:00:00. > :00:12.In hello, welcome to a new series of Inside Out north-west with me, Diane
:00:13. > :00:20.Oxbridge. Tonight, bed blocking, accusing is A We look for
:00:21. > :00:25.answers. At the moment we've got every single cubicle bar one fault.
:00:26. > :00:28.We investigate whether our NHS is still free to everyone, wherever
:00:29. > :00:32.they live. It matters because it leads to
:00:33. > :00:37.inequality and health care. That's the problem. Some people get health
:00:38. > :00:41.care for free, but others won't. And we discover how a baby rhino is
:00:42. > :00:45.helping save the endangered species from extinction.
:00:46. > :00:48.When they are this more life as an adventure.
:00:49. > :00:55.They are like puppies, aren't they? Yes.
:00:56. > :01:01.Daily life in the emergency department at Furness General
:01:02. > :01:09.Every day we hear another warning about the crisis within the NHS. Bed
:01:10. > :01:13.blocking, cancelled operations, queues in accident and emergency.
:01:14. > :01:16.The system is under strain. We've had exclusive access to one of the
:01:17. > :01:20.busiest emergency department to see exactly what pressure staff are
:01:21. > :01:22.facing and how they are innovating to cope. Peter Marshall reports.
:01:23. > :01:26.Daily life in the emergency department at Furness General
:01:27. > :01:32.But we need one for that one as well.
:01:33. > :01:39.More and more patients are coming through the doors.
:01:40. > :01:42.It s consultant Paul Grout s job to help treat them.
:01:43. > :01:45.As you can see at the moment we ve got every single cubicle bar one
:01:46. > :01:48.full of patients that have come in on ambulances needing
:01:49. > :02:01.Absolutely, the problem we have at the moment is we haven t got
:02:02. > :02:03.anywhere for those ambulance patients to be put.
:02:04. > :02:07.Consequently, ambulances are backing up here waiting to be able to hand
:02:08. > :02:11.You have a paediatric cubicle as well?
:02:12. > :02:14.Yes, which at the moment we ve actually had to put an elderly
:02:15. > :02:19.patient in because we ve run out of suitable cubicles for them.
:02:20. > :02:23.Just an indication of how busy it is and it s only, what,
:02:24. > :02:31.Well, it s now gone two in the afternoon and still all
:02:32. > :02:33.So what do patients like 73-year-old Derek Parkin,
:02:34. > :02:35.here with respiratory problems, make of it?
:02:36. > :02:37.They are great, they re quite attentive to be
:02:38. > :02:42.Does he feel patients are under pressure to move out quicker?
:02:43. > :02:46.Well, I think it s all partly a question of education.
:02:47. > :02:49.I mean, people are coming in unnecessarily.
:02:50. > :02:52.I mean, I was reluctant to come in because it s been on the regional
:02:53. > :02:58.news that patients have been asked not to attend both
:02:59. > :03:06.So I ve left it until the last minute to come in today
:03:07. > :03:09.and I couldn t leave it any longer and I had to succumb.
:03:10. > :03:11.Well it's now gone two in the afternoon and still all
:03:12. > :03:13.but one of the cubicles in the emergency
:03:14. > :03:17.There are patients still waiting for beds and the ambulance crews
:03:18. > :03:20.who brought them to the hospital have to wait with the patients
:03:21. > :03:24.The University Hospitals of Morecambe Bay trust which runs
:03:25. > :03:28.Furness, also runs the emergency department at Lancaster
:03:29. > :03:31.where they ve introduced a so called corridor nurse to tackle queues.
:03:32. > :03:34.Is it right in a civilised society that we have
:03:35. > :03:40.In an ideal environment what we would have is a patient
:03:41. > :03:46.coming through the front door, being appropriately triaged and then
:03:47. > :03:49.moved earlier to an area where they can be seen by the right
:03:50. > :03:53.And with all the changes that we are trying to make
:03:54. > :03:57.we would hope that in the future that is what we will be achieving.
:03:58. > :03:59.So what are they doing to ease pressures?
