16/01/2017 Inside Out East


16/01/2017

Is the NHS still a national service? The programme talks to patients and clinicians who say rationing is fracturing the NHS, as decision-makers struggle to balance the books.


Similar Content

Browse content similar to 16/01/2017. Check below for episodes and series from the same categories and more!

Transcript


LineFromTo

Is the NHS still a National Service?

0:00:060:00:09

Do I think my health is more important than ?400 a year

0:00:090:00:12

which is half the cost of a holiday?

0:00:120:00:14

The answer is my health is more important.

0:00:140:00:18

As NHS budgets get tighter, we meet the people prepared

0:00:180:00:20

to pay to see their doctor and compare our GP services

0:00:200:00:23

with our friends in Ireland.

0:00:230:00:27

If a patient rings up, you can be seen today

0:00:270:00:31

or tomorrow and in the NHS there are waiting lists.

0:00:310:00:35

We investigate whether NHS treatments are different

0:00:350:00:37

depending on where you live.

0:00:370:00:40

We will see different decisions taken in different parts

0:00:400:00:42

of the country and different services being

0:00:420:00:44

available to patients.

0:00:440:00:48

And the Suffolk hospital trying to do more with less money.

0:00:480:00:51

I have been seen straightaway here.

0:00:510:00:52

Wheeled in and nurses and doctors all around me.

0:00:520:00:54

Very good.

0:00:540:00:55

Revealing the stories that matter closer to home.

0:00:550:00:57

Inside Out is back.

0:00:570:01:07

Hello, this is the start of the new series of

0:01:160:01:18

Inside Out here on BBC One.

0:01:180:01:22

I am in Jaywick on the Essex coast and we have a special programme

0:01:220:01:25

that is all about health care.

0:01:250:01:27

Finding a GP is getting harder in many places

0:01:270:01:29

in the east of England.

0:01:290:01:31

In Essex we found 10% of surgeries, 10%, are now not accepting

0:01:310:01:34

new patients and some people are choosing to pay to see a private

0:01:340:01:37

GP instead of waiting.

0:01:370:01:45

When we visit an NHS GP, we expect them to deliver expert

0:01:450:01:48

care without having to pay.

0:01:480:01:52

But like a lot of modern life, things are changing.

0:01:520:01:56

Perhaps in the future, if we want free minutes,

0:01:560:02:01

we ll need to take out a contract with our service provider.

0:02:010:02:04

Not so unlike shopping for a new phone - one that offers

0:02:040:02:07

the best deal to meet your needs.

0:02:070:02:09

But why?

0:02:090:02:12

Later, we meet one man who says going private is the only option.

0:02:120:02:18

Do I think my health is more important than ?400 a year

0:02:180:02:23

which is half the cost of a holiday and the answer is my

0:02:230:02:26

health is more important.

0:02:260:02:29

NHS GP practice is under more pressure than ever before ?

0:02:290:02:31

and excessive workloads have forced some surgeries to

0:02:310:02:34

take drastic action.

0:02:340:02:40

In Essex, 26 surgeries, that s 10%, are refusing to take on new patients

0:02:400:02:46

? leaving them to seek a doctor elsewhere.

0:02:460:02:48

Other practices are struggling to keep up with demand.

0:02:480:02:50

Take Jaywick.

0:02:500:02:52

Here, a combination of an ageing population, doctors retiring

0:02:520:02:56

and problems recruiting has put huge strain on the local GP surgery.

0:02:560:03:04

Dr Peter Skew joined The Green Elms Medical Practice five

0:03:040:03:07

years ago ? his aim?

0:03:070:03:10

To turn around a failing practice.

0:03:100:03:15

The practice population is in and from the most deprived

0:03:150:03:17

ward in the whole of England.

0:03:170:03:22

The practice had not had a regular doctor for two or three years.

0:03:220:03:27

The patients were fed up of seeing repeatedly different doctors.

