:00:00. > :00:08.Hello and welcome to a brand new series.
:00:09. > :00:11.Tonight: A close up look at health care.
:00:12. > :00:14.We're on the rounds with a local GP fighting financial pressure
:00:15. > :00:27.I want to do what I'm trained to do, not be some clinical accountant.
:00:28. > :00:29.We need a health service to fit patients not patients
:00:30. > :00:36.We ask: Do we still have a national health service, or does
:00:37. > :00:45.where you live increasingly affect your care?
:00:46. > :00:50.The fact that had to pay for my trip but is criminal. It is absolutely
:00:51. > :00:58.cruel. Sorry. Should a lesson in
:00:59. > :01:03.life-saving be compulsory? She was lying there on the sofa
:01:04. > :01:05.totally unconscious If I hadn't done CPR my mother
:01:06. > :01:09.wouldn't have survived today. I'm Chris Jackson and
:01:10. > :01:22.this is Inside Out. Tonight, in a special programme,
:01:23. > :01:24.we look at increasing As budgets tighten and the number
:01:25. > :01:29.of patients arriving in the doctor's surgery rockets,
:01:30. > :01:34.GPs are under increasing pressure We followed one doctor from Tyneside
:01:35. > :01:39.to find out first-hand how Mike Scott has been a GP
:01:40. > :01:47.at Newburn Surgery in Newcastle The NHS is under huge
:01:48. > :02:00.financial pressure. GPs like Mike are at the sharp
:02:01. > :02:02.end, making decisions The surgery has more than five
:02:03. > :02:13.and a half thousand patients. Donna has back problems
:02:14. > :02:18.and suffers from depression. I got to the stage where
:02:19. > :02:21.I didn't want to be here. When they said I was useless
:02:22. > :02:26.I thought what is the point? The drug that works
:02:27. > :02:31.for Donna is being rationed, We're being strongly encouraged
:02:32. > :02:36.by the people who run our health I think the plan is probably
:02:37. > :02:43.for the next four weeks is keeping If I'm struck off it'll
:02:44. > :02:48.take a few years. I'm going to be retired soon
:02:49. > :02:51.anyway, so we don't need After losing eight and a half
:02:52. > :02:54.stone Donna needs surgery I can't get anything
:02:55. > :02:59.for that on the NHS. Almost for devilment I think I'll
:03:00. > :03:07.put in an application, because you've just told me
:03:08. > :03:12.you felt suicidal. But I'll have to fill
:03:13. > :03:15.in a thing called an IFR, I want to do what I'm trained
:03:16. > :03:28.for, not be some sort We need to configure the health
:03:29. > :03:33.service to fit the patients, not the patients to fit the design
:03:34. > :03:38.of the services. In 2016 Newburn issued more
:03:39. > :03:43.than 35,000 prescriptions. The push is not to prescribe
:03:44. > :03:48.antibiotics for colds and flu. It's costly and risks
:03:49. > :03:53.developing superbugs. Ok, well that's all sore
:03:54. > :03:58.and red and septic. I think we'll rely on mother nature
:03:59. > :04:00.to sort this one out. I'm afraid there'll be
:04:01. > :04:05.a wait for Dr Scott. There's a patient at Waverley Lodge
:04:06. > :04:12.who has had three seizures So would you mind looking at this
:04:13. > :04:17.as soon as possible, please? Deprivation, unemployment
:04:18. > :04:21.and child poverty in Newburn are all "significantly worse"
:04:22. > :04:26.than the national average. More than 300 of the surgery's
:04:27. > :04:31.patients are registered as diabetic. You've near as cured your diabetes
:04:32. > :04:38.with losing that two stone. Dorothy has a severe muscle wasting
:04:39. > :04:50.disease, and has developed If the nurse hadn't been
:04:51. > :04:56.in would you have been Dorothy has had the muscle wasting
:04:57. > :05:06.disease for fifteen years. I've had it specially refrigerated
:05:07. > :05:09.to give you a thrill. Dorothy used to have a driver
:05:10. > :05:16.who got her out of the house. Sometimes I can sit in the house
