:00:08. > :00:18.Welcome to the programme. This week we are in Trafford, investigating
:00:18. > :00:19.
:00:19. > :00:23.how changes to the NHS will affect But first, how our health workers
:00:23. > :00:29.and patients cabin with the big freeze? We are just taking
:00:29. > :00:34.precautions, taking it to the hospital. What is the future for
:00:34. > :00:38.the region's most formidable patient? We are here to highlight
:00:38. > :00:43.the plight of people with mental health problems. And what do
:00:43. > :00:53.radical changes to the NHS mean for people in the north-west? All the
:00:53. > :01:06.
:01:06. > :01:10.sample bottles you could ever need When the weather hit us hard the
:01:10. > :01:13.images is put to the test. Despite the conditions we have been
:01:13. > :01:18.experiencing in the north-west, the service continues to provide a
:01:19. > :01:28.vital lifeline for those in need. We have been following the story in
:01:29. > :01:36.
:01:36. > :01:39.Friday - winter descends with full force, causing disruption, school
:01:40. > :01:46.closures and problems on the road across the north-west. Many choose
:01:46. > :01:50.to stay at home, but for frontline health workers, there is no choice.
:01:50. > :02:00.Care worker Rachel Walmsley is making early visits to homes around
:02:00. > :02:01.
:02:01. > :02:07.Whalley in Lancashire. We do like a cup of tea? Coffee? Yes? No problem.
:02:07. > :02:13.We come every morning to get doubled up, get him in the bath,
:02:13. > :02:21.brush his teeth, shave, dressed, and taken downstairs. If we don't
:02:21. > :02:26.get here, then they are in a predicament. He will be left in his
:02:26. > :02:31.bedroom all day. The weather can be a problem at times of ice and snow,
:02:31. > :02:35.we are on tight schedules, we do have a certain amount of time at
:02:35. > :02:43.each visit, it is difficult when we are trying to get more rural
:02:43. > :02:48.locations. It looks like difficult terrain to navigate! Would you give
:02:48. > :02:56.it gets worse? If it got worse, I would try and get up, but we would
:02:56. > :03:00.have to bring the family and told We know that people are hungry and
:03:00. > :03:07.we do our best. We don't want to keep you from doing your job any
:03:07. > :03:14.longer. We will let you get on with it. Thank you! You can see the
:03:14. > :03:17.challenges that carers like rich will have to face. -- ritual. The
:03:17. > :03:25.weather isn't too bad right now although the Met Office are
:03:25. > :03:28.predicting things will get worse as the afternoon goes on. The patient
:03:28. > :03:33.has a back pain to come and a detailed with regard to whether
:03:33. > :03:36.they can walk. As the weather deteriorates, the north-west at
:03:36. > :03:44.ambulance service at faces an even bigger challenge. It is getting
:03:44. > :03:54.bigger -- busy in the control room. We urged informing them, they will
:03:54. > :04:04.get moving. -- are just informing them. Paramedic Wayne Pemberton is
:04:04. > :04:07.
:04:07. > :04:15.A teenager has been injured in a sledging accident near Parbold, she
:04:15. > :04:20.has crashed into a barbed-wire fence at the foot of a steep hill.
:04:20. > :04:28.What are you suspecting injury why is? Sheet has got a lot of lumbar
:04:28. > :04:33.pain. She cannot feel this right leg. Let's get her secure. How
:04:33. > :04:39.would you doing? It is a 16-year- old, lost control, has impacted
:04:39. > :04:49.with a back on this poll, her lower lumbar is where she is getting all
:04:49. > :04:50.
:04:50. > :04:56.the pain. A decision is made to fly her to the Royal Preston Hospital.
:04:56. > :05:04.Can you manage over there? Or Your Right? I have got you. Keep your
:05:04. > :05:14.elbows tucked in for me. It is 23 miles away, but the helicopter
:05:14. > :05:26.
:05:26. > :05:31.should get them back within five She stable at the moment, that the
:05:31. > :05:36.paramedics have given them some treatment, given them some
:05:36. > :05:40.painkillers, she stable at the moment. The treatment will continue
:05:40. > :05:46.in the air, then she will be handed over to the hospital staff and they
:05:46. > :05:51.will take her run from there. the crew made their way back to the
:05:51. > :06:00.ambulance, there is another accident. Incredibly, a casket and
:06:00. > :06:04.crashes through a fence just 100 yards up the road -- a car skids.