0:03:270:03:30

Dr Skew concentrated his effort on recruitment ? offering terms

0:03:300:03:34

such as defined hours, to attract GPs to the practice.

0:03:340:03:39

Now the surgery has five regular GPs and one long term locum.

0:03:390:03:44

The philosophy of this practice is to problem-solve.

0:03:440:03:48

And because we know the patient is going to come back to us

0:03:480:03:51

if we don t get it right, we have a much stronger driver

0:03:510:03:54

to get it right, to problem-solve.

0:03:540:03:59

I hate to say this, but locums do not have that

0:03:590:04:02

ongoing responsibility.

0:04:020:04:03

So, what do the patients think?

0:04:030:04:05

It s an excellent surgery compared with what it was 15/20 years ago.

0:04:050:04:13

It s far better now than it was when we were mostly locums.

0:04:130:04:16

But you know, now I ve got no complaints whatsoever.

0:04:160:04:21

Dr Skew has turned his surgery around, so what s to stop other NHS

0:04:210:04:24

practices doing the same?

0:04:240:04:30

At the moment General Practice is under a huge amount of pressure.

0:04:300:04:35

The situation is the worst it has been and surveys of GPs

0:04:350:04:43

which look at work load and stress suggest it is becoming,

0:04:430:04:47

the workload issues is becoming a crisis and that plays

0:04:470:04:49

into your ability to recruit and retain GPs.

0:04:490:04:59

A world away from Jaywick is the affluence city of Chelmsford.

0:04:590:05:05

Here unemployment is low and living standards are high.

0:05:050:05:07

You can tell by the variety of shops.

0:05:070:05:12

And when it comes to picking a GP, here it is a bit like shopping.

0:05:120:05:17

And each GP service offers a different deal.

0:05:170:05:21

So, for instance, if a regular GP-run practice is not for you ? how

0:05:210:05:25

about an NHS surgery run by an external operator?

0:05:250:05:30

As of July last year, Sutherland Lodge Surgery

0:05:300:05:34

is run by Virgin Care.

0:05:340:05:37

It s one of five NHS medical centres run by Virgin in Essex.

0:05:370:05:44

Now you d be forgiven for thinking the medical centre was failing

0:05:440:05:49

was handed to the private sector to sort out.

0:05:490:05:50

But no.

0:05:500:05:51

Only recently it was rated outstanding by the Care

0:05:510:05:54

Quality Commission.

0:05:540:05:56

The surgery then had its funding cut back.

0:05:560:06:01

The GPs at Sutherland Lodge decided they d had enough ? and so they took

0:06:010:06:05

the drastic decision to close the practice.

0:06:050:06:09

This is astounding.

0:06:090:06:11

Shirley-Anne Hall has been a patient at Sutherland Lodge

0:06:110:06:17

for over 70 years.

0:06:170:06:20

Virgin Care Services has been identified as the preferred bidder

0:06:200:06:23

to take on the running of Sutherland Lodge Surgery.

0:06:230:06:25

It s like you should be grateful that this is now happening.

0:06:250:06:28

Well, I guess we are grateful because otherwise

0:06:280:06:29

what were we going to have?

0:06:300:06:31

Nothing?

0:06:310:06:32

And no other doctor s surgery in the area can take on more

0:06:320:06:35

patients ? they ve said so.

0:06:350:06:37

What s it like now?

0:06:370:06:37

It just seems to be locums.

0:06:370:06:41

So, you wonder if things carry on ? or if I had something

0:06:410:06:45

seriously wrong with me, would I be seen by the same person

0:06:450:06:47

or just a continuation of different people?

0:06:470:06:52

That doesn t make me feel very happy.

0:06:520:06:58

A spokesperson for Virgin Care said:

0:06:580:07:03

But if you re one of those patients

0:07:150:07:16

no longer registered with Sutherland Lodge

0:07:160:07:18

? or you want to look elsewhere, what can you do?

0:07:180:07:23

Maybe find another NHS doctor ? stick with the tried

0:07:230:07:25

and tested older model.

