16/01/2017 Inside Out London

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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