16/01/2017 Inside Out London


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Hello. Welcome to a new series of Inside Out. I hope you had a lovely


break. Tonight were putting health care under the spotlight. As budgets


tighten and patient numbers rocket the NHS is being forced to ration


different treatments depending on where you live. So we ask, do we


still have a truly national health. It's now a local health service. It


leads to inequality in health care. Some people will get health care for


free and some won't. With NHS hospitals are learning more from


Private treatments is a two tier system becoming a reality? It means


NHS beds, services, staff once devoted to NHS patients are now


being diverted to private care. And could your local pharmacy be under


threat? Everything is going. We don't need the pharmacy to go.


As many recent headlines have shown, the NHS is under colossal pressure


at the moment. A combination of soaring demand and limited


resources. The fallout from this is that increasingly treatment is being


rationed regionally. But if the care available to patients depends more


than ever on where we happen to live, can we still claim to have a


truly national health? Chris Jackson investigates.


The NHS is facing the most significant challenge in its


history. There are fears the service we've grown up with is bidding to


fragment. It is not a National Service. Absolutely there is a


postcode lottery. 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's treating more patients,


but is it becoming a postocde lottery, where access can


depend on where you live? It feels like my bones


are screaming at me at time. 33-year-old Ben Franklin


has Hepatitis C. The virus can cause


life-threatening liver damage. I could possibly lose


the flat over my head. There are new drugs that could


potentially cure Ben s Hepatitis. And just get absolutely


wasted and ruin my liver, Buit I wouldbn't be surprised


if somebody else would. The money is there for just


over 10,000 treatments. It s claimed that means


there are no queues in parts of the north, and long waits


in places like London. Two people with exactly the same


state of liver damage could present themselves in different


parts of the country, and in one they'll be able to walk


in and get Hepatitis C treatment immediately,


and get cured. And in another part of the country,


they may go there and be told, "Sorry, you're


going to have to wait." NHS England told us it was regularly


reallocating unused Hepatitis C treatments to places


with waiting lists. The number of patients treated


will increase by 25% next year. So Ben is taking the risk,


of treating himself ? with cheaper The fact that I've had to pay


for my treatment, it's criminal. Ben is hoping the generic drugs will


kill him within a matter of weeks. -- cure him within a matter of


weeks. The Hepatitis C Trust


estimates that around 1,000 people in Britain may have


bought the drugs abroad. If you go outside, there


are halos around lights. Gloria McShane has


cataracts in both eyes. Go up or down stairs


with any kind of confidence. Cataracts are supposed


to be treated within four Gloria, who lives in the north-east,


says she s been waiting seven. It's too long, because there's such


potential for accidents, and there's such a change


in a person's mode. If Gloria had lived in Luton her


wait could have been Absolutely there is


a postcode lottery. It's not about clinical need,


it's about some places in England having poor systems,


having budgetary pressures and That doesn't feel too


"national" to me. Gloria expects to get her


operation later this month. It really makes me angry


because I think that it's almost Clinical Commissioning Groups,


or CCGs, control health budgets. It s claimed some are delaying


treatments like cataract surgery, Others are requiring patients


to lose weight before getting Postponing an operation


in the circumstances can And whilst the CCG's say it can be


"clinically justified", the Royal College of


surgeons say it can't. There is very good evidence that


people are now not getting elective operations simply because of


financial restrictions. It is up to the clinicians


to decide who should have what treatments, and therefore


a bureaucratic system that produces a blanket


ban is morally wrong. It s also 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 The same private company oversees


referrals in North Tyneside. We've spoken to doctors


who say the system is The GPs who fear speaking out, have


told us that cancer diagnoses are I tried to get a patient


referred to a dermatologist. The referral management


service said it was a It was a nasty,


invasive skin cancer. They're putting up barriers,


using delaying tactics. It's getting between the doctor


and the specialist. 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 The number of referrals knocked back