0:07:250:07:28

Or as some websites claim ? help ease the pressure

0:07:280:07:31

and save the NHS money, by upgrading to a private GP

0:07:310:07:36

for a faster, maybe better, service.

0:07:360:07:40

And if you re shopping in Chelmsford and you can afford it,

0:07:400:07:43

it won t take long to find a private GP to suit your needs.

0:07:430:07:48

Private GP Services was set up by Dr Anne Squire 16 years ago.

0:07:480:07:55

We see a very wide social mix.

0:07:550:07:57

You have to remember that what we charge for an appointment

0:07:570:08:00

is less than most people pay at the vets.

0:08:000:08:02

It s a pay as you go service ? you don t have to sign up to keep

0:08:020:08:06

coming back to us in any way.

0:08:060:08:09

So you're benefiting from the very fact that the NHS

0:08:090:08:11

is buckling under the strain?

0:08:110:08:16

I think in the last two years, 18 months to two years,

0:08:160:08:21

we are seeing an increasing number of new patients, who are here

0:08:210:08:24

because they cannot get an appointment with their NHS GP.

0:08:240:08:26

And it really isn t that people are discontented with their own GP,

0:08:260:08:32

but they re discontented with the time it takes to see them.

0:08:320:08:37

Tim Wood registered with the Private GP Services ten years ago.

0:08:370:08:43

Do you think that people like yourself will move more

0:08:430:08:45

into paying for their treatment?

0:08:450:08:49

I had this discussion with couple of mates about this.

0:08:490:08:53

One said, why should I go near a GP, it should be means tested.

0:08:530:08:58

I should not be allowed near a GP.

0:08:590:09:04

The GP, the NHS should be people that cannot afford to come

0:09:040:09:07

to places like this.

0:09:070:09:08

If you decide to go private, pay-as-you-go single

0:09:080:09:10

consultations start from ?80.

0:09:100:09:15

But what s the impact on the NHS GP services?

0:09:150:09:18

If you can t get access, then the private sector is very good

0:09:180:09:21

at then expanding to soak that up.

0:09:210:09:26

As services improve, what happens is the private sector

0:09:260:09:28

tends to contract again ? because people go back

0:09:280:09:31

to the public service.

0:09:310:09:35

If GP practice is struggling in England, it's perhaps worth

0:09:350:09:39

looking at how GP services are delivered elsewhere in Europe.

0:09:390:09:42

I ve come to Ireland - to Dublin.

0:09:420:09:45

Everyone in Ireland is entitled to receive medical care

0:09:450:09:47

through the public health system.

0:09:470:09:50

The service, however, is means-tested - those on benefits

0:09:500:09:54

or low incomes get a medical card entitling them to free treatment.

0:09:540:10:01

The remainder of the population either has private insurance or pays

0:10:010:10:03

on a treatment-by-treatment basis ? so back to pay as you go.

0:10:030:10:09

Could this be the future for the NHS?

0:10:090:10:12

Dr Mark Murphy is a GP and chair of communications

0:10:120:10:15

for the Irish College of General Practitioners.

0:10:150:10:21

Only 40% of the population can receive free at

0:10:210:10:23

the point of contact care.

0:10:230:10:26

So the other 60% of the population have to pay the market

0:10:260:10:29

price to see a GP.

0:10:290:10:31

That could be 50 euros, it could be 60 euros.

0:10:310:10:34

There is this squeezed middle.

0:10:340:10:36

So about 20% of the population in Ireland neither have a medical

0:10:360:10:39

card, so they have to pay to see me as a GP.

0:10:390:10:43

But they don t have private health insurance either and unfortunately

0:10:430:10:46

they can face catastrophic out-of-pocket payments

0:10:460:10:51

when they re unwell ? and that really is not the norm

0:10:510:10:53

in most developed countries.

0:10:530:10:56

Is it frustrating as a GP to work within these

0:10:560:10:58

constructing parameters?

