0:00:04 > 0:00:10This programme contains scenes which some viewers may find upsetting.
0:00:13 > 0:00:1418th October, 2012.
0:00:16 > 0:00:21Across Britain 100 cameras are filming the NHS on a single day.
0:00:21 > 0:00:24This change will be a disaster.
0:00:26 > 0:00:29On this day more than 1.5 million of us will be treated.
0:00:31 > 0:00:34Three days ago you had a stroke.
0:00:34 > 0:00:371,500 of us will die.
0:00:37 > 0:00:402,000 will be born.
0:00:42 > 0:00:47The NHS is the largest public healthcare system in the world.
0:00:48 > 0:00:52We want that to be in your voice all the time.
0:00:52 > 0:00:54Hello, we're going to help you.
0:00:54 > 0:00:56- We rely on it... - Be really brave.
0:00:56 > 0:00:59- ..complain about it... - In the bin, that's because of you!
0:00:59 > 0:01:02..often we take it for granted.
0:01:02 > 0:01:04Lucas! Lucas!
0:01:04 > 0:01:07What we expect from the NHS is ever-increasing.
0:01:07 > 0:01:10The money to pay for it isn't.
0:01:12 > 0:01:16If we could see what this institution does in a single day...
0:01:18 > 0:01:21..what would it make us think?
0:01:21 > 0:01:25This entire series tells the story of one day.
0:01:25 > 0:01:26So, why isn't she waking up?
0:01:26 > 0:01:29100 cameras,
0:01:29 > 0:01:33capturing the NHS as you've never seen it before.
0:01:33 > 0:01:35Baby born at five to three.
0:01:51 > 0:01:54RADIO: 'It's seven o'clock on Thursday 18th October.'
0:01:56 > 0:01:59- Do they do showers there? I can't remember- Yes.- Do they?
0:01:59 > 0:02:02- Yes, and you can change clothes there.- OK.
0:02:11 > 0:02:15The plan is ordinary surgery to start with
0:02:15 > 0:02:19so a morning of booked patients,
0:02:19 > 0:02:21and then I'm duty doctor in the afternoon,
0:02:21 > 0:02:25which is the bit that most of us don't like terribly much.
0:02:27 > 0:02:31Dr Liz Lee is one of nearly 40,000 GPs in Britain
0:02:31 > 0:02:34treating an ever-growing number of patients.
0:02:34 > 0:02:38There are so many people with so much more wrong with them now
0:02:38 > 0:02:39than there used to be.
0:02:39 > 0:02:42When you are young you are very unlikely to do much
0:02:42 > 0:02:45going to the doctor, but by the time you're 70 or 80,
0:02:45 > 0:02:47you've probably got two or three significant illnesses
0:02:47 > 0:02:49and you are going quite a lot.
0:02:49 > 0:02:52I mean, we just haven't got enough doctors, because even now everyone
0:02:52 > 0:02:56will tell you everywhere you go, you can never get in to see your doctor.
0:02:56 > 0:02:58Nicky Barden.
0:02:58 > 0:03:02Liz could see as many as 40 patients today.
0:03:04 > 0:03:07I've been having a long-standing problem now with my hands,
0:03:07 > 0:03:10a lot of stiffness and joint pain, across my knuckles.
0:03:10 > 0:03:13It's a bit of a concern for me as I am a musician.
0:03:13 > 0:03:16- What sort of musician are you? - A guitarist.
0:03:16 > 0:03:20The thing about general practice is this great breadth of medical
0:03:20 > 0:03:23problems, so you have to know a bit about everything.
0:03:23 > 0:03:25Can you make a fist?
0:03:26 > 0:03:30'And also breadth of life, so you get babies, you do get dying people,
0:03:30 > 0:03:32'and everything in between.'
0:03:32 > 0:03:36Because you are feeling dizzy, I think, is that right?
0:03:36 > 0:03:3852 kilograms, eight and a bit.
0:03:38 > 0:03:40Just say, "Ah."
0:03:40 > 0:03:43My guess is you'd like to try an antibiotic and see if...
0:03:43 > 0:03:46- Yes, if I can do.- Yes, I think that's very reasonable actually.
0:03:46 > 0:03:50To maximise the number of patients Liz can see in a day,
0:03:50 > 0:03:54her appointments are strictly limited to 12½ minutes per patient.
0:03:56 > 0:04:0112½ minutes, it's not long enough to do an excellent job.
0:04:01 > 0:04:04It's long enough if you got a sore throat or a simple thing,
0:04:04 > 0:04:08it's really easily long enough, but, actually,
0:04:08 > 0:04:12when patients have complex problems, it is nowhere near long enough.
0:04:12 > 0:04:18I woke up in the night with a metal taste in my mouth.
0:04:18 > 0:04:21It's like headache but it's like the whole of the inside of your head...
0:04:23 > 0:04:25The task is pretty awesome really.
0:04:25 > 0:04:30Endlessly sifting, sifting, all sorts of funny aches and pains
0:04:30 > 0:04:33and things that actually could, in the end, be something that's
0:04:33 > 0:04:36life-threatening for the person who presents them to you.
0:04:36 > 0:04:39'At the back of my mind I do worry that I will let my patients down
0:04:39 > 0:04:43'and some who should be referred on do not get referred on.'
0:04:43 > 0:04:47Every so often it happens, within all surgeries, that there is
0:04:47 > 0:04:51a patient who comes and sees us several times with symptoms that we
0:04:51 > 0:04:55don't pick up and actually turn out in retrospect to have been cancer.
0:04:57 > 0:05:00I think that has happened to every GP
0:05:00 > 0:05:02who's practised for any length of time.
0:05:02 > 0:05:03Janet Bowden.
0:05:05 > 0:05:08I'm only running 10 minutes late, which isn't bad, actually,
0:05:08 > 0:05:10at this stage in the morning.
0:05:10 > 0:05:13Hello, I'm Dr Liz. Come on in.
0:05:15 > 0:05:19- RADIO:- 'The government said it is still committed to reducing home energy bills.'
0:05:21 > 0:05:23Ah!
0:05:25 > 0:05:27SHE GROANS
0:05:27 > 0:05:29We're only booking for the afternoon now,
0:05:29 > 0:05:32there are no more morning appointments.
0:05:36 > 0:05:40SIRENS WAIL
0:05:52 > 0:05:54- Safe?- Yes.
0:06:01 > 0:06:04It is a mobile X-ray unit rather than a doctor's surgery.
0:06:04 > 0:06:06We only do chest X-rays.
0:06:08 > 0:06:10We often get asked for other things
0:06:10 > 0:06:14but we have no other facilities, just chest X-rays.
0:06:14 > 0:06:16That's it, come and stand here again now.
0:06:18 > 0:06:21The TB bus was set up eight years ago by the Department Of Health
0:06:21 > 0:06:27to address the problem of increasing TB amongst certain groups of people.
0:06:29 > 0:06:32Tuberculosis, a highly infectious disease
0:06:32 > 0:06:34that was last rife in Victorian slums,
0:06:34 > 0:06:37is on the rise again in Britain. And, just like then,
0:06:37 > 0:06:41it's spreading rapidly amongst the most deprived members of society.
0:06:43 > 0:06:46Take in a breath again, breathe in. Big breath in.
0:06:46 > 0:06:48Breathe in, Paul.
0:06:48 > 0:06:53We go to anywhere that homeless people gather, where drinkers...
0:06:53 > 0:06:56Drink treatment centres, drug treatment centres.
0:06:56 > 0:06:59OK, breathe out.
0:06:59 > 0:07:04The idea is that the people we deal with don't tend to go to a GP
0:07:04 > 0:07:07if they feel unwell, they put it down to what they are taking.
0:07:07 > 0:07:09So we go to them.
0:07:09 > 0:07:11The team use a simple chest X-ray
0:07:11 > 0:07:15to scan the patient's lungs for signs of the disease.
