Episode 7 Keeping Britain Alive: The NHS in a Day

This programme contains scenes which some viewers may find upsetting.

18th of October, 2012.

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

This change will be a disaster.

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.

WHISTLE SOUNDS

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

We want that to be in your voice all 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.

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 2:55am.

RADIO: 10th of October. The main stories.

The report finds alarming failures...

Official estimates suggest the number of people being trafficked in and out...

BABY CRIES

The stabbing we will bring into two. Is that all right?

Every night while we sleep, the NHS continues its work,

looking after us 24 hours a day.

RADIO TRANSMISSION: It's a 20-year-old female.

She's requested no lights and siren.

She is 15 weeks pregnant

and has taken an overdose of mixed medication.

Repeat that. BEEPING

Yeah, that's all received and we're mobile on that.

Paramedics Mel and Jay are halfway through their 12-hour night shift.

We have a young lady.

She's 15 weeks pregnant, apparently,

and she's taken an overdose of painkillers.

Overdoses are really common. Yeah. Really common.

They're normally just for attention.

There's normally no suicidal intent but we shall see.

Mel thinks she recognises the name and the address.

And last time she wanted a bit of company.

But I'm not very good at company!

-HORN SOUNDS

-Women drivers! It's always women!

It also said that she's asked we don't use lights

and sirens so we'll turn them off when we get up the street.

Apparently 999 do requests now!

The name really, really rings a bell.

I think it's going to drive me mad till I get there!

Have a sit-down. What's the problem tonight?

Stupid. Don't be stupid!

They've picked up the patient

and Mel recognises her as a regular caller.

It's all over now. Don't be ridiculous.

-Sit yourself down.

-Sit down.

-Sit down!

-What do you think's going to happen?

-Sit down!

Do you think we're going to let you just jump out of the cab? Eh?

-Seriously?

-Sit down.

What do you think is going to happen?

Sit on the seat!

We're here to help you. Now sit on the seat.

Where are you going to go? We'll get the police and you'll get arrested.

You are not getting off the ambulance.

-You called for our help, haven't you?

-I didn't call you.

I called NHS Direct.

Sit down. Don't be silly about it.

-Just get the police in. She is not going to come.

-Fine.

You're not getting off the ambulance.

You're not, cos I've locked the doors now.

INDISTINCT RADIO SPEECH

Thank you. Can we get police, please?

We've pulled up at the side of the road.

-This patient is trying to jump off the ambulance.

-One, two, three. Yes.

I'm not going to let you go to jump into the road in front of cars!

It's not going to happen, is it?

You keep asking but I'm a stubborn twat, so no.

RADIO: Can we confirm that you're remaining where you are at the moment?

You're not going to get out, are you?

It's locked so you can't get out.

We're going to be watching it all night. You'll be videoed up there.

In the UK, one in three of us struggles with a sleep disorder.

Basically, the reason I'm here is that I've been having very

disturbed sleep and it's mainly my wife, actually,

that's pointed it out to me, but I tend to kick in my sleep,

I twitch in my sleep

and I'm starting to give my wife a few bruises, I think.

SIGHING

-Shall we go through some CCTV today, Carlos?

-Can do, yeah.

SIREN SOUNDS

In west London, a young man has been stabbed

and is on his way to the specialist trauma centre in St Mary's.

This is Leon. 20-year-old male.

Was standing at the gateway to a house, somebody ran past him

-that he didn't see.

-Right.

Consultant Mark Wilson leads the team as they assess

the extent of Leon's injuries.

Incised wound of the left scapula.

-Not sucking or blowing.

-OK.

-He's had five milligrams of morphine.

-OK, fine.

All right. Thank you very much. OK, let's take it from the top. Hi, Leon.

How are you? I'm one of the doctors. Are you all right? So airways clear.

-Talking.

-Let's have a quick listen to your chest, OK?

Deep breaths in and out.

We've got a line in, we've got the bloods off.

'Trauma is a big thing.'

Trauma's the commonest cause of death in the under-40s, worldwide.

We're going to put a couple of stitches in this as well, all right?

Do you know what you were stabbed with, by any chance?

'Usually, we have very little history as patients come through the doors'

so you start with a blank canvas

and you treat in priority things that are likely to kill you

and you're assessing and treating as you go on.

-Is this to set him up for the chest X-ray?

-Yeah.

The only thing that's really of obvious concern, immediate,

is his tachycardia, his fast heart rate.

That can be a sign of blood loss, which can occur

without you really knowing it in young, fit people

cos they compensate very well.

But he kind of looks too well for that.