:04:00. > :04:03.To find out we go deeper into the hospital.
:04:04. > :04:07.We currently have over half the beds with people who are medically fit
:04:08. > :04:12.to go elsewhere either home or nursing care.
:04:13. > :04:19.Those patients are effectively trapped in, blocking hospital beds
:04:20. > :04:22.while waiting for a bed in a nursing or care home.
:04:23. > :04:25.Dena Mason's one of the trust's new discharge co-ordinators brought
:04:26. > :04:33.Social workers also now work on the ward
:04:34. > :04:35.And the hospital has just commissioned 12
:04:36. > :04:42.Well, hopefully if the trust have beds that we can move people
:04:43. > :04:45.to when they are waiting for a long term bed it means it would be able
:04:46. > :04:49.to free up some of the acute beds that are needed for people
:04:50. > :04:57.This is Faversham House nursing home in Greater Manchester,
:04:58. > :05:04.one of over 40 homes and two hospitals, in the Trafford area
:05:05. > :05:11.piloting a new system to reduce delays faced when searching
:05:12. > :05:19.We used to have a team of people who used to ring the nursing homes
:05:20. > :05:21.on a Friday morning, they d complete a spread sheet
:05:22. > :05:24.with the available bed information and then email it out to the teams
:05:25. > :05:27.of people who need to know what beds are available in Trafford.
:05:28. > :05:31.It can be out of date by the time the phone call is finished.
:05:32. > :05:42.This new Bed State Tracker app gives real time information on what beds
:05:43. > :05:45.It can be updated every minute of the day.
:05:46. > :05:47.And if beds are found sooner, patients leave hospital sooner.
:05:48. > :05:54.Should the rest of the NHS be looking at this?
:05:55. > :05:59.There's nothing worse than somebody sat in a hospital
:06:00. > :06:11.If they can get the right in a nursing home they should be
:06:12. > :06:17.moved out as soon as possible and that frees up that bed.
:06:18. > :06:26.So anything we can do to help people moving out
:06:27. > :06:29.Back to Furness General we've been allowed in to a patient safety
:06:30. > :06:32.meeting, now held four times a day to head off potential crises.
:06:33. > :06:40.And a spanner is about to be thrown into the works.
:06:41. > :06:46.Ward seven is closed. We are presently have six patients out of a
:06:47. > :06:49.population of 33 infected with no norovirus.
:06:50. > :06:54.The fight to clear cubicles just got tougher.
:06:55. > :06:57.The battle to tackle the queues and free up beds won t be won
:06:58. > :07:01.There s also a war being waged out in local communities.
:07:02. > :07:04.The hospital trust is working with other trusts, GPs
:07:05. > :07:07.and councils in a project called Better Care Together,
:07:08. > :07:10.one of its aims is to treat more patients in their homes.
:07:11. > :07:13.In Kendal, nurse Alison Nicholson helps that happen.
:07:14. > :07:27.Today visiting the family of a former patient 95-year-old
:07:28. > :07:30.Granddad didn't like the hospitals, didn t want to go in a home,
:07:31. > :07:35.That's all he ever wanted was to die at home.
:07:36. > :07:38.I can only speak on behalf of the frail and the very
:07:39. > :07:41.old, and the evidence base for the frail and old
:07:42. > :07:43.is that hospital isn t always the right place.
:07:44. > :07:46.It s full of germs, unfortunately, it s full of opportunities to slip
:07:47. > :07:49.over, and we know that older people really de-condition in a matter
:07:50. > :07:52.of days from being in hospital, so the bigger picture for us
:07:53. > :07:54.is to start planning with our community and our population
:07:55. > :08:00.about bringing their care and services closer to home now.
:08:01. > :08:04.With Alison co-ordinating his care Miles was able to spend the final
:08:05. > :08:13.Without that care plan and that early intervention I think Miles
:08:14. > :08:17.would have continued on his little journey round various hospitals.
:08:18. > :08:20.Out patients, ambulances, but we were able to break the cycle
:08:21. > :08:29.Another community, another innovation.
