21/01/2013 Inside Out London

Hello, tonight we are on patrol with the the volunteers providing

vital support to the West Midlands Ambulance Service as heavy snow

sparks a big interest -- increase in 999 call.

There are an awful lot of very poorly people that we saw yesterday.

It was taking an awfully long time to get to the incidence and to get

back out on the road. We will find out how our region

coped with it the deluge of snow that followed a Met Office warning.

We were promised snow and we have This is the male health centre, the

fictional home of the hugely popular BBC One daytime show

Doctors. Every day over 800,000 people attend surgeries, more than

200,000 a visit hospital. How safe are you on the wards? We have

discovered that nearly half of all serious incidents in hospital

involved a condition that is almost always preventable.

This is obviously going back, just general family members and sisters

and brothers. Some cars. He was really into his cars. Claire Cross,

from Tewkesbury, loves talking about her first hero, her dad.

was very quiet actually. Very home loving. But amongst the hundreds of

photos, there is one that she can hardly bear to look at. He didn't

really have a quality of life. I don't feel. He just sat in a chair

watching television or sleeping and that was his life from that point

on really. So what was it that robbed David Chalkley of his

independence, forcing him to spend his final days in a nursing home?

Alarmingly, it was something that happened to him in hospital,

something that ensured he would never walk again. I feel that he's

suffered needlessly. I feel that he could have possibly stayed at home

a bit longer and enjoyed a bit more of family life and being around the

surroundings that he loved and his garden. Instead of going off into a

strange place and having to stay there until the end of his life.

Two years on, Clare wants to know if what happened to her dad could

have been avoided and if others are suffering as well. We offered to

help. And we've discovered that each year

there are thousands of similar incidents in hospitals across

England, costing the health service billions. And they're almost always

preventable. What am I talking about? Simple bed sores. The NHS

insists hospitals record and investigate all incidents that

unexpectedly cause death or severe harm. It calls them Serious

Untoward Incidents. So under Freedom of Information laws, we

asked to see last year's summary. It turns out there were almost

12,000. They're broken down into more than 70 categories, like child

deaths, surgical errors, and delayed diagnoses. But more than

40% of all the serious incidents recorded at English hospitals last

year involved severe bed sores. They're also known as pressure

ulcers because they happen when pressure restricts blood supply to

the skin. And they range from small sores to large open wounds. Their

severity is graded from one to four. Most aren't suitable to show on

this programme. And they can be lethal. It was a bed sore that

claimed the life of paralysed actor Christopeher Reeve, a man who was

for so long known simply as Superman. Perhaps what's most

worrying about our research is that the NHS itself admits that in 95%

of cases bed sores are completely So what's going on? Why are

thousands of people suffering unnecessarily? Could it be

something to do with the standard of nursing in our hospitals? We

asked the Royal College of Nursing. Well, I put it down to a lack of

staff actually. If we think of the complex needs of some of these

patients we may need two or in fact three nurses to deliver appropriate

care to one patient. So for example, turning someone who is obese would

take more than one nurse and if you've got four nurses who are on

duty at one time on a ward of say 36 patients, to take three nurses

off to be able to turn one patient on a regular basis, you know, takes

time. So is it simply down to a lack of nurses? Well, the

Department of Health told us nursing ratios are down to

individual hospitals. So we had a look at the worst offender. Last

year 192 severe bed sores were recorded under the care of Dudley

Group NHS Trust, more than any other in England. Half occurred

here at Russells Hall Hospital and half in the community. So I've come

to ask the woman in charge why. The latest figures for serious untoward

incidents, the number of bed sores recorded at hospitals, your

hospital had the highest number. Is that down to not enough nurses?

What's the reason? No, absolutely not. As an organisation we have

followed the guidance from the National Patient Safety Agency

which says that high recording levels of incidents throughout

hospitals actually tends to be indicative of a high level of

patient safety culture, of openness, of an honest culture of where

people report and then learn from it. So are you saying that other

hospitals aren't doing that? Well, I can't speak for other hospitals

but what I can speak for is Dudley Group and that we have a system of

recording and capturing pressure sores throughout the hospital which

is extremely rigorous and not only do we capture them from within the

hospital itself but also those that are prevalent in the community.

you've always been so rigorous, though, at recording and reporting

these you would have known that there was a problem. Why didn't you

do something about it sooner? I think the whole NHS has

acknowledged that there's been a problem with pressures sores.

That's why it's been a national priority. And we, as an

organisation, have acknowledged it's been a problem so we started

the initiatives that we've been running over the last two years.