to GPs in England has risen You can see the details


of our research online. 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,


the quality of patient So we will see different decisions


taken in different parts of the country and different


services being available So, is the NHS still


a National Service? One of our most prominent


medics is clear. I think it matters, because it leads


to an equality in health care. Some people will get health care


for free and others won't. It's a National Service


with local variation In a statement, the Department of


Health told us, far from rationing, more people than ever


are getting prompt treatment. 3261 more cancer patients


are being seen every day, We asked the Health Secretary and


NHS England for an interview, both The people actually paying for NHS


services, the typical commissioners, it


did agree to speak. It's a National Service


with local variation based on the needs of


the Demographically, populations


vary quite significantly We don't want to squander


any money, we have limited resources,


so it's really important that the very sources


have we spent more effectively, getting the best value for our


For those forced to take their own action rationing


Still to come on tonight's show. We're talking of a cut of 12% in


pharmacy budgets. For a lot of pharmacies that is a big hit. What


you are going to see ultimately the Government doesn't change course is


large-scale closures of pharmacies. An Inside Out London investigation


has discovered that over the last five years,


nearly all of the capital s NHS foundation hospitals have seen


a significant rise in their income Many of us, it seems,


are willing to pay ? often tens of thousands of pounds -


to avoid long waiting lists or get Dr Ranj Singh asks if this


is this a slippery slope towards a two-tier NHS,


where less well-off patients When the NHS was first launched,


back in 1948, it was founded on three core principles -


that it met the needs of everyone, that it was free at the point


of delivery, and that it was based on clinical need,


not ability to pay. 69 years on, and campaigners warn


that all three of those core principles are now under existential


threat; in an NHS increasingly reliant on private services,


private patients and private income. What people want to know


is that you re going to get the services that you need,


when you need them, free at the point of delivery


because you ve paid for them, not that somebody is


going to come and see You can have anything


you want if you pay for it, But in a cash strapped NHS,


do we really have the luxury of saying no to the profits


of the private market? I don t think privatization needs


to be something that is feared. Across the capital, income


from private health care is booming, both in luxurious Harley Street


clinics and, perhaps more surprisingly, within NHS


hospitals themselves. The story really begins


with the Health and Social Care Act 2012, which actually


took away the duty form the Secretary of State to provide


a national health service. The health and social care act,


passed by the coalition Government, lifted a cap on non NHS income


for foundation trusts from just 2% to 49%,


effectively allowing some NHS hospitals to generate almost half


of their incomes through private They are now incentivized,


to say under their license we are going to actually cut,


or delist the services Or we will reduce those


services or we will reduce That then incentivises


people to think, well, we better take out private health


insurance or we better I understand the concerns that


Allyson has, but the fact remains that the NHS is facing yet another


year of massive pressures and as someone who works


within the system every day, I can see how difficult it is


becoming for patients and staff. So, is a revenue stream now


generating almost 300 million pounds a year in London alone,


actually an essential asset for an institution


calling out for money? Or will it, as other fear,


lead to a two tier system where those who can t pay


are increasingly left behind? There is a sense amongst patients


who can t afford to pay, of only if I had the money,


I could jump the cue, We are not against private health


care system, that is fine, the problem is our concern


is for those who simply cannot begin to think


of having private healthcare. Joe McKeever suffers


from intense back pain, but the pain relief injections


he used to receive, are no It s now got from three


months, to six months, six months to nine months,


now to a year between injections and OK for six months they work,


and then after six months it starts People like me, who have been


reliant on it for so long, all of a sudden stop,


it's like taking someone's life Early last year Joe saw no options


but to pay for a private It worked, but he says he can t


afford to keep paying I was in pain, I needed some relief,


and the only way to do You can have anything


you want if you pay for it, I need it, I ve paid in my national


insurance over the years, Our investigation discovered that


over the past five years there has been a 22% increase in private


patient numbers within NHS Foundation Trust hospital


across the capital, over the last five years, and a 38% increase


in private patient income. We showed Allyson some


of these numbers. We looked at 14 foundation trust


across London and looked at the amount of income


they generate form private care within the NHS hospitals


over five years. One that stands out,


and this is only one example, is the Homerton Hospital,


has increase its private income Now the caveat here is that it was


