21/01/2013 Inside Out North West

Welcome to the programme. This week we are in Trafford, investigating

how changes to the NHS will affect But first, how our health workers

and patients cabin with the big freeze? We are just taking

precautions, taking it to the hospital. What is the future for

the region's most formidable patient? We are here to highlight

the plight of people with mental health problems. And what do

radical changes to the NHS mean for people in the north-west? All the

sample bottles you could ever need When the weather hit us hard the

images is put to the test. Despite the conditions we have been

experiencing in the north-west, the service continues to provide a

vital lifeline for those in need. We have been following the story in

Friday - winter descends with full force, causing disruption, school

closures and problems on the road across the north-west. Many choose

to stay at home, but for frontline health workers, there is no choice.

Care worker Rachel Walmsley is making early visits to homes around

Whalley in Lancashire. We do like a cup of tea? Coffee? Yes? No problem.

We come every morning to get doubled up, get him in the bath,

brush his teeth, shave, dressed, and taken downstairs. If we don't

get here, then they are in a predicament. He will be left in his

bedroom all day. The weather can be a problem at times of ice and snow,

we are on tight schedules, we do have a certain amount of time at

each visit, it is difficult when we are trying to get more rural

locations. It looks like difficult terrain to navigate! Would you give

it gets worse? If it got worse, I would try and get up, but we would

have to bring the family and told We know that people are hungry and

we do our best. We don't want to keep you from doing your job any

longer. We will let you get on with it. Thank you! You can see the

challenges that carers like rich will have to face. -- ritual. The

weather isn't too bad right now although the Met Office are

predicting things will get worse as the afternoon goes on. The patient

has a back pain to come and a detailed with regard to whether

they can walk. As the weather deteriorates, the north-west at

ambulance service at faces an even bigger challenge. It is getting

bigger -- busy in the control room. We urged informing them, they will

get moving. -- are just informing them. Paramedic Wayne Pemberton is

A teenager has been injured in a sledging accident near Parbold, she

has crashed into a barbed-wire fence at the foot of a steep hill.

What are you suspecting injury why is? Sheet has got a lot of lumbar

pain. She cannot feel this right leg. Let's get her secure. How

would you doing? It is a 16-year- old, lost control, has impacted

with a back on this poll, her lower lumbar is where she is getting all

the pain. A decision is made to fly her to the Royal Preston Hospital.

Can you manage over there? Or Your Right? I have got you. Keep your

elbows tucked in for me. It is 23 miles away, but the helicopter

should get them back within five She stable at the moment, that the

paramedics have given them some treatment, given them some

painkillers, she stable at the moment. The treatment will continue

in the air, then she will be handed over to the hospital staff and they

will take her run from there. the crew made their way back to the

ambulance, there is another accident. Incredibly, a casket and

crashes through a fence just 100 yards up the road -- a car skids.

Just an update from this incident, it is one vehicle, it has left the

road, rolled three or four times, we have the 14-year-old female with

some injuries, fully immobilised -- 40-year-old female. We will see you,

received and understood. The driver is conscious and is responding to

questions, but it is important they immobilise her until she can be

We will put it back over you. Nice and steady there. There is loads of

room here to get her out. problem. We are just taking

precaution, take her to the hospital so the doctor can see her

but she is good, she is fine. took to the driver's family, fire

and rescue arrive at the scene. was starting to get pain, so we

thought on the safe side, if possible, take the roof off and do

it that way back was all right with Preston, the teenager injured in

She has undergone several X-rays, she had an X-ray which has come

back as OK, she is to complaining of some back pain, looks like

muscular skeletal pain, we have set her up with some pain relief can

see how it goes. At the car accident, a decision has been made

not to remove the roof but to get the driver out through the back of

the vehicle. A much better idea, now you have had a look at it, to

be honest. Just waiting for the fire service to extricate the lady

from the car. Are you OK there? Structure is just to the right

She is not rocking at all, she's We managed to treat a lady in the

car, managed to stabilise her condition, extricate her from the

car with the assistance of the fire service into the back of the

ambulance when she was treated and taken to hospital. We will make

ourselves available and cleaner, liaise with the emergency centre

and find that if there are any other incidents they need us to

attend. We are now clear at the incident in Parbold, if you have

nothing outstanding will head back Amazingly the driver of the car

didn't suffer any serious injuries and has since been discharged from

hospital. The girl entered in the sledging accident was allowed home

later that evening. Care worker Rachel Walmsley finally managed to

complete all her visits. Today we have seen the impact that bad

weather can have on frontline NHS staff. Fortunately we did have a

lot of warning which made plenty of provisions have been put in place

and that has meant that the district nurses, there carers,

paramedics and doctors and nurses of the hospitals like this one have

been able to maintain a high standard of care in spite of the

I can confirm you have two eyes! Shaking up the NHS can but what

The borough of Trafford here in Greater Manchester is recognised as

the birthplace of the NHS. The local hospital, Trafford General

commentary did the first NHS patient back in 1948. 65 years

later the NHS is undergoing a major transformation. In the first of two

films looking at those changes, we investigate how mental health

services could change here in the north-west and how patient will

This is Rob from Salford, he is 55 and he is mentally ill. One in four

but will be at some point in our lives. Today he is protesting

because his local droppings and there could be closing for good

because of budget cuts. -- local drop-in centre. And this is his

partner Vee. We are here this morning to highlight the plight of

many people with mental health problems. Rob says she is the love

of his life. They have been together for 27 years, but life

changed dramatically two years ago. He suffered a breakdown after

experiencing flashbacks for trauma and abuse which he suffered as a

child and young adults. He often progresses to a childlike state,

regularly self- harms and since 2010 has tried to take his own life

26 times. What is life like? Hell, basically. There are times when I

feel as though one can't go on. The only way for me to cope is to sort

of end it all. And I feel just lately that is the majority of the

time. I have more bad days for my have good days at the minute.

