16/01/2017 Inside Out London


16/01/2017

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

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

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

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

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

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

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

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

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

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

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

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

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at the moment. A combination of soaring demand and limited

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

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

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

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truly national health? Chris Jackson investigates.

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The NHS is facing the most significant challenge in its

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

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

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postcode lottery. This is the start -

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this is going to get worse. So, is the NHs in danger of ceasing

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to be a "National" service, where everyone is entitled

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to the same care? It's treating more patients,

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but is it becoming a postocde lottery, where access can

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depend on where you live? It feels like my bones

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

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has Hepatitis C. The virus can cause

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life-threatening liver damage. I could possibly lose

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

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potentially cure Ben s Hepatitis. And just get absolutely

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

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if somebody else would. The money is there for just

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over 10,000 treatments. It s claimed that means

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

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in places like London. Two people with exactly the same

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state of liver damage could present themselves in different

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

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in and get Hepatitis C treatment immediately,

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

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

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

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reallocating unused Hepatitis C treatments to places

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with waiting lists. The number of patients treated

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

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

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

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

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weeks. The Hepatitis C Trust

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estimates that around 1,000 people in Britain may have

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bought the drugs abroad. If you go outside, there

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are halos around lights. Gloria McShane has

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cataracts in both eyes. Go up or down stairs

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with any kind of confidence. Cataracts are supposed

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

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

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potential for accidents, and there's such a change

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

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wait could have been Absolutely there is

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

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

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having budgetary pressures and That doesn't feel too

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"national" to me. Gloria expects to get her

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operation later this month. It really makes me angry

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

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

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treatments like cataract surgery, Others are requiring patients

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to lose weight before getting Postponing an operation

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

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"clinically justified", the Royal College of

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

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people are now not getting elective operations simply because of

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financial restrictions. It is up to the clinicians

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to decide who should have what treatments, and therefore

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a bureaucratic system that produces a blanket

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ban is morally wrong. It s also claimed new systems

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for vetting appointments with specialists are another

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form of rationing. Why are they treating their patients

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with such contempt? Last month MPs complained

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about a private company being paid ?10 for every GP

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referral they stopped. This is rationing by the back door

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and has the potential to compromise The same private company oversees

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referrals in North Tyneside. We've spoken to doctors

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

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

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referred to a dermatologist. The referral management

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service said it was a It was a nasty,

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invasive skin cancer. They're putting up barriers,

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using delaying tactics. It's getting between the doctor

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and the specialist. In a statement, North Tyneside

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CCG said there was no evidence the system caused

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additional risk or delay. Cancer referrals do not go

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through the system and are made The number of referrals knocked back

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to GPs in England has risen You can see the details

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of our research online. The NHS is under an unprecedented

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level of pressure at the moment. If it doesn't get

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more funding, waiting times are going to get longer,

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the quality of patient So we will see different decisions

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taken in different parts of the country and different

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services being available So, is the NHS still

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a National Service? One of our most prominent

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

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

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

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with local variation In a statement, the Department of

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

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are getting prompt treatment. 3261 more cancer patients

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

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

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services, the typical commissioners, it

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did agree to speak. It's a National Service

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with local variation based on the needs of

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the Demographically, populations

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vary quite significantly We don't want to squander

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any money, we have limited resources,

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so it's really important that the very sources

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

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For those forced to take their own action rationing

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

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

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

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

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has discovered that over the last five years,

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nearly all of the capital s NHS foundation hospitals have seen

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

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

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

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

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

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

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

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

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

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that all three of those core principles are now under existential

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threat; in an NHS increasingly reliant on private services,

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private patients and private income. What people want to know

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

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when you need them, free at the point of delivery

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because you ve paid for them, not that somebody is

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going to come and see You can have anything

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

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

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of the private market? I don t think privatization needs

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

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

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clinics and, perhaps more surprisingly, within NHS

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hospitals themselves. The story really begins

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with the Health and Social Care Act 2012, which actually

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took away the duty form the Secretary of State to provide

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

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

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for foundation trusts from just 2% to 49%,

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effectively allowing some NHS hospitals to generate almost half

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of their incomes through private They are now incentivized,

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

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or delist the services Or we will reduce those

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services or we will reduce That then incentivises

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

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insurance or we better I understand the concerns that

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

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year of massive pressures and as someone who works

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

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

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generating almost 300 million pounds a year in London alone,

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actually an essential asset for an institution

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

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

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are increasingly left behind? There is a sense amongst patients

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

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

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

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is for those who simply cannot begin to think

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of having private healthcare. Joe McKeever suffers

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from intense back pain, but the pain relief injections

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

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

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

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

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

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

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

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

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and the only way to do You can have anything

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

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insurance over the years, Our investigation discovered that

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

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patient numbers within NHS Foundation Trust hospital

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

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in private patient income. We showed Allyson some

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of these numbers. We looked at 14 foundation trust

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across London and looked at the amount of income

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they generate form private care within the NHS hospitals

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over five years. One that stands out,

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

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

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

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

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where as some other trust have increased it by tens

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of millions of pounds. And we can see this pattern

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now being replicated right across London,

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in varying proportions, but a huge increase,

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

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years, foundation trust will be looking to increase their income

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

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will be public patients. And that is very concerning,

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of course, because that means that NHS beds,

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services staffs, that were once dedicated to NHS patients,