:08:30. > :08:32.Millom, 50 minutes from Furness General is piloting Tele-health,
:08:33. > :08:39.a direct video link to the emergency department at Furness General.
:08:40. > :08:42.It s helped cut emergency admissions to the hospital from Millom
:08:43. > :08:49.From being one of the most isolated places in the whole of Cumbria this
:08:50. > :08:56.technology stops people having to travel.
:08:57. > :08:59.What I would like to see very soon is that if you are waiting
:09:00. > :09:02.for a diagnosis, a serious diagnosis like cancer, is that you don t
:09:03. > :09:04.have to travel somewhere like Manchester or Newcastle,
:09:05. > :09:07.that you can come into the surgery, you can ink up to Tele-health
:09:08. > :09:11.with your doctor to that consultant and the you can sort out a care plan
:09:12. > :09:16.and that to me is just a fantastic idea for our future.
:09:17. > :09:19.Two years ago local residents here had to fight to save their local
:09:20. > :09:27.health services now they are equal partners with the NHS
:09:28. > :09:31.Education is a key part of their work.
:09:32. > :09:34.We all know that the NHS is under pressure, we see it
:09:35. > :09:37.on the news every day, we see it in the newspapers.
:09:38. > :09:44.When resources are limited you have to be more careful
:09:45. > :09:49.You have to use them appropriately and get the best value for money.
:09:50. > :09:52.And we have a bit of a slogan, think before you act.
:09:53. > :09:55.Just take a couple of seconds to think do I really need to access
:09:56. > :09:58.that service or do I need to think about using another service.
:09:59. > :10:01.The NHS will change over the next few years.
:10:02. > :10:06.On the front line, theyll do what they've always done, offer
:10:07. > :10:12.What would you say to those who say the answer is more beds?
:10:13. > :10:21.The answer isn't more beds in hospitals.
:10:22. > :10:23.The answer is looking at ways of getting patients
:10:24. > :10:26.back to their own home with appropriate support.
:10:27. > :10:29.One of the problems of keeping people in any institution
:10:30. > :10:32.is when you do that you reduce their ability to look
:10:33. > :10:35.If you keep people at home, you can keep them at home
:10:36. > :10:38.with much smaller inputs into their health care needs.
:10:39. > :10:53.It s better for everyone including the health economy.
:10:54. > :11:02.As we've seen NHS budgets are tightening. Patient numbers are
:11:03. > :11:06.rocketing. This adds pressure to Russia and treatment. So, is the NHS
:11:07. > :11:12.still a National Service? Does where you live matter more than ever when
:11:13. > :11:19.it comes to clear an offer? -- rationed treatment. The NHS is
:11:20. > :11:23.affecting the most significant financial challenge in its history.
:11:24. > :11:27.There are fears the service we've grown up with is beginning to
:11:28. > :11:33.fragment. It's not a National Service. It's criminal. Absolutely
:11:34. > :11:51.criminal. This is going to get worse. On a bad day it ruins your
:11:52. > :11:57.life,. It feels like my bones are screaming at times. 33-year-old Ben
:11:58. > :12:03.has hepatitis C. A virus that caused life-threatening liver damage. --
:12:04. > :12:08.can cause. I'm about to my job. I've been off sick. And I could possibly
:12:09. > :12:13.lose the flat. There are drugs that could queue the hepatitis, but they
:12:14. > :12:18.are expensive and rationed. Then has been denied them.
:12:19. > :12:24.All I got was, wait, basically, because my liver wasn't bad enough.
:12:25. > :12:27.And that made me want to go out and just get absolutely wasted, Andrew
:12:28. > :12:31.with my liver. Just so that they would treat me. I wouldn't do that,
:12:32. > :12:36.but it wouldn't surprise me if but it wouldn't surprise me if
:12:37. > :12:40.anyone else wouldn't. The money is there for 10,000 treatments. Each
:12:41. > :12:43.area has a target to meet. It is claimed that means there are no
:12:44. > :12:49.queues in parts of the North and long waits in London. To people with
:12:50. > :12:52.exactly the same state of limit damage could present themselves in
:12:53. > :12:56.different parts of the country. In one they can walk and get hepatitis
:12:57. > :12:59.treatment immediately, and get skewered. In another part of the
:13:00. > :13:06.country they may go there and be told, I'm sorry, you have to wait.