It's more likely to be something he's taken or something else going on

that's giving him tachycardia.

Or pain. Pain alone can cause a fast heart rate.

-We'll take the dressing down.

-Leave that for the minute.

-Let's get the scan and chest X-ray done first and we will do that in a minute.

-No blood at the meatus.

No scrotal haematoma. OK. Good.

Well, on the scan we think we've seen some blood within his thorax

so that means he's probably bleeding internally, which would account for the high heart rate.

So we want to do a CT scan now and just see exactly how much blood he has got in his chest.

Nice, deep breaths.

-And again.

-I'll come with you.

If Leon has a lot of blood on his chest,

the pressure could force his lungs to collapse.

On three. One, two, three.

-Are you all right?

-We will be as quick as we can.

SIREN SOUNDS

Because their patient tried to jump out of the ambulance,

Mel and Jay now have a police escort to the hospital.

Every single person that you deal with,

it's constantly in the back of your mind that,

you know, this could kick off, really.

There was no reason to do what she's just tried to do.

To be fair, I thought she was going to hit me.

Once a completely unconscious patient just flipped.

Pulled my crewmate over his chest, kicked me twice in the chest

and flung me into a wall.

And then once in the back of the ambulance,

we spent an hour and a half with this girl, who was drunk,

so that she was safe till her boyfriend came and picked her up.

And just completely out of the blue,

she dug her nails in me and drew a tiny bit of blood.

Whoever the judge was when they dealt with her proper threw the book at her.

And it's the way it should be. It should be zero tolerance.

What are you doing? Just sit yourself down.

-Do you want me to pull over?

-Just carry on.

-I think we'll be all right.

-OK.

Where's your seatbelt? Move.

-Nearly there now, anyway.

-PATIENT: Help me! Get off!

Don't spoil it.

-I'm only going to

-BLEEP

-do it again anyway.

-Do what?

Take the tablets again.

See, this really annoys me because she's saying that she's only going to do it again.

She's been sectioned three times in the last three days.

How long is this going to carry on for?

Going by her history she's had an ambulance out every single day.

The same sort of thing.

Throwing herself off ambulances, out of police cars.

From all the different stations, we've all got our regular callers.

You all right, mate?

Right, just wondering if you've got any ongoing situations at the moment?

I think an 18-year-old with his mum and dad

so I don't think that... He's compliant at the moment.

Right, OK. Is there any other ongoing situations?

'We've had quite a lot of tussles.'

I've been here nearly 16, 17 years.

I don't want to frighten anyone but I've had two broken noses,

I've been stabbed once, just slightly.

It was just a small blade.

That was about 1997, wasn't it? So, hence we've got these.

Every day, the NHS coordinates the collection and distribution

of organs, thousands of litres of blood and other vital fluids.

In this neonatal unit in London,

premature babies are given breast milk,

donated by new mums across the country.

Anna's baby was born 13 weeks premature.

I didn't have milk first three days and this is normal

because the body is not ready for feeding the baby.

And then one of the nurses told me that, "Don't worry.

"They would be given donor's milk."

I was so grateful to women which were giving milk,

for free, to somebody else

and maybe one day to meet them and to tell thank you.

It's really, really important.

SIGHING

SIREN SOUNDS

We're going to a 31-year-old female that's pregnant.

Don't know how far gone she is but it's just coming through as labour.

She's having contractions every five minutes, apparently.

You know, they've had nine months to prepare for a birth, really.

And then as soon as they start getting contractions,

they'll call us rather than phone a taxi or whatever.

-Materna-taxi.

-Yeah, materna-taxi, we call it!

Last year, more than 700,000 babies were born in Britain.

Around 20,000 were born outside of an NHS hospital.

I wonder if he's round the other side of the building.

Nearly 40 of them were born in am ambulance.

Hello.

-When did the contractions start, then?

-Yesterday.

-OK.

You've got no urge to push or anything like that, have you?

All right.

GROANING

Oh, gosh!

I don't want to patronise you and tell you to do all your breathing and stuff like that.

All right.

People just think we're an extension of the GP service

so most jobs, they're not life-threatening.

I've not been to somebody who's been mangled by a train yet.

I've not been to a decapitation. I'd quite like to see that.

I've not had a really bad burn, either.

I've had burns but not really, really bad ones.

There's still loads to see.

-It's very small.

-Small and tiny,

-yeah.

And this one, just because of the rip. Yes.

Stab victim Leon's scan results are in.

They show he has a significant amount of blood in his chest.

The doctors need to release the pressure on his lungs immediately.