That included this awareness campaign in which managers showed

off parts of the body prone to bed sores. And the hospital says the

number of cases has now started to come down. It develops under the

skin. If it is not treated it can quickly become so via... But it's

not just Dudley Group NHS Trust that believes better awareness and

training is the answer. This information video has gone out to

frontline staff across the Midlands. There are simple steps you can take

to prevent pressure ulcers. education the only solution or so

do our hospitals be doing even more? Well, there was one in the

West Midlands that last year didn't record any severe bed sores at all.

It was this one, the Robert Jones & Agnes Hunt Orthopaedic Hospital in

Oswestry. And I'm here to discover its secret. How are you? We have

just turned you so we will check your dressings... Matron Julie

Roberts has agreed to share that secret. And I'm shocked when I

realise this is it, nurses simply turn patients and check their skin

every couple of hours. So this is something that's really, really

basic in preventing these pressure sores? It is. Yeah. We assess all

our patients on admission. And obviously we look at their age,

their skin integrity, any medication that they're on, what

their mobility is like. And that really makes a difference to

preventing these sores? As well as physically turning them. You have

to continually turn them. You and your team of nurses are spending a

lot of time turning patients aren't you? We are but we do it from the

top to the bottom. And fortunately a lot of our patients now are quite

independent and mobile very, very quickly after surgery because we do

get them up on the day of surgery. So we promote independence very

quickly. So there isn't as many as you'd think. I'll turn you over to

your left hand side... It's perhaps unfair, though, to compare this

specialist orthopaedic trust with general city hospitals which must

cater for all types of complex conditions. Here they're able to

invest in expensive specialist equipment like this mechanical

turning bed and these motorised foot pumps. But perhaps we can

learn from the ethos here. We're quite old-fashioned. I remember

when I first started here 25 years ago that I was told by my

consultant here, patients do not get pressure sores and if they do I

will chop your hands and head off, because it was so important that

that didn't happen. And that is what I try to instill in all the

training in all the nurses on this specific unit and within this

hospital. Back in Tewkesbury I tell Claire what we've learnt.

We found that over 40% of serious incidents of bed sores -- of bed

sores. And show her some of the footage from Oswestry. They're

checking the skin underneath the hills that they're not red. That's

something that Dad could have probably done with. Now obviously

we've only just shown you the numbers and that short film. As

it's all sinking in, what's your reaction? I'm quite cross now. I

didn't realise the numbers were so high. And it just makes me want to

ask the question why hospitals such as Oswestry can't pass on their

good practice and their training to other hospitals. Why can one

hospital do it and other hospitals can't? But the hospital where

Claire's dad got his bed sores has been in touch. The Alexandra

Hospital in Redditch claims new practices brought in last year have

helped bring about a significant reduction in the incidence of

pressure ulcers and Claire has accepted an invitation to see the

changes for herself. Well, if they can improve, it is

great, they are going in the right direction. There obviously is room

for improvement on some hospitals and the sooner it happens the

better really. So, what is your verdict on the

NHS? You can talk to was right now on Twitter, using the hash tag

inside out. You can also contact me on e-mail.

Still to come tonight: Under a blanket of snow, how Red Cross

volunteers the road to the rescue. They are very appreciative of the

sport we can -- support we can provide and having a good

communication link is essential. But next, the NHS is about to

undergo its biggest ever shake-up. What does this mean for you and me

and our families? At the doctor and This is lovely, madam, because this

inhaler would actually go with your coat. And a free examination. Do

you want to come here and cough, sir? I can give you those half

price. Plus something for your water retention. I'm a GP. And

today I'm taking healthcare into the community, where it's needed.

All the sample bottles you could ever need and I'll throw in a

crutch. It's all free. It's all paid for. This is what the biggest

shake-up in the history of the NHS is all about - giving local doctors,

nurses and patients the chance to call the shots and shop around for

the best care. At least that's the Government's plan. But many doctors

think the reforms are untested, expensive and over-complicated - a

view I shared with the former health secretary Andrew Lansley.

The difficulty with this is that it's 353 pages of wonk. It's

absolutely impossible to understand it. I choose my words carefully. It

is unreadable. What did you actually say? It's wonk. But I've

been wading through the jargon, and it's clear the reforms will affect

us all. It's vital we put politics aside and try to understand exactly

what they'll mean for patients. Until now the NHS has been like a

big supermarket chain that only sells its own brands. It's a one

stop shop where all the tricky decisions are made for you. In

theory, you should get the same high quality care whether you live

in Scunthorpe or Southend. But like any monopoly, it's far from perfect.

The Government's bringing in the market place model instead -

introducing more choice and competition, and putting GPs in

charge instead of civil servants. But will it work?

So if I just check your eyes there... I can confirm you have two

eyes. We're doing two X-rays for the price of one. And I can throw

in a free brain scan if you like. One change we're told patients

should notice is care much closer to home.

