21/01/2013 Inside Out North East and Cumbria

Inside Out. In the next half an hour, we're carrying out a check-up

on the local health service. When disaster strikes, how will YOUR

emergency unit cope? We've been taking the temperature of one

department on Teesside. We had all of our resuscitation rooms filled.

At that point, we would have struggled to have dealt with

another seriously ill patient. Confused by the Government's health

changes? We've brought in a doctor for a closer inspection. All the

sample bottles you could ever need, and I'll throw in a crutch. The

Government's bringing in the market place model, putting local GPs in

charge. But will it work? What happens when you get the

diagnosis we all dread? One Tyneside reporter tells his own

story. With fate, you don't know who's going to get hit by what and

when. I never knew it would be me. Stories from the heart of the North

East and Cumbria, this is Inside This winter, more people than ever

have been pitching up at A&E, some seriously ill, others just

seriously worried. But dealing with so many patients has put emergency

staff in our region under intense pressure. And I want to know: Can

A&E cope or is radical surgery the One of the biggest A&E units in the

North in its busiest month. Nearly 200 people turn up at North Tees in

Stockton every day in January. Dr Moy has just started night shift.

If you're worried at all, please just bring him back and I think

he'll be grand, OK? Thank you very much. Not at all. Good night.

Before I had even got changed, I had to run into the resuscitation

room and resuscitate a gentleman who had suffered a cardiac arrest,

get his heart re-started and then arrange to have him transferred.

That was the start of my evening! Every A&E department is in the same

boat: Too many patients, too few beds. The number of people using

A&E in the North East has risen 20% in four years. Last year, nearly

one million people turned up at their emergency departments. And

the knock-on effect? Ambulances queuing outside some A&Es, leaving

patients stranded. I do think patients' lives are put at risk,

yes. It's shocking, to be quite honest. Teesside paramedic and

Unison rep Alan Short retired in 2011. As a rapid response driver

working alone, he was first on the scene. We had a little lady who'd

slipped in the snow and broke the neck of her femur. Obviously, we

couldn't move her. We called for a vehicle, no vehicle available. So

relatives and neighbours were going round and they were bringing out

phone directories as I was trying to lift her up, which was painful

for her because to slide the directories and blankets underneath

her to try and keep her off the snow. That lady in the snow waited

for two hours. What can be a big problem is when we have ambulances

arriving at a rate faster than we can move the patients on and the

ambulances have to queue to unload their patients. Unfortuantely, they

often have to wait in a corridor. Although the paramedics stay with

them, it's not the safest of What's coming, Ange? Frontline

staff are all feeling the pressure. There's an elderly lady coming in

who sounds pretty sick. So we'll need to sort that out. You're

constantly aware that there are more patients arriving than you can

safely manage, and you're constantly worrying about not what

you have to deal with but what you know is coming in. How are you?

just my leg's got loads of spots. It HAS got loads of spots!

what's the solution to overstretched A&Es? Surely it's to

open more emergency departments. But apparently not. Current

thinking is to have fewer specialised centres. And that means

closing some A&E units down, and it's happening already. Bishop

Auckland shut in 2009 and Hartlepool closed in 2011. There

are now 16 A&E departments in our region. Soon, there will be fewer.

Both Hartlepool and North Tees Hospitals will close altogether

when a new hospital opens in Wynyard. That's proposed for 2017.

Further north, a "super" emergency care hospital in East Cramlington

is due to open in 2015. It'll serve a huge patch from Haltwhistle, an

hour by car - to Berwick, an hour and 25 minutes, but the argument is

you'll get the best acute care 24/7, even if you have to travel further.

When it opens, Wansbeck, North Tyneside and Hexham hospitals will

have an A&E walk-in in effect, a minor injuries service, not an

emergency department. If I have a heart attack tomorrow, I want to be

able to have 21st century care! Now, if that means I've got to travel a

bit further to get it, that's what I want. One of the consequences of

modern medicine is you need super- specialised people to deliver those

new kinds of care. And where we used to be able to have, perhaps,

just a junior doctor looking on over emergencies in every hospital,

now that super-specialist care is tending to be centralised in fewer

But closing A&E departments is hugely contentious. If in doubt,

come to Hartlepool. We have a hospital. We should have an

accident & emergency. I think it's terrible. I think it's really

scandalous. I take it you're not happy. No, it's rubbish. The thing

is, I have not found one person today who doesn't think that.

nearest A&E is here in Stockton, 13 miles away. But clinicians say the

changes, which happened 18 months ago, are for the best. The old A&E

in Hartlepool was chronically understaffed. In my view, we

couldn't have kept it open, not safely, not to the level that I

would have been happy with. When someone came in who was seriously

ill, they were going to get treated as well as I would want to be

treated, or any of my family would want to be treated. And I think one

of the things to make clear is I live in Harlepool, so I knew what I

was talking about. Couldn't you have got more staff in, then?

have loved to have got more staff in. It wasn't through lack of

trying, it wasn't through lack of getting the finance. We've actually

been out to India to recruit doctors. But there is really a

national shortage of doctors for emergency departments.