:06:04. > :06:09.Just an update from this incident, it is one vehicle, it has left the
:06:09. > :06:18.road, rolled three or four times, we have the 14-year-old female with
:06:18. > :06:24.some injuries, fully immobilised -- 40-year-old female. We will see you,
:06:24. > :06:27.received and understood. The driver is conscious and is responding to
:06:28. > :06:37.questions, but it is important they immobilise her until she can be
:06:38. > :06:46.
:06:46. > :06:53.We will put it back over you. Nice and steady there. There is loads of
:06:53. > :06:55.room here to get her out. problem. We are just taking
:06:55. > :07:00.precaution, take her to the hospital so the doctor can see her
:07:00. > :07:09.but she is good, she is fine. took to the driver's family, fire
:07:09. > :07:13.and rescue arrive at the scene. was starting to get pain, so we
:07:13. > :07:23.thought on the safe side, if possible, take the roof off and do
:07:23. > :07:30.
:07:30. > :07:40.it that way back was all right with Preston, the teenager injured in
:07:40. > :07:52.
:07:52. > :07:58.She has undergone several X-rays, she had an X-ray which has come
:07:58. > :08:01.back as OK, she is to complaining of some back pain, looks like
:08:01. > :08:06.muscular skeletal pain, we have set her up with some pain relief can
:08:06. > :08:10.see how it goes. At the car accident, a decision has been made
:08:10. > :08:13.not to remove the roof but to get the driver out through the back of
:08:13. > :08:21.the vehicle. A much better idea, now you have had a look at it, to
:08:21. > :08:28.be honest. Just waiting for the fire service to extricate the lady
:08:28. > :08:38.from the car. Are you OK there? Structure is just to the right
:08:38. > :08:59.
:08:59. > :09:02.She is not rocking at all, she's We managed to treat a lady in the
:09:02. > :09:05.car, managed to stabilise her condition, extricate her from the
:09:05. > :09:10.car with the assistance of the fire service into the back of the
:09:10. > :09:14.ambulance when she was treated and taken to hospital. We will make
:09:14. > :09:17.ourselves available and cleaner, liaise with the emergency centre
:09:17. > :09:25.and find that if there are any other incidents they need us to
:09:25. > :09:35.attend. We are now clear at the incident in Parbold, if you have
:09:35. > :09:37.
:09:37. > :09:40.nothing outstanding will head back Amazingly the driver of the car
:09:40. > :09:45.didn't suffer any serious injuries and has since been discharged from
:09:45. > :09:50.hospital. The girl entered in the sledging accident was allowed home
:09:50. > :09:55.later that evening. Care worker Rachel Walmsley finally managed to
:09:55. > :09:59.complete all her visits. Today we have seen the impact that bad
:09:59. > :10:03.weather can have on frontline NHS staff. Fortunately we did have a
:10:03. > :10:07.lot of warning which made plenty of provisions have been put in place
:10:07. > :10:11.and that has meant that the district nurses, there carers,
:10:11. > :10:14.paramedics and doctors and nurses of the hospitals like this one have
:10:14. > :10:24.been able to maintain a high standard of care in spite of the
:10:24. > :10:31.
:10:31. > :10:41.I can confirm you have two eyes! Shaking up the NHS can but what
:10:41. > :10:42.
:10:42. > :10:46.The borough of Trafford here in Greater Manchester is recognised as
:10:46. > :10:52.the birthplace of the NHS. The local hospital, Trafford General
:10:52. > :10:56.commentary did the first NHS patient back in 1948. 65 years
:10:56. > :11:01.later the NHS is undergoing a major transformation. In the first of two
:11:01. > :11:04.films looking at those changes, we investigate how mental health
:11:04. > :11:14.services could change here in the north-west and how patient will
:11:14. > :11:16.