What we're going to need to do is put a chest drain in,

which is a tube that goes in around your lungs

to try and reabsorb some of the air that is now trapped in there

and also to drain the blood out and allow the lungs to re-expand.

How long am I going to be here for?

Probably around 24 hours. 48 hours, probably.

-All right?

-OK.

We'll crack on and do that.

Unfortunately, it's a very common injury.

Common across the whole of London. We probably see two or three a night.

Two or three within 24 hours, here.

Even in my relatively short career, over 15 years,

I've seen the numbers go really quite high.

They just become more and more common.

Hurting, man!

We just need to suture up your wound on your back, OK?

-No, man! It's hurting!

-Give it a few minutes.

We'll give you some more painkillers as well, OK.

Just treat him with more analgesia.

It hurts, man.

-One-year-old.

-One-year-old.

-One month old.

-Another trauma call is coming in.

A baby has fallen face first onto concrete.

Please make sure that's switched off.

-Next stop is theatre.

-So, Vicky.

Vicky.

Mum, do you want to just come here?

Actually, you can stand here for a minute.

What we're going to do is we're going to transfer Max across to this other table.

It's not clear whether baby Max lost consciousness after he fell.

This is just a scan to make sure there is no bleeding on the tummy or the chest, OK.

And we'll probably do a little X-ray after that, just to make sure there is no broken bones,

which I'm sure there won't be.

Did he cry when he, when you fell down the stairs?

Yeah, he cried but a really strange cry, like...

IMITATES WHINING CRY

-Sure, sure.

-All right.

Some bruising over the nose and the forehead.

-Bruising on his forehead.

-Have a little sit-down.

BABY CRIES

-OK, little man.

-Roll him over.

-Ready, steady, roll.

We couldn't get sats because he's so tiny.

And rest about 60.

I know. It happens so often. It really does. Honestly.

In terms of Max, was it normal, well normal delivery?

-40 weeks?

-Yeah.

-Yeah. Two weeks early.

-38 weeks.

'Managing a head injury properly'

makes a massive difference in outcome.

You can obviously save people's lives.

That's not actually the big deal.

For me, it's preventing brain injury that renders people

needing 24-hour care or nursing care for the rest of their life.

If I can prevent that, I find it rewarding.

Shall we just, now we've done that, let's just lift him up

and have a look down the back.

BABY CRIES

I'll just shine lights in your eyes, now.

That's it.

I've got a nine o'clock tutorial.

The weirdest things we've seen.

Went to a woman who had her womb stolen, she reckoned, didn't we?

-That was a pretty strange one.

-Hi, Gordon.

We're going to use your wheelchair to get you out to the ambulance.

Is that all right? Because it's comfier than ours.

Mel and Jay have been called out to 85-year-old Gordon.

He may have suffered a stroke.

So he says confusion is worse today than...

It's much worse this evening. Yes.

Paramedic Jay thinks he recognises the symptoms as something less serious.

It sounds really crude but the smell when we lifted him up,

it does smell very water infection-y.

I have not smelled that before.

It sounds really bad but that's the kind of whiff the UTI makes,

which would explain the increased confusion

cos it can really knock you off your feet.

-It could be.

-Yeah. Definitely, yeah.

The hospital quickly confirms that Gordon hasn't had a stroke.

You'll be all right soon.

'As soon as he's had antibiotics, he'll be fine.

'That is a quite typical job, really.'

We don't mind jobs like that, I don't think.

When it's, it's genuine, you know.

It's not a dire emergency but, you know,

still needs sorting so he needs to get to hospital, so...

The population's allegedly getting older. People die, don't they?

Guaranteed. It's the only thing that is guaranteed.

If I was in the state of some of our patients,

I'd probably want to be dead before it got to that point.

I've always said the first time I wet myself and it's not through alcohol, I want to be put down.

BABY CRIES

At St Mary's, Dr Wilson's team have found no serious injuries

in four-week-old Max.

-It's going to be fine. He's fine.

-Really?

He's fine, don't worry. Really fine.

-He's moving all four limbs very powerfully.

-Very good.

-Oh, yes.

Let's wrap him up. Let's give him back to Victoria.

Dr Wilson will keep Max under observation until the morning, to be safe.

If at any point he's a bit drowsy or not quite right,

then we'll reassess him and do a scan. Is that OK?

I mean, is there anything like brain damage, in terms of that knock?

-That's...

-Honestly?

I've doctored loads of kids like this who are not right.

He's right. He's fine.

If there's something going on in his head, we'll know about it

and we'll do something about it.

-It's fine.

-OK!

-You must be really worried. Are you...