:13:07. > :13:09.NHS England told us it regularly reallocated and used treatments to
:13:10. > :13:18.places with waiting lists. But the number of patients treated will
:13:19. > :13:23.increase by 25% next year. So Ben is taking the risk of treating himself
:13:24. > :13:32.with cheaper copies of the new drugs. How much have you spent on a
:13:33. > :13:39.box? ?1300. ?1300. But I don't really have. The fact that I've had
:13:40. > :13:46.to pay for my treatment, it's criminal. It is absolutely criminal.
:13:47. > :13:50.Clinical commissioning groups all CCG 's control has budgets. It's
:13:51. > :13:54.claimed some are delaying treatment is like cataract surgeries by
:13:55. > :13:57.slowing down referrals. Others require patients to lose weight
:13:58. > :14:02.before getting operations like hip replacements. This bowling an
:14:03. > :14:07.operation in these circumstances can save money in the short term. And
:14:08. > :14:12.while these CCG 's fate can be clinically justified the Royal
:14:13. > :14:16.College of surgeons say it can't. There is very good evidence that
:14:17. > :14:22.people are now not getting elective operations which they desperately,
:14:23. > :14:24.sometimes, require, simply because of the financial restriction. It is
:14:25. > :14:30.up to the commission is to decide who should have what treatment. And
:14:31. > :14:36.therefore, a bureaucratic system, which produces a blanket wrapped, we
:14:37. > :14:39.think it is morally wrong. It's claimed that new systems for vetting
:14:40. > :14:46.appointments are another form of rationing. Why are they treating
:14:47. > :14:51.their patients with such contempt? Last month MPs complained about a
:14:52. > :14:56.private company being paid ?10 for every GP referral they stopped. This
:14:57. > :15:00.is rationing by the back door and has the potential to compromise
:15:01. > :15:05.patient safety. The same private company overseas referrals in
:15:06. > :15:10.Tyneside. We spoke to doctors who say the system is putting patients
:15:11. > :15:15.at risk. The GPs who there speaking out her told us that cancer
:15:16. > :15:18.diagnoses are being held up. I tried to get a patient referred to a
:15:19. > :15:23.dermatologist. The Management service said it was a skin lesion
:15:24. > :15:30.and rejected it. That was a disaster. It was a nasty embraces
:15:31. > :15:35.skin cancer. The system's dangerous. They are putting up barriers. They
:15:36. > :15:39.are using delaying tactics. It's getting between the doctor and the
:15:40. > :15:41.specialist. In a statement North Tyneside CCG said there was no
:15:42. > :15:46.evidence the system caused additional risk will delay. Cancer
:15:47. > :15:50.referrals to not go through the system and are made directly to
:15:51. > :15:55.hospital. The number of referrals not bad to GPs in England has risen
:15:56. > :16:02.to about 30% in the last two years. The details are available online.
:16:03. > :16:06.Shortage and regional difference have always been part of the NHS.
:16:07. > :16:13.Today the differences could get much worse. So is the NHS still a
:16:14. > :16:20.National Service? One of our most prominent medics is clear. No, it's
:16:21. > :16:24.not a National Service. It's now a local health service. It matters
:16:25. > :16:28.because it leads to inequality and health care. Some people get health
:16:29. > :16:32.care for free, others won't. Statement the Department of Health
:16:33. > :16:37.said that far from rationing more people than ever are getting prompt
:16:38. > :16:43.treatment. 3261 more cancer patients are being seen every day and
:16:44. > :16:46.standards of care are improving. We asked the Health Secretary and NHS
:16:47. > :16:50.England for interview. Both declined. The people actually paying
:16:51. > :16:56.for NHS services, the clinical commissioners, did agree to speak.