0:10:580:11:00

I suppose the one advantage of the Irish health care system

0:11:000:11:03

from a General Practice perspective above the NHS, is that we generally

0:11:030:11:07

have ? if a patient rings up, they can be seen today or tomorrow ?

0:11:070:11:10

and I know in the NHS there are waiting lists.

0:11:100:11:12

If you want to see a specific GP you may have to wait

0:11:120:11:16

two or three weeks.

0:11:160:11:17

The Irish system works well for those who can afford it.

0:11:170:11:25

But asking people here in England to pay to see their NHS GP would be

0:11:250:11:29

politically unpalatable.

0:11:290:11:30

So what s to be done?

0:11:300:11:31

Across the region, GPs are looking at ways to maintain local services,

0:11:310:11:34

while at the same time working with other practices

0:11:340:11:36

to share certain costs.

0:11:360:11:37

And the Government says it s committed to spending

0:11:370:11:39

more on GP practice.

0:11:390:11:44

There s no doubt that many doctors and patients remain committed

0:11:440:11:46

to the NHS but without better funding, some surgeries may be

0:11:460:11:49

forced to reduce services or worse, close down altogether.

0:11:490:11:56

I think that if people have to pay to get the right care,

0:11:560:12:00

the whole of society has failed somewhere.

0:12:000:12:04

It s not just the NHS ? it s what does society want

0:12:040:12:08

from their health care providers?

0:12:080:12:11

And if they only get it privately, we ve failed.

0:12:110:12:17

Now we are back on air, it is great to hear

0:12:170:12:20

from you if there is something you think we should be looking into.

0:12:200:12:23

Get in touch with me on Twitter...

0:12:230:12:25

Or you can e-mail...

0:12:250:12:31

You are watching Inside Out for the East of England here on BBC One.

0:12:310:12:35

Later, the hospital that hopes to be a blueprint for the region.

0:12:350:12:38

Pleasure to meet you, sir.

0:12:380:12:40

You will get better soon.

0:12:400:12:42

I'm going home to see my cat.

0:12:420:12:48

As budgets get smaller, patient numbers go up.

0:12:490:12:52

We are looking at the pressure to ration treatments so is the NHS

0:12:520:12:56

still a National Service and does where you live matter more

0:12:560:12:58

than ever when it comes to the treatment on offer to you?

0:12:580:13:03

Chris Jackson has been investigating.

0:13:030:13:08

The NHS is facing the most significant financial

0:13:080:13:10

challenge in its history.

0:13:100:13:15

There are fears the service we have grown up with is

0:13:150:13:17

beginning to fragment.

0:13:170:13:20

It is not a National Service.

0:13:200:13:22

Absolutely there is a postcode lottery.

0:13:220:13:25

It is criminal.

0:13:250:13:27

It is absolutely criminal.

0:13:270:13:30

This is the start, this is going to get worse.

0:13:300:13:36

So, is the NHS in danger of ceasing to be a National Service

0:13:360:13:39

where everyone is entitled to the same care?

0:13:390:13:44

It is treating more patients but is it becoming a postcode

0:13:440:13:46

lottery where access depends on where you live?

0:13:460:13:49

We are going to put that to the test.

0:13:490:13:57

On a bad day, it ruins your life.

0:13:570:14:01

Muscle pains, it feels like my bones are screaming at me at times.

0:14:010:14:09

33-year-old Ben Franklin has hepatitis C, the virus can cause

0:14:090:14:11

life-threatening liver damage.

0:14:110:14:13

I am about to lose my job, I have not been at work since April,

0:14:130:14:16

I've been off sick.

0:14:160:14:18

And I could lose the flat over my head.

0:14:180:14:21

There are new drugs that can potentially cure the hepatitis

0:14:210:14:24

but they are expensive and rationed.

0:14:240:14:27

Ben has been denied them.

0:14:270:14:35

All I got was wait, because my liver was not bad enough and that made me

0:14:350:14:38

want to go out and get wasted and ruin my liver

0:14:380:14:41

just so they would treat me.