:05:17. > :05:26.for three weeks doing nothing. Often, patients have already
:05:27. > :05:32.diagnosed their illness Don't worry, we'll
:05:33. > :05:38.preserve your modesty. I'm not bothered, when
:05:39. > :05:46.you get to nearly 83. Right, go on, give us
:05:47. > :05:52.a couple of deep breaths. Yeah, you're sounding
:05:53. > :05:54.like a bag of weasels here. I think your vest's tucked
:05:55. > :05:59.into your socks here, or something. It's a bit more than
:06:00. > :06:04.a cold, certainly. You've got a flare up
:06:05. > :06:07.of the bronchitis. Newburn has five part
:06:08. > :06:16.time GPs, earning less If I had 15 minutes to see
:06:17. > :06:26.all my complex patients, with half a dozen different medical
:06:27. > :06:29.problems, I'm sure I could improve But you basically have
:06:30. > :06:37.to do what's feasible. The average waiting time in England
:06:38. > :06:39.for a routine appointment I can understand when people are
:06:40. > :06:49.poorly they really want to be seen. It's hard if you try to say there's
:06:50. > :06:52.no appointments left. There's all sorts of
:06:53. > :07:01.squeeks and rattles. You know i don't like steroids,
:07:02. > :07:05.but I don't mind a period of them. OK doctor, I'll go
:07:06. > :07:07.on your recommendation. The Commissioning Group that funds
:07:08. > :07:10.hospital services recently began paying GPs to reduce the number
:07:11. > :07:13.of referrals they make Inevitably people who should have
:07:14. > :07:21.been referred will not be referred. If your practice is signed up
:07:22. > :07:29.for that, don't trust your doctor anymore, because when he tells
:07:30. > :07:32.you I don't think you need to go to hospital, he could be saying
:07:33. > :07:35.I honestly don't think you need to go to hospital, or he could be
:07:36. > :07:38.thinking I need to save up for my foreign holiday
:07:39. > :07:42.and if I don't refer this patient it'll cover some of the cash flow
:07:43. > :07:48.we missed from last year. If I'm honest I don't think
:07:49. > :07:50.anybody's going to be saying that, but it puts
:07:51. > :07:54.you in an invidious situation. Newcastle Gateshead Clinical
:07:55. > :07:57.Commissioning Group said in a statement the aim
:07:58. > :07:59.was to improve quality, get the best service,
:08:00. > :08:01.and make best use of resources. There are other schemes in other
:08:02. > :08:08.areas where after you've made a referral another doctor,
:08:09. > :08:10.who doesn't know the patient, looks at the referral letter
:08:11. > :08:13.and says no you can't If somebody who doesn't know me
:08:14. > :08:22.and doesn't know them says "no", I just don't accept that and I'll do
:08:23. > :08:29.everything to circumvent that. Newburn made almost two
:08:30. > :08:31.and a half thousand referrals For operations like removing tonsils
:08:32. > :08:40.there are many hurdles to overcome. Seven or more well documented
:08:41. > :08:42.clinically significant adequately treated sore throats
:08:43. > :08:45.in the previous year. Seven episodes of disabling
:08:46. > :08:49.tonsilitis in a year! That to me is just
:08:50. > :08:59.a rationing criteria. I think that bar
:09:00. > :09:01.is set far too high. Mike has more telephone
:09:02. > :09:02.consultations. A seriously ill patient is deemed
:09:03. > :09:06.fit for work by the Department Hello, it's Dr Scott
:09:07. > :09:11.from the surgery here. I haven't got a clue,
:09:12. > :09:16.my nerves are shattered. I find it mind boggling that someone
:09:17. > :09:20.who has never met you in their life He has very severe arthritis
:09:21. > :09:28.and a very severe depression. I think my opinion as to
:09:29. > :09:31.whether he's capable of working is worth a whole lot more
:09:32. > :09:34.than the other guy, who is doing a tick box exercise