Hartlepool, they've split the service emergencies go to A&E in

Stockton. But if you're an urgent case but not a medical emergency -

you'll come here. Supporters say it's the best way to lance that

boil of overcrowded A&E units. It sounds great on paper, but how does

it work in practice? It's called the One Life centre, in the middle

of Hartlepool. I've got that stuck on my finger. So about what time

did it happen? About 30 minutes ago. Doesn't hurt. It's only a finger,

isn't it? I've got another nine! LAUGHS That's what we need to be

careful of, to make sure it's not in the bone. So I'll send you for

the X-ray, and we'll know more when you've had the X-ray. We'll be back

to see how Michael gets on, but meanwhile, in Stockton, A&E is full.

A baby with suspected meningitis arrives by ambulance from

Hartlepool. I phoned the NHS Direct and they sent me to the One Life.

They made an appointment in the walk-in centre, and they said it

was an urgent reaction. And then, when I took him home, he started

going purple. So I phoned the NHS again and they sent an ambulance

out for him, brought us here. It's been the worst day of my life.

Konor is is fine, but he's been bounced around the new system,

finally ending up in A&E. A familiar story to readers of the

Hartlepool Mail, who complained in their droves about the One Life

centre. Back in the market, people tell me worryingly - how even the

experts are confused. My daughter's epileptic and she had quite a bad

fit one day. We called the ambulance because her head was cut

open. And they couldn't decide where she had to go. THEY didn't

know? No. They phoned the One Life centre, they couldn't decide,

because head was cut open, where she should go. And I was sat there,

watching her bleed heavily for 20 minutes. It's not working, is it,

really? Yes, it is. I feel it's working. Some patients will be sent

from the One Life centre to other places. They'll be sent from our

minor injuries unit to other places. But having said that, when you had

accident & emergency working in Hartlepool, people were sent to

other places. Everything, hopefully, will settle down. I think things

are getting better than they were in the first few months, but there

will always be times when people make mistakes. But Dr Clive Peedell,

a consultant oncologist in Middlesbrough, thinks closing

emergency units is all about saving money. He's campaigning against

health reform, including A&E closure. We've called for a

moratorium on A&E closures up and down the country. Most of it's

actually financially-based. We've been told that it's going to be

clinically-based. And until things are clinically proven, we think

that's unacceptable. Right, Michael. We've got you in the fracture unit,

coming in at five past two today. That's over at Hartlepool Hospital

in the outpatient department. Do you know where that is? The nail's

gone into the bone. Michael has to go to the hospital to have it

removed. You're not one of the big bosses, so you're on the ground

here. Do you think it's better for patients? I think it's better for

minor injuries because, obviously, the service is dedicated to them.

And they're not... I mean, they're not waiting with all the other

patients that are in the department as well, so it's a lot quicker.

think the service is very good, the care's very good. They've done

everything they could to help me with me problem. The North East

Ambulance Service says it works closely with all hospitals to

ensure patients arrive and are admitted as quickly as possible.

Cure or kill - opinion's divided on whether having fewer, specialised

emergency departments will save A&E. But for now, back on night shift.

It's been busy. We had all of our resuscitation rooms filled. At that

point, we would have struggled to have dealt with another seriously

ill patient. Potentially, there could have been a brief period in

which a patient would have been left waiting without a

resuscitation facility. If it becomes as bad as it has been over

the last ten years, then I wouldn't think the ambulance service or the

hospital would be able to cope. For 65 years, the National Health

Service has been there to look after us when we're ill. But in

just ten weeks' time, the NHS will undergo the biggest shake-up in its

history. So what DOES that mean for us, the patients? We asked TV

doctor and comedian Phil Hammond to 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. What do you

reckon? 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. So 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 So the Government's bringing in the

market place model instead, introducing more choice and

competition, and putting local 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 closer to the person because there is a bit of a

trauma you suffer from a trauma from the chemotherapy and the

travelling. Bringing the treatment closer to the person is a lot

better. You do feel a little bit better. 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!

�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 Specsave, 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... 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. So we're not going to try and sell

a hearing aid, upsell a patient, you know, at all during that time.

Market 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 customers had been queuing not for their life savings but for

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

private companies in delivering care to patients, then there's

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 for you 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 you, I trust you"?

Have you chosen YOUR family doctor? 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.