0:07:15 > 0:07:21It's this white circle here, which could be a cavity,
0:07:21 > 0:07:24which means that the bug has actually eaten away part of the lung
0:07:24 > 0:07:28and it's consumed it. That's why TB used to be called consumption,
0:07:28 > 0:07:30because it consumed the lungs.
0:07:30 > 0:07:32- And your first name?- Olwyn.
0:07:32 > 0:07:35Pop your jacket on there, Olwyn.
0:07:35 > 0:07:39Every time the TB bus is here, I always go and have a test
0:07:39 > 0:07:42because you never know when you're going to catch TB.
0:07:44 > 0:07:50My father had TB years ago and I know what the consequences are of TB.
0:07:50 > 0:07:54This country is rife with it again, I mean, we got rid of it,
0:07:54 > 0:07:59or were supposed to, and now it's back with a stronger strain of TB,
0:07:59 > 0:08:01that's even worse to get rid of.
0:08:02 > 0:08:05- There we are. Are you taking any medication?- Loads.
0:08:08 > 0:08:11If left untreated the disease becomes more infectious
0:08:11 > 0:08:13and requires costly medical care.
0:08:14 > 0:08:17Catching cases early will save the NHS millions.
0:08:19 > 0:08:21Your elbows forward.
0:08:21 > 0:08:23OK, breathe in now.
0:08:23 > 0:08:28We get a lot of people who turn around and say, "Oh, I don't care.
0:08:28 > 0:08:30"If it gets me, it gets me."
0:08:30 > 0:08:33This is a breakfast voucher for you.
0:08:33 > 0:08:38- You get a free breakfast today or tomorrow.- Thank you, cheers.
0:08:38 > 0:08:39We give a voucher out.
0:08:39 > 0:08:42Anyone who has a chest X-ray will get a free breakfast,
0:08:42 > 0:08:46so it's a way of encouraging them to come on.
0:08:46 > 0:08:48Damn, I forgot to put the socks out.
0:08:48 > 0:08:49Drat!
0:08:49 > 0:08:51I thought of that last night.
0:08:51 > 0:08:54We collect socks because often, for people that are homeless,
0:08:54 > 0:08:58They... It doesn't sound very much to you and I,
0:08:58 > 0:09:01but to have a clean, dry, pair of socks is quite something.
0:09:01 > 0:09:03It's the old carrot.
0:09:09 > 0:09:11Well done.
0:09:28 > 0:09:30I am late.
0:09:30 > 0:09:32I think whatever I do I'm always five minutes late,
0:09:32 > 0:09:35it's just in-built into my nature.
0:09:35 > 0:09:37But I'm usually a bit late for clinic
0:09:37 > 0:09:40so the patients who know me well, they are always late as well
0:09:40 > 0:09:46so a clinic that's supposed to start at 8:30 usually starts at about 9:15.
0:09:50 > 0:09:53People on the outside sort of think,
0:09:53 > 0:09:56"Oh, brain surgeon," and they think about that
0:09:56 > 0:09:59and they think it must be some sort of mysterious,
0:09:59 > 0:10:01really important job and it is an important job
0:10:01 > 0:10:04and it is great to say that you're a brain surgeon
0:10:04 > 0:10:09but the reality is that I think that all medicine, you can risk life.
0:10:10 > 0:10:12We can cause damage
0:10:12 > 0:10:17to patients and we can do really stupid things
0:10:17 > 0:10:19that can really hurt patients,
0:10:19 > 0:10:23or fantastic things that really can save patients.
0:10:23 > 0:10:25- Morning, boss! - Morning, morning, morning.
0:10:25 > 0:10:29Conor Mallucci works at Alder Hey Hospital's neurosurgical unit,
0:10:29 > 0:10:32an internationally renowned treatment centre for children
0:10:32 > 0:10:34with brain and spine disorders.
0:10:34 > 0:10:36- How are you doing?- Good, good.
0:10:36 > 0:10:39- Hey, Ben, how you?- Hello. - Are you all right?
0:10:39 > 0:10:41How has he been? Perfect.
0:10:41 > 0:10:43- Any problems.- No.- Yeah?
0:10:43 > 0:10:46- Have you had your dinner?- No.
0:10:46 > 0:10:50'GPs probably see 20 or 30 patients with headache a day
0:10:50 > 0:10:53'and most of them are just headache. If I see a child with a headache'
0:10:53 > 0:10:56I stick him in a scanner and I know what is wrong with him, you know?
0:10:57 > 0:10:59Hey, Prasanna.
0:11:00 > 0:11:04Today, Conor's patients include Prasanna, a teenage boy with
0:11:04 > 0:11:08an incurable brain tumour that's left him with disabilities.
0:11:08 > 0:11:10I'm going to look at this scan, double check it.
0:11:10 > 0:11:13Do you want to wait here for a sec while we just have a look?
0:11:13 > 0:11:15Can we just have a quick look at that?
0:11:15 > 0:11:18After more than 50 operations at another hospital,
0:11:18 > 0:11:21surgeons there were unable to offer Prasanna any more treatment.
0:11:21 > 0:11:24The family came to Alder Hey for a second opinion
0:11:24 > 0:11:26and Conor agreed to operate.
0:11:27 > 0:11:31It's one of those cases where different doctors will be of different opinions.
0:11:31 > 0:11:34Not everybody, when you put a clinical question in the room,
0:11:34 > 0:11:36is always going to agree.
0:11:37 > 0:11:41The operation today will reduce cysts that have grown on the tumour
0:11:41 > 0:11:45to try and alleviate some of Prasanna's more disabling symptoms.
0:11:45 > 0:11:47Yes, those cysts are getting bigger.
0:11:47 > 0:11:49'At some point with Prasanna you need to think,
0:11:49 > 0:11:52"How many more operations can we do on this child?"
0:11:52 > 0:11:55We've always got to sit back and say, is it in his best interests?
0:11:55 > 0:11:58And I think we are all very happy as a team,
0:11:58 > 0:12:02it's the right thing to do and we are going to do an operation that is
0:12:02 > 0:12:06hopefully safe and it might, and probably will, help Prasanna.
0:12:06 > 0:12:09- Hello, how are you?- Say good morning.
0:12:09 > 0:12:12Are you all right? Nice to see you.
0:12:12 > 0:12:14- He has been asleep for the last day so...- Yes.
0:12:14 > 0:12:18- Good, so we are going to do this about lunchtime, OK?- OK.
0:12:19 > 0:12:23Alder Hey's £3 million highly specialised brain scanner,
0:12:23 > 0:12:26the only one of its kind for children in Europe,
0:12:26 > 0:12:28allows Conor to be more precise.
0:12:29 > 0:12:33We are very technology dependent and we are very expensive.
0:12:33 > 0:12:35I'm one of the worst offenders
0:12:35 > 0:12:39because whenever there's a new bit of kit that I think will improve
0:12:39 > 0:12:42patient care I will try it, use it, and show that it works.
0:12:45 > 0:12:47It is one of those luxuries,
0:12:47 > 0:12:50but it is not a luxury for a child's parents with a brain tumour,
0:12:50 > 0:12:53it's a necessity. So, how do you cost that? You don't.
0:12:55 > 0:13:00- I saw Sam sitting on a bus. - I saw Sam sitting on a bus.
0:13:10 > 0:13:13Do you mind telling me why you are here to see the doctor?
0:13:13 > 0:13:17I'm not here to see the doctor, I'm here to read the paper.
0:13:22 > 0:13:24I've just lost my job
0:13:24 > 0:13:28and I do equate that with this outbreak of eczema.
0:13:29 > 0:13:33Two hours into her morning surgery and Liz is on her eighth patient.