:09:35. > :09:39.for a private company contracted But there are three home
:09:40. > :09:54.visits still to do. I was fine, then this gripping pain
:09:55. > :09:58.started again, and then I vomited. OK, so what you need from me tonight
:09:59. > :10:12.is pain relief and not vomiting. Home visits are costly
:10:13. > :10:18.in time terms, but can That lady there I think as a result
:10:19. > :10:26.of visiting her this evening we can keep her out of hospital,
:10:27. > :10:28.whereas, if we hadn't seen her tonight she could have been
:10:29. > :10:32.in hospital by midnight. I give myself a day off each week,
:10:33. > :10:35.as well as the weekend. I'm going to go home and I may pour
:10:36. > :10:45.myself a nice cold beer and watch something that involves no mental
:10:46. > :10:53.effort at all on the telly. While Dr Mike is facing
:10:54. > :10:56.the squeeze on the front line, others are looking at the wider
:10:57. > :10:58.picture and asking, is the NHS Does where you live now matter more
:10:59. > :11:06.than ever when it comes The NHS is facing the most
:11:07. > :11:13.significant financial There are fears the service
:11:14. > :11:36.we have grown up with is There is a postcode lottery. It is
:11:37. > :11:40.absolutely criminal. This is going to get worse.
:11:41. > :11:43.So, is the NHS in danger of ceasing to be a "national" service,
:11:44. > :11:46.where everyone is entitled to the same care?
:11:47. > :11:50.It's treating more patients but is it becoming a postcode
:11:51. > :11:52.lottery, where access can depend on where you live?
:11:53. > :12:09.On a bad day ruined your life. It feels like my bones are screaming at
:12:10. > :12:12.me at times. 33-year-old Ben Franklin
:12:13. > :12:14.has Hepatitis C. The virus can cause
:12:15. > :12:25.life-threatening liver damage. I am about to lose my job. I have
:12:26. > :12:27.been of work six since April and they could possibly lose the flat
:12:28. > :12:29.over my head. There are new drugs that could
:12:30. > :12:32.potentially cure Ben's Hepatitis. That made me want to go out and just
:12:33. > :12:42.get absolutely wasted and ruin my liver just
:12:43. > :12:45.so they would treat me. I wouldn't do that but I wouldn't be
:12:46. > :12:49.surprised if somebody else would. The money is there for just
:12:50. > :12:52.over 10,000 treatments. It's claimed that means
:12:53. > :12:57.there are no queues in parts of the North and long waits
:12:58. > :13:03.in places like London. Two people with exactly the same
:13:04. > :13:06.state of liver damage could present themselves in different parts
:13:07. > :13:08.of the country and in one they'll be able to walk in and get Hepatitis C
:13:09. > :13:11.treatment immediately, and get cured, and in another part
:13:12. > :13:15.of the country they may go there and be told "Sorry you're
:13:16. > :13:18.going to have to wait". NHS England told us it was regularly
:13:19. > :13:23.reallocating unused Hepatitis C treatments to places
:13:24. > :13:28.with waiting lists. The number of patients treated
:13:29. > :13:37.will increase by 25% next year. So Ben is taking the risk
:13:38. > :13:46.of treating himself with cheaper The fact that I've had to pay
:13:47. > :14:05.for my treatment, it's criminal. Ben is hoping the generic drugs will
:14:06. > :14:26.cure him within a matter of weeks. The Hepatitis C trust estimates that
:14:27. > :14:32.around 1,000 people in Britain may If you go outside there
:14:33. > :14:41.are halos around lights. Lights and shadows,
:14:42. > :14:44.it's hard to see things. Gloria McShane has
:14:45. > :14:50.cataracts in both eyes. Go up or down stairs
:14:51. > :14:57.with any kind of confidence. Cataracts are supposed
:14:58. > :14:59.to be treated within four Gloria, who lives in the North East,
:15:00. > :15:06.says she's been waiting seven. It's too long because there's such
