0:00:06 > 0:00:09Is the NHS still a National Service?
0:00:09 > 0:00:12Do I think my health is more important than ?400 a year
0:00:12 > 0:00:14which is half the cost of a holiday?
0:00:14 > 0:00:18The answer is my health is more important.
0:00:18 > 0:00:20As NHS budgets get tighter, we meet the people prepared
0:00:20 > 0:00:23to pay to see their doctor and compare our GP services
0:00:23 > 0:00:27with our friends in Ireland.
0:00:27 > 0:00:31If a patient rings up, you can be seen today
0:00:31 > 0:00:35or tomorrow and in the NHS there are waiting lists.
0:00:35 > 0:00:37We investigate whether NHS treatments are different
0:00:37 > 0:00:40depending on where you live.
0:00:40 > 0:00:42We will see different decisions taken in different parts
0:00:42 > 0:00:44of the country and different services being
0:00:44 > 0:00:48available to patients.
0:00:48 > 0:00:51And the Suffolk hospital trying to do more with less money.
0:00:51 > 0:00:52I have been seen straightaway here.
0:00:52 > 0:00:54Wheeled in and nurses and doctors all around me.
0:00:54 > 0:00:55Very good.
0:00:55 > 0:00:57Revealing the stories that matter closer to home.
0:00:57 > 0:01:07Inside Out is back.
0:01:16 > 0:01:18Hello, this is the start of the new series of
0:01:18 > 0:01:22Inside Out here on BBC One.
0:01:22 > 0:01:25I am in Jaywick on the Essex coast and we have a special programme
0:01:25 > 0:01:27that is all about health care.
0:01:27 > 0:01:29Finding a GP is getting harder in many places
0:01:29 > 0:01:31in the east of England.
0:01:31 > 0:01:34In Essex we found 10% of surgeries, 10%, are now not accepting
0:01:34 > 0:01:37new patients and some people are choosing to pay to see a private
0:01:37 > 0:01:45GP instead of waiting.
0:01:45 > 0:01:48When we visit an NHS GP, we expect them to deliver expert
0:01:48 > 0:01:52care without having to pay.
0:01:52 > 0:01:56But like a lot of modern life, things are changing.
0:01:56 > 0:02:01Perhaps in the future, if we want free minutes,
0:02:01 > 0:02:04we ll need to take out a contract with our service provider.
0:02:04 > 0:02:07Not so unlike shopping for a new phone - one that offers
0:02:07 > 0:02:09the best deal to meet your needs.
0:02:09 > 0:02:12But why?
0:02:12 > 0:02:18Later, we meet one man who says going private is the only option.
0:02:18 > 0:02:23Do I think my health is more important than ?400 a year
0:02:23 > 0:02:26which is half the cost of a holiday and the answer is my
0:02:26 > 0:02:29health is more important.
0:02:29 > 0:02:31NHS GP practice is under more pressure than ever before ?
0:02:31 > 0:02:34and excessive workloads have forced some surgeries to
0:02:34 > 0:02:40take drastic action.
0:02:40 > 0:02:46In Essex, 26 surgeries, that s 10%, are refusing to take on new patients
0:02:46 > 0:02:48? leaving them to seek a doctor elsewhere.
0:02:48 > 0:02:50Other practices are struggling to keep up with demand.
0:02:50 > 0:02:52Take Jaywick.
0:02:52 > 0:02:56Here, a combination of an ageing population, doctors retiring
0:02:56 > 0:03:04and problems recruiting has put huge strain on the local GP surgery.
0:03:04 > 0:03:07Dr Peter Skew joined The Green Elms Medical Practice five
0:03:07 > 0:03:10years ago ? his aim?
0:03:10 > 0:03:15To turn around a failing practice.
0:03:15 > 0:03:17The practice population is in and from the most deprived
0:03:17 > 0:03:22ward in the whole of England.
0:03:22 > 0:03:27The practice had not had a regular doctor for two or three years.
0:03:27 > 0:03:30The patients were fed up of seeing repeatedly different doctors.
0:03:30 > 0:03:34Dr Skew concentrated his effort on recruitment ? offering terms
0:03:34 > 0:03:39such as defined hours, to attract GPs to the practice.
0:03:39 > 0:03:44Now the surgery has five regular GPs and one long term locum.
0:03:44 > 0:03:48The philosophy of this practice is to problem-solve.