0:13:35 > 0:13:38Now you've lost your job, is the stress levels going to go down,
0:13:38 > 0:13:42- or are they just going up and up? - They're going up at the moment
0:13:42 > 0:13:45because I have actually gone for a lot of jobs and not got them.
0:13:45 > 0:13:47I think my age. You know, a middle-aged woman,
0:13:47 > 0:13:50it does sort of count against you looking for work.
0:13:50 > 0:13:53- What sort of work? - Careers adviser.
0:13:55 > 0:13:58As the first port of call for most of our medical needs,
0:13:58 > 0:14:03trips to see the GP account for 90% of our interaction with the NHS.
0:14:03 > 0:14:08One of our jobs is to keep most medical treatments out in
0:14:08 > 0:14:13general practice because we are so much cheaper than the hospital services.
0:14:13 > 0:14:17- Just remember that it's more important to be happy...- OK.
0:14:17 > 0:14:19..than to worry about your cholesterol.
0:14:19 > 0:14:21- That's all right.- All right?- Yes.
0:14:21 > 0:14:24Some people describe us as gatekeepers.
0:14:24 > 0:14:27- He was crying. - I was crying.- Were you?
0:14:27 > 0:14:30'I can sort of think of the whole NHS as a sort of ecosystem'
0:14:30 > 0:14:34and we are a very important sort of outer rim of the ecosystem
0:14:34 > 0:14:37and we have to prevent people getting into the central bit.
0:14:37 > 0:14:39- OK, so I'll stick on the diet. - Stick on the diet, yes.
0:14:39 > 0:14:43- Very good, thanks. Thanks very much.- OK, bye.
0:14:58 > 0:15:01One of the most expensive wards in any hospital
0:15:01 > 0:15:03is the intensive care unit.
0:15:08 > 0:15:1361-year-old Stuart has been in intensive care for almost four weeks
0:15:13 > 0:15:16after suffering a massive heart attack.
0:15:18 > 0:15:21His children, Sarah and Andrew, have been at his bedside
0:15:21 > 0:15:23every day since it happened.
0:15:23 > 0:15:29He was competing at a motorsport event and he pulled over
0:15:29 > 0:15:34on to the grass and it was apparent that he was very in distress.
0:15:34 > 0:15:39Thank goodness he got quick attention by the paramedics
0:15:39 > 0:15:40that were at the venue.
0:15:40 > 0:15:43Yes, he was lucky that it happened there
0:15:43 > 0:15:47because he had medical assistance as soon as possible
0:15:47 > 0:15:51- and in these cases that is what really is...- Makes a big difference.
0:15:52 > 0:15:55Lucky to be attended there by the paramedics
0:15:55 > 0:15:59and then airlifted here to the Queen Elizabeth Hospital.
0:15:59 > 0:16:03Stuart has been unconscious since he arrived in hospital.
0:16:04 > 0:16:08Every day he spends here costs the NHS £2,000.
0:16:09 > 0:16:13- How long have you been here now? - It's day 25.- Yes.- Yes.
0:16:13 > 0:16:16Where were you when you heard about your dad?
0:16:16 > 0:16:21I was actually on my honeymoon in Mauritius, so, yes, that was...
0:16:21 > 0:16:26That was a whole other dimension to the sort of situation we were in,
0:16:26 > 0:16:29I guess, but, you know, we just came straight here.
0:16:29 > 0:16:33As soon as we could we came straight here. Yes.
0:16:34 > 0:16:37When was the last time you spoke to him?
0:16:37 > 0:16:42It was when my brother gave us a lift to the airport,
0:16:42 > 0:16:45so they were just seeing us off,
0:16:45 > 0:16:49so in a really sad way, at least it was a goodbye,
0:16:49 > 0:16:52but not the good sort of goodbye that he would anticipate having.
0:16:54 > 0:16:58Until Stuart's condition improves, doctors can't be certain
0:16:58 > 0:17:01whether he has sustained any long-term damage.
0:17:02 > 0:17:04All his family can do is wait.
0:17:05 > 0:17:07We daren't plan anything
0:17:07 > 0:17:10because for every positive there's
0:17:10 > 0:17:12been a couple of little negatives,
0:17:12 > 0:17:17so we haven't planned, we haven't really planned at all.
0:17:17 > 0:17:22I am waiting to see how brain-damaged he is.
0:17:24 > 0:17:27That's what I need to come to terms with now really.
0:17:27 > 0:17:30His heart's working properly...
0:17:33 > 0:17:36Now we've got to see what's there.
0:17:53 > 0:17:55When you wake up in the morning first thing,
0:17:55 > 0:17:59is that when you cough most? When you've been lying down at night,
0:17:59 > 0:18:02when you sit up, wake up in the morning...
0:18:02 > 0:18:05- When I wake up in the morning.- You do a big cough in the morning then?
0:18:05 > 0:18:07- I am not waking because of the coughing.- OK.
0:18:07 > 0:18:09After the smoking cigarettes.
0:18:09 > 0:18:13- Do you see blood in it?- Yes. - Blood? Every day there is blood?
0:18:13 > 0:18:14The last two weeks every day.
0:18:14 > 0:18:17The last two weeks there's been blood. OK.
0:18:17 > 0:18:22In east London, Jane has found someone with the early signs of TB.
0:18:22 > 0:18:26So this gentleman came from Lithuania eight years ago
0:18:26 > 0:18:29but has been sleeping under a bridge in Shadwell.
0:18:29 > 0:18:34Has been complaining of a cough, he's coughed up some blood,
0:18:34 > 0:18:37and he feels very lethargic, which are all symptoms of TB.
0:18:37 > 0:18:39Once the X-ray came up
0:18:39 > 0:18:43and I could see this patch here of infection,
0:18:43 > 0:18:47this sort of white streak here,
0:18:47 > 0:18:49obviously that needs to be investigated.
0:18:49 > 0:18:52So you drink, do you take any drugs? Do you smoke heroin or...?
0:18:52 > 0:18:54No, I am smoking cigarettes.
0:18:54 > 0:18:58- But no crack, no heroin? - No, I am drinking beer and vodka.
0:18:58 > 0:18:59Beer and vodka.
0:18:59 > 0:19:03OK, so, what we'll do is we will get you to give a sputum sample.
0:19:03 > 0:19:08- If you can cough... - Yes.- And cough some up into a pot.
0:19:08 > 0:19:11We do see quite large pockets of Eastern Europeans
0:19:11 > 0:19:15in different parts of London because they tend to gravitate together.
0:19:15 > 0:19:19There is also a lot of them sleeping rough now.
0:19:19 > 0:19:21They came here for the job
0:19:21 > 0:19:24but the jobs have dried up and they are now homeless.
0:19:24 > 0:19:27I want the phlegm from the bottom of your chest.
0:19:27 > 0:19:28HE COUGHS UP
0:19:30 > 0:19:32Let's just see. OK.
0:19:32 > 0:19:35Yes, that's OK. And another one in here.
0:19:35 > 0:19:37HE COUGHS UP
0:19:39 > 0:19:41OK, beautiful. Yes.
0:19:41 > 0:19:43Perfect. Thank you.
0:19:46 > 0:19:50This one mobile X-ray units attends to 10,000 homeless people
0:19:50 > 0:19:51living in London.
0:19:51 > 0:19:55Every day is different. I know a lot of people say that
0:19:55 > 0:19:59about their jobs but with this one every day really is different.
0:19:59 > 0:20:04We have done some pretty rough estates at night, haven't we?
0:20:04 > 0:20:07We did have supermarket trolleys thrown at us in Brixton
0:20:07 > 0:20:10when we were screening down there one evening.
0:20:10 > 0:20:13We had a chap last week who was absolutely plastered.
0:20:13 > 0:20:16We actually got him up onto the van and his legs went
0:20:16 > 0:20:21and he was all over the place. But this chap got off the van,
0:20:21 > 0:20:24stood on the pavement, shook his trouser leg
0:20:24 > 0:20:28and the poo dropped down his trouser leg onto the pavement.