:15:07. > :15:09.potential for accidents, and there's such a change
:15:10. > :15:14.in a person's mood. If Gloria had lived in Luton her
:15:15. > :15:17.wait could have been Absolutely, there is
:15:18. > :15:26.a postcode lottery. It's not about clinical need,
:15:27. > :15:29.it's about some places in England having poor systems,
:15:30. > :15:33.having budgetary pressures and That doesn't feel
:15:34. > :15:39.too national to me. Gloria expects to get her
:15:40. > :15:44.operation later this month. It really makes me angry,
:15:45. > :15:46.because I think that it's almost Clinical Commissioning Groups,
:15:47. > :15:53.or CCGs, control health budgets. It's claimed some are delaying
:15:54. > :15:56.treatments like cataract surgery Others are requiring patients
:15:57. > :16:02.to lose weight before getting Postponing an operation
:16:03. > :16:08.in these circumstances can And whilst the CCGs say it can be
:16:09. > :16:13."clinically justified", the Royal College of Surgeons
:16:14. > :16:19.say it can't. There's very good evidence that
:16:20. > :16:21.people are now not getting elective operations simply
:16:22. > :16:29.because of financial restrictions. It is up to the clinicians to decide
:16:30. > :16:32.who should have what treatments and therefore a bureaucratic system
:16:33. > :16:37.that produces a blanket It's also claimed new systems
:16:38. > :16:43.for vetting appointments with specialists are another
:16:44. > :16:48.form of rationing. Why are they treating their patients
:16:49. > :16:53.with such contempt? Last month, MPs complained
:16:54. > :16:55.about a private company being paid ?10 for every GP
:16:56. > :17:00.referral they stopped. This is rationing by the back door
:17:01. > :17:03.and has the potential The same private company oversees
:17:04. > :17:09.referrals in North Tyneside. We've spoken to doctors
:17:10. > :17:11.who say the system is The GPs, who fear speaking out,
:17:12. > :17:17.have told us that cancer I tried to get a patient
:17:18. > :17:23.referred to a dermatologist. The referral management
:17:24. > :17:26.service said it was a skin They're putting up barriers,
:17:27. > :17:40.using delaying tactics. It's getting between the doctor
:17:41. > :17:44.and the specialist. In a statement, North Tyneside CCG
:17:45. > :17:47.said there was No evidence the system caused additional
:17:48. > :17:50.risk or delay. Cancer referrals do not go
:17:51. > :17:53.through the system and are made The number of referrals knocked back
:17:54. > :17:59.to GPs in England has risen You can see the details
:18:00. > :18:07.of our research online. Shortage and regional difference
:18:08. > :18:11.have always been part of the NHS. Today, the differences
:18:12. > :18:16.could get much worse. The NHS is under an unprecedented
:18:17. > :18:19.level of pressure at the moment. If it doesn't get more funding,
:18:20. > :18:22.waiting times are going to get longer, the quality of patient care
:18:23. > :18:25.is going to suffer. So we will see different decisions
:18:26. > :18:28.taken in different parts of the country and different
:18:29. > :18:30.services being So, is the NHS still
:18:31. > :18:36.a national service? One of our most prominent
:18:37. > :18:39.medics is clear. I think it matters, because it leads
:18:40. > :18:49.to inequality in healthcare. Some people will get health care
:18:50. > :19:14.for free and others won't. We asked the Health Secretary
:19:15. > :19:17.and NHS England for an interview. The people actually
:19:18. > :19:19.paying for NHS services, the clinical commissioners,
:19:20. > :19:21.did agree to speak. It's a national service
:19:22. > :19:23.with local variation based Demographically, populations
:19:24. > :19:26.vary quite significantly It's really important
:19:27. > :19:31.that we commission and respond to the needs of that population