0:03:48 > 0:03:51And because we know the patient is going to come back to us
0:03:51 > 0:03:54if we don t get it right, we have a much stronger driver
0:03:54 > 0:03:59to get it right, to problem-solve.
0:03:59 > 0:04:02I hate to say this, but locums do not have that
0:04:02 > 0:04:03ongoing responsibility.
0:04:03 > 0:04:05So, what do the patients think?
0:04:05 > 0:04:13It s an excellent surgery compared with what it was 15/20 years ago.
0:04:13 > 0:04:16It s far better now than it was when we were mostly locums.
0:04:16 > 0:04:21But you know, now I ve got no complaints whatsoever.
0:04:21 > 0:04:24Dr Skew has turned his surgery around, so what s to stop other NHS
0:04:24 > 0:04:30practices doing the same?
0:04:30 > 0:04:35At the moment General Practice is under a huge amount of pressure.
0:04:35 > 0:04:43The situation is the worst it has been and surveys of GPs
0:04:43 > 0:04:47which look at work load and stress suggest it is becoming,
0:04:47 > 0:04:49the workload issues is becoming a crisis and that plays
0:04:49 > 0:04:59into your ability to recruit and retain GPs.
0:04:59 > 0:05:05A world away from Jaywick is the affluence city of Chelmsford.
0:05:05 > 0:05:07Here unemployment is low and living standards are high.
0:05:07 > 0:05:12You can tell by the variety of shops.
0:05:12 > 0:05:17And when it comes to picking a GP, here it is a bit like shopping.
0:05:17 > 0:05:21And each GP service offers a different deal.
0:05:21 > 0:05:25So, for instance, if a regular GP-run practice is not for you ? how
0:05:25 > 0:05:30about an NHS surgery run by an external operator?
0:05:30 > 0:05:34As of July last year, Sutherland Lodge Surgery
0:05:34 > 0:05:37is run by Virgin Care.
0:05:37 > 0:05:44It s one of five NHS medical centres run by Virgin in Essex.
0:05:44 > 0:05:49Now you d be forgiven for thinking the medical centre was failing
0:05:49 > 0:05:50was handed to the private sector to sort out.
0:05:50 > 0:05:51But no.
0:05:51 > 0:05:54Only recently it was rated outstanding by the Care
0:05:54 > 0:05:56Quality Commission.
0:05:56 > 0:06:01The surgery then had its funding cut back.
0:06:01 > 0:06:05The GPs at Sutherland Lodge decided they d had enough ? and so they took
0:06:05 > 0:06:09the drastic decision to close the practice.
0:06:09 > 0:06:11This is astounding.
0:06:11 > 0:06:17Shirley-Anne Hall has been a patient at Sutherland Lodge
0:06:17 > 0:06:20for over 70 years.
0:06:20 > 0:06:23Virgin Care Services has been identified as the preferred bidder
0:06:23 > 0:06:25to take on the running of Sutherland Lodge Surgery.
0:06:25 > 0:06:28It s like you should be grateful that this is now happening.
0:06:28 > 0:06:29Well, I guess we are grateful because otherwise
0:06:30 > 0:06:31what were we going to have?
0:06:31 > 0:06:32Nothing?
0:06:32 > 0:06:35And no other doctor s surgery in the area can take on more
0:06:35 > 0:06:37patients ? they ve said so.
0:06:37 > 0:06:37What s it like now?
0:06:37 > 0:06:41It just seems to be locums.
0:06:41 > 0:06:45So, you wonder if things carry on ? or if I had something
0:06:45 > 0:06:47seriously wrong with me, would I be seen by the same person
0:06:47 > 0:06:52or just a continuation of different people?
0:06:52 > 0:06:58That doesn t make me feel very happy.
0:06:58 > 0:07:03A spokesperson for Virgin Care said:
0:07:15 > 0:07:16But if you re one of those patients
0:07:16 > 0:07:18no longer registered with Sutherland Lodge
0:07:18 > 0:07:23? or you want to look elsewhere, what can you do?
0:07:23 > 0:07:25Maybe find another NHS doctor ? stick with the tried
0:07:25 > 0:07:28and tested older model.
0:07:28 > 0:07:31Or as some websites claim ? help ease the pressure
0:07:31 > 0:07:36and save the NHS money, by upgrading to a private GP
0:07:36 > 0:07:40for a faster, maybe better, service.