-Who is around?

-Husband's in Switzerland.

-Oh, right.

Great(!) Not helpful.

'Working nights isn't great.

'But unfortunately, trauma tends to occur in the evenings

'and night-time which is obviously why the emergency department is quite busy at that time.'

I have no life. I'm a doctor.

It's destroyed my life.

No. I do have a bit of a life outside. I've got some kids which I sort of see occasionally.

I lost my footing at the top of the concrete stairs

and I spun off down the stairs.

I grabbed hold of the banister but I held onto him as much as I could.

I went over and so did he.

And it's just incomprehensible to even think about right now.

They're just so fragile at this age.

RADIO: Radio Lancashire at 7:06am.

The weather, a mostly fine day with sunny spells.

A few scattered showers likely.

SMASHING CROCKERY

Morning!

I wasn't here yesterday because I'm working the weekend.

Sadly we had a lady that died yesterday, by the looks of it.

Looks like we got quite a few complex patients on today

so we need to get up and out, really, this morning.

Dot has been a district nurse for 26 years.

There are fewer district nurses than ever before

and Dot is the only full-time nurse covering the area.

Just give me a ring, girls, if you need me.

I'll be over the hill and far away!

'The demands of the job have increased.

'There's more complex patients that we see in community

'so it might not be that there is more patients to see'

but the time that we need to spend with these patients is longer.

Cos a lot of patients are elderly

and have quite a lot of long-term conditions.

And it's really important that we don't just support them

but we support the families as well.

And you see, that's quite a big aspect of our work.

We don't just go in and deal with the physical side of care,

we do deal with a lot of psychological

and social well-being needs of patients.

KNOCKING Hello!

We'll have a good chat about things.

-What we need to do is do your catheter today.

-OK.

And I've also brought you a flu jab, Hugh.

-Right.

-Are you feeling better?

-You weren't feeling very well last week, were you?

-I think so.

Can you not remember? THEY LAUGH

So that everything's to hand.

Thank you very much.

-How long have you been married?

-1948.

-So a long time. A long time.

-63.

Wonderful.

Morning! It's Dot!

A lot of these patients that we go to see

may not have family living nearby and often it's the case that

they might be, we might be the only people they see throughout that day.

KNOCKING

Hello!

-Shall we pop it in your leg? Are you all right with your...?

-Yes.

I think if we do it up here. OK.

This is the last one, then. Wonderful.

We get a lot more complex patients in the community.

Patients coming out of hospital

with chest drains and lines in

that need management and we wouldn't have seen those type of patients

in the community years ago.

They would have remained in hospital.

We got this house for less than £800.

-Wow! Golly, me!

-Yeah, yeah.

Haven't times changed? Yes. Can't believe it, can you, really now?

-And the rest is history, as they say!

-Yes. Yes.

-You've never looked back!

-No. No.

-Only when Jack died.

-Oh.

-That was the worst day of my life.

-I bet it was.

How many years ago was that, now?

That Jack died?

-Can you remember when he died?

-12.

-12, is it?

There we go, love.

The heart started beating, happily, which is a good sign.

RADIO: Flooding in Fife has closed some roads this morning...

She's got really little hands.

She has got very little hands, hasn't she?

Kiss on the cheek.

Hi, I'm Will.

I always feel a little bit strange as a 26-year-old guy,

surrounded by people having babies and various fertility problems.

So I tend to keep my head down a little bit.

The department is hidden away with just two little signs

to show you where you're going.

-So this is Cue.

-Do you want a glass of water?

No, I'm all right, thank you. All well hydrated.

There is the stigma attached to being a sperm donor.

My family were quite horrified to start with, actually.

Mum's reaction was one of complete terror.

Thinking that I was going to have a load of kids

running around my feet and something along those lines.

When you're finished, ring the doorbell two times

-and I will come here, OK?

-Fantastic.

-A pot and a pen.

-Thank you very much.

-Cheers, Will.

-All right, see you.

Will is one of a growing number of sperm donors in the UK.

With over 50,000 women having fertility treatment each year,

the demand for sperm has never been higher.

This is the room that we get.

The other one has a window in which has recently gained a curtain

because some people could see in once.

But basically, a couch, a sink and a toilet

and they provide you with some slightly dated material.

Something from back in the '80s, I think.

So I think most people tend to just ignore that

and bring some of their own stuff.

So, rather important, make sure the door is very much closed.

Cue always tells me that we're getting,

you got to stay in here for at least half an hour

because the longer you take, the better the sample you give is.

So I'm not allowed out this room for at least half an hour,

otherwise Cue gets angry with me.