:16:57. > :17:01.It's a National Service. With local variation based on the need of the
:17:02. > :17:05.population. Demographically populations vary significantly from
:17:06. > :17:07.county. It's really important that county. It's really important
:17:08. > :17:11.we commission and respond to the we commission and respond to the
:17:12. > :17:15.needs of our population by local basis. It's about making sure the
:17:16. > :17:19.par three is correct. We don't want to squander money. We have limited
:17:20. > :17:23.resources. It's important that we spend most effectively and get the
:17:24. > :17:26.best value for our population. For those forced to take their own
:17:27. > :17:29.action rationing appears all too real.
:17:30. > :17:33.It s a year since a baby white rhino was born at Knowlsey Safari.
:17:34. > :17:35.Rhinos face uncontrolled poaching for huge profits.
:17:36. > :17:39.As a top European breeding centre it plays a vital role in keeping
:17:40. > :17:53.I was given exclusive access behind the scenes to the calves first
:17:54. > :17:57.I m not sure what I was expecting when I went to Knowsley safari
:17:58. > :18:13.I d heard she weighed 7 stone at one week!
:18:14. > :18:15.We are looking at a proud mum but you seem a bit
:18:16. > :18:20.Yeah, she's phenomenal any rhino birth
:18:21. > :18:25.But this girl just seems to have captured the hearts of everybody
:18:26. > :18:27.we have actually had 11 born in the last decade.
:18:28. > :18:30.It s fascinating when you think of a rhino you think of the size,
:18:31. > :18:43.But for me for the first time to be this close to one you see
:18:44. > :18:45.playfulness and elegance it s a completely different animal
:18:46. > :18:49.Absolutely, obviously, when there this small life is just
:18:50. > :18:54.Yes, absolutely I mean you ve seen the way that she runs around
:18:55. > :19:06.Once that calf's born, it's her soul purpose to protect
:19:07. > :19:22.She's so giddy, isn't she. Yes, she is just absolutely off the wall
:19:23. > :19:29.sometimes. Rhino horn is now worth more
:19:30. > :19:38.than gold on the black market. This makes white rhinos one
:19:39. > :19:40.of the most hunted animals in the wild especially
:19:41. > :19:42.in South Africa. The slaughter is fuelled
:19:43. > :19:49.by the mistaken belief that rhino horn cures anything
:19:50. > :19:56.from cancer to hangovers. With such huge profits,
:19:57. > :20:03.criminal syndicates Poaching in the wild is literally
:20:04. > :20:06.desolating these numbers we estimated just on 20,000
:20:07. > :20:08.surviving in the wild and when you re looking
:20:09. > :20:11.at up 1400, 1500 of these It is absolutely vital
:20:12. > :20:16.that we try our hardest to make sure Unfortunately, with these
:20:17. > :20:24.guys its not sport a lot Traditional medicine markets
:20:25. > :20:27.in the far east also what we have found out now
:20:28. > :20:30.is that there is a growing number of poachers that are taking
:20:31. > :20:32.these for status symbol. One of the most frightening
:20:33. > :20:35.situations that has occurred with them, is that its showing
:20:36. > :20:37.peoples expendable wealth, you'll get people grinding it up
:20:38. > :20:39.and putting it into drinks. Absolutely, it has no medicinal
:20:40. > :20:43.purposes what so ever. At Knowsley there s enough space
:20:44. > :20:49.for rhinos to live and breed She just wants a bit of sun
:20:50. > :20:56.on her back, A bit of warm weather. A bit of warm weather a bit of sun
:20:57. > :21:01.on her back, when the wind Then the public will
:21:02. > :21:17.be able to see her. And for Jason, everything
:21:18. > :21:20.is going to plan. And the calf has been named
:21:21. > :21:24.Nom voo la which means She is, she s a star,
:21:25. > :21:34.and she s perfect. She s been a massive
:21:35. > :21:38.hit with the public, And how has she settled
:21:39. > :21:42.because she was indoors This big wide world has got
:21:43. > :21:46.to be so alien to them, Yes, absolutely, it does
:21:47. > :21:51.take her a bit of time to get used to all the sights and sounds