0:07:40 > 0:07:43And if you re shopping in Chelmsford and you can afford it,
0:07:43 > 0:07:48it won t take long to find a private GP to suit your needs.
0:07:48 > 0:07:55Private GP Services was set up by Dr Anne Squire 16 years ago.
0:07:55 > 0:07:57We see a very wide social mix.
0:07:57 > 0:08:00You have to remember that what we charge for an appointment
0:08:00 > 0:08:02is less than most people pay at the vets.
0:08:02 > 0:08:06It s a pay as you go service ? you don t have to sign up to keep
0:08:06 > 0:08:09coming back to us in any way.
0:08:09 > 0:08:11So you're benefiting from the very fact that the NHS
0:08:11 > 0:08:16is buckling under the strain?
0:08:16 > 0:08:21I think in the last two years, 18 months to two years,
0:08:21 > 0:08:24we are seeing an increasing number of new patients, who are here
0:08:24 > 0:08:26because they cannot get an appointment with their NHS GP.
0:08:26 > 0:08:32And it really isn t that people are discontented with their own GP,
0:08:32 > 0:08:37but they re discontented with the time it takes to see them.
0:08:37 > 0:08:43Tim Wood registered with the Private GP Services ten years ago.
0:08:43 > 0:08:45Do you think that people like yourself will move more
0:08:45 > 0:08:49into paying for their treatment?
0:08:49 > 0:08:53I had this discussion with couple of mates about this.
0:08:53 > 0:08:58One said, why should I go near a GP, it should be means tested.
0:08:59 > 0:09:04I should not be allowed near a GP.
0:09:04 > 0:09:07The GP, the NHS should be people that cannot afford to come
0:09:07 > 0:09:08to places like this.
0:09:08 > 0:09:10If you decide to go private, pay-as-you-go single
0:09:10 > 0:09:15consultations start from ?80.
0:09:15 > 0:09:18But what s the impact on the NHS GP services?
0:09:18 > 0:09:21If you can t get access, then the private sector is very good
0:09:21 > 0:09:26at then expanding to soak that up.
0:09:26 > 0:09:28As services improve, what happens is the private sector
0:09:28 > 0:09:31tends to contract again ? because people go back
0:09:31 > 0:09:35to the public service.
0:09:35 > 0:09:39If GP practice is struggling in England, it's perhaps worth
0:09:39 > 0:09:42looking at how GP services are delivered elsewhere in Europe.
0:09:42 > 0:09:45I ve come to Ireland - to Dublin.
0:09:45 > 0:09:47Everyone in Ireland is entitled to receive medical care
0:09:47 > 0:09:50through the public health system.
0:09:50 > 0:09:54The service, however, is means-tested - those on benefits
0:09:54 > 0:10:01or low incomes get a medical card entitling them to free treatment.
0:10:01 > 0:10:03The remainder of the population either has private insurance or pays
0:10:03 > 0:10:09on a treatment-by-treatment basis ? so back to pay as you go.
0:10:09 > 0:10:12Could this be the future for the NHS?
0:10:12 > 0:10:15Dr Mark Murphy is a GP and chair of communications
0:10:15 > 0:10:21for the Irish College of General Practitioners.
0:10:21 > 0:10:23Only 40% of the population can receive free at
0:10:23 > 0:10:26the point of contact care.
0:10:26 > 0:10:29So the other 60% of the population have to pay the market
0:10:29 > 0:10:31price to see a GP.
0:10:31 > 0:10:34That could be 50 euros, it could be 60 euros.
0:10:34 > 0:10:36There is this squeezed middle.
0:10:36 > 0:10:39So about 20% of the population in Ireland neither have a medical
0:10:39 > 0:10:43card, so they have to pay to see me as a GP.
0:10:43 > 0:10:46But they don t have private health insurance either and unfortunately
0:10:46 > 0:10:51they can face catastrophic out-of-pocket payments
0:10:51 > 0:10:53when they re unwell ? and that really is not the norm
0:10:53 > 0:10:56in most developed countries.
0:10:56 > 0:10:58Is it frustrating as a GP to work within these
0:10:58 > 0:11:00constructing parameters?
0:11:00 > 0:11:03I suppose the one advantage of the Irish health care system
0:11:03 > 0:11:07from a General Practice perspective above the NHS, is that we generally
0:11:07 > 0:11:10have ? if a patient rings up, they can be seen today or tomorrow ?