0:14:410:14:42

I wouldn't do that but I wouldn't be surprised if anyone else wouldn't.

0:14:420:14:46

The money is there for 10,000 treatments each area

0:14:460:14:50

has a target to meet, it is claimed that means

0:14:500:14:53

there are no queues in part of the North and long waits

0:14:530:14:56

in places like London.

0:14:560:14:59

Two people with the same state of liver damage could present

0:14:590:15:03

themselves in different parts of the country and in one

0:15:030:15:05

they will walk in, get hepatitis C treatment immediately,

0:15:050:15:07

get cured and in another part of the country they may go and be

0:15:070:15:11

told you will have to wait.

0:15:110:15:14

This is inherently unfair.

0:15:140:15:18

NHS England told us it was regularly reallocating and used hepatitis C

0:15:180:15:23

treatments to places with waiting lists.

0:15:230:15:29

The number of patients treated will increase by 25% next year.

0:15:290:15:34

The fact it is down to money that upsets me the most.

0:15:340:15:38

It is just money.

0:15:380:15:41

So, Ben is taking the risk of treating himself with cheaper

0:15:410:15:43

copies of the new drugs.

0:15:440:15:51

How much have you spent on that box?

0:15:510:15:53

?1300.

0:15:530:15:54

?1300 that I don't really have.

0:15:540:15:57

The fact I have had to pay for my treatment and...

0:15:570:16:01

It is criminal.

0:16:010:16:02

It is absolutely criminal.

0:16:020:16:05

Sorry.

0:16:050:16:08

I'm just tired of being tired.

0:16:080:16:12

Basically.

0:16:120:16:19

Ben is hoping the generic drugs will cure him within a matter

0:16:190:16:22

of weeks and he is not alone.

0:16:220:16:26

The hepatitis C trust estimates around 1000 people in Britain may

0:16:260:16:30

have brought the drugs abroad.

0:16:300:16:37

If you go outside, there are halos around the lights,

0:16:370:16:42

lights and shadows, it is hard to see things which are distorted.

0:16:420:16:45

Gloria has cataracts in both eyes.

0:16:450:16:50

I can't take stairs, go up or down stairs

0:16:500:16:52

with any kind of confidence.

0:16:520:16:55

Cataracts are supposed to be treated within four points

0:16:550:16:58

five months of referral.

0:16:580:17:00

Gloria, who lives in the Northeast says she has been waiting seven.

0:17:000:17:03

Is too long because there is such potential for accidents

0:17:030:17:09

and there is such a change in a person s mood.

0:17:090:17:16

If Gloria had lived in Luton, her wait could have been 15 days.

0:17:160:17:19

The postcode lottery.

0:17:190:17:21

Absolutely there is a postcode lottery.

0:17:210:17:23

It is not about clinical need, it is about some places in England

0:17:230:17:29

having poor systems, budgetary pressures and deep

0:17:290:17:31

prioritising cataract surgery.

0:17:310:17:37

That does not feel too national to me.

0:17:370:17:41

Gloria expects an operation later this month.

0:17:410:17:42

It makes me angry because I think it is almost

0:17:420:17:45

like a survival of the fittest.

0:17:450:17:49

Clinical commissioning groups control health budgets.

0:17:490:17:57

It is claimed some are delaying treatment is like cataract surgery

0:17:570:18:00

by slowing down referrals.

0:18:000:18:01

Others are requiring patients to lose weight before getting

0:18:010:18:03

operations like hip replacements.

0:18:030:18:08

Postponing an operation in these circumstances can save money

0:18:080:18:11

in the short term and whilst the CCG say they can be

0:18:110:18:19

clinically justified, the Royal College

0:18:190:18:20

of surgeons says not.

0:18:200:18:22

There is good evidence people are now not getting elective

0:18:220:18:25

operations which they desperately sometimes require simply

0:18:250:18:26

because of financial restrictions.

0:18:260:18:29

It is up to the clinicians to decide who should have what treatments.

