16/01/2017 Inside Out East

Is the NHS still a National Service?

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

which is half the cost of a holiday?

The answer is my health is more important.

As NHS budgets get tighter, we meet the people prepared

to pay to see their doctor and compare our GP services

with our friends in Ireland.

If a patient rings up, you can be seen today

or tomorrow and in the NHS there are waiting lists.

We investigate whether NHS treatments are different

depending on where you live.

We will see different decisions taken in different parts

of the country and different services being

available to patients.

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

I have been seen straightaway here.

Wheeled in and nurses and doctors all around me.

Very good.

Revealing the stories that matter closer to home.

Inside Out is back.

Hello, this is the start of the new series of

Inside Out here on BBC One.

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

that is all about health care.

Finding a GP is getting harder in many places

in the east of England.

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

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

GP instead of waiting.

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

care without having to pay.

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

Perhaps in the future, if we want free minutes,

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

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

the best deal to meet your needs.

But why?

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

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

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

health is more important.

NHS GP practice is under more pressure than ever before ?

and excessive workloads have forced some surgeries to

take drastic action.

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

? leaving them to seek a doctor elsewhere.

Other practices are struggling to keep up with demand.

Take Jaywick.

Here, a combination of an ageing population, doctors retiring

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

Dr Peter Skew joined The Green Elms Medical Practice five

years ago ? his aim?

To turn around a failing practice.

The practice population is in and from the most deprived

ward in the whole of England.

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

The patients were fed up of seeing repeatedly different doctors.

Dr Skew concentrated his effort on recruitment ? offering terms

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

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

The philosophy of this practice is to problem-solve.

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

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

to get it right, to problem-solve.

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

ongoing responsibility.

So, what do the patients think?

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

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

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

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

practices doing the same?

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

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

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

the workload issues is becoming a crisis and that plays

into your ability to recruit and retain GPs.

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

Here unemployment is low and living standards are high.

You can tell by the variety of shops.

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

And each GP service offers a different deal.

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

about an NHS surgery run by an external operator?

As of July last year, Sutherland Lodge Surgery

is run by Virgin Care.

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

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

was handed to the private sector to sort out.

But no.

Only recently it was rated outstanding by the Care

Quality Commission.

The surgery then had its funding cut back.

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

the drastic decision to close the practice.

This is astounding.

Shirley-Anne Hall has been a patient at Sutherland Lodge

for over 70 years.

Virgin Care Services has been identified as the preferred bidder

to take on the running of Sutherland Lodge Surgery.

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

Well, I guess we are grateful because otherwise

what were we going to have?

Nothing?

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

patients ? they ve said so.

What s it like now?

It just seems to be locums.

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

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

or just a continuation of different people?

That doesn t make me feel very happy.

A spokesperson for Virgin Care said:

But if you re one of those patients

no longer registered with Sutherland Lodge

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

Maybe find another NHS doctor ? stick with the tried

and tested older model.

Or as some websites claim ? help ease the pressure

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

for a faster, maybe better, service.

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

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

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

We see a very wide social mix.

You have to remember that what we charge for an appointment

is less than most people pay at the vets.

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

coming back to us in any way.

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

is buckling under the strain?

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

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

because they cannot get an appointment with their NHS GP.

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

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

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

Do you think that people like yourself will move more

into paying for their treatment?

I had this discussion with couple of mates about this.

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

I should not be allowed near a GP.

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

to places like this.

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

consultations start from ?80.

But what s the impact on the NHS GP services?

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

at then expanding to soak that up.

As services improve, what happens is the private sector

tends to contract again ? because people go back

to the public service.

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

looking at how GP services are delivered elsewhere in Europe.

I ve come to Ireland - to Dublin.

Everyone in Ireland is entitled to receive medical care

through the public health system.

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

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

The remainder of the population either has private insurance or pays

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

Could this be the future for the NHS?

Dr Mark Murphy is a GP and chair of communications

for the Irish College of General Practitioners.

Only 40% of the population can receive free at

the point of contact care.

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

price to see a GP.

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

There is this squeezed middle.

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

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

But they don t have private health insurance either and unfortunately

they can face catastrophic out-of-pocket payments

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

in most developed countries.

Is it frustrating as a GP to work within these

constructing parameters?

I suppose the one advantage of the Irish health care system

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

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

and I know in the NHS there are waiting lists.

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

two or three weeks.

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

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

politically unpalatable.

So what s to be done?

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

while at the same time working with other practices

to share certain costs.

And the Government says it s committed to spending

more on GP practice.

There s no doubt that many doctors and patients remain committed

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

forced to reduce services or worse, close down altogether.

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

the whole of society has failed somewhere.

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

from their health care providers?

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

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

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

Get in touch with me on Twitter...

Or you can e-mail...

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

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

Pleasure to meet you, sir.

You will get better soon.

I'm going home to see my cat.

As budgets get smaller, patient numbers go up.

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

still a National Service and does where you live matter more

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

Chris Jackson has been investigating.

The NHS is facing the most significant financial

challenge in its history.

There are fears the service we have grown up with is

beginning to fragment.

It is not a National Service.

Absolutely there is a postcode lottery.

It is criminal.

It is absolutely criminal.

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

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

where everyone is entitled to the same care?

It is treating more patients but is it becoming a postcode

lottery where access depends on where you live?

We are going to put that to the test.

On a bad day, it ruins your life.

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

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

life-threatening liver damage.

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

I've been off sick.

And I could lose the flat over my head.

There are new drugs that can potentially cure the hepatitis

but they are expensive and rationed.

Ben has been denied them.

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

want to go out and get wasted and ruin my liver

just so they would treat me.

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

The money is there for 10,000 treatments each area

has a target to meet, it is claimed that means

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

in places like London.