0:11:10 > 0:11:12and I know in the NHS there are waiting lists.
0:11:12 > 0:11:16If you want to see a specific GP you may have to wait
0:11:16 > 0:11:17two or three weeks.
0:11:17 > 0:11:25The Irish system works well for those who can afford it.
0:11:25 > 0:11:29But asking people here in England to pay to see their NHS GP would be
0:11:29 > 0:11:30politically unpalatable.
0:11:30 > 0:11:31So what s to be done?
0:11:31 > 0:11:34Across the region, GPs are looking at ways to maintain local services,
0:11:34 > 0:11:36while at the same time working with other practices
0:11:36 > 0:11:37to share certain costs.
0:11:37 > 0:11:39And the Government says it s committed to spending
0:11:39 > 0:11:44more on GP practice.
0:11:44 > 0:11:46There s no doubt that many doctors and patients remain committed
0:11:46 > 0:11:49to the NHS but without better funding, some surgeries may be
0:11:49 > 0:11:56forced to reduce services or worse, close down altogether.
0:11:56 > 0:12:00I think that if people have to pay to get the right care,
0:12:00 > 0:12:04the whole of society has failed somewhere.
0:12:04 > 0:12:08It s not just the NHS ? it s what does society want
0:12:08 > 0:12:11from their health care providers?
0:12:11 > 0:12:17And if they only get it privately, we ve failed.
0:12:17 > 0:12:20Now we are back on air, it is great to hear
0:12:20 > 0:12:23from you if there is something you think we should be looking into.
0:12:23 > 0:12:25Get in touch with me on Twitter...
0:12:25 > 0:12:31Or you can e-mail...
0:12:31 > 0:12:35You are watching Inside Out for the East of England here on BBC One.
0:12:35 > 0:12:38Later, the hospital that hopes to be a blueprint for the region.
0:12:38 > 0:12:40Pleasure to meet you, sir.
0:12:40 > 0:12:42You will get better soon.
0:12:42 > 0:12:48I'm going home to see my cat.
0:12:49 > 0:12:52As budgets get smaller, patient numbers go up.
0:12:52 > 0:12:56We are looking at the pressure to ration treatments so is the NHS
0:12:56 > 0:12:58still a National Service and does where you live matter more
0:12:58 > 0:13:03than ever when it comes to the treatment on offer to you?
0:13:03 > 0:13:08Chris Jackson has been investigating.
0:13:08 > 0:13:10The NHS is facing the most significant financial
0:13:10 > 0:13:15challenge in its history.
0:13:15 > 0:13:17There are fears the service we have grown up with is
0:13:17 > 0:13:20beginning to fragment.
0:13:20 > 0:13:22It is not a National Service.
0:13:22 > 0:13:25Absolutely there is a postcode lottery.
0:13:25 > 0:13:27It is criminal.
0:13:27 > 0:13:30It is absolutely criminal.
0:13:30 > 0:13:36This is the start, this is going to get worse.
0:13:36 > 0:13:39So, is the NHS in danger of ceasing to be a National Service
0:13:39 > 0:13:44where everyone is entitled to the same care?
0:13:44 > 0:13:46It is treating more patients but is it becoming a postcode
0:13:46 > 0:13:49lottery where access depends on where you live?
0:13:49 > 0:13:57We are going to put that to the test.
0:13:57 > 0:14:01On a bad day, it ruins your life.
0:14:01 > 0:14:09Muscle pains, it feels like my bones are screaming at me at times.
0:14:09 > 0:14:1133-year-old Ben Franklin has hepatitis C, the virus can cause
0:14:11 > 0:14:13life-threatening liver damage.
0:14:13 > 0:14:16I am about to lose my job, I have not been at work since April,
0:14:16 > 0:14:18I've been off sick.
0:14:18 > 0:14:21And I could lose the flat over my head.
0:14:21 > 0:14:24There are new drugs that can potentially cure the hepatitis
0:14:24 > 0:14:27but they are expensive and rationed.
0:14:27 > 0:14:35Ben has been denied them.
0:14:35 > 0:14:38All I got was wait, because my liver was not bad enough and that made me
0:14:38 > 0:14:41want to go out and get wasted and ruin my liver
0:14:41 > 0:14:42just so they would treat me.