:21:52. > :21:54.and smells, moreso the sounds and smells than the actual sight
:21:55. > :21:58.but her Mum shows her the way And it's amazing to watch
:21:59. > :22:17.you with these truly wild animals, call them by their name and one
:22:18. > :22:21.by one they get up by their name Yeah, we try to keep them as wild
:22:22. > :22:30.as we possibly can in this environment but there are certain
:22:31. > :22:33.things we need to do for them every now and again we may need
:22:34. > :22:36.to intervene with medical care so to be on friendly
:22:37. > :22:40.terms with the rhino And has anything
:22:41. > :22:48.taken her by surprise? So when she came out full
:22:49. > :22:57.of beams and energy, I think it took them more
:22:58. > :23:01.by surprise because it was like wow, what s this,
:23:02. > :23:06.we haven t seen one like this So she s not just an attraction
:23:07. > :23:14.for the visitors here at Knowsley, she s actually an attraction
:23:15. > :23:16.for the animals? Yeah, and it s all
:23:17. > :23:21.part of what we do. And I ve just been given a rare
:23:22. > :23:24.opportunity to meet this star It s not something the public should
:23:25. > :23:29.try these animals are dangerous. But I m in safe hands
:23:30. > :23:32.with Eveline de Wolfe, the Head of animal management
:23:33. > :23:36.and her trusted team of keepers. So all the time you are
:23:37. > :23:38.reassuring Mum we re ok, Yeah, but they have built up a very
:23:39. > :23:49.good trust relationship They are very trustworthy,
:23:50. > :23:56.they work very closely And I remember from last time,
:23:57. > :24:09.they do like being touched. They are very tactile
:24:10. > :24:11.amongst themselves as well. The next big step
:24:12. > :24:22.is meeting her Dad. Because they are
:24:23. > :24:28.separated, aren t they? We try to imitate what
:24:29. > :24:30.happens in the wild. So the next big life step
:24:31. > :24:33.for her is meeting her dad. These girls are very experienced,
:24:34. > :24:36.the Mum has done it Nomvula is finally
:24:37. > :24:49.meeting her father. It could be a very good introduction
:24:50. > :25:05.or he could not be very pleasant when he comes out or the females
:25:06. > :25:11.vice versa could not be But, touch wood, most times it
:25:12. > :25:22.goes according to plan. All you can do is leave it up to
:25:23. > :25:26.them. We have a couple of vehicles in places and if anything does get
:25:27. > :25:29.out of hand when we are in a position where we can intervene and
:25:30. > :25:42.separate them, and potentially take it from there. Roger, John, ready
:25:43. > :25:52.when you are. We're ready. Standing by. It's time to let her out. An
:25:53. > :25:57.orphaned bull from Africa this rhino was fined wondering by his mother's
:25:58. > :26:02.dead body. She had been shot by poachers, and her horn removed. His
:26:03. > :26:08.nose is right to the ground. What is he smelling? Detecting the centre of
:26:09. > :26:11.the females. I wouldn't be surprised if when he does come out he follows
:26:12. > :26:22.the exact route the females talk when they out. This is a smart he
:26:23. > :26:28.hasn't come across yet. The opportunity for a calf and for a
:26:29. > :26:32.mother to experience a ball with a young calf, it's all very much part
:26:33. > :26:37.of that, you know, that life cycle. It's what would happen in the wild.
:26:38. > :26:42.That's what we are trying to replicate within the captive
:26:43. > :26:55.environment. The rhinos sees her father for the first time. Cheeky
:26:56. > :27:03.Madame! She's not afraid of anything. That nose to nose greeting
:27:04. > :27:09.is really, sort of, significant. It really is a way of communicating,
:27:10. > :27:23.sort of, saying hello, really. The fact he backed away as good. Wherein
:27:24. > :27:26.a good here. Yeah, this introduction couldn't have gone better. I'm
:27:27. > :27:32.really so glad you're here to see it and see exactly what we can do with
:27:33. > :27:39.these guys. That went brilliantly, mate. I