So I will now turn this film off and see you in half an hour.

SIREN SOUNDS

Which way? Left or right?

Any other pains or aches?

Right. I'll get out the way for a second.

Yeah. How are you, are you OK?

In south London, a motorbike has collided with a van.

Gareth Davies is a doctor with London's Air Ambulance.

He's been called to the scene as the biker's injuries may be life-threatening.

If you can just, you may have to grit to teeth a little bit

while we do this, OK?

Just squeeze my hand. OK, so we just move it over.

Just bear with us, we're going to move it over now. Three, two, one.

Big breath.

The biker's femur has been snapped by the impact of the crash.

Gareth is worried there may be more internal damage.

You're shivering a bit, I know.

I think you may be in a bit of shock and a bit cold.

So your breathing's fine. Just let me see you move your feet again for me.

OK, that's brilliant.

So I'm just feeling for a pulse in his leg cos the major bone,

his thigh bone has been broken.

When it breaks, it can damage the blood supply if it goes into the leg.

And the way we check for that is looking at the colour of the foot and checking for pulse.

There was some question about whether there was a pulse there

and actually I'm quite happy that there is a pulse there.

It feels reasonably warm.

Do you want to give him a bit more, then?

-Cos he's a big bloke.

-Give him another 10 more?

-Yeah.

I'll give you some more morphine, OK?

The bone in his thigh is a massive bone.

It's one of the biggest,

strongest in the body and to snap it requires a huge amount of energy.

Huge!

And it's that event that fills you full of adrenaline

and puts you into shock.

When the city wakes up, people start moving and start injuring themselves.

That's the long and short of it.

There'll be a team in there of about seven or eight people.

They're going to fuss round you, take some X-rays and things.

-That's all normal, all right?

-Yep.

-You're going to be fine.

Can't guarantee that you might not need an operation on that leg

but we'll see. OK.

So, now the second stitch so we'll use two.

A request from Peter to nurse Sue. In fact, it's a dedication, Peter.

So make sure you're tuned in. I'm sure you will be by now.

Elvis Presley and some Jailhouse Rock!

OK, so that's all done.

I've taken a grand total of 28 minutes.

Produced my sample.

-There's our scientist in there.

-Pop that in there.

'I can't imagine what it must be like

'to discover that you can't have children.'

It is an opportunity to sort of give a gift, I suppose,

and you can't pass up that sort of opportunity.

So this is the expenses for time and getting here and so on.

-Thank you very much.

-OK. I'll walk you out.

'That's I think something like the 16th donation'

so now off to another hospital to actually go and learn something useful for a medical degree.

DOT: All right. Go steady. All right. Bye-bye, love. Bye-bye, now.

With more people being treated at home than ever before,

Dot and her team visit over 30 patients every day.

We have a number of complex patients, really, on our caseload.

And some of them are reaching the end stage of life.

And I always think it's very much like

when a midwife delivers a newborn baby.

It's such a fantastic experience

and one, probably, they will never forget

because every child delivers different but for us,

we're seeing the end stage of life

and it's really important for us that we get it right,

cos we've only got one chance to get it right.

Dot's next patient is Jill, who is looked after by her husband, Robert.

Jill, hello.

SHE MOANS

I sing to her quite a lot, but fairly badly.

Some of her favourite sort of nursery rhymes

which I know she likes from years ago and things that we used to,

sort of, have a joke about when she was well.

And I go over those over and over sometimes, you know.

It seems to really perk her up. Yeah.

Robert gave up his job as an engineer eight years ago

to become his wife's full-time carer.

Jill has a very complex long-term condition

and she's been nursed in bed for several years now.

Sadly, it has affected her very badly

and she is unable to talk now

and is totally reliant on Robert

and the carers that go in four times a day to provide care for her.

She understands everything, everything that you say.

But yeah, she's quick.

You used to not think so, by looking at her,

you wouldn't think she would be, but she is.

And with me talking to her all the time,

I know that she's there, you know.

The doctors don't know whether she can see properly or hear properly.

They haven't said she can

but they're not sure that she can or not.

But I know that she can.

Peter is due in this morning.

The hostel's, I suppose, support worker rang just to say

he's leaving now to get to work.

If he gets to work, he needs to see what state Peter's in to get him here.

So he's got to ring me close to 11:00am so I said...yeah.

Let's see what happens, eh?

You can tell as soon as they walk in.

I think it depends how fast the front door opens and you go,

"Oh, God. They nearly took the door off the hinges then.

"What mood are they in today?"