:11:16. > :11:20.This is Rob from Salford, he is 55 and he is mentally ill. One in four
:11:20. > :11:23.but will be at some point in our lives. Today he is protesting
:11:23. > :11:31.because his local droppings and there could be closing for good
:11:31. > :11:37.because of budget cuts. -- local drop-in centre. And this is his
:11:37. > :11:42.partner Vee. We are here this morning to highlight the plight of
:11:42. > :11:47.many people with mental health problems. Rob says she is the love
:11:47. > :11:51.of his life. They have been together for 27 years, but life
:11:51. > :11:56.changed dramatically two years ago. He suffered a breakdown after
:11:56. > :12:01.experiencing flashbacks for trauma and abuse which he suffered as a
:12:01. > :12:05.child and young adults. He often progresses to a childlike state,
:12:06. > :12:15.regularly self- harms and since 2010 has tried to take his own life
:12:15. > :12:23.26 times. What is life like? Hell, basically. There are times when I
:12:23. > :12:31.feel as though one can't go on. The only way for me to cope is to sort
:12:31. > :12:37.of end it all. And I feel just lately that is the majority of the
:12:37. > :12:40.time. I have more bad days for my have good days at the minute.
:12:40. > :12:45.problem for mental illnesses, people with physical illness can
:12:45. > :12:48.tell you where it hurts and why it hurt and pawing each to the right
:12:48. > :12:52.direction, people with mental illness, where confusion and
:12:52. > :12:57.disorientation come in, you have to guess what to do for them, they
:12:57. > :13:00.can't tell you necessarily. If an episode occurs which can be
:13:00. > :13:05.harrowing, where he has taken a load of tablets and can't say why,
:13:06. > :13:10.how can you stop him doing it? You can't. Mental illness is the
:13:10. > :13:15.largest cause of the stability in our society. In the north-west
:13:15. > :13:19.around 1.7 5 million people will at some point need support from mental
:13:19. > :13:27.health services. Sooner what does services are run what is spent on
:13:27. > :13:32.them will be decided at by GPs, for the first time. Get it right and we
:13:32. > :13:37.will save the NHS millions by reducing accident emergency
:13:37. > :13:42.admissions and the need for long care. Get it wrong, we could see an
:13:42. > :13:47.increase in benefits, dependency, prison depression and suicide. But
:13:47. > :13:51.all of those changes come at a time of massive cuts, both to local
:13:51. > :14:00.council and NHS budget. So the fear is that mental health services will
:14:00. > :14:04.It is inevitable that providers are going to start to make efficiency
:14:04. > :14:08.savings which may be seen as cuts already and we are already seeing
:14:08. > :14:12.some services going. They have been threats to addiction services that
:14:12. > :14:16.have gone to the voluntary sector which can be part of the job but
:14:16. > :14:22.cannot do it with the complexity. What is the impact when the Serbs
:14:22. > :14:25.is our loss? You get by for a few months but then starts to hit, more
:14:25. > :14:29.referrals to accident and emergency, more getting picked up by the
:14:29. > :14:36.Ambulance Service. We are trying to move away from that of care.
:14:36. > :14:40.Patients like Rob do have some good days but there are lots of bad days.
:14:40. > :14:44.Since his drop in centre close, Vee believes his condition has
:14:44. > :14:49.deteriorated. His illness means they have gone from earning a
:14:49. > :14:53.combined income of nearly �50,000 to potentially losing a home at
:14:53. > :15:00.their level. When I went to see rock at home, he had been drinking.
:15:00. > :15:07.People will watch this and say you need to stop drinking and smoking a
:15:07. > :15:15.and make an effort. I say yes, I agree with them. But it's not that
:15:15. > :15:24.easy. I've worked so hard for this house. Please, somebody, tell me
:15:24. > :15:34.how I can help myself. How would you sum up what life is like for
:15:34. > :15:34.
:15:34. > :15:43.you and Vee? She hasn't got any life. She hasn't got any life. All
:15:43. > :15:48.she does is care for me. All she does is worry about me. As his
:15:48. > :15:53.full-time care, what impact does it have on your life? Terrible, I had
:15:53. > :15:59.lost my confidence, I had a brilliant job, I was senior
:15:59. > :16:03.management. Sometimes now, I cannot even face the day. It is difficult.
:16:03. > :16:09.She says she misses the relief she had when Rock spent time at his
:16:09. > :16:12.drop in centre. In other parts of the north-west, people with mental
:16:12. > :16:20.health problems are seeing grip their possessions disappear because
:16:20. > :16:24.of budget cuts. More than 70 miles away in Kendal, is Workbase. For 20
:16:24. > :16:31.years it provided therapeutic art services for people with depression.