0:18:290:18:35

And therefore a bureaucratic system which produces a blanket

0:18:350:18:38

ban is morally wrong.

0:18:380:18:42

It is claimed new systems for vetting appointments

0:18:420:18:44

with specialists are another form of rationing.

0:18:440:18:47

Why are they treating their patients with such contempt?

0:18:470:18:52

Last month, MPs complained about a private company

0:18:520:18:58

being paid ?10 for every GP referral they stopped.

0:18:580:19:00

This is rationing by the back door and has the potential

0:19:000:19:03

to compromise patient safety.

0:19:030:19:05

The same private company overseas referrals in North Tyneside.

0:19:050:19:07

We have spoken to doctors who say the system is

0:19:070:19:10

putting patients at risk.

0:19:100:19:16

The GPs who fear speaking out have told us cancer

0:19:160:19:19

diagnoses are being held up.

0:19:190:19:21

In a statement, North Tyneside CCG said there was no evidence

0:19:410:19:43

the system caused additional risk or delay.

0:19:430:19:50

Cancer referrals do not go through the system and are made

0:19:500:19:53

directly to hospital.

0:19:530:19:56

The number of referrals knocked back to GPs in England has risen by 30%

0:19:560:20:00

in the last two years.

0:20:000:20:05

You can see the details of the research online.

0:20:050:20:07

Shortage and regional difference have always been part of the NHS.

0:20:070:20:10

Today, the differences could get much worse.

0:20:100:20:14

The NHS is under an unprecedented level of pressure at the moment.

0:20:140:20:17

If it doesn't get more funding, waiting times are going to get

0:20:170:20:20

longer and the quality of patient care is going to suffer.

0:20:200:20:27

We will see different decisions taken in different parts

0:20:270:20:29

of the country and different services being

0:20:290:20:31

available to patients.

0:20:310:20:34

So, is the NHS still a National Service?

0:20:340:20:36

One of our most prominent medics is clear.

0:20:360:20:38

No, it is not a National Service.

0:20:380:20:40

It is a local health service.

0:20:400:20:42

It matters because it leads to inequality in health care,

0:20:420:20:45

that is the problem so some people will get health care

0:20:450:20:47

for free and others won't.

0:20:470:20:49

In a statement, the Department of Health told us far

0:20:490:20:52

from rationing, more people than ever are getting

0:20:520:20:54

prompt treatment.

0:20:540:20:58

standards of care are improving.

0:21:070:21:08

We asked the health secretary and NHS England

0:21:080:21:10

for an interview but both declined.

0:21:100:21:12

The people paying for NHS services, the clinical commissioners,

0:21:120:21:14

did agree to speak.

0:21:140:21:15

It is a National Service with local variation based

0:21:150:21:17

on the need of the population.

0:21:170:21:21

Demographically, populations vary quite significantly from town

0:21:210:21:23

to rural, county to county.

0:21:230:21:30

It is really important we commission and respond to the needs

0:21:300:21:32

of the population on a local basis.

0:21:320:21:34

It is about making sure the pathway is correct,

0:21:340:21:36

we don't want to squander any money.

0:21:360:21:38

We have limited resources so it's important we spend most effectively

0:21:380:21:41

and get the best value for the population.

0:21:410:21:44

For those forced to take their own action, rationing

0:21:440:21:46

appears all too real.

0:21:460:21:53

Our hospitals are also facing cuts.

0:21:530:21:55

They have been asked to make plans to be more efficient.

0:21:550:21:59

Our health reporter Nicki Fox has been to Bury St Edmunds to see how

0:21:590:22:02

the West Suffolk Hospital is trying to offer better care

0:22:020:22:05

with less money.

0:22:050:22:14

This leaflet is coming through your letterbox one day soon.

0:22:140:22:17

The NHS as it was when it was set-up in 1948.

0:22:170:22:22

How different it is today.

0:22:220:22:25

With 22 billion to save and not enough hospital beds

0:22:250:22:32

there is a new plan for the NHS.