Dr Simon Abram's GP practice has opened its doors to what are known

as zero tolerance patients.

It's become the only place in Liverpool that takes patients

who have been banned from other surgeries for abusive or violent behaviour

and habitual drug use.

It's well known that general practice

has problems with access

and the people who succeed in getting through are those people

who are educated and sophisticated

and can work out how systems can be got through.

There is an appointment being made on there as well.

Patients come to their GP practice for healthcare

and any patient is coming for healthcare,

no matter what their behaviour is.

I've whacked doctors across Liverpool

for years and years, right? And I've got away with it.

-All right?

-Nice to see you.

I used to go into GPs surgeries using other people's names,

just to get tablets, nitrazepam, anything ending in "pam" I'll take.

Do you mind if I just have a quick look at the notes?

-No, go on, doctor. Help yourself.

-Some of them are hard work.

We had a man outside the other day and he was lying on the ramp

and wouldn't move and all the other patients were looking at him

and stuff but you can't help it, that's just the way he is.

-You've got your prescription?

-I've got that. That's done.

That's sorted. Thank you very much, yeah.

I'm on eight milligrams of diazepam now.

Next week is six milligrams

so six weeks from next Wednesday, doctor, I'll be off them.

-Thank you very much.

-Do you think you are going to manage that?

-Is that OK?

-Do you think I'll manage that? I think I will, yeah.

I'll struggle a little bit but I'll be all right.

-I'll get there, doctor.

-It's probably the last tablet that's going to be the hardest.

Yeah, it will. When I get on the last one, you can probably,

I'll see yourself or stick it on the notes or something,

give me some Zopiclone or something, just to help me sleep.

Hmm. That's out of the frying pan and into the fire.

I don't see much point in that. Yes.

What else can you help me with?

If you want, I mean, I suspect you can get down to one tablet like that.

But if you want to,

I'm reasonably happy to say let's go to half a tablet.

'It's put me on the right track, it has. It's definitely helped me.'

They could have just said no and washed their hands of me,

"We're not helping you, Stefan.

"Go away and come back in a fortnight's time for your inhaler for your asthma."

'Cos not all GPs are as nice as what you make out to be.

'You know, I've dealt with a lot of doctors in my experience.'

I know. You're old school you, doctor!

All of our patients can do what they like, can't they?

Cos we can't throw them off anyway. It doesn't matter.

They'll only boomerang back to us, won't they?

The ones that don't behave are here for good.

But the future of the surgery and its zero tolerance patients is now under threat.

A local regeneration project means the surgery has to move

and they are struggling to find new premises.

There is a risk that we won't have anywhere to go.

The sort of traditional thing that would happen is

the practice list would be dispersed to local practices

and the zero tolerance facility would be lost.

There are no guarantees at all

that the services we provide would be replicated.

I think it could be a disaster.

We got back from New York...

I was basically riding on a skateboard and...

I tried to stop.

My leg just completely twisted and it's dislocated.

Gareth is on his way back to the air ambulance

when another trauma call comes in.

A mother and child have fallen through a window.

SIREN SOUNDS

INDISTINCT SPEECH

A one-year-old has fallen out of a building and is not breathing

so we're just making our way back to the helicopter now,

as quick as we can, and make our way to that job.

No-one likes dealing with children that are ill or injured...

..and it always adds another layer of anxiety

that isn't there for adult jobs.

The baby is in a critical condition 15 miles away

but the helicopter should get Gareth there in a matter of minutes.

The golden hour is a term used to describe

a period after really serious injury

where it's absolutely vital to get things right.

And if you don't do things in a timely manner, it will result

in the patient's death, at worst, or leave them severely disabled.

So a lot of clinicians feel that the golden hour is part of the hospital environment but actually,

it belongs to the patient.

And most of that period is out at the site of the accident or on the way to hospital.

The baby's mother has already been taken to hospital.

He fell nine foot onto a hard surface.

Mother was holding him on our arrival. Respiratory arrest.

-Blood on his face.

-His airway was soiled.

Second dose of adrenaline at the moment.

Can we just stop and see where we are?

We're getting some kind of rhythm but very, very slow.

The baby's been in cardiac arrest for over 10 minutes,

in spite of the ambulance crew's attempts to resuscitate him.

Gareth manages to get a tube down into his lungs

to take over his breathing but there's no heartbeat.

So shall we just decompress his chest, as well?

So let's do some thoracostomies.

He pierces the side of the baby's chest in an effort to relieve

any pressure that might be stopping his lungs from working.

There is no air in there.

We're letting you know we're bringing you a one-year-old little boy

who is in traumatic cardiac arrest.