:19:32. > :19:38.on a local basis. It's about making sure
:19:39. > :19:41.that the pathway is correct. We don't want to squander any money,
:19:42. > :19:43.we have limited resources, so it's really important
:19:44. > :19:45.that the resources we have we spend more effectively,
:19:46. > :19:47.getting the best value For those forced to take
:19:48. > :19:53.their own action, rationing Have local decisions about the care
:19:54. > :20:00.available made a difference to you? You'll find me on twitter,
:20:01. > :20:04.my hashtag is insideoutcj. Or e-mail me at
:20:05. > :20:12.chrisjackson@bbc.co.uk. In the UK there are over 30,000
:20:13. > :20:17.cardiac arrests every year But just one in 10 Brits
:20:18. > :20:23.know how to give CPR. Campaigners say resuscitation should
:20:24. > :20:28.be taught in schools. We met one Newcastle teenager
:20:29. > :20:30.who understands more than most just how important this life
:20:31. > :20:38.saving skill is. I raise money for a charity that
:20:39. > :20:44.places defibrillators in primary schools and public places and raises
:20:45. > :20:51.awareness of CPR. I started fundraising
:20:52. > :20:55.in 2014 when I lost my best Michael was just 14
:20:56. > :21:01.when he had a cardiac arrest. It was triggered
:21:02. > :21:04.by an asthma attack. You know when you just know
:21:05. > :21:09.something bad has happened. It was just such a shock,
:21:10. > :21:14.you didn't expect it to happen. It was the most
:21:15. > :21:16.horrible feeling ever. She was absolutely devastated,
:21:17. > :21:19.totally broken-hearted. As a mother it was hard
:21:20. > :21:24.watching her go through it because I couldn't do anything
:21:25. > :21:26.to make it better. She cried all the time,
:21:27. > :21:30.played the same music Bobbi has now raised over ?10,000
:21:31. > :21:38.and funded her own CPR But after what happened
:21:39. > :21:45.to her friend, she wants everyone to know just how important
:21:46. > :21:50.it is to know lifesaving skills. If you don't act fast and do CPR
:21:51. > :21:58.you've got so much less I think it's something
:21:59. > :22:02.when you get to a certain age you should be trained
:22:03. > :22:07.in because anything could happen. But if Bobbi lived in Denmark,
:22:08. > :22:10.she and her peers would Resuscitation skills, CPR,
:22:11. > :22:14.has been a compulsory part of the school curriculum
:22:15. > :22:22.here for the last 10 years. In a Copenhagen classroom,
:22:23. > :22:24.11 and 12-year-olds are being challenged
:22:25. > :22:26.to make their own films Each film will be a campaign film
:22:27. > :22:36.telling me and you how to act if you see a person dropping dead
:22:37. > :22:41.on the streets. The aim is that the children
:22:42. > :22:44.have a fun and creative day. By making films about it,
:22:45. > :22:47.they will obtain knowledge and the idea that it's a good
:22:48. > :22:54.thing to help. It's always interesting to see
:22:55. > :22:57.the children's perspective on these quite difficult issues
:22:58. > :23:05.about life and death. 20-year-old Rasmus knows more
:23:06. > :23:07.than most people just how Two years ago he was at
:23:08. > :23:12.home alone with his mum She was lying there on the sofa
:23:13. > :23:19.totally unconscious. The only thing that kept me
:23:20. > :23:24.going was I could hear her breathe If I hadn't done CPR my mother
:23:25. > :23:31.wouldn't have survived today. It is a very, very
:23:32. > :23:34.good thing to know. You never know when
:23:35. > :23:36.it's going to happen. It could happen all of
:23:37. > :23:39.a sudden, like for me. My mum, of course
:23:40. > :23:41.she is very grateful. The first thing she told me
:23:42. > :23:44.when she could speak again was, I didn't know how to respond
:23:45. > :23:56.to that but, I guess I did. Now nearly 70% of people