0:20:28 > 0:20:31He kicked it aside and walked off.
0:20:31 > 0:20:33With 50 people screened,
0:20:33 > 0:20:36the bus is ready to move on to its next location.
0:20:36 > 0:20:39We are going to Emmaus House,
0:20:39 > 0:20:41where the nuns feed the homeless.
0:20:41 > 0:20:42In Acton.
0:20:44 > 0:20:45That is very busy and popular.
0:20:51 > 0:20:55Well, he is two months old and he has got two lesions in his spine.
0:20:56 > 0:21:00I have explained to the patient, earwax is not a medical emergency.
0:21:06 > 0:21:10At the GP surgery, Liz's next patient is a regular.
0:21:10 > 0:21:13Last week she came in with chest pains,
0:21:13 > 0:21:16asking to be referred to a specialist.
0:21:16 > 0:21:19The cardiologist is looking at the letter right now
0:21:19 > 0:21:23and so now that bit is out of our hands,
0:21:23 > 0:21:26- which I know leaves you sort of sitting, worrying about it.- Yeah.
0:21:26 > 0:21:29If they have got any worries, they will get you straight in
0:21:29 > 0:21:32but that bit is being sorted out now.
0:21:32 > 0:21:37Just looking back at the specialists you have seen recently, it's...
0:21:37 > 0:21:38it's a lot.
0:21:39 > 0:21:42Jackie has already had over 100 consultations with
0:21:42 > 0:21:46specialists for a variety of conditions, including depression,
0:21:46 > 0:21:49which, so far, has been resistant to treatment.
0:21:50 > 0:21:55I am thinking, if your neck was the cause of the problems here,
0:21:55 > 0:21:58I wonder if a lot of the cause of your chest pain is going to
0:21:58 > 0:22:02be muscles as well and it is all part of your sort of depression, really.
0:22:05 > 0:22:09I suppose my question is whether you think some of this could be
0:22:09 > 0:22:12psychological or whether... I mean, both of you, really.
0:22:12 > 0:22:17Whether you think it is that you have got physical troubles as well.
0:22:17 > 0:22:20You worry there is a physical thing going on.
0:22:20 > 0:22:22Yeah, I think there is something.
0:22:22 > 0:22:25There is something more than just blood pressure cos if she
0:22:25 > 0:22:28is struggling to breathe, there has got to be a reason for it.
0:22:28 > 0:22:32- What is your fear? Heart attack sort of thing?- Yes, definitely.
0:22:32 > 0:22:37There is nothing to say that you are about to have a heart attack.
0:22:39 > 0:22:44- You feel more distressed to me today than Jackie does.- Yeah, I am.
0:22:44 > 0:22:47Cos I just keep thinking we are being let down, really,
0:22:47 > 0:22:50by a lot of it is because nothing is moving on quick enough
0:22:50 > 0:22:53and she has been like this so long now it is getting very worrying.
0:22:53 > 0:22:55I am worried about her.
0:22:55 > 0:22:57Yeah, I don't know what to say, really.
0:22:57 > 0:23:00I mean, people are looking, people are trying.
0:23:00 > 0:23:01Do you get that feeling or...?
0:23:01 > 0:23:04I just feel that, you know, something should be done quite
0:23:04 > 0:23:07quickly because she is not getting any better.
0:23:07 > 0:23:10I really want to get something done as soon as we can, obviously,
0:23:10 > 0:23:13cos she is suffering with this at the moment and obviously
0:23:13 > 0:23:15day-to-day life is making it really uncomfortable
0:23:15 > 0:23:17for both of us, really.
0:23:17 > 0:23:18Thank you.
0:23:20 > 0:23:24I don't know why some people's depression is what we
0:23:24 > 0:23:29call resistant depression, nothing fixes it.
0:23:29 > 0:23:31I kind of feel like with the depression,
0:23:31 > 0:23:33the answer must lie outside medicine
0:23:33 > 0:23:35cos we have tried all our medical fixes
0:23:35 > 0:23:38and we can't do it but there are people who
0:23:38 > 0:23:42just stay sort of unfixed,
0:23:42 > 0:23:48and live these very, very, sort of, blighted lives really, in some ways.
0:23:48 > 0:23:51You know. So, it is not like a minimal fix.
0:23:51 > 0:23:54It is not like, "Just pull yourself together and get over it."
0:23:54 > 0:23:57It is actually a blight on her life
0:23:57 > 0:23:58and we still can't fix it.
0:24:03 > 0:24:06- RADIO:- It is one o'clock. The latest news now...
0:24:22 > 0:24:23INAUDIBLE
0:24:27 > 0:24:29Saying you've got a nice rest overnight.
0:24:31 > 0:24:34- Just tired you out quite a bit with your physio.- Yeah.
0:24:34 > 0:24:37- So it is good that you're sleepy. - Yeah.
0:24:37 > 0:24:39Don't worry about that.
0:24:42 > 0:24:46And you're safe and well. You are really well looked after.
0:24:47 > 0:24:51Doctors don't know whether Stuart is aware of his surroundings
0:24:51 > 0:24:53and so Sarah and Andrew have been encouraged
0:24:53 > 0:24:56to interact with their dad as much as possible.
0:24:57 > 0:25:00They play a lot of Rolling Stones and Eric Clapton
0:25:00 > 0:25:05and things like that cos Dad's a real little rocker at heart so...
0:25:05 > 0:25:07- He likes a bit of ELO as well.- Yeah.
0:25:09 > 0:25:13We start to imagine what it would be like for ourselves
0:25:13 > 0:25:15and he must be so bored.
0:25:15 > 0:25:18You know, we can only anticipate that he is confused
0:25:18 > 0:25:21and he is not really quite sure what is happening so if we can be
0:25:21 > 0:25:26here as much as we can so he can hear our voices and play him nice music...
0:25:26 > 0:25:30Yeah, nice music when he seems more... He can rest.
0:25:30 > 0:25:35He has tried to whistle a few times. So we know that he is enjoying it.
0:25:39 > 0:25:43When Stuart had his heart attack, he was over 100 miles from home.
0:25:43 > 0:25:46But he can't be moved to his local hospital
0:25:46 > 0:25:50until an intensive care bed becomes free.
0:25:50 > 0:25:55In the meantime, the family are being housed nearby.
0:25:55 > 0:25:59I want to get home to my own creature comforts.
0:25:59 > 0:26:02When I left Reading it was the end of the summer.
0:26:02 > 0:26:05It feels like it is the start of the winter now.
0:26:05 > 0:26:08You know, it has been nearly four weeks so...
0:26:10 > 0:26:13We had to get into a little routine.
0:26:13 > 0:26:18As a teacher, I am a timetable person and I like a routine
0:26:18 > 0:26:21and we get up at the same time, we get here at the same time
0:26:21 > 0:26:24and then they go and see their dad.
0:26:25 > 0:26:29I guard our belongings that we have camped out with here
0:26:29 > 0:26:32and then they come back.
0:26:32 > 0:26:34Then it is my turn to go in and sit with him then.
0:26:47 > 0:26:50Kevin Edmonds, please, to room 15.
0:26:59 > 0:27:02Conor is about to start his second operation of the day to
0:27:02 > 0:27:05relieve the pressure in Prasanna's brain.
0:27:09 > 0:27:11It's not the surgery itself that's difficult,
0:27:11 > 0:27:14it's more that where we are is dangerous.
0:27:14 > 0:27:16But we have drained the first cyst nicely, we are inside it.
0:27:16 > 0:27:19We're just going to cut away more of the wall so it doesn't come back
0:27:19 > 0:27:22and we are going to go looking for the second cyst.
0:27:27 > 0:27:32Most tumour operations, we expect the children to be up, talking,
0:27:32 > 0:27:35moving, possibly eating and drinking the same night.