But should we really be worried? Say, "Ahhh!" That's great, thank

you. 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 superfast 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 take over more NHS services, 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? Well, all

of our GPs like any GPs in the country have to offer patients a

choice when they're being referred for another service. And 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. Would it make any difference to you, as a patient,

whether it's run by an ordinary NHS GP or a private company? Nope.

all that matters to you is what? What do you care about in your

treatment? That I get the best treatment I possibly 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

We all tend to take our health for granted, and no matter how

successful we are, the lottery of life can take that all away. So how

do you cope when illness strikes out of nowhere and threatens to rob

you of everything that you hold dear? Well, a colleague of mine has

had the courage to reveal, in his The pub quiz can tax the brain, but

the bigger questions in life have no easy answers. With fate, you

don't know who's going to get hit by what and when. I never knew it

would be me. For exactly a year, I've been living with a devastating

diagnosis - I have MS. Multiple Sclerosis is taking away things

which have made my life so special, including a career I loved. Now, on

BBC Radio 4, Farming Today with Mark Holdstock. Good morning. Trade

unions want Portugese workers laid off by Bernard Matthews to be

compensated... Yup, that's me. I thought I had it all a great job

that took me all over the country, a great home and a car even Jeremy

Clarkson might envy. For a quarter of a century, I'd worked my way up,

from local radio in Newcastle to the ultimate: A regular voice on

Britain's national networks. A farm near Guildford in Surrey will have

to take down 100 acres of terminals, and we can hear more about it now

from Mark Holdstock, presenter of the BBC Radio programme, Farming

Today. Yes, Jeremy. This is a case which has been dragging on for a

couple of years now... Well, I had a very happy time presenting

Farming Today, and one of the early-stage symptoms of what I had

was that my speech was affected, and I wasn't able to talk as

clearly as I had in the past. And eventually, I was dropped. Now,

they grow strawberries for Waitrose, amongst others, and what they did

was they bought this farm - it's an old, arable farm... It's almost

like listening to a different person. I now realise that wasn't

because I wasn't any good at what I was doing. It was because I had a

medical condition that I didn't It's time for me to find out what's

going on in MY 50 shades of grey matter. You OK there, Mike? Yup.

are starting off straightaway, lot son not of noise coming up. Your

immune system attacks perfectly healthy brain. It goes in, a tax

and area and leaves a scarf. As those scars accumulate, we can see

people become more disabled. The white areas are the abnormal scars.

None of this white stuff should be here. I've spent my life asking

direct questions. Now's no different. Is that there any cure,

treatment, that will actually make a difference? No, no drugs which

altered the course of the disease. We have treatments for the symptoms

Other forms of MS can be treated to slow down the deterioration. Sadly,

I have a specific type that is aggressive and unstoppable. As I

would find out later, my scan would prove anything but routine. Wembley

going places, we can appear a bit drunk. And the tendency to slow

your words. The one person who's been beside me throughout is my

wife Jane. Like me, with a career spent in radio, she's not

comfortable appearing on camera. I am going to be bed-bound and unable

to walk. I did not know much about ms, and I kind of presumed it was a

terminal illness. It is not - it won't kill you. And you could have

that for 20 years or more. It will get to a point where I can no

longer dress myself, feed myself. I can probably barely speak. I felt

troubled by the idea of having to let somebody else look after you.

Ultimately, you must have to do that. I do worry about becoming a

burden, and not just to my wife. One of the most important things

for me is having my friends, as well as Jane. It is something which

has kept me going. And I do worry about the possibility that some

people feel... Have a fear of illness. I needn't worry too much

with this lot. Back at the quiz, we've just won a round of free

beer! His team often when. And it is often down to mark. So, I would

not be too worried about the brain at the moment! He says he may end

up in a wheelchair. It is very bad news. And he knows that and is

being realistic about it, but he is also being pragmatic and saying, OK,

while I can, I will enjoy myself as much as possible. When I can no

longer come along here and see this, when I am no longer able to get to

places, it will be such a feeling of loss, of bereavement. And at

almost this so much. I am still working not radio, but writing for

the Northern Farmer. Today, it's farm diversification in Cumbria,

where visitors can see cows being milked over afternoon tea. The

beauty of working from home is taking advantage of the

inspirational views from the window of my flat. I've also decided to

tell my story in an online blog I've called "The Trainee Cripple".

Maybe uncomfortable to some as a title, but it's a no-holds-barred

account of life when the body fails. The next big reality check is the

fact the home I adore can only be reached up a set of very awkward

steps. I will have to sell this. There is practically no way that I

cannot use this flat when I go, as I will, in a wheelchair. That said.

My earlier scan showed I am suitable for a new drugs trial,

three years long. It may not help me, but it could help others. But

what MS has really taught me is the importance of defying my body, to

keep going with the life I love, in the place I love, around the people

Mark has a lot more to say on his blog. You'll find a link on my blog.

Just head to the usual place: bbc.co.uk/chrisjackson. But that's