problem for mental illnesses, people with physical illness can

tell you where it hurts and why it hurt and pawing each to the right

direction, people with mental illness, where confusion and

disorientation come in, you have to guess what to do for them, they

can't tell you necessarily. If an episode occurs which can be

harrowing, where he has taken a load of tablets and can't say why,

how can you stop him doing it? You can't. Mental illness is the

largest cause of the stability in our society. In the north-west

around 1.7 5 million people will at some point need support from mental

health services. Sooner what does services are run what is spent on

them will be decided at by GPs, for the first time. Get it right and we

will save the NHS millions by reducing accident emergency

admissions and the need for long care. Get it wrong, we could see an

increase in benefits, dependency, prison depression and suicide. But

all of those changes come at a time of massive cuts, both to local

council and NHS budget. So the fear is that mental health services will

It is inevitable that providers are going to start to make efficiency

savings which may be seen as cuts already and we are already seeing

some services going. They have been threats to addiction services that

have gone to the voluntary sector which can be part of the job but

cannot do it with the complexity. What is the impact when the Serbs

is our loss? You get by for a few months but then starts to hit, more

referrals to accident and emergency, more getting picked up by the

Ambulance Service. We are trying to move away from that of care.

Patients like Rob do have some good days but there are lots of bad days.

Since his drop in centre close, Vee believes his condition has

deteriorated. His illness means they have gone from earning a

combined income of nearly �50,000 to potentially losing a home at

their level. When I went to see rock at home, he had been drinking.

People will watch this and say you need to stop drinking and smoking a

and make an effort. I say yes, I agree with them. But it's not that

easy. I've worked so hard for this house. Please, somebody, tell me

how I can help myself. How would you sum up what life is like for

you and Vee? She hasn't got any life. She hasn't got any life. All

she does is care for me. All she does is worry about me. As his

full-time care, what impact does it have on your life? Terrible, I had

lost my confidence, I had a brilliant job, I was senior

management. Sometimes now, I cannot even face the day. It is difficult.

She says she misses the relief she had when Rock spent time at his

drop in centre. In other parts of the north-west, people with mental

health problems are seeing grip their possessions disappear because

of budget cuts. More than 70 miles away in Kendal, is Workbase. For 20

years it provided therapeutic art services for people with depression.

But now the estate agents are in and they are packing up for good.

It is devastating news for Graham who started coming here nine years

ago. If my doctor had not mention this case, to be quite honest, I

would have been a total wreck by now, not wanting to do anything. It

has motivated me and got me out. When you look to the future without

this place which has been part of your life for nearly a decade, had

you feel? It does scare me because I got a lot of friends here. It

just scares me knowing I won't see them again. For years, mental

health was described as having Cinderella services - overlooked

and under resourced but now the government has pledged at parity of

esteem between mental and physical health. But if that promise comes

as the NHS looks to save �20 billion by 2015. Can they really

give mental health services the attention they need. That question

of four on GPs like Tom Tasker. Under the new system of from the

1st April, he will work with Salford Council to decide where

money should be spent on mental health services. Some say GPs like

him don't have the right sort of experience to be making those

important decisions. I would disagree with that. I have a long

history of working with mental health, I have developed clinical

expertise and commissioning expertise over a decade. A how much

will service users be a part of the process, how much do you listen to

them? Our mantra for service users is - they should be no decision

about me, without me. So they will be involved in commissioning?

This could be the opportunity of a lifetime. To put mental health

services at the heart of NHS care and with that, make the north-west

happier, wealthier and as a good place. This is our time, over the

next two years if mental health wanted to make a difference and

people will believe us, this is the time for mental health services to

be turned around. What is the future for rock and Vee? We will

still be together of this leak. Brilliant because we have been

together for 27 years and we intend to stay together for life. If they

can keep him alive, we will be. It is just a case of getting experts

to happen. Next week, Robb is off to London. The NHS has paid for him

to see a specialist who is hoped will put him back on track and Vee

says she won't give up her fight or her megaphone until he is.

We have seen how changes to the NHS will affect the users of mental

health services but the reforms go much wider will stop in 10 weeks'

time, the NHS will undergo the biggest reorganisation in its

history. To the doctor and comedian Phil Hammond takes us on a journey

of what the changes will make for all of us.

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. 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. 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 from perfect. The Government's bringing in the

market place model instead - introducing more choice and

competition, and putting 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 to the person. Because it is a bit of a trauma,

suffering 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! Two caulies, �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 Specsavers, 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 two beeps which will allow you to

use the telephone then. 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. We're not going to try and sell a hearing aid,

upsell a patient at all during that time. More 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 its customers had been queuing

not for their life savings but for life-saving surgery. If there is

going to be a bigger role for private companies in delivering

care to patients, then there is 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 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, I trust you."? 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.

Say "ahh." Ahh. That's great, thank you. But should we really be

worried? 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 super-fast 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 takes over more of the NHS, 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?

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

choice when they're being referred for another service. 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? No. So all that matters to you is what? What

do you care about in your treatment? That I get the best

treatment I possibly can 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 chance!

That's all from me here in Trafford. If you missed any of the programme,

you can catch it again on the BBC iPlayer. I am back next Monday