Hospitals and GPs will have more freedom to bring in innovative

ideas. Technology might monitor your health at home and routine

surgery could be done at high street clinics. Hospitals in

Gloucestershire have already teamed up with a charity to send this

mobile chemotherapy unit into rural communities. For cancer patients

like Graham Freeman, it's a lifeline. The concept is great,

moving the treatment to the person. Because it is a bit of a trauma,

suffering from the chemotherapy and the travelling. Bringing the

treatment closer to the person is a lot better. You do feel a little

bit better. Everything is positive. It is one of the few positives

since I have found out about cancer. It is one of the positive things we

have got. But could this shift towards more localised care mean

hospitals will have to close? To find out I've come to London, to

one of the world's most respected independent think tanks on health

policy - the King's Fund. I don't think we'll see many hospitals

closing as a result of care coming closer to home. It will mean

hospitals changing their roles, perhaps fewer A&E departments,

fewer maternity services provided in existing hospitals. But that

could be to the benefit of patients if we're able to plan that in the

appropriate way and get better outcomes by concentrating those

services in fewer hospitals. might not be keen though, if it's

your A&E that's closing. The second thing patients should notice is

more choice. Three tomatoes for �1! Anybody?

Three inhalers for the price of two. Come and get them! Two caulies,

�1.50 over there! We've got a separate queue here for six

symptoms or less. Competition in the NHS isn't new, but the reforms

step it up a notch. The NHS will become a marketplace,

with private companies competing with the NHS for business. So when

your GP says you need a scan, your options may look less like this,

and more like this. But it should be quality, not price, that will

decide which are allowed to offer care. It's already happening here

on the high street, where Specsavers are treating NHS

patients in 218 of its hearing centres. When I came to Specsavers,

they do private and NHS, which I find is better than going to the

hospital. You know you go to the hospital, there's a lot of

travelling and I don't think you get such a personal attention. So

this is much, much better. When you press the button in, you'll hear

two beeps which will allow you to use the telephone then. The plan is

for patients like Doreen to choose their provider by looking at new

performance league tables. But companies must play by the rules

and can't encourage NHS patients to go private. Ultimately, Specsavers

want to protect the NHS work that we've managed to gain here and we

don't want to do anything to try and jeopardise that. We're not

going to try and sell a hearing aid, upsell a patient at all during that

time. More competition could drive up standards and lower costs. But

if profits slip, companies could pull out or even go under, leaving

patients in the lurch. Remember the collapse of Northern Rock? Imagine

if its customers had been queuing not for their life savings but for

life-saving surgery. If there is going to be a bigger role for

private companies in delivering care to patients, then there is

always a possibility, however remote, that that company will not

be successful, that we will see something like Northern Rock in

healthcare. The Government's anticipating that. It's putting in

place what's called a "failure regime" so that the regulator can

intervene and ensure continuity of services even if the organisations

are not providing care to the right standard. The third thing patients

may notice is a shift in their relationship with their GP. So if I

said, "Trust me, I know the best place to go to get your heart

surgery." Would you say, "Yeah, you're the doctor. Dr Phil, you

look like a ginger George Clooney. I love, I trust you."?

Since the birth of the NHS, doctors have taken the trust of patients

for granted. But as GPs offer more and more treatments, they could

find themselves referring patients to their own services. Add private

companies into the mix and there's real scope for a conflict of

interest. So just open really wide. Say "ahh." Ahh. That's great, thank

you. But should we really be worried? In Bath, Jasmine Bishop is

seeing a GP on the NHS. But believe it or not, he actually works for

Virgin. Yup - they of planes, trains and super-fast broadband

fame also run this walk-in centre, along with 170 other NHS services...

Although you wouldn't know it from the branding. As Virgin takes over

more of the NHS, what's to stop you referring patients on to another

Virgin service to make money for the company, rather than in the

best interests of the patient? of our GPs, like any GP in the

country, have to offer patients a choice when they're being referred

for another service. So in the end, it's down to the patient to choose

where they go. And of course, GPs and other clinical staff have a

professional responsibility too to make sure that they're finding the

best care for their patients. That doesn't differ because those GPs

are employed by us. And you have to ask if patients really mind who

provides their care. Did you know that this health

centre was run by Virgin? No. it make any difference to you as a

patient whether it's run by an ordinary NHS GP or a private

company? No. So all that matters to you is what? What do you care about

in your treatment? That I get the best treatment I possibly can get

really. Which of these sample bottles would

you like, madam? We've got three on choice today.