0:22:320:22:37

And this means keeping more people out of A

0:22:370:22:39

and discharging patients quicker.

0:22:390:22:40

I have come to West Suffolk Hospital to see what it is like

0:22:400:22:43

on a typical shift.

0:22:430:22:44

Here it is about reducing the number of people stepping

0:22:440:22:47

through these doors.

0:22:470:22:48

The big struggle for this hospital is to find beds for those patients

0:22:480:22:51

who need to be admitted and that s because it s harder to release those

0:22:510:22:55

who need to go home.

0:22:550:22:59

We have got a very rural population, an ageing population.

0:22:590:23:03

we have to make sure local services are tailored to meet that need.

0:23:030:23:07

Bill Pleasance was rushed to A the night before.

0:23:070:23:11

I woke up and had a slight sort of discomfort.

0:23:110:23:13

anyway I put it down to indigestion.

0:23:140:23:17

It got worse, that frightened me and as it got worse in the end

0:23:170:23:23

I pressed my life line alarm and the paramedics came

0:23:230:23:29

within a very few minutes and decided it was not a heart

0:23:290:23:33

attack or they didn t think it was but they wanted me to come

0:23:330:23:37

into A and be checked over.

0:23:370:23:46

They are wonderful what they have done so far.

0:23:460:23:48

Really wonderful.

0:23:480:23:49

He is being fast tracked to get him home as soon as possible.

0:23:490:23:53

As Bill waits to hear if he is going home,

0:23:530:23:55

Rosemary McNeil has just been rushed in.

0:23:550:24:00

Your heart is beating so fast.

0:24:000:24:04

She has a history of heart problems.

0:24:040:24:07

Were you having palpitations?

0:24:070:24:15

It is unlikely she will go home today.

0:24:150:24:20

They had to shock my heart several times now.

0:24:200:24:27

I have been seen straightaway here - wheeled in and nurses

0:24:270:24:29

and doctor all around me.

0:24:290:24:30

Very good.

0:24:300:24:31

This hospital wants to lead the way by making sure that the care

0:24:310:24:35

is in place at home so patients can be discharged quickly,

0:24:350:24:37

this helps prevents bed blocking.

0:24:370:24:41

It is late morning and Bill gets a visit from a care practitioner.

0:24:410:24:44

My name is Sue.

0:24:440:24:46

I work for the early intervention team.

0:24:460:24:51

My role is to keep you as independent as possible.

0:24:510:24:53

I don t want to take that away from you so we need just tweak very

0:24:530:24:58

slightly the care you have got which will enable you

0:24:580:25:00

to return home safely.

0:25:000:25:03

Yes, yes.

0:25:030:25:05

That will be fine.

0:25:050:25:10

It turns out the tweaking is sorting out lunch

0:25:100:25:12

on a regular basis for Bill.

0:25:120:25:14

That is all that is needed.

0:25:140:25:16

I will let the staff know on the ward that

0:25:160:25:19

you and I have spoken.

0:25:190:25:22

What we are going to put into place and then see how you're

0:25:220:25:25

are getting home today.

0:25:250:25:26

This part of the county has to make 50 million worth of savings,

0:25:260:25:31

hospitals cost a lot more than care in the community so more care out

0:25:310:25:34

of hospital is one way this Trust will save money.

0:25:340:25:38

Our vision for the future is we will only do in hospital

0:25:380:25:42

what needs to be done in hospital that means we will continue

0:25:420:25:46

to provide excellent surgery and getting people treated

0:25:460:25:49

in emergency care but we are also working in the community.

0:25:490:25:56

So these people will have the support they need

0:25:560:25:58

in their own homes they won t be told you can t come

0:25:580:26:01

to hospital and then not have the support they need.

0:26:010:26:03

Absolutely we are very committed to providing the same services

0:26:030:26:06

to local people but do it in a more joined up proactive way.

0:26:060:26:11

Until these changes happen this A remains under pressure

0:26:110:26:15

and is still the best place to get the most expert care

0:26:150:26:18

when things go wrong.