0:14:42 > 0:14:46I wouldn't do that but I wouldn't be surprised if anyone else wouldn't.
0:14:46 > 0:14:50The money is there for 10,000 treatments each area
0:14:50 > 0:14:53has a target to meet, it is claimed that means
0:14:53 > 0:14:56there are no queues in part of the North and long waits
0:14:56 > 0:14:59in places like London.
0:14:59 > 0:15:03Two people with the same state of liver damage could present
0:15:03 > 0:15:05themselves in different parts of the country and in one
0:15:05 > 0:15:07they will walk in, get hepatitis C treatment immediately,
0:15:07 > 0:15:11get cured and in another part of the country they may go and be
0:15:11 > 0:15:14told you will have to wait.
0:15:14 > 0:15:18This is inherently unfair.
0:15:18 > 0:15:23NHS England told us it was regularly reallocating and used hepatitis C
0:15:23 > 0:15:29treatments to places with waiting lists.
0:15:29 > 0:15:34The number of patients treated will increase by 25% next year.
0:15:34 > 0:15:38The fact it is down to money that upsets me the most.
0:15:38 > 0:15:41It is just money.
0:15:41 > 0:15:43So, Ben is taking the risk of treating himself with cheaper
0:15:44 > 0:15:51copies of the new drugs.
0:15:51 > 0:15:53How much have you spent on that box?
0:15:53 > 0:15:54?1300.
0:15:54 > 0:15:57?1300 that I don't really have.
0:15:57 > 0:16:01The fact I have had to pay for my treatment and...
0:16:01 > 0:16:02It is criminal.
0:16:02 > 0:16:05It is absolutely criminal.
0:16:05 > 0:16:08Sorry.
0:16:08 > 0:16:12I'm just tired of being tired.
0:16:12 > 0:16:19Basically.
0:16:19 > 0:16:22Ben is hoping the generic drugs will cure him within a matter
0:16:22 > 0:16:26of weeks and he is not alone.
0:16:26 > 0:16:30The hepatitis C trust estimates around 1000 people in Britain may
0:16:30 > 0:16:37have brought the drugs abroad.
0:16:37 > 0:16:42If you go outside, there are halos around the lights,
0:16:42 > 0:16:45lights and shadows, it is hard to see things which are distorted.
0:16:45 > 0:16:50Gloria has cataracts in both eyes.
0:16:50 > 0:16:52I can't take stairs, go up or down stairs
0:16:52 > 0:16:55with any kind of confidence.
0:16:55 > 0:16:58Cataracts are supposed to be treated within four points
0:16:58 > 0:17:00five months of referral.
0:17:00 > 0:17:03Gloria, who lives in the Northeast says she has been waiting seven.
0:17:03 > 0:17:09Is too long because there is such potential for accidents
0:17:09 > 0:17:16and there is such a change in a person s mood.
0:17:16 > 0:17:19If Gloria had lived in Luton, her wait could have been 15 days.
0:17:19 > 0:17:21The postcode lottery.
0:17:21 > 0:17:23Absolutely there is a postcode lottery.
0:17:23 > 0:17:29It is not about clinical need, it is about some places in England
0:17:29 > 0:17:31having poor systems, budgetary pressures and deep
0:17:31 > 0:17:37prioritising cataract surgery.
0:17:37 > 0:17:41That does not feel too national to me.
0:17:41 > 0:17:42Gloria expects an operation later this month.
0:17:42 > 0:17:45It makes me angry because I think it is almost
0:17:45 > 0:17:49like a survival of the fittest.
0:17:49 > 0:17:57Clinical commissioning groups control health budgets.
0:17:57 > 0:18:00It is claimed some are delaying treatment is like cataract surgery
0:18:00 > 0:18:01by slowing down referrals.
0:18:01 > 0:18:03Others are requiring patients to lose weight before getting
0:18:03 > 0:18:08operations like hip replacements.
0:18:08 > 0:18:11Postponing an operation in these circumstances can save money
0:18:11 > 0:18:19in the short term and whilst the CCG say they can be
0:18:19 > 0:18:20clinically justified, the Royal College
0:18:20 > 0:18:22of surgeons says not.
0:18:22 > 0:18:25There is good evidence people are now not getting elective
0:18:25 > 0:18:26operations which they desperately sometimes require simply
0:18:26 > 0:18:29because of financial restrictions.
0:18:29 > 0:18:35It is up to the clinicians to decide who should have what treatments.