Two people with the same state of liver damage could present

themselves in different parts of the country and in one

they will walk in, get hepatitis C treatment immediately,

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

told you will have to wait.

This is inherently unfair.

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

treatments to places with waiting lists.

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

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

It is just money.

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

copies of the new drugs.

How much have you spent on that box?

?1300.

?1300 that I don't really have.

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

It is criminal.

It is absolutely criminal.

Sorry.

I'm just tired of being tired.

Basically.

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

of weeks and he is not alone.

The hepatitis C trust estimates around 1000 people in Britain may

have brought the drugs abroad.

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

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

Gloria has cataracts in both eyes.

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

with any kind of confidence.

Cataracts are supposed to be treated within four points

five months of referral.

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

Is too long because there is such potential for accidents

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

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

The postcode lottery.

Absolutely there is a postcode lottery.

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

having poor systems, budgetary pressures and deep

prioritising cataract surgery.

That does not feel too national to me.

Gloria expects an operation later this month.

It makes me angry because I think it is almost

like a survival of the fittest.

Clinical commissioning groups control health budgets.

It is claimed some are delaying treatment is like cataract surgery

by slowing down referrals.

Others are requiring patients to lose weight before getting

operations like hip replacements.

Postponing an operation in these circumstances can save money

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

clinically justified, the Royal College

of surgeons says not.

There is good evidence people are now not getting elective

operations which they desperately sometimes require simply

because of financial restrictions.

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

And therefore a bureaucratic system which produces a blanket

ban is morally wrong.

It is claimed new systems for vetting appointments

with specialists are another form of rationing.

Why are they treating their patients with such contempt?

Last month, MPs complained about a private company

being paid ?10 for every GP referral they stopped.

This is rationing by the back door and has the potential

to compromise patient safety.

The same private company overseas referrals in North Tyneside.

We have spoken to doctors who say the system is

putting patients at risk.

The GPs who fear speaking out have told us cancer

diagnoses are being held up.

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

the system caused additional risk or delay.

Cancer referrals do not go through the system and are made

directly to hospital.

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

in the last two years.

You can see the details of the research online.

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

Today, the differences could get much worse.

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

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

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

We will see different decisions taken in different parts

of the country and different services being

available to patients.

So, is the NHS still a National Service?

One of our most prominent medics is clear.

No, it is not a National Service.

It is a local health service.

It matters because it leads to inequality in health care,

that is the problem so some people will get health care

for free and others won't.

In a statement, the Department of Health told us far

from rationing, more people than ever are getting

prompt treatment.

standards of care are improving.

We asked the health secretary and NHS England

for an interview but both declined.

The people paying for NHS services, the clinical commissioners,

did agree to speak.

It is a National Service with local variation based

on the need of the population.

Demographically, populations vary quite significantly from town

to rural, county to county.

It is really important we commission and respond to the needs

of the population on a local basis.

It is about making sure the pathway is correct,

we don't want to squander any money.

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

and get the best value for the population.

For those forced to take their own action, rationing

appears all too real.

Our hospitals are also facing cuts.

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

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

the West Suffolk Hospital is trying to offer better care

with less money.

This leaflet is coming through your letterbox one day soon.

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

How different it is today.

With 22 billion to save and not enough hospital beds

there is a new plan for the NHS.

And this means keeping more people out of A

and discharging patients quicker.

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

on a typical shift.

Here it is about reducing the number of people stepping

through these doors.

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

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

who need to go home.

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

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

Bill Pleasance was rushed to A the night before.

I woke up and had a slight sort of discomfort.

anyway I put it down to indigestion.

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

I pressed my life line alarm and the paramedics came

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

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

into A and be checked over.

They are wonderful what they have done so far.

Really wonderful.

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

As Bill waits to hear if he is going home,

Rosemary McNeil has just been rushed in.

Your heart is beating so fast.

She has a history of heart problems.

Were you having palpitations?

It is unlikely she will go home today.

They had to shock my heart several times now.

I have been seen straightaway here - wheeled in and nurses

and doctor all around me.

Very good.

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

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

this helps prevents bed blocking.

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

My name is Sue.

I work for the early intervention team.

My role is to keep you as independent as possible.

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

slightly the care you have got which will enable you

to return home safely.

Yes, yes.

That will be fine.

It turns out the tweaking is sorting out lunch

on a regular basis for Bill.

That is all that is needed.

I will let the staff know on the ward that

you and I have spoken.

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

are getting home today.

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

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

of hospital is one way this Trust will save money.

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

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

to provide excellent surgery and getting people treated

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

So these people will have the support they need

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

to hospital and then not have the support they need.

Absolutely we are very committed to providing the same services

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

Until these changes happen this A remains under pressure

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

when things go wrong.

A three-day history of chest infection.

Not responded to antibiotics.

How difficult is it for everyone to judge whether a patient

like this should be coming into hospital or not?

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

difficult for you to make a decision out there.

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

For these pre hospital guys it is so difficult

for them as they don t know.

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

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

to A you get the clinical decision from doctors.

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

and you came and well that

not such a bad thing but on the other way

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

Your lovely neighbour has made you some lunch.

But it is in cases like Bill's where pressure

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

he has been hoping for.

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

there until they wheel me out!

There is no place like it.

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

And the hospital is able to free up another bed.

It is busy and demand is high.

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

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

what is clear from my time here is that the West

Suffolk is changing.

That is it.

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

of billions every year.

Get in touch on Twitter or e-mail.

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

Also, the big vision, Milton Keynes 50 years

on, is it a success?

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

People have been campaigning for years to have proper sea

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

to bed fearing the worst.

Inside Out next Monday at 7:30pm.

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