0:27:35 > 0:27:38With Prasanna, I will be happy if he is awake
0:27:38 > 0:27:43and he recognises us and he, you know, communicates with us.
0:27:45 > 0:27:47But he has had a heavy toll, Prasanna,
0:27:47 > 0:27:51and his mum and dad know that and they just want to stay with him
0:27:51 > 0:27:54as long as possible with as good a quality of life as possible.
0:27:58 > 0:28:01With his operation complete, Prasanna is taken into recovery.
0:28:06 > 0:28:11As part of the efficiency savings facing the whole of the NHS,
0:28:11 > 0:28:16Alder Hey has to make cuts of £33 million to its budget by 2016.
0:28:17 > 0:28:22Fellow brain surgeon Sasha is doing her bit to cut equipment costs.
0:28:22 > 0:28:27Oh, there will be £200,000 worth of stuff altogether, you know.
0:28:27 > 0:28:32Because there are things up here that cost £10,000.
0:28:32 > 0:28:34You know, it adds up and people just don't realise.
0:28:34 > 0:28:36They think if something...
0:28:36 > 0:28:38If you don't actually have to pay for something
0:28:38 > 0:28:43and it is there for the taking then you just don't think, you know,
0:28:43 > 0:28:45and that is the key thing - just to get people to think.
0:28:45 > 0:28:48I also go round the hospital turning off lights.
0:28:48 > 0:28:53She is pricing up all the equipment so that we know whenever...
0:28:53 > 0:28:56I am the most expensive neurosurgeon here, by the way,
0:28:56 > 0:28:58because I just use all the kit that I can
0:28:58 > 0:29:00and don't worry about the cost
0:29:00 > 0:29:06but as a part of our new striving to economise on the NHS,
0:29:06 > 0:29:09she is pricing up all the kit so if ever we use something,
0:29:09 > 0:29:13we know how much it costs so we will need less wasteful, hopefully. Sasha?
0:29:13 > 0:29:15Did you yell?
0:29:15 > 0:29:19Now that you are pricing, why don't you put 200,000 on this trolley?
0:29:19 > 0:29:25- 200,000? I can go to 99,000. £99,999.- This was 150 grand.
0:29:25 > 0:29:27I don't have that big a price sticker.
0:29:27 > 0:29:29Are you really pricing everything up?
0:29:29 > 0:29:31Yeah, look. Come and see. It's great.
0:29:31 > 0:29:35- What is that? £60?- £600. - 600 quid for one of these?
0:29:37 > 0:29:38That's shocking.
0:29:38 > 0:29:43The reason why NHS is on its feet is because these cost £430.
0:29:43 > 0:29:45That's just ridiculous.
0:29:45 > 0:29:48There is no competition so I think manufacturers can charge what
0:29:48 > 0:29:53they like. We put in valves for, how much, £600?
0:29:53 > 0:29:55At least this is good quality German engineering.
0:29:55 > 0:29:57This is £600 for a valve.
0:29:57 > 0:30:03But an average shunt, 400, 600, about £2,000 just in equipment.
0:30:03 > 0:30:07Let alone the cost. And who knows how much it costs to make? 20 quid?
0:30:07 > 0:30:11My next target is actually to get prices for re-sterilisation
0:30:11 > 0:30:13of all the trays under here so I can price that up as well
0:30:13 > 0:30:15so people know that if they open a tray
0:30:15 > 0:30:18even though it can be re-sterilised and it is not disposable,
0:30:18 > 0:30:20it still costs £150-odd to re-sterilise a tray
0:30:20 > 0:30:27so if you open it up unnecessarily that's another £150. You know.
0:30:27 > 0:30:29And you wouldn't do that with your own money.
0:30:29 > 0:30:31That's my message, really.
0:30:31 > 0:30:33- INTERVIEWER:- Will you be less wasteful?- No.
0:30:35 > 0:30:39'Rationing those sorts of expenses is not my job, thank God.'
0:30:41 > 0:30:45My job is to do the best that I can do for patients with brain tumours,
0:30:45 > 0:30:48with the best equipment and give them
0:30:48 > 0:30:51the best patient journey in that horrific time.
0:30:53 > 0:30:56The beauty of NHS, particularly in surgery,
0:30:56 > 0:31:01is that hopefully the decisions are the most pure and ethical because
0:31:01 > 0:31:05the only thing you are focusing on is doing the right thing by that child.
0:31:07 > 0:31:09- Hello.- Hello, hello. How are you? Are you all right?
0:31:09 > 0:31:14Everything is fine, everything went absolutely fine. OK? Yeah, good?
0:31:14 > 0:31:17- He's just out of a scan and we are just waking him up.- OK.
0:31:17 > 0:31:20We will do another scan tomorrow just to check him
0:31:20 > 0:31:21and then we'll see how he goes.
0:31:22 > 0:31:24OK? All right?
0:31:34 > 0:31:37We have many patients who come into our hospital and they say,
0:31:37 > 0:31:42"Well, the NHS is free." The NHS has never been free.
0:31:42 > 0:31:46We pay our taxes to have an NHS service so it has never been free.
0:31:47 > 0:31:52Last year, the NHS spent £42 million treating overseas patients
0:31:52 > 0:31:55who are not entitled to free healthcare.
0:31:55 > 0:31:57So, right now, what we are going to do...
0:31:57 > 0:32:03We have a patient in our day surgery unit and we are going to
0:32:03 > 0:32:09interview this patient and try to confirm their status.
0:32:09 > 0:32:12Many larger hospitals have started to employ overseas managers
0:32:12 > 0:32:16like Carlton to try and get on top of this growing problem.
0:32:28 > 0:32:30- Good morning.- Good morning.
0:32:30 > 0:32:34My name is Carlton Stephens, I'm from the overseas visitors team.
0:32:34 > 0:32:39'My main concern is is the person entitled to NHS care and,
0:32:39 > 0:32:42'if not, are they chargeable?'
0:32:42 > 0:32:47- How long have you lived in the UK for?- 12 years.- 12 years.
0:32:47 > 0:32:51- Which country are you from? - Lithuania.- Lithuania?- Yes.- OK.
0:32:51 > 0:32:53We have been called racist.
0:32:55 > 0:32:59We have been told that we are targeting certain groups.
0:32:59 > 0:33:05We have been called every conceivable name you can think of.
0:33:07 > 0:33:10But I say to my team,
0:33:10 > 0:33:13"As long as you follow the Department of Health
0:33:13 > 0:33:17"guidance on the interviewing and assessing of patients
0:33:17 > 0:33:22"and their entitlement to NHS care, you cannot go wrong."
0:33:22 > 0:33:28Do you have any form of documentation to show that you are an EU citizen?
0:33:28 > 0:33:32- Yeah, I left other things outside. - OK, that's absolutely fine.
0:33:32 > 0:33:37Now, from the information that you have presented, I can tell you that
0:33:37 > 0:33:43you are entitled to NHS care but for me to confirm that,
0:33:43 > 0:33:47what I would like is a copy of either your passport or ID card.
0:33:48 > 0:33:53Every year, Carlton and his team invoice over 400 overseas patients,
0:33:53 > 0:33:58calculating the exact cost of the health care they have received.
0:33:58 > 0:34:01- INTERVIEWER:- How much is it to have a baby?
0:34:01 > 0:34:03To have a baby...
0:34:05 > 0:34:10..if it is normal delivery, with complications,
0:34:10 > 0:34:14it will cost £1977.00.
0:34:15 > 0:34:18- What does that mean? Is that a stroke?- That's a stroke, yeah.
0:34:18 > 0:34:24That's a stroke and it says for the overseas visitors,
0:34:24 > 0:34:28the cost is 11,000...
0:34:29 > 0:34:37So, the total cost for this is £14,408.12.
0:34:40 > 0:34:43There is one that I gave you the other day. Yeah, this one.