half a million to start with, it s now ?1 million,


so in absolute figures it might not be an huge amount,


where as some other trust have increased it by tens


of millions of pounds. And we can see this pattern


now being replicated right across London,


in varying proportions, but a huge increase,


and this is what you going to expect to see over the next five to ten


years, foundation trust will be looking to increase their income


so that they are 49% private income and only 51%


will be public patients. And that is very concerning,


of course, because that means that NHS beds,


services staffs, that were once dedicated to NHS patients,


are now being diverted to private For some NHS trusts,


private patient care has become so important,


that they are opening up new multi million pound units both


overseas and here in London. Just around the corner


from here in the prestigious Harley Street area of London,


is a brand new clinic that was opened late last year


by the Royal Brompton, At the same time, the trust


is facing remedial action, for missing NHS waiting list target


at its main hospital site. Meanwhile the traditional private


clinics around here are also seeing a significant rise in patient


numbers, in part as a result It s inevitable that people


are going to be let down by the NHS across a broad array of services,


because the NHS can no longer provide all the things


which the population had been led to have expectations that it


might be able to do so. Across London, all NHS


Foundation Trust hospitals now host separate private wings of their own,


but Professor Ayliffe believes that traditional private clinics should


welcome the emerging competition. Completion in the private sector


is going to drive up standards, and improve care and I'm very


pleased about that. I don't think privatization needs


to be something that is feared. The private sector can be clever,


it can be much more efficient at changing and adapting


to different needs. That is the ability


that the nationalized We are one of the richest countries


in the world we can afford to pay for health service. We should be


spending our money more wisely and not on all the Private for-profit


companies. I've been a doctor for many years and I treat patients from


allsorts of backgrounds. Some can afford to pay but many can't and I


find myself increasingly conflicted. We are told that 100% of any surplus


revenue generated from private patients at NHS foundation trusts,


are reinvested back into the hospitals as a whole;


hospitals that are facing a particular difficult


financial environment. But I m not sure this


is what the NHS is meant to be But I m not sure this is


what the NHS is meant to be about - private patients subsidizing


what would inevitably be But for me, perhaps the most


frustrating thing of all is this, the people that run these hospitals


and their private units across London, have all refused


to talk to us.They have refused to argue their case for private


patients, and it is this lack of transparency that raises so many


suspicions and doubts. I believe when I was a kid the NHS


for was a nonprofit organization, but now it's been turned


into a multinational company. We all know how inundated with


patient's GP's surgeries and any departments can get. That's why the


Government is pushing for more of us to go to our local pharmacy form


treatment of minor medical ailments. It makes sense. But some pharmacies,


particularly those in the capital, are having to deal with huge cuts to


their budgets, Poznan futures in jeopardy.


This state of the art robot dispenses pills in this


The machine maybe brand new, but this pharmacist has been


here for 34 years and is one of the hubs of the community


He listens and he has a kindly approach as well.


He has always got a bit of a smile on his fizzog.


Every time we need them they're here ready for us and sometimes


there s a chance I don t even go to the GP.


I say I got this or I got that - they help me out.


My new born twins, one of them had quite a bad nappy rash


and it was quite difficult to get a doctor's appointment.


And the pharmacist we saw was quite useful at recommending something,


so didn t need to see the GP, didn t need a prescription.


We all know our GPs are completely overwhelmed and it can take days


The Government is now trying to encourage more and more or us


with simple illness such as coughs, colds and flu to go ands


see a pharmacist before we bother our GP.


Dilip Mehta is one such pharmacist trying to take some of the strain


off local GPs by offering services that in the past only they could.


where we sit down with the patients, discuss their medications.


If there s any issues we send a report to the doctor


When somebody s on a new medication, especially blood pressure medication


or heart medication, we either call them in or we ring them up


after a week or, if they need a blood pressure check,


we tell them come and have a blood pressure check


If it s a blood pressure medication we follow


them up after a month, ask them if there s


Can do that for you - are you registered


Yes - in Chiswick, though, not round here.


It's not a problem, though, we can do that for you.


We have been doing flu service for the last few years - it has been


They can come on a Saturday or thy can come whenever,


This is what the customers like about it,


so the uptake of flu services is quite high in pharmacies.


Dillip's knowledge and awareness were vital when one woman


He said, no, this is a serious matter.


I don t want to scare you, I don t want to frighten


She said yeah, yeah, I know, I made an appointment for two weeks.