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are now being diverted to private For some NHS trusts,

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private patient care has become so important,

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that they are opening up new multi million pound units both

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overseas and here in London. Just around the corner

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from here in the prestigious Harley Street area of London,

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is a brand new clinic that was opened late last year

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

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is facing remedial action, for missing NHS waiting list target

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at its main hospital site. Meanwhile the traditional private

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clinics around here are also seeing a significant rise in patient

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

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

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because the NHS can no longer provide all the things

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which the population had been led to have expectations that it

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

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

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but Professor Ayliffe believes that traditional private clinics should

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welcome the emerging competition. Completion in the private sector

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

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pleased about that. I don't think privatization needs

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

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it can be much more efficient at changing and adapting

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to different needs. That is the ability

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that the nationalized We are one of the richest countries

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

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

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

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

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

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revenue generated from private patients at NHS foundation trusts,

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are reinvested back into the hospitals as a whole;

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hospitals that are facing a particular difficult

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financial environment. But I m not sure this

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

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

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what would inevitably be But for me, perhaps the most

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

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and their private units across London, have all refused

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

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

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

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

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into a multinational company. We all know how inundated with

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

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

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

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

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their budgets, Poznan futures in jeopardy.

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This state of the art robot dispenses pills in this

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The machine maybe brand new, but this pharmacist has been

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

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He listens and he has a kindly approach as well.

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

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

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

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

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

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

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

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

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

:20:42.:20:44.

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

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

:20:51.:20:53.

see a pharmacist before we bother our GP.

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

:20:58.:21:00.

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

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

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

:21:18.:21:20.

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

:21:21.:21:28.

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

:21:29.:21:32.

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

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we tell them come and have a blood pressure check

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If it s a blood pressure medication we follow

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them up after a month, ask them if there s

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Can do that for you - are you registered

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Yes - in Chiswick, though, not round here.

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

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

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

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This is what the customers like about it,

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

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Dillip's knowledge and awareness were vital when one woman

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He said, no, this is a serious matter.

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

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

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Please go to your GP and tell him urgent.

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

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Thank God Dr Warren saw her and she was referred

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to the hospital - a colonoscopy was done,

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You know, without this man maybe I die.

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

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

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

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

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

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

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

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

:23:41.:23:47.

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

:23:48.:23:52.

What you will see ultimately if the Government doesn t change

:23:53.:24:01.

course could be large scale closures of pharmacies.

:24:02.:24:07.

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

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You re offered some protection if you re the only chemist

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That means that the cuts could effect London very badly.

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Try travelling a mile in our busy metropolis

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

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here in Hertfordshire this community pharmacy less than a mile

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from Harpenden is fighting to stay alive.

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

:24:38.:24:40.

serves the population of ten to 12 thousand people just

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because its marginally within the arbitrary one-mile limit

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of Harpenden, just short of a mile away

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

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the business non viable obviously I will not sign the lease

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

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and we will close in the next few months.

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

:25:12.:25:15.

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

:25:16.:25:18.

economy work, you need a source of fresh food,

:25:19.:25:21.

a post office, and a source of health care.

:25:22.:25:30.

I would feel devastated because not only is it the pharmacy

:25:31.:25:42.

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

:25:43.:25:45.

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

:25:46.:25:47.

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

:25:48.:25:51.

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

:25:52.:25:54.

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

:25:55.:25:56.

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

:25:57.:25:59.

into Harpendon that has an impact on the environment.

:26:00.:26:01.

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

:26:02.:26:05.

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

:26:06.:26:08.

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

:26:09.:26:15.

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

:26:16.:26:18.

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

:26:19.:26:23.

costly factor for the NHS than if they were getting

:26:24.:26:27.

over the counter advice from their local pharmacy.

:26:28.:26:30.

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

:26:31.:26:34.

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

:26:35.:26:37.

And it seems the Government are just as unsure.

:26:38.:26:43.

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

:26:44.:26:47.

for the Department of Health they said they couldn t estimate

:26:48.:26:49.

the economic cost to patients having to travel to pharmacies nor

:26:50.:26:53.

could they estimate the number of pharmacies that might have

:26:54.:26:57.

We asked them if they know knew what the effect

:26:58.:27:00.

They told us, "Our modernisation package will not jeopardise

:27:01.:27:06.

the quality of services provided but will protect patient access

:27:07.:27:09.

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

:27:10.:27:14.

meaning no area will be left without access

:27:15.:27:17.

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

:27:18.:27:24.

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

:27:25.:27:27.

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

:27:28.:27:32.

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

:27:33.:27:38.

So let's hope that some sensible and realistic decisions

:27:39.:27:40.

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

:27:41.:27:56.

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

:27:57.:28:01.

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

:28:02.:28:06.

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

:28:07.:28:11.

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

:28:12.:28:17.

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

:28:18.:28:22.

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

:28:23.:28:25.

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

:28:26.:28:30.

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

:28:31.:28:34.

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

:28:35.:28:40.

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

:28:41.:28:47.

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

:28:48.:28:53.

for watching. We'll see you next week.

:28:54.:29:04.

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

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Today, an inquest was told that security forces

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Donald Trump provokes a mixed reaction.

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

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But foreign ministers are concerned by his comments

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who worked at Crew Alexandra, has pleaded not guilty to eight

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