0:18:35 > 0:18:38And therefore a bureaucratic system which produces a blanket
0:18:38 > 0:18:42ban is morally wrong.
0:18:42 > 0:18:44It is claimed new systems for vetting appointments
0:18:44 > 0:18:47with specialists are another form of rationing.
0:18:47 > 0:18:52Why are they treating their patients with such contempt?
0:18:52 > 0:18:58Last month, MPs complained about a private company
0:18:58 > 0:19:00being paid ?10 for every GP referral they stopped.
0:19:00 > 0:19:03This is rationing by the back door and has the potential
0:19:03 > 0:19:05to compromise patient safety.
0:19:05 > 0:19:07The same private company overseas referrals in North Tyneside.
0:19:07 > 0:19:10We have spoken to doctors who say the system is
0:19:10 > 0:19:16putting patients at risk.
0:19:16 > 0:19:19The GPs who fear speaking out have told us cancer
0:19:19 > 0:19:21diagnoses are being held up.
0:19:41 > 0:19:43In a statement, North Tyneside CCG said there was no evidence
0:19:43 > 0:19:50the system caused additional risk or delay.
0:19:50 > 0:19:53Cancer referrals do not go through the system and are made
0:19:53 > 0:19:56directly to hospital.
0:19:56 > 0:20:00The number of referrals knocked back to GPs in England has risen by 30%
0:20:00 > 0:20:05in the last two years.
0:20:05 > 0:20:07You can see the details of the research online.
0:20:07 > 0:20:10Shortage and regional difference have always been part of the NHS.
0:20:10 > 0:20:14Today, the differences could get much worse.
0:20:14 > 0:20:17The NHS is under an unprecedented level of pressure at the moment.
0:20:17 > 0:20:20If it doesn't get more funding, waiting times are going to get
0:20:20 > 0:20:27longer and the quality of patient care is going to suffer.
0:20:27 > 0:20:29We will see different decisions taken in different parts
0:20:29 > 0:20:31of the country and different services being
0:20:31 > 0:20:34available to patients.
0:20:34 > 0:20:36So, is the NHS still a National Service?
0:20:36 > 0:20:38One of our most prominent medics is clear.
0:20:38 > 0:20:40No, it is not a National Service.
0:20:40 > 0:20:42It is a local health service.
0:20:42 > 0:20:45It matters because it leads to inequality in health care,
0:20:45 > 0:20:47that is the problem so some people will get health care
0:20:47 > 0:20:49for free and others won't.
0:20:49 > 0:20:52In a statement, the Department of Health told us far
0:20:52 > 0:20:54from rationing, more people than ever are getting
0:20:54 > 0:20:58prompt treatment.
0:21:07 > 0:21:08standards of care are improving.
0:21:08 > 0:21:10We asked the health secretary and NHS England
0:21:10 > 0:21:12for an interview but both declined.
0:21:12 > 0:21:14The people paying for NHS services, the clinical commissioners,
0:21:14 > 0:21:15did agree to speak.
0:21:15 > 0:21:17It is a National Service with local variation based
0:21:17 > 0:21:21on the need of the population.
0:21:21 > 0:21:23Demographically, populations vary quite significantly from town
0:21:23 > 0:21:30to rural, county to county.
0:21:30 > 0:21:32It is really important we commission and respond to the needs
0:21:32 > 0:21:34of the population on a local basis.
0:21:34 > 0:21:36It is about making sure the pathway is correct,
0:21:36 > 0:21:38we don't want to squander any money.
0:21:38 > 0:21:41We have limited resources so it's important we spend most effectively
0:21:41 > 0:21:44and get the best value for the population.
0:21:44 > 0:21:46For those forced to take their own action, rationing
0:21:46 > 0:21:53appears all too real.
0:21:53 > 0:21:55Our hospitals are also facing cuts.
0:21:55 > 0:21:59They have been asked to make plans to be more efficient.
0:21:59 > 0:22:02Our health reporter Nicki Fox has been to Bury St Edmunds to see how
0:22:02 > 0:22:05the West Suffolk Hospital is trying to offer better care
0:22:05 > 0:22:14with less money.
0:22:14 > 0:22:17This leaflet is coming through your letterbox one day soon.
0:22:17 > 0:22:22The NHS as it was when it was set-up in 1948.
0:22:22 > 0:22:25How different it is today.