0:26:180:26:20

A three-day history of chest infection.

0:26:200:26:22

Not responded to antibiotics.

0:26:220:26:25

How difficult is it for everyone to judge whether a patient

0:26:250:26:28

like this should be coming into hospital or not?

0:26:280:26:32

I think everyone has a duty of care so it is really

0:26:320:26:35

difficult for you to make a decision out there.

0:26:350:26:38

I think the best place is to come to A and take it from there.

0:26:380:26:42

For these pre hospital guys it is so difficult

0:26:420:26:44

for them as they don t know.

0:26:440:26:50

If a mistake is made then there is an awful lot of trouble,

0:26:500:26:55

so if it s not a clear cut decision then the best place is to bring them

0:26:550:26:59

to A you get the clinical decision from doctors.

0:26:590:27:08

If you didn t have to come if you're came here

0:27:080:27:10

and you came and well that

0:27:100:27:12

not such a bad thing but on the other way

0:27:120:27:17

round you would want it to be the other way round.

0:27:170:27:20

Your lovely neighbour has made you some lunch.

0:27:200:27:24

But it is in cases like Bill's where pressure

0:27:240:27:26

on the hospital can be relieved - by late afternoon he gets the news

0:27:260:27:29

he has been hoping for.

0:27:290:27:32

Where I live is a cottage, and I would like to stop

0:27:320:27:35

there until they wheel me out!

0:27:350:27:36

There is no place like it.

0:27:360:27:41

I will be glad to go home and see my cat!

0:27:410:27:45

And the hospital is able to free up another bed.

0:27:450:27:49

It is busy and demand is high.

0:27:490:27:53

The big plan for the NHS is the type of care being offered is changing.

0:27:530:27:57

This hospital wants to be a blue print for other hospitals to follow

0:27:570:28:00

what is clear from my time here is that the West

0:28:000:28:05

Suffolk is changing.

0:28:050:28:08

That is it.

0:28:080:28:09

Next week we investigate the rise in scams conning the elderly out

0:28:090:28:12

of billions every year.

0:28:120:28:13

Get in touch on Twitter or e-mail.

0:28:130:28:23

From a bitterly cold Jaywick on the east coast, see next week.

0:28:250:28:32

Also, the big vision, Milton Keynes 50 years

0:28:320:28:35

on, is it a success?

0:28:350:28:41

And what is the way forward to protect our coastal communities?

0:28:410:28:44

People have been campaigning for years to have proper sea

0:28:440:28:46

defences and they say whenever there is a storm surge they will go

0:28:460:28:49

to bed fearing the worst.

0:28:490:28:53

Inside Out next Monday at 7:30pm.

0:28:530:28:57

Hello, I'm Louisa Preston with your 90 second update.

0:29:090:29:12

30 British tourists shot dead in Tunisia in 2015.

0:29:120:29:14

Murdered by an Islamist gunman.

0:29:140:29:15

Today, an inquest was told that security forces

0:29:150:29:17

were deliberately slow to respond.

0:29:170:29:20

Donald Trump provokes a mixed reaction.

0:29:200:29:22

Downing Street welcomes the promise of a "quick and fair" trade deal.

0:29:220:29:25

But foreign ministers are concerned by his comments

0:29:250:29:27

that Nato is obsolete.

0:29:270:29:29

A snap election in Northern Ireland.

0:29:290:29:32

It follows the collapse of the power-sharing Government.

0:29:320:29:34

Sinn Fein refused to nominate a new deputy first minister.

0:29:340:29:36

Martin McGuinness resigned in a dispute with the DUP.

0:29:360:29:40

The former football coach Barry Bennell,

0:29:400:29:42

Is the NHS still a national service - or does where you live matter most when it comes to being treated? Inside Out talks to patients and clinicians who say rationing is fracturing the NHS, as local decision-makers struggle to balance the books.


Download Subtitles

SRT

ASS