The bottom line is that if you have a good idea to improve your care,

tell your GP. If he or she can make it happen, we know the reforms are

working. It's been a huge upheaval just to get the NHS to listen to

patients. And I hope for all our sakes it works. I can't lug all

this back again. Come on, it's got to go today. Last

chance! You are watching Inside out here in

the West Midlands. The Met Office did warn it is going to snow and it

has cost chaos. 999 services were at full stretch but they were able

to call on the vital support of some volunteers.

For the last four days, snow and freezing temperatures have gripped

in the West Midlands. We still have a Met Office amber warning in place,

the second highest and it is staying right the way through to

tonight. The snow is staying with us. If snow made driving

difficult... This is the worst I have known it for a few years, to

be honest. This is the first time we have had to turn around and come

back. Emergency services struggled to reach patients in need but there

is help at hand. Hundreds of volunteers turned out to exist.

Meet one of them, Adrian, a former teacher who has been volunteering

for the Red Cross since he was a child. Today he is operational with

the 4x4 Red Cross ambulance. I have West Midlands and villains service

when the weather gets extreme and I am joining them. Talk me through

which you do at the beginning of a shift. There are two main things we

like to do when we are setting up the ambulance. One of which is to

check the roadworthiness of the vehicle, the lights and the engine,

the tyres and bodywork. The next thing is to check the integrity of

the vehicle in terms of the supplies. It is quite a long shift

and we need to know we have got the right amount of equipment. It is

the special Land Rover which makes the team so useful when 10

centimetres of snow has fallen. are very lucky to have his vehicle.

It is worth its weight in gold, with certainly snow responses and

also inaccessible places due to flooding, or also muddied, things

like music festivals in the summer. It is useful in any kind of weather,

we would be utilised to get too inaccessible places. Either a very

rural locations or perhaps places hit hard by the snow and have lots

of hills. I will let you get on with your prep because I know you

have to sign on at the beginning of the shift. Thank you.

Signing on for a shift with the today, over. Now, the team are

signed on. Adrian just needs to check one last thing. Can I have

clarified with regards to transfer a fusion of patience, are all

patients when being transported to hospital going Asprey yesterday,

over? The weather meant the roads were blocked yesterday so every

patient they picked up had to be blue lighted to hospital through

the traffic. We had a lot of poorly people yesterday and the problem

was that it was taking an awfully long time not only to get two

incidents but to get back out on the road. To assist with getting

patients into care and to get us back onto the road, we were asked

to do that. So it is just a waiting game? I am afraid so, yes. It is

one of those things, it can happen at any moment. On Friday, they had

six jobs in six hours and they are expecting another busy day. Whilst

Adrian and the other volunteers wait at kiss, many are out enjoying

the snow that has covered the West Midlands. -- which at the base. A

call has, in. -- has come in. Roger, I do, all received. Lovely, cheers,

thank you. You have got to get moving, but what is happening?

are going to a patient in Walsall assessed by their GP. It is

recommended due to a systemic problem with their joints, and also

be a pig feed that they have into their stomach, they need to go into

hospital. -- also a feat that they have into her stomach.

The snow eased off, so getting to the patient is quick. It is a vital

piece of equipment for us and we operate as a resource for the

ambulance service. We can get to places that a land ambulance would

struggle or possibly even be dangerous for it to go.

We will just take that and to check on her.

What is the first thing you will do? We will have a chat. This is

residential accommodation. We would chat with the staff and patient and

find out what has been happening, how they are feeling, what has been

going on the last couple of days. This is a line in it and it keeps

getting moved. Kathleen has only just come out of hospital but is

still in pain and her GP wants her to be readmitted. What is your

assessment? This lady has had recent surgery and has been

receiving antibiotics at home. The main problem for her is that the

antibiotics are unable to get into her system because there is a

blockage in the tubing she has been set up with. It is important post

operatively to receive those drugs on a regular basis so we need to

take her to hospital so it can be rectified -- rectified and the

medication process can start to harbour with recovery. With their

elderly patient on the ambulance, the snow does not stop them getting

her into Walsall Manor Hospital. Kathleen has had knee surgery and

she needs antibiotics. She had was seen by the community nurses

morning and her line is blocked. Hopefully they will be able to give

her the antibiotics that she needs in hospital to take the pain away.

With this job done, it is back to base with the team, but the weather

is still threatening. It may get a lot I see you later on with the

prediction of more snow. -- a lot I see her. It could become more

treacherous. You might get a cup of tea and! Are if you are lucky.

Coming along makes a huge difference, doesn't it? We are very

lucky to have as they go and it really comes into its own in bad

weather. Certainly with the snow that we have now, I cannot see it

not been used over the next two days. I will let you get back and

get ready for the next job. Thank They at his it. Do not forget you

can find more information on our Facebook page. With more of this

forecast over the next few days, stay tuned to your local BBC radio

station. From snowing Birmingham, good night.