0:34:43 > 0:34:49It is going to be thousands of pounds.
0:34:49 > 0:34:56I would say this could be in the region of up to 100,000.
0:34:56 > 0:34:59Chemotherapy is very expensive.
0:35:11 > 0:35:16In the last 10 years, the birth rate in Britain has increased by 20%.
0:35:16 > 0:35:20We're going to start another drip just to give you some more fluids.
0:35:20 > 0:35:25And keep that pan there, just to keep an eye on the colour of your water.
0:35:25 > 0:35:27At Birmingham Women's Hospital,
0:35:27 > 0:35:30a consultant-led delivery suite caters for the growing
0:35:30 > 0:35:33number of women whose births have added complications.
0:35:34 > 0:35:38I think I might change your position just to see
0:35:38 > 0:35:40if it will help baby cos the heartbeat is
0:35:40 > 0:35:42dipping down a little bit and sometimes
0:35:42 > 0:35:45if the cord is just wrapped around baby somewhere it can put
0:35:45 > 0:35:48a little bit of extra pressure on baby's heart rate.
0:35:48 > 0:35:5224-year-old Rebecca and her partner Andy are having their fourth baby.
0:35:53 > 0:35:57The midwives are concerned about the baby's heart rate.
0:35:57 > 0:36:00Shall I have a little walk then, being as...
0:36:00 > 0:36:02Or do you want me to jump on the bed?
0:36:02 > 0:36:04Stand up for a little bit and see if that makes a difference.
0:36:04 > 0:36:07If not we might have to just lie you on your side and see if that helps.
0:36:07 > 0:36:09- Is that all right?- Yeah.- Yeah?
0:36:11 > 0:36:15- Is the heartbeat OK, yeah? - It is dipping down a little bit.
0:36:15 > 0:36:17- It has got a bit low, isn't it, the heartbeat?- Yes.
0:36:17 > 0:36:21- Can I just feel your pulse?- Yeah.
0:36:21 > 0:36:23When she gets to the contractions, it does drop a bit anyway,
0:36:23 > 0:36:25doesn't it?
0:36:25 > 0:36:29When she gets to pushing, it can drop sometimes but we are not
0:36:29 > 0:36:33at that stage yet so that's why we get a bit concerned and worried.
0:36:33 > 0:36:34It's all happening.
0:36:34 > 0:36:37I do need to get the doctors to have a little look at baby's
0:36:37 > 0:36:39heartbeat though so stay on your side a little bit.
0:36:39 > 0:36:42We are probably going to start another drip just to give you
0:36:42 > 0:36:46- some more fluids.- It's not going to be for ever, babe. You know that.
0:36:46 > 0:36:49- I know.- It won't be long.- I can't wait for him to come.- I know.
0:36:49 > 0:36:51It won't be long. I love you.
0:36:54 > 0:36:55Hello.
0:36:59 > 0:37:03Rebecca, I just need to talk to you about the heart rate
0:37:03 > 0:37:05monitoring on baby, OK?
0:37:05 > 0:37:09What we want to know is whether baby is becoming distressed or not
0:37:09 > 0:37:12and we can either take a little sample of blood
0:37:12 > 0:37:14from the top of baby's head.
0:37:14 > 0:37:16It is like doing a pinprick on your baby's head.
0:37:16 > 0:37:19The only other option of knowing that the baby is fine is to deliver
0:37:19 > 0:37:22- the baby.- A Caesarean, or...?
0:37:22 > 0:37:27- Yeah, well...- Is this a choice you are offering or is it...?
0:37:27 > 0:37:29No, no, I am just watching at the moment.
0:37:29 > 0:37:32If baby's heart rate doesn't recover then we might not have a choice.
0:37:32 > 0:37:34Do I need to push?
0:37:34 > 0:37:37BEEPING
0:37:37 > 0:37:40We just need to make sure baby's heartbeat is OK, sweetheart.
0:37:40 > 0:37:44- She is still 4cm.- Yeah, still 4cm.
0:37:44 > 0:37:48What's happening is that this baby's heart rate has dropped.
0:37:48 > 0:37:52- Is that the true reading there? - That's the true reading there.
0:37:52 > 0:37:53Oh, my God.
0:37:53 > 0:37:56- Yeah, I think so.- It's not worth taking the risk, is it?
0:37:56 > 0:37:58Baby's heart rate is not coming up
0:37:58 > 0:38:02so I think we need to take you to the operating room, OK?
0:38:02 > 0:38:06I am so sorry, darling. You are doing so well.
0:38:06 > 0:38:09We are going to take you to theatre straight away, darling.
0:38:09 > 0:38:12Once you are asleep, it only takes a minute to deliver the baby.
0:38:12 > 0:38:15It takes a bit longer to put you back together again.
0:38:15 > 0:38:17- Is this an emergency Caesarean?- Yes.
0:38:17 > 0:38:20- Would I be able to be with her or not?- If she is asleep, no.
0:38:20 > 0:38:22It's going to be all right.
0:38:22 > 0:38:25It is going to be over soon, darling, all right?
0:38:25 > 0:38:26BEEPING
0:38:28 > 0:38:31Do you want some help?
0:38:31 > 0:38:33Follow us to theatre.
0:38:49 > 0:38:52Do you want to just move your arm up to that?
0:38:52 > 0:38:55What is all this traffic anyway? Has there been an accident?
0:38:55 > 0:38:58Has she lost enough blood to fill an average mug?
0:39:07 > 0:39:09Let's go this way.
0:39:09 > 0:39:11- INTERVIEWER:- Where are we going, Liz?
0:39:11 > 0:39:15We are going to do a home visit to a patient of mine
0:39:15 > 0:39:19who has got lung cancer
0:39:19 > 0:39:24and is sort of receiving terminal care.
0:39:24 > 0:39:27I kind of need to get some certain things sorted out in this family.
0:39:29 > 0:39:34The reason why it is more difficult than you might expect
0:39:34 > 0:39:38is that there are two sick people in this house.
0:39:40 > 0:39:42Eric and his son.
0:39:42 > 0:39:47And so it is an incredibly unusual and difficult situation.
0:39:47 > 0:39:48As you will see.
0:40:02 > 0:40:07Hello. Hello, hello. Where shall I sit? Shall I sit over there?
0:40:07 > 0:40:09Here if you like, love.
0:40:09 > 0:40:13Eric is in the advanced stages of lung cancer.
0:40:13 > 0:40:16He is being cared for by his wife Betsy.
0:40:17 > 0:40:22Their son Gary has also been diagnosed with terminal cancer.
0:40:22 > 0:40:27So, what I am hearing is that it is understandably pretty tense
0:40:27 > 0:40:32here from time to time. Is it pretty tense here all the time?
0:40:32 > 0:40:37I think the trouble is we are all here all day long, all together.
0:40:37 > 0:40:41- But you can't go anywhere. Is that the frustration?- I can't go nowhere.
0:40:41 > 0:40:44He is sat in here all the time.
0:40:44 > 0:40:47The boy has asked you if you would like to go anywhere.
0:40:47 > 0:40:49I don't want to go anywhere.
0:40:49 > 0:40:53But then you don't want to be sat in here all the time, do you?
0:40:53 > 0:40:56No, I don't want to go. Where do you want to go?
0:40:56 > 0:40:59I'm just wondering if this is part of your illness that actually
0:40:59 > 0:41:03everything is... You are fed up with it all. Yes.
0:41:03 > 0:41:05Yes. That is it.
0:41:05 > 0:41:08That is it, isn't it? First of all...
0:41:08 > 0:41:11I get tired of being picked at.
0:41:11 > 0:41:15Yeah, it's... What...
0:41:15 > 0:41:19If we are looking into the future, if we look ahead now,
0:41:19 > 0:41:22- we can't have you... - Arguing.- ..arguing.