-We'll be with you in about one minute.

-Four minutes.

-Four minutes.

Gareth has done everything he can but the baby still has no pulse.

They continue chest compressions and head for the nearest hospital.

I mean, I'm not sure that blood is going to turn this around.

I think we have addressed everything that will be addressed.

'Today is an example of just how fragile things are.

'Just walking down some steps in your own home

'can result in absolute tragedy and it does make us as individuals

'appreciate every moment of life cos we know that tomorrow,

'we may not be here. It may be us. It may be our turn.'

SIREN SOUNDS

It's one of those you don't think about too much now and worry about it later.

These guys did a sterling job there, so...

A lot of unanswered questions

which we will find answers, as much as we can, when we get a chance.

So now the thing is to get ready for the next one.

Come on, then. Hospital corners all around.

Not so much now but I used to be known as the vampire.

-That's lovely.

-There we go.

For some people, it's maybe a cultural thing.

They don't want anybody else to have it.

I suppose, you know, you can't expect people to embrace it because you do.

You've got to find a way of engaging them and so at the beginning,

I used to bribe the midwives

and say I'd give a £20 Marks and Spencer's voucher

to the midwife who collects the most cords that month!

OK! Here we have it!

It took a bit longer than we thought but we got it.

It was a little bit tricky getting out

so we may have lost a little bit.

Pull the umbilical cord through.

We take the cannula.

Take the lid off. Get the nice, big juicy vein.

King's was one of the first hospitals in the UK

to collect umbilical cord blood for stem cell treatment

that can cure diseases such as leukaemia.

And what we try to do now is get as much blood out of the placenta

as we possibly can by massaging.

BABY CRIES

You get cords that are really short.

We've had cords where we've had to stand out here to reach the bottom!

Really, really long cords.

We had cords that have been really thick and kind of curly,

that look like, remind me of the grips that go around and hold curtains back.

That kind of twine.

We've had cords with knots in.

And you can see the cord is emptying.

You can see the last of the bits of blood going down.

So we will clamp it off.

I find that African women tend to have really big kind of fat cords

and Caucasian women often have quite slim chords.

See if you can guess the nationality by looking at the umbilical cord!

-See that white thing in the middle?

-Yeah.

-That's the tendon...

-OK.

-..that I've stitched up.

HUMMING

She used to like this before she was poorly.

Hair stroking.

-Do you love her in the same way, then?

-Oh, yeah.

Exactly the same. No difference at all.

That's for certain, is that.

I tell her that every day, as well. Every day.

So she knows.

It's in sickness and in health

and there's no chance of her ever going into a home,

not unless something happens to me.

As long as I'm here, stood straight up, then that's how it will be.

So at one point they wanted to stop...

..her food and sort of leave her to just fade away.

And so I sort of lost it a little bit, to be honest.

And told them what I thought.

And then one person actually said to me,

from the social services, at that point,

"Are you thinking of Jill or are you thinking of yourself?"

She actually said that in the meeting!

Well, I've been here about four years now.

We've come to sort of have a very good sort of relationship together.

I think he knows he can trust me and I've got his best interests at heart

at the end of the day and, obviously, Jill's as well.

It's important that they've got trust in you

and they know that you're there for them at the end of the day.

Robert himself has got problems of his own.

He's suffering with a long-term condition as well.

Nearly two years after his wife became ill,

Robert was diagnosed with Parkinson's disease.

We don't look after Robert and he goes under,

then Jill has to go in somewhere, so we sort of look at his needs,

from a respite point of view and make sure that he gets a regular rest

so that then he can carry on again when she comes home.

KNOCKING

Hello, Jill! All right, Jill? Hello.

Hello, darling.

Have you got a nice smile for us? Yes!

You're wide awake this afternoon, aren't you? Yeah.

It's a bit vocal this afternoon, Jill.

SHE LAUGHS

-The grandchildren are here.

-That might be the difference, then.

I think they've all just come back from school, Jill.

All be coming up to see you, won't they?

There we go.

It's not been all bad, you know.

You just make the best of what you've got

because you have no choice.

And that's what I think we've done

and she's seen her grandchildren grow up.

They come up here every day and talk to her.

She really beams when they come into the room.

So she's, although she's in bed,

she leads as good a life as she can, under the circumstances.

She has seen them a lot and has given them something back as well.

So it's not really wasted at all.

So how are you feeling, Robert, at the moment?

I'm feeling not too bad, considering.

Got used to the new pills. A bit stronger as well.

I'm getting a few aches at the moment,

which means I'm probably overdoing the job a little bit.