0:22:25 > 0:22:32With 22 billion to save and not enough hospital beds
0:22:32 > 0:22:37there is a new plan for the NHS.
0:22:37 > 0:22:39And this means keeping more people out of A
0:22:39 > 0:22:40and discharging patients quicker.
0:22:40 > 0:22:43I have come to West Suffolk Hospital to see what it is like
0:22:43 > 0:22:44on a typical shift.
0:22:44 > 0:22:47Here it is about reducing the number of people stepping
0:22:47 > 0:22:48through these doors.
0:22:48 > 0:22:51The big struggle for this hospital is to find beds for those patients
0:22:51 > 0:22:55who need to be admitted and that s because it s harder to release those
0:22:55 > 0:22:59who need to go home.
0:22:59 > 0:23:03We have got a very rural population, an ageing population.
0:23:03 > 0:23:07we have to make sure local services are tailored to meet that need.
0:23:07 > 0:23:11Bill Pleasance was rushed to A the night before.
0:23:11 > 0:23:13I woke up and had a slight sort of discomfort.
0:23:14 > 0:23:17anyway I put it down to indigestion.
0:23:17 > 0:23:23It got worse, that frightened me and as it got worse in the end
0:23:23 > 0:23:29I pressed my life line alarm and the paramedics came
0:23:29 > 0:23:33within a very few minutes and decided it was not a heart
0:23:33 > 0:23:37attack or they didn t think it was but they wanted me to come
0:23:37 > 0:23:46into A and be checked over.
0:23:46 > 0:23:48They are wonderful what they have done so far.
0:23:48 > 0:23:49Really wonderful.
0:23:49 > 0:23:53He is being fast tracked to get him home as soon as possible.
0:23:53 > 0:23:55As Bill waits to hear if he is going home,
0:23:55 > 0:24:00Rosemary McNeil has just been rushed in.
0:24:00 > 0:24:04Your heart is beating so fast.
0:24:04 > 0:24:07She has a history of heart problems.
0:24:07 > 0:24:15Were you having palpitations?
0:24:15 > 0:24:20It is unlikely she will go home today.
0:24:20 > 0:24:27They had to shock my heart several times now.
0:24:27 > 0:24:29I have been seen straightaway here - wheeled in and nurses
0:24:29 > 0:24:30and doctor all around me.
0:24:30 > 0:24:31Very good.
0:24:31 > 0:24:35This hospital wants to lead the way by making sure that the care
0:24:35 > 0:24:37is in place at home so patients can be discharged quickly,
0:24:37 > 0:24:41this helps prevents bed blocking.
0:24:41 > 0:24:44It is late morning and Bill gets a visit from a care practitioner.
0:24:44 > 0:24:46My name is Sue.
0:24:46 > 0:24:51I work for the early intervention team.
0:24:51 > 0:24:53My role is to keep you as independent as possible.
0:24:53 > 0:24:58I don t want to take that away from you so we need just tweak very
0:24:58 > 0:25:00slightly the care you have got which will enable you
0:25:00 > 0:25:03to return home safely.
0:25:03 > 0:25:05Yes, yes.
0:25:05 > 0:25:10That will be fine.
0:25:10 > 0:25:12It turns out the tweaking is sorting out lunch
0:25:12 > 0:25:14on a regular basis for Bill.
0:25:14 > 0:25:16That is all that is needed.
0:25:16 > 0:25:19I will let the staff know on the ward that
0:25:19 > 0:25:22you and I have spoken.
0:25:22 > 0:25:25What we are going to put into place and then see how you're
0:25:25 > 0:25:26are getting home today.
0:25:26 > 0:25:31This part of the county has to make 50 million worth of savings,
0:25:31 > 0:25:34hospitals cost a lot more than care in the community so more care out
0:25:34 > 0:25:38of hospital is one way this Trust will save money.
0:25:38 > 0:25:42Our vision for the future is we will only do in hospital
0:25:42 > 0:25:46what needs to be done in hospital that means we will continue
0:25:46 > 0:25:49to provide excellent surgery and getting people treated
0:25:49 > 0:25:56in emergency care but we are also working in the community.
0:25:56 > 0:25:58So these people will have the support they need
0:25:58 > 0:26:01in their own homes they won t be told you can t come
0:26:01 > 0:26:03to hospital and then not have the support they need.