0:41:22 > 0:41:25We can't have you like this because it is horrible, isn't it?
0:41:25 > 0:41:28- 50 bloody years, we have been together.- BETSY:- 55.
0:41:28 > 0:41:31Well, 55, if you want to get technical.
0:41:31 > 0:41:34You haven't been arguing for 55 years, have you?
0:41:34 > 0:41:38Just leave me up in bed and I'll stay up there out of the way.
0:41:38 > 0:41:42- BETSY:- We don't want you in bed all the time.
0:41:42 > 0:41:46What I have got here is something we give
0:41:46 > 0:41:52when we deal with people who, like you, to try and find out...
0:41:52 > 0:41:54- You class me as very ill then? - I do, yes.
0:41:54 > 0:41:56You can't even go out any more much, can you?
0:41:56 > 0:41:58Don't you think you are very ill?
0:41:58 > 0:42:00Well, I am walking better today than I was yesterday.
0:42:00 > 0:42:05You know what is happening to you at the moment, do you?
0:42:05 > 0:42:08Well, as far as I know, I am just waiting to die.
0:42:08 > 0:42:10Does it feel a bit hopeless to you then?
0:42:12 > 0:42:15Well, got to, hasn't it?
0:42:15 > 0:42:20- Anything you look forward to at the moment?- Not really, no.- No.
0:42:22 > 0:42:27We should talk about where you would like to be
0:42:27 > 0:42:30in the next few weeks and months
0:42:30 > 0:42:34and whether here is the right place for you or whether somewhere else is.
0:42:34 > 0:42:36And it is your choice.
0:42:36 > 0:42:38Because this is...
0:42:38 > 0:42:42- Do you know, I think this is too much in some way?- So do I.
0:42:42 > 0:42:45- I don't agree with it at all.- No.
0:42:45 > 0:42:48I would rather have a quiet life and what is it?
0:42:48 > 0:42:51But I'm never going to get that.
0:42:51 > 0:42:55I suppose living should be the most important thing but then...
0:42:59 > 0:43:03..I don't see there is much in life for me.
0:43:03 > 0:43:06That's the honest truth about it.
0:43:06 > 0:43:08We understand that life is miserable.
0:43:08 > 0:43:12But that is very difficult for everybody and actually...
0:43:14 > 0:43:17..Bet needs a break and if she is going to keep looking after you,
0:43:17 > 0:43:20she does need a break and perhaps we can help organise that.
0:43:20 > 0:43:25Either you go somewhere for a few days where you can, you know,
0:43:25 > 0:43:29have some nurses look after you or else we get some people in to help.
0:43:29 > 0:43:33Where I really want to be is here and that is it and all about it.
0:43:33 > 0:43:36This is where I should like to end up my days.
0:43:36 > 0:43:39So, when you come to the very end, you'd like to be here.
0:43:39 > 0:43:41Yes, I would, yes.
0:43:41 > 0:43:44I don't know whether it is right for Bet,
0:43:44 > 0:43:47by the time you get the undertakers in here and all the rest,
0:43:47 > 0:43:50traipsing up and down the stairs, everybody up the house.
0:43:52 > 0:43:56It is adding more work to her job, house cleaning
0:43:56 > 0:44:01and all the rest of it. I don't know whether that really is the thing.
0:44:01 > 0:44:05You can't bring all that into it, can you?
0:44:05 > 0:44:11Everybody has to face all these problems. Everyone has to face them.
0:44:13 > 0:44:15Would you like to have a little time away and then come back?
0:44:15 > 0:44:19That sort of thing. Just to get a break from the... It's a bit intense.
0:44:19 > 0:44:23- Yeah.- We need to start thinking about these things.
0:44:23 > 0:44:26Otherwise you guys are going to be fighting.
0:44:26 > 0:44:31You know, it's sad, isn't it, to have to be like this?
0:44:31 > 0:44:35I think it is terrible that we have got to be fighting.
0:44:35 > 0:44:37The same as I have said.
0:44:37 > 0:44:4140, 50 years together and to end up like this
0:44:41 > 0:44:44when we know we haven't got that much time to mess about.
0:44:47 > 0:44:49OK, well, thank you for seeing us.
0:44:49 > 0:44:53We will try and do something, try and arrange something. Yeah?
0:45:01 > 0:45:03- INTERVIEWER:- Tricky.
0:45:03 > 0:45:08Tricky is understatement.
0:45:08 > 0:45:10Such a difficult situation.
0:45:10 > 0:45:14They're kind of locked into it and nobody seems to be able to...
0:45:17 > 0:45:22Nobody seems to be able to find a way out. We will try and help.
0:45:24 > 0:45:27Liz has more than a doctor's understanding of what Eric
0:45:27 > 0:45:29and his family are going through.
0:45:30 > 0:45:35She herself was diagnosed with cancer a year ago.
0:45:35 > 0:45:39- Did you think you were going to die, Liz?- Um...
0:45:41 > 0:45:43I didn't ever...
0:45:43 > 0:45:46No, I never got to the stage where I thought, "This is it."
0:45:46 > 0:45:52But there were moments in my journey, as we call it,
0:45:52 > 0:45:57my cancer journey, when I was waiting for results and things
0:45:57 > 0:46:00such as the result of a scan and I thought, "If this is wrong...
0:46:00 > 0:46:02"If this is the wrong result, I am going to die."
0:46:02 > 0:46:04So, I did have the thing of sitting
0:46:04 > 0:46:07waiting for someone to give a result that was rather like,
0:46:07 > 0:46:11you know, he puts on his black cap and it's all over.
0:46:11 > 0:46:14And I was lucky.
0:46:14 > 0:46:20The news was good so I was clear but it's a sort of life-changer.
0:46:20 > 0:46:23But it is one that makes you confront the possibility of your
0:46:23 > 0:46:27mortality and it is very hard, I think, to have it without
0:46:27 > 0:46:30actually at times feeling terrified that you are going to die.
0:46:31 > 0:46:34So, um, pretty horrific.
0:46:35 > 0:46:40Big breaths. Breathe away on that gas. That's lovely. That's it.
0:46:40 > 0:46:44- Big breath in. - Is Becky all right there?
0:46:44 > 0:46:47Yeah, she is obviously a bit upset and a bit frightened but she
0:46:47 > 0:46:51understands what is happening and she is happy with the decision, I think.
0:46:51 > 0:46:54Nothing is going to happen to her after, though, is it?
0:46:54 > 0:46:58- She will be all right.- No. - All right. Thank you.
0:46:58 > 0:47:01Because the baby's heart rate has dropped dangerously low,
0:47:01 > 0:47:03doctors have decided to give Andy's partner Rebecca
0:47:03 > 0:47:05an emergency Caesarean.
0:47:06 > 0:47:09Well, she was in distress, wasn't she?
0:47:14 > 0:47:17The baby's heartbeat continued to drop, did it?
0:47:22 > 0:47:24Let's hope things are OK then.
0:47:36 > 0:47:39The last pregnancies went perfect, like, you know.
0:47:39 > 0:47:41Couldn't wish for better ones.
0:47:45 > 0:47:46It's hard work.
0:47:46 > 0:47:49It has got to be hard work, ain't it, going through all the labour?
0:47:52 > 0:47:55We can't... A male can't describe it, can he?
0:47:55 > 0:47:59You have just got to... You know, you feel helpless. What can you do?
0:48:02 > 0:48:05You want to be in there holding her hand, ain't it? And you can't.
0:48:05 > 0:48:07Nothing more you can do.
0:48:09 > 0:48:14- Coming in?- All right, yes. Thank you.- Sit in that green chair.
0:48:14 > 0:48:15All we ask is that...
0:48:15 > 0:48:18The baby's heart rate has stabilised
0:48:18 > 0:48:21and Andy is allowed into the theatre for the birth.
0:48:21 > 0:48:23Are you all right, baby?