Just striking a balance, you know.

All right, take care, love. Bye for now. Bye.

It's so hard, I mean...

Do you ever think what sort of quality of life somebody has?

I think it depends how you measure quality of life,

doesn't it, at the end of the day?

Quality of life means lots of different things to people, really.

I think Jill's very happy.

She's very comfortable and Robert's around her all the time.

She's very much aware of that.

I know that you can't actually talk but she displays a lot of emotions

through her eyes and her facial expressions so from what we see,

she's got quality of life cos that is her life at the end of the day.

Just because somebody can't be independent

and lead a normal life... What's normal, at the end of the day?

So I think you've just got to accept everybody

for the life that they're living and just try and support that life.

My main focus is to keep my own illness at bay as much as I can

and not think about it and focus on Jill.

Because I wouldn't be able to do it if I didn't do that.

I'll never give in. Never.

It's just not me.

Everybody knows that who knows me. I'll never, never give in.

He's having to crack his knuckles about seven or eight times a day.

-It's worse than he's making out.

-CRACKING KNUCKLES

INDISTINCT CHATTER

How is he doing?

This gentleman will pass away in the next hour or so.

Right. Give me a shout when it happens.

A patient, Philip, has been brought into A&E.

He has a history of long-term ill-health

and has had a suspected heart attack.

You can ring back on 854515, it would be much appreciated.

The nurses are struggling to find next of kin.

Yep, can do.

Often, by now, we've had the care home on the phone,

asking how they're doing.

But we haven't had that so far, neither.

He doesn't have any family so what we'll do,

we'll have a nurse with him and she will stay with him and hold his hand

until he passes so at least, you know,

at least there's someone with him as he passes.

I wouldn't say it's something I enjoy

but I think it's a fundamental part of your job

and it's something that needs to be done well.

Still, you see, he's got a very good pulse

and he's actually making respiratory effort without any oxygen.

The patient's vital signs are still normal.

One of the nurses asked whether they should support him with fluids.

No, I wouldn't. No. Let's just leave him for an hour or something.

If we give him fluids, all we'll do is just kind of prolong it, really.

I would just give him just some very, very low flow oxygen.

'He's cardiac arrested twice'

and he's got a significant past amount of history

which would mean that if we did resuscitate him...

..it would prolong his agony so sometimes you got to make a decision

and sometimes a difficult decision to let someone pass away naturally

or to be more aggressive. And in his case,

it's in his best interests, really, just to let him pass away naturally.

And I'm sure that will happen probably within the next hour or so

but he's not in any pain and he's fairly settled.

An hour later, the patient's vital signs are still holding up

so he is taken to a side room and given fluids.

Within minutes of the move, the patient dies.

I was unable to go with him

so I've just been to find out now and the wards have asked

if I'd like to go around and help prepare him to go to the mortuary.

So that's nice of them and I feel like it's the last thing I can do for that patient.

It is sad.

You always just have a think about the funeral,

who is going to be there and sadly for some people who are alone,

that is how it ends.

So it is upsetting.

Where's this nurse, Mum? Where's the nurse?

-The fire brigade brought her in through there?

-I think so.

-Jesus.

-It's the end of Gareth's shift.

The baby he treated earlier died in hospital.

Since he's nearby, he has decided to return to the site of the accident

to try and draw a line under this tragedy.

HE SIGHS

Gareth does this whenever he can.

The glass was very, very thin. The wood was all rotten.

There's no banister at all.

And there is a disrupted plant pot with mud on it all down the stairs,

so I can only presume that she was walking down the stairs,

tripped on a plant pot and then with that,

she's then come through the glass.

You can see just behind that there's a smashed window there

and it looks as though Mum had the little fellow in her arms,

came down the stairs, slipped and went through the window

and then onto the porch and that's where he was injured.

And it's a miracle she hasn't been injured as well,

or more badly injured than that...

..nor that they didn't suffer injuries from the glass.

It's like many of these tragedies,

there are just a bizarre set of circumstances behind them.

I think it's just important for everyone to square things away,

not be left with unknowns and you know,

that's true for everybody, I think.

'And it's nice to have an understanding

'or an explanation of what happened.'

Home sweet home.

When you deal with cases that are very tragic,

it's hard to go away feeling high about what you've done,

but I think you can leave feeling we and society did absolutely

everything humanly possible to try and bring him back from the brink.

And, I don't know, I'll think about it on the way home,

try and turn it into a normal Thursday evening if I can.

My wife is a nurse and no doubt it will come up over tea

and just probably think how lucky we are.

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