

-I might put a bit of weight on now.

You couldn't really hope for more than that.

When we see patients who have such a good effect. Just by

implanting an electrode you get this very clear effect on the tremor,

and the outcome is usually good.

Almost there.

Just support her head from the back a bit.

-Oh, thank God for that.

-Free!

If I had to have that on my head again I don't think

-I could go through with that.

-So, it wasn't worth it then?

Oh, it was, yes! HE LAUGHS

As you say, it is half a day's discomfort for the rest of your life.

And if you had my life when I had them shakes, you do believe it.

That's very good. Very, very, very good.

-You can do neurosurgery now with these hands.

-Yes!

-I can strangle you as well!

-With some training. Some training.

Don't give me any ideas!

No. Oh, yeah!

Um, two small and two large.

Are you happy in this room?

I am brilliant in this room at the moment, yes.

Just looking for accommodation at the moment, looking for a nice home.

-Right. So when you leave here.

-When I leave here, nice home.

-Are you likely to be leaving fairly soon?

-Hopefully.

I am hoping to be leaving very soon.

I'd like to.

And how long have you been on this unit?

I have been on here for four months. Four months.

The staff have been brilliant with me.

Sometimes I can be very, very difficult. Sometimes...

I'm very, very charming and they're nice, brilliant to have around me

so cigarette time and down for a coffee.

How were you when you came in here then?

Cut off. I want get out of this room, I have been in here all day.

Over the last few days, the psychiatric team have been meeting

to discuss Chris's progress.

-Hi, Chris.

-Hello, how are you?

-I'm all right, and you? You know all of us in the room.

-I do, yes. Hello.

-Have a seat, Chris.

-Thank you very much.

Before you came into hospital, when you were unwell,

what was going on in your mind?

I guess I've never really fitted into regular society,

though it's quite an impossibility.

The National Health Service, to me,

has always been a solace for when I am not so good.

I am known to be a relative of Her Majesty, Her Royal Highness

Queen Anne I, the sickly queen of childbirth,

and people seem to think I am

brassed gold sovereignty

and it's just never really been that way.

I get a lot of support from an awful lot of people,

an awful lot of celebrities,

even the Pope messages now and again,

in his own way, so I am very, very blessed.

You have done quite well in the unit

and I am really pleased to hear from staff the progress you have made.

The nursing staff are great but these are faces that

I don't really want to see for ever. I need to go, I need to leave.

One day, and hopefully it is soon, I'll be in my home.

From this hospital environment, would you like to move to an accommodation

where you've your own space, your own room, and staff to support you?

I think until I find somewhere that I appreciate,

I think it will be an ample home and a happy home life,

a huge garden, with apple trees.

My frustrations in the community are sometimes too out of control

for support workers to deal with and, with that -

it doesn't just stem from money,

there's a lot of things, a lot of issues

and I discuss them with my doctors and my nurses,

though not into great detail like I should -

I don't let out enough steam as I should.

Here is solitude and it's where I can rest

and feel reassured that no-one can get in and no-one can watch me

and no-one can stalk me, if you will.

I get a lot of that.

This is also the culprit that makes your hair fall out.

-So it just starts coming out in clumps?

-Yes.

-Yes.

But it is entirely up to you, some ladies like to take it

all off themselves and some like to just wait and see what happens.

'I would be lying if I said it didn't affect me,

'in the way that you take stuff home with you, and there is always

'somebody that you carry home with you on a daily basis.'

You know, you can't be sentimental all the time,

you've got a job to do, you have to do it.

'These people are expecting you to treat them

'to make them better, to let them go home.'

You know, we have 130 patients,

that's 130 stories that are going to break your heart if you let it

so you have got to just carry on, really.

Eight years ago, Sandra was diagnosed with breast cancer.

-Hats, hats.

-Very stylish.

-Yes.

-She's the queen of hats.

-Hats.

Every time I come I have a different hat on, nearly,

and everybody always comments on my hats.

I do it to detract from everything else.

Everybody is looking at my hat and not my steroid filled face.

-Is that what it feels like?

-Yes.

Because my cancer is secondary cancers now, so I did have a bit of

a reprieve after my initial diagnosis, and treatment,

and chemo, and radiotherapy, and that seemed to do OK

and I just went onto a daily chemo and...

that stopped working and I wasn't feeling as well.

I found a lump myself

and then we knew it had turned into secondaries. So...

You don't have as much chance with secondaries

once you've got those. They've just kept reappearing and reappearing

up until this year and I have brain tumours now,

so it has spread to my brain now.

This controls the pain, nothing controls the cancer now.

-Really nice to meet you.

-OK.

-Really nice to meet you. All the very best.

Health secretary Jeremy Hunt

must oversee savings of up to £20 billion within the NHS by 2015.

What we've got here is the very best in cancer care.

It's very exciting to see the NHS offering

really the very best in the world

and talking to patients about what it was like to

actually have their cancer care in a completely different environment

where they are able to stay at a hotel that's run by the hospital

and not feel that they are an inpatient.

Those stories I think are very striking.

But I've also had some pretty crunchy discussions

about the challenges facing hospitals in London,

and the fact that admissions to A&E are going up by 5% every year,

the pressure that's putting on the system and...

and I'm going to have some pretty big decisions to take

in the spring and it's been very useful background for that.

One of the interesting things I think for a politician is that

the NHS is a political hot potato,

but when you come inside a hospital, it's an ideology free zone -

no-one's really interested in left or right,

they just want to talk about what's better for the patients

and I think that's incredibly motivating.

Are you there?

-Better.

-Yes.

Good.

It's all over.

Are you OK there, Rose? You did very well, OK.

-LUDVIC:

-'Rose's operation would have cost around £18,000.

'I think it would be a very sad day'

if, as a country,

we said we can't afford to do deep brain stimulation on the NHS.

'I think it would be very sad for patients.

'This is a condition which is seriously affecting Rose's life.'

We have a very effective

and cost-effective way of helping the tremor

and so I can't see any reason why the NHS shouldn't offer surgery.

-Hello.

-How are you?

-Very well.

-You're showing off now.

-Good.

-We got there.

-We did. Got a bit emotional there, at the end.

-Yes.

-Yes.

-Yes. I suppose that was relief.

-It is all over. Wasn't it?

-Yes.

-It is a big thing to go through.

-Well, yes.

-I wouldn't like to do it again.

-I don't blame you.

I got my cup of tea.

-You did, did you?

-I did.

-I held him to it.

-With three sugars.

-Three sugars!

-Very good. You were an absolute star today, well done.

-Thank you.

A lot of it goes over to you.

-Goodbye.

-Thank you very much.

-Bye. See you.

How much better can you have than that?

You can't.

No matter where you go, you won't get doctors like that. Lovely.

'It's one of the problems, if you like, with healthcare,

'is that in to some degree it's a bottomless pit.

'But as Aneurin Bevan said so many years ago,'

"You can tell how civilised a culture is

"by how they look after their old and their sick."

Once we stop looking after these people,

then perhaps we have lost a little bit of humanity.

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

Working To Save Lives, which accompanies this series,

call this number:

Or you can go to the website:

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Subtitles by Red Bee Media Ltd