0:48:27 > 0:48:29Are you all right, honey?
0:48:38 > 0:48:41And it is a cancer of the lining of the stomach.
0:48:57 > 0:49:01Well, the patient we are about to see, from the information that
0:49:01 > 0:49:06I have, I feel that there may be an issue with their status.
0:49:06 > 0:49:09I think that they are living abroad
0:49:09 > 0:49:12and they have come back to the UK just to seek treatment
0:49:12 > 0:49:15and then go back to whichever country they are from.
0:49:17 > 0:49:20In reality, what they should do is go back to their own country,
0:49:20 > 0:49:26seek treatment there and then they can return to continue
0:49:26 > 0:49:28whatever their business is in the UK.
0:49:36 > 0:49:40My name is Carlton Stephens, I'm the overseas manager for King's.
0:49:40 > 0:49:42HE CLEARS THROAT
0:49:42 > 0:49:46Are you a British citizen or do you...?
0:49:46 > 0:49:50- I am not a British citizen. - OK. Are you a visitor to the UK?
0:49:50 > 0:49:51I am not a visitor.
0:49:51 > 0:49:55I work with a company which has business in the UK and outside UK.
0:49:55 > 0:50:00Do you have any documentation on you at the moment with your name
0:50:00 > 0:50:05- and address on?- No. No. Not on me, no.- Not on you.
0:50:05 > 0:50:08So, what type of visa are you on?
0:50:08 > 0:50:10Forgotten.
0:50:12 > 0:50:16The patient may not know it but without a settlement visa
0:50:16 > 0:50:18he is not entitled to free healthcare.
0:50:21 > 0:50:27He says that he has a settlement visa and he told me
0:50:27 > 0:50:29approximately around 1999.
0:50:32 > 0:50:35So he doesn't have a settlement visa, does he?
0:50:40 > 0:50:43Well, that's not good news.
0:50:43 > 0:50:47It could be a simple mistake and we have to take it at face value.
0:50:47 > 0:50:49We cannot say that he has misled us.
0:50:49 > 0:50:52It could just be a simple mistake he forgot.
0:50:52 > 0:50:57But I will be informing him that he is a chargeable patient and
0:50:57 > 0:51:01he will be charged for all treatment that he is going to receive.
0:51:01 > 0:51:04Which is a pity.
0:51:04 > 0:51:05Because I do like him.
0:51:05 > 0:51:11He is a very approachable man and I think he was honest with us...
0:51:13 > 0:51:15..but not fully.
0:51:17 > 0:51:23Because this was picked up by my team,
0:51:23 > 0:51:30we have now been able to inform this gentleman that he will be charged,
0:51:30 > 0:51:34we will be able to recoup the monies, I believe, in this case
0:51:34 > 0:51:39and I think the word will get round that that is the case
0:51:39 > 0:51:42in this trust and that is my aim -
0:51:42 > 0:51:48to make this trust known as a trust that diligently looks for,
0:51:48 > 0:51:52finds and bills patients that are not entitled to NHS care.
0:52:03 > 0:52:07Very cold water. So, we have delivered your baby's head.
0:52:07 > 0:52:10- Do we know what we are having?- A boy.
0:52:11 > 0:52:15Hello, little one. Hello.
0:52:15 > 0:52:17BABY CRIES
0:52:23 > 0:52:24Aaw.
0:52:24 > 0:52:28- Congratulations.- Thank you. - Got there in the end.
0:52:31 > 0:52:34Like a quarter of all babies born in Britain,
0:52:34 > 0:52:36baby Joe is delivered by Caesarean section.
0:52:43 > 0:52:47- You have got a visitor. Lift your head.- OK. He's very well.
0:52:51 > 0:52:53And at just three minutes old,
0:52:53 > 0:52:56he has already cost the NHS over £2,000.
0:53:11 > 0:53:13- Have a good weekend.- Yeah, and you.
0:53:19 > 0:53:22We have just got to sort out the transport, yeah.
0:53:22 > 0:53:25Then hopefully we'll get him back later on today and he can go home.
0:53:25 > 0:53:28Oh, Mum'll be really pleased. That's great. That's really good.
0:53:31 > 0:53:34There's been some unexpected news for Stuart's family.
0:53:34 > 0:53:38An intensive care bed has become free at his local hospital.
0:53:38 > 0:53:41We are going back to Reading today.
0:53:41 > 0:53:44- Oh, wow. Oh, fantastic.- Yeah.
0:53:52 > 0:53:54That's really brilliant.
0:53:54 > 0:53:58It is very emotional. It will be very emotional to leave.
0:53:58 > 0:54:02Cos it feels more longer than 25 days.
0:54:02 > 0:54:06Then hope. Don't mope.
0:54:06 > 0:54:09I was just thumbing through a magazine there
0:54:09 > 0:54:12and I was looking at new bathrooms and things and I was thinking,
0:54:12 > 0:54:14"No, you can't have that, Liz.
0:54:14 > 0:54:18"You are now going to have to think in terms of if I can ever get him
0:54:18 > 0:54:25"home, he's probably going to need things that help disabled people."
0:54:25 > 0:54:29So it's a whole new ball game for me now.
0:54:29 > 0:54:32Totally, totally different.
0:54:45 > 0:54:48Let me just take that up there.
0:54:48 > 0:54:51- How is that?- That's not too bad.
0:54:52 > 0:54:57After 10 hours consulting, Liz still has a backlog of patients to see.
0:54:57 > 0:54:59That's lovely. Thank you very much.
0:54:59 > 0:55:02Another hour and a bit and then I have to do that...
0:55:02 > 0:55:06Hope I don't get a late visit cos a late visit is the last thing
0:55:06 > 0:55:09you kind of want, especially if it is a difficult one, in the evening.
0:55:09 > 0:55:12Mr Gaetani?
0:55:12 > 0:55:14- INTERVIEWER: - At the end of the day, Liz,
0:55:14 > 0:55:16do you go home thinking you have done some good?
0:55:16 > 0:55:18Today I think so, yes.
0:55:19 > 0:55:21Today I have done some good.
0:55:23 > 0:55:27And if you went and asked my patients, the ones who have seen me,
0:55:27 > 0:55:30it would be interesting to hear what they say, you know.
0:55:30 > 0:55:32And some will say, "No good at all,"
0:55:32 > 0:55:35but a lot will say, "Yes, she sorted out the problem I had.
0:55:35 > 0:55:38"I came with a problem, I went out feeling better than when I came in."
0:55:38 > 0:55:41- Oh, yes.- There's another one coming up as well.
0:55:41 > 0:55:44It went down about a week ago then came up again.
0:55:44 > 0:55:46- So, you need antibiotics.- OK.
0:55:46 > 0:55:48- To get rid of those.- OK.- Very good.
0:55:48 > 0:55:54I've seen 40 people today. I made one referral to hospital.
0:55:54 > 0:55:56But the rest I have managed here.
0:55:56 > 0:55:59Therefore I have worked as a gatekeeper all day long.
0:55:59 > 0:56:01This is the NHS, you know.
0:56:01 > 0:56:05It is not expensive private medicine where everything is on offer.
0:56:05 > 0:56:09It is a limited resource and we have to husband it
0:56:09 > 0:56:12and I hope nobody has suffered as a result.
0:56:19 > 0:56:22I'll see you tomorrow. See you tomorrow.
0:57:25 > 0:57:26To order your free copy
0:57:26 > 0:57:27of the Open University's booklet,
0:57:27 > 0:57:29Working To Save Lives,
0:57:29 > 0:57:31which accompanies this series,
0:57:31 > 0:57:35call 0845 271 0015 or go to
0:57:35 > 0:57:39bbc.co.uk/keepingbritainalive
0:57:39 > 0:57:41and follow the links to the OU.
0:57:44 > 0:57:48Subtitles by Red Bee Media Ltd