:16:31. > :16:35.But now the estate agents are in and they are packing up for good.
:16:35. > :16:41.It is devastating news for Graham who started coming here nine years
:16:41. > :16:48.ago. If my doctor had not mention this case, to be quite honest, I
:16:48. > :16:54.would have been a total wreck by now, not wanting to do anything. It
:16:54. > :16:57.has motivated me and got me out. When you look to the future without
:16:57. > :17:04.this place which has been part of your life for nearly a decade, had
:17:04. > :17:14.you feel? It does scare me because I got a lot of friends here. It
:17:14. > :17:17.
:17:17. > :17:21.just scares me knowing I won't see them again. For years, mental
:17:21. > :17:24.health was described as having Cinderella services - overlooked
:17:24. > :17:30.and under resourced but now the government has pledged at parity of
:17:30. > :17:38.esteem between mental and physical health. But if that promise comes
:17:38. > :17:47.as the NHS looks to save �20 billion by 2015. Can they really
:17:47. > :17:51.give mental health services the attention they need. That question
:17:51. > :17:55.of four on GPs like Tom Tasker. Under the new system of from the
:17:55. > :17:58.1st April, he will work with Salford Council to decide where
:17:58. > :18:02.money should be spent on mental health services. Some say GPs like
:18:02. > :18:07.him don't have the right sort of experience to be making those
:18:07. > :18:12.important decisions. I would disagree with that. I have a long
:18:12. > :18:16.history of working with mental health, I have developed clinical
:18:16. > :18:20.expertise and commissioning expertise over a decade. A how much
:18:20. > :18:27.will service users be a part of the process, how much do you listen to
:18:27. > :18:32.them? Our mantra for service users is - they should be no decision
:18:32. > :18:37.about me, without me. So they will be involved in commissioning?
:18:37. > :18:41.This could be the opportunity of a lifetime. To put mental health
:18:41. > :18:49.services at the heart of NHS care and with that, make the north-west
:18:49. > :18:52.happier, wealthier and as a good place. This is our time, over the
:18:52. > :18:55.next two years if mental health wanted to make a difference and
:18:55. > :19:01.people will believe us, this is the time for mental health services to
:19:01. > :19:06.be turned around. What is the future for rock and Vee? We will
:19:06. > :19:10.still be together of this leak. Brilliant because we have been
:19:10. > :19:13.together for 27 years and we intend to stay together for life. If they
:19:13. > :19:19.can keep him alive, we will be. It is just a case of getting experts
:19:19. > :19:22.to happen. Next week, Robb is off to London. The NHS has paid for him
:19:22. > :19:32.to see a specialist who is hoped will put him back on track and Vee
:19:32. > :19:36.says she won't give up her fight or her megaphone until he is.
:19:36. > :19:40.We have seen how changes to the NHS will affect the users of mental
:19:40. > :19:44.health services but the reforms go much wider will stop in 10 weeks'
:19:44. > :19:50.time, the NHS will undergo the biggest reorganisation in its
:19:50. > :19:53.history. To the doctor and comedian Phil Hammond takes us on a journey
:19:53. > :19:56.of what the changes will make for all of us.
:19:56. > :20:00.This is lovely, madam, because this inhaler would actually go with your
:20:00. > :20:04.coat. And a free examination. Do you want to come here and cough,
:20:04. > :20:09.sir? I can give you those half price. Plus something for your
:20:09. > :20:14.water retention. I'm a GP. And today I'm taking healthcare into
:20:14. > :20:17.the community, where it's needed. All the sample bottles you could
:20:17. > :20:21.ever need and I'll throw in a crutch. It's all free. It's all
:20:21. > :20:25.paid for. This is what the biggest shake-up in the history of the NHS
:20:25. > :20:31.is all about - giving local doctors, nurses and patients the chance to
:20:31. > :20:35.call the shots and shop around for the best care. At least that's the
:20:35. > :20:38.Government's plan. But many doctors think the reforms are untested,
:20:38. > :20:45.expensive and over-complicated - a view I shared with the former
:20:45. > :20:47.health secretary Andrew Lansley. The difficulty with this is that
:20:48. > :20:51.it's 353 pages of wonk. It's absolutely impossible to understand
:20:51. > :20:55.it. I choose my words carefully. It is unreadable. What did you
:20:55. > :20:58.actually say? It's wonk. But I've been wading through the jargon, and
:20:58. > :21:03.it's clear the reforms will affect us all. It's vital we put politics
:21:03. > :21:06.aside and try to understand exactly what they'll mean for patients.