Please go to your GP and tell him urgent.


to the GP and he said and he did give her when she told him the story


Thank God Dr Warren saw her and she was referred


to the hospital - a colonoscopy was done,


You know, without this man maybe I die.


He pushed me, he say, go away, take now -


We thank God and we thank Mr Dilip for saving her life


No wonder he is so well thought of in the local community


but pharmacies cost us the tax payer over ?2.8 billion a year and now


the Government is keen to reduce the bill and are making cuts.


With around 90% of the income of pharmacies coming from the NHS


many pharmacists say these cuts could put them out of business.


Were talking of a cut of 12% in pharmacy budgets in the months


December to March 2017 and more cuts to follow after that now for a lot


What you will see ultimately if the Government doesn t change


course could be large scale closures of pharmacies.


Not all pharmacies will feel the full force of the cuts.


You re offered some protection if you re the only chemist


That means that the cuts could effect London very badly.


Try travelling a mile in our busy metropolis


Its not just the inner city that will be hit though,


here in Hertfordshire this community pharmacy less than a mile


from Harpenden is fighting to stay alive.


This pharmacy and although it's the only pharmacy in the area and it


serves the population of ten to 12 thousand people just


because its marginally within the arbitrary one-mile limit


of Harpenden, just short of a mile away


will be subject to the full force of the cuts now that will leave


the business non viable obviously I will not sign the lease


on a business I know will not be able to pay its way


and we will close in the next few months.


This community we're serving here is 10,000 to 12,000 people.


One of the things we know about a community that makes a micro


economy work, you need a source of fresh food,


a post office, and a source of health care.


I would feel devastated because not only is it the pharmacy


friends you know you build up a rapoor with people don t


you everythings going we don t need the pharmacy to go.


If I were to have to go to harpendon because this pharmacist had closed


I would have to climb into my car and like many people and bear


in mind that this pharmacist serves between 8,000 and 10,000


people in the locality - you'd then have lots of car journeys


into Harpendon that has an impact on the environment.


It just seems strange to me that at a time when nhs funding is such


a critical issue that pharmacist s who are able to provide expert


advice on many many many issues maybe minor problems but if people


don't get that advice in their local pharmacy, well,


to their GP and that I would suggest is probably a much higher


costly factor for the NHS than if they were getting


over the counter advice from their local pharmacy.


It doesn t make economic sense to me - it's quite absurd.


So those local people are unsure of the effect on their daily life


And it seems the Government are just as unsure.


In a report signed off three months ago, by the under secretary of state


for the Department of Health they said they couldn t estimate


the economic cost to patients having to travel to pharmacies nor


could they estimate the number of pharmacies that might have


We asked them if they know knew what the effect


They told us, "Our modernisation package will not jeopardise


the quality of services provided but will protect patient access


in areas where there are fewer pharmacies and higher health needs,


meaning no area will be left without access


You can't help but wonder what s going on here -


one minute it's "use your local pharmacist" and the next


but one thing is for certain - with our growing and ageing


population, we are going to need our pharmacists more than ever before.


So let's hope that some sensible and realistic decisions


And that just about wraps up tonight 's health care special. Before we


go, let's look at what is coming up on next week's programme. We


investigate why the West Ham stadium deal continues to be a burden on


taxpayers. As far as I can see, there is no end to taxpayer's money


being used to prop up this white elephant. How a high-speed rail link


cutting across this oasis could damage wildlife. I hate what they're


doing it. I'm so scared of the destruction of this perfect habitat.


And we go behind-the-scenes at a London icon. If using the thousands


of people who travel over the bridge and through the bridge and river


every day. None of them are aware of this massive space that exists here.


And that is all from this week's Inside Out. If you missed any after


nights's show, head to our website. The address is on screen. Thank you


for watching. We'll see you next week.


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With NHS budgets under pressure more and more hospital Trusts are choosing to make money by offering patients private treatments. In an Inside Out NHS special Dr Ranj Singh asks if we are creating a two-tier health system. Chris Jackson asks if we can still claim to be a truly national health service. And - Jo Good finds out how community pharmacies are taking the load off overstretched GPs.

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