:23:57. > :24:00.in Denmark know CPR. That's compared to just 10%
:24:01. > :24:03.in the UK and the survival rate This is the emergency dispatch
:24:04. > :24:13.centre in Copenhagen. It is about changing the attitude
:24:14. > :24:15.that you can do something and you cannot do anything wrong,
:24:16. > :24:20.to take a social responsibility. It does have an impact
:24:21. > :24:23.on survival, it does have an impact on the new future
:24:24. > :24:28.generation of lifesavers. Give me just one reason not to teach
:24:29. > :24:31.children CPR in school. It's just one hour,
:24:32. > :24:35.it's cost effective, Back in the classroom,
:24:36. > :24:44.the 6th grade students are finishing It's about this boy
:24:45. > :24:51.who when he's smaller he learns Then he comes out in real life
:24:52. > :24:58.where this accident actually happened and he ended
:24:59. > :25:03.up helping him. So my role is the person
:25:04. > :25:08.who saves Theodor's life. You can save lives,
:25:09. > :25:27.everybody can save lives. But the more you hesitate,
:25:28. > :25:30.the chances of surviving get That's what one paramedic
:25:31. > :25:33.wants to teach children This class is for five
:25:34. > :25:45.and six-year-olds in South Shields. Little ones are
:25:46. > :25:50.absolutely like sponges. I've been completely shocked
:25:51. > :25:52.at how much they can, not only take on board but retain
:25:53. > :25:56.and then deliver down the line. I think the characters really help,
:25:57. > :26:01.they always want to get involved with the characters
:26:02. > :26:03.and the activities we run. It's not compulsory
:26:04. > :26:06.but I absolutely think it should be because personally I think it's one
:26:07. > :26:08.of the most important life So are we any closer to making this
:26:09. > :26:15.the norm in UK classrooms, The Department of Education told us:
:26:16. > :26:21."We have given head teachers more freedom than ever to shape
:26:22. > :26:24.the curriculum to the We would also encourage teachers
:26:25. > :26:29.to draw upon high-quality resources in the classroom,
:26:30. > :26:31.including guidance on first We're way behind the curve
:26:32. > :26:40.here and we're failing our population because people
:26:41. > :26:46.are dying prematurely unnecessarily. It makes me really sad because it's
:26:47. > :26:50.such a simple thing to introduce. It doesn't cost much
:26:51. > :26:57.and the benefits would be so huge. A North East MP says
:26:58. > :27:01.she is lobbying her government. There is so much evidence that
:27:02. > :27:04.having those skills throughout the population can make
:27:05. > :27:08.a substantial difference in life That's our challenge as campaigners
:27:09. > :27:14.to persuade them there is a strong evidential base to the government
:27:15. > :27:17.saying we want to invest in this In Newcastle, it's a special day
:27:18. > :27:31.for 15-year-old Bobbi. Overall I've bought 10
:27:32. > :27:44.defibrillators and they've been placed in the areas where me
:27:45. > :27:48.and Michael lived. Now our area's heart safe
:27:49. > :27:51.and I just want to get as many We're still really close
:27:52. > :27:57.to Michael's family. We're just keeping his memory alive
:27:58. > :28:00.and hoping that nobody else has The winner of the Young Role Model
:28:01. > :28:13.award goes to Bobbi Potts. Amazing, I'm so happy,
:28:14. > :28:16.I can't believe it to be Everyone in this room will know that
:28:17. > :28:30.Michael had a cardiac arrest. He'd be over the moon,
:28:31. > :28:37.he really would be. Next week: The County Durham vet
:28:38. > :28:48.who has transformed the lives of neglected street dogs
:28:49. > :28:50.in Sri Lanka and how Until then, from
:28:51. > :29:09.Tyneside, good night. Hello, I'm Louisa Preston
:29:10. > :29:11.with your 90 second update. 30 British tourists shot
:29:12. > :29:14.dead in Tunisia in 2015.