:21:06. > :21:13.Until now the NHS has been like a big supermarket chain that only
:21:13. > :21:17.sells its own brands. It's a one stop shop where all the tricky
:21:17. > :21:21.decisions are made for you. In theory, you should get the same
:21:21. > :21:29.high quality care whether you live in Scunthorpe or Southend. But like
:21:29. > :21:31.any monopoly, it's far from perfect. The Government's bringing in the
:21:31. > :21:36.market place model instead - introducing more choice and
:21:36. > :21:41.competition, and putting GPs in charge instead of civil servants.
:21:41. > :21:45.But will it work? So if I just check your eyes there... I can
:21:45. > :21:50.confirm you have two eyes. We're doing two X-rays for the price of
:21:50. > :21:53.one. And I can throw in a free brain scan if you like. One change
:21:53. > :21:56.we're told patients should notice is care much closer to home.
:21:56. > :22:00.Hospitals and GPs will have more freedom to bring in innovative
:22:00. > :22:05.ideas. Technology might monitor your health at home and routine
:22:05. > :22:08.surgery could be done at high street clinics. Hospitals in
:22:08. > :22:13.Gloucestershire have already teamed up with a charity to send this
:22:13. > :22:19.mobile chemotherapy unit into rural communities. For cancer patients
:22:19. > :22:26.like Graham Freeman, it's a lifeline. The concept is great,
:22:26. > :22:33.moving the treatment to the person. Because it is a bit of a trauma,
:22:34. > :22:37.suffering from the chemotherapy and the travelling. Bringing the
:22:37. > :22:42.treatment closer to the person is a lot better. You do feel a little
:22:42. > :22:48.bit better. But could this shift towards more localised care mean
:22:48. > :22:50.hospitals will have to close? To find out I've come to London, to
:22:51. > :22:57.one of the world's most respected independent think tanks on health
:22:57. > :23:01.policy - the King's Fund. I don't think we'll see many hospitals
:23:01. > :23:03.closing as a result of care coming closer to home. It will mean
:23:03. > :23:07.hospitals changing their roles, perhaps fewer A&E departments,
:23:07. > :23:11.fewer maternity services provided in existing hospitals. But that
:23:11. > :23:13.could be to the benefit of patients if we're able to plan that in the
:23:13. > :23:19.appropriate way and get better outcomes by concentrating those
:23:19. > :23:24.services in fewer hospitals. might not be keen though, if it's
:23:24. > :23:30.your A&E that's closing. The second thing patients should notice is
:23:30. > :23:35.more choice. Three tomatoes for �1! Anybody? Three inhalers for the
:23:35. > :23:38.price of two. Come and get them! Two caulies, �1.50 over there!