0:26:03 > 0:26:06Absolutely we are very committed to providing the same services
0:26:06 > 0:26:11to local people but do it in a more joined up proactive way.
0:26:11 > 0:26:15Until these changes happen this A remains under pressure
0:26:15 > 0:26:18and is still the best place to get the most expert care
0:26:18 > 0:26:20when things go wrong.
0:26:20 > 0:26:22A three-day history of chest infection.
0:26:22 > 0:26:25Not responded to antibiotics.
0:26:25 > 0:26:28How difficult is it for everyone to judge whether a patient
0:26:28 > 0:26:32like this should be coming into hospital or not?
0:26:32 > 0:26:35I think everyone has a duty of care so it is really
0:26:35 > 0:26:38difficult for you to make a decision out there.
0:26:38 > 0:26:42I think the best place is to come to A and take it from there.
0:26:42 > 0:26:44For these pre hospital guys it is so difficult
0:26:44 > 0:26:50for them as they don t know.
0:26:50 > 0:26:55If a mistake is made then there is an awful lot of trouble,
0:26:55 > 0:26:59so if it s not a clear cut decision then the best place is to bring them
0:26:59 > 0:27:08to A you get the clinical decision from doctors.
0:27:08 > 0:27:10If you didn t have to come if you're came here
0:27:10 > 0:27:12and you came and well that
0:27:12 > 0:27:17not such a bad thing but on the other way
0:27:17 > 0:27:20round you would want it to be the other way round.
0:27:20 > 0:27:24Your lovely neighbour has made you some lunch.
0:27:24 > 0:27:26But it is in cases like Bill's where pressure
0:27:26 > 0:27:29on the hospital can be relieved - by late afternoon he gets the news
0:27:29 > 0:27:32he has been hoping for.
0:27:32 > 0:27:35Where I live is a cottage, and I would like to stop
0:27:35 > 0:27:36there until they wheel me out!
0:27:36 > 0:27:41There is no place like it.
0:27:41 > 0:27:45I will be glad to go home and see my cat!
0:27:45 > 0:27:49And the hospital is able to free up another bed.
0:27:49 > 0:27:53It is busy and demand is high.
0:27:53 > 0:27:57The big plan for the NHS is the type of care being offered is changing.
0:27:57 > 0:28:00This hospital wants to be a blue print for other hospitals to follow
0:28:00 > 0:28:05what is clear from my time here is that the West
0:28:05 > 0:28:08Suffolk is changing.
0:28:08 > 0:28:09That is it.
0:28:09 > 0:28:12Next week we investigate the rise in scams conning the elderly out
0:28:12 > 0:28:13of billions every year.
0:28:13 > 0:28:23Get in touch on Twitter or e-mail.
0:28:25 > 0:28:32From a bitterly cold Jaywick on the east coast, see next week.
0:28:32 > 0:28:35Also, the big vision, Milton Keynes 50 years
0:28:35 > 0:28:41on, is it a success?
0:28:41 > 0:28:44And what is the way forward to protect our coastal communities?
0:28:44 > 0:28:46People have been campaigning for years to have proper sea
0:28:46 > 0:28:49defences and they say whenever there is a storm surge they will go
0:28:49 > 0:28:53to bed fearing the worst.
0:28:53 > 0:28:57Inside Out next Monday at 7:30pm.
0:29:09 > 0:29:12Hello, I'm Louisa Preston with your 90 second update.
0:29:12 > 0:29:1430 British tourists shot dead in Tunisia in 2015.
0:29:14 > 0:29:15Murdered by an Islamist gunman.
0:29:15 > 0:29:17Today, an inquest was told that security forces
0:29:17 > 0:29:20were deliberately slow to respond.
0:29:20 > 0:29:22Donald Trump provokes a mixed reaction.
0:29:22 > 0:29:25Downing Street welcomes the promise of a "quick and fair" trade deal.
0:29:25 > 0:29:27But foreign ministers are concerned by his comments
0:29:27 > 0:29:29that Nato is obsolete.
0:29:29 > 0:29:32A snap election in Northern Ireland.
0:29:32 > 0:29:34It follows the collapse of the power-sharing Government.
0:29:34 > 0:29:36Sinn Fein refused to nominate a new deputy first minister.
0:29:36 > 0:29:40Martin McGuinness resigned in a dispute with the DUP.
0:29:40 > 0:29:42The former football coach Barry Bennell,