:23:38. > :23:42.We've got a separate queue here for six symptoms or less. Competition
:23:42. > :23:45.in the NHS isn't new, but the reforms step it up a notch. The NHS
:23:45. > :23:52.will become a marketplace, with private companies competing with
:23:52. > :23:59.the NHS for business. So when your GP says you need a scan, your
:23:59. > :24:02.options may look less like this, and more like this. But it should
:24:02. > :24:08.be quality, not price, that will decide which are allowed to offer
:24:08. > :24:10.care. It's already happening here on the high street, where
:24:10. > :24:18.Specsavers are treating NHS patients in 218 of its hearing
:24:18. > :24:25.centres. When I came to Specsavers, they do private and NHS, which I
:24:25. > :24:27.find is better than going to the hospital. You know you go to the
:24:27. > :24:36.hospital, there's a lot of travelling and I don't think you
:24:36. > :24:39.get such a personal attention. So this is much, much better. When you
:24:39. > :24:43.press the button in, you'll hear two beeps which will allow you to
:24:43. > :24:46.use the telephone then. The plan is for patients like Doreen to choose
:24:46. > :24:49.their provider by looking at new performance league tables. But
:24:49. > :24:53.companies must play by the rules and can't encourage NHS patients to
:24:53. > :24:57.go private. Ultimately, Specsavers want to protect the NHS work that
:24:57. > :25:00.we've managed to gain here and we don't want to do anything to try
:25:00. > :25:06.and jeopardise that. We're not going to try and sell a hearing aid,
:25:06. > :25:11.upsell a patient at all during that time. More competition could drive
:25:11. > :25:16.up standards and lower costs. But if profits slip, companies could
:25:16. > :25:20.pull out or even go under, leaving patients in the lurch. Remember the
:25:20. > :25:26.collapse of Northern Rock? Imagine if its customers had been queuing
:25:26. > :25:28.not for their life savings but for life-saving surgery. If there is
:25:28. > :25:31.going to be a bigger role for private companies in delivering
:25:31. > :25:34.care to patients, then there is always a possibility, however
:25:34. > :25:37.remote, that that company will not be successful, that we will see
:25:37. > :25:40.something like Northern Rock in healthcare. The Government's
:25:40. > :25:42.anticipating that. It's putting in place what's called a "failure
:25:42. > :25:45.regime" so that the regulator can intervene and ensure continuity of
:25:45. > :25:53.services even if the organisations are not providing care to the right
:25:53. > :25:58.standard. The third thing patients may notice is a shift in their
:25:58. > :26:01.relationship with their GP. So if I said, "Trust me, I know the best
:26:01. > :26:04.place to go to get your heart surgery." Would you say, "Yeah,
:26:04. > :26:11.you're the doctor. Dr Phil, you look like a ginger George Clooney.
:26:11. > :26:15.I love, I trust you."? Since the birth of the NHS, doctors have
:26:15. > :26:18.taken the trust of patients for granted. But as GPs offer more and
:26:18. > :26:22.more treatments, they could find themselves referring patients to
:26:22. > :26:29.their own services. Add private companies into the mix and there's
:26:29. > :26:33.real scope for a conflict of interest. So just open really wide.
:26:33. > :26:37.Say "ahh." Ahh. That's great, thank you. But should we really be
:26:37. > :26:40.worried? In Bath, Jasmine Bishop is seeing a GP on the NHS. But believe
:26:40. > :26:43.it or not, he actually works for Virgin. Yup - they of planes,
:26:43. > :26:48.trains and super-fast broadband fame also run this walk-in centre,
:26:48. > :26:52.along with 170 other NHS services... Although you wouldn't know it from
:26:52. > :26:55.the branding. As Virgin takes over more of the NHS, what's to stop you
:26:55. > :27:01.referring patients on to another Virgin service to make money for
:27:01. > :27:04.the company, rather than in the best interests of the patient?
:27:04. > :27:11.of our GPs, like any GP in the country, have to offer patients a
:27:11. > :27:15.choice when they're being referred for another service. So in the end,
:27:15. > :27:18.it's down to the patient to choose where they go. And of course, GPs
:27:18. > :27:22.and other clinical staff have a professional responsibility too to
:27:22. > :27:28.make sure that they're finding the best care for their patients. That
:27:28. > :27:31.doesn't differ because those GPs are employed by us. And you have to
:27:31. > :27:37.ask if patients really mind who provides their care. Did you know
:27:37. > :27:40.that this health centre was run by Virgin? No. Would it make any
:27:40. > :27:45.difference to you as a patient whether it's run by an ordinary NHS
:27:45. > :27:48.GP or a private company? No. So all that matters to you is what? What
:27:49. > :27:52.do you care about in your treatment? That I get the best
:27:52. > :27:55.treatment I possibly can get really. Which of these sample bottles would
:27:55. > :27:59.you like, madam? We've got three on choice today. The bottom line is
:27:59. > :28:03.that if you have a good idea to improve your care, tell your GP. If
:28:03. > :28:07.he or she can make it happen, we know the reforms are working. It's
:28:07. > :28:12.been a huge upheaval just to get the NHS to listen to patients. And
:28:12. > :28:21.I hope for all our sakes it works. I can't lug all this back again.
:28:21. > :28:25.Come on, it's got to go today. Last chance!
:28:25. > :28:29.That's all from me here in Trafford. If you missed any of the programme,
:28:29. > :28:39.you can catch it again on the BBC iPlayer. I am back next Monday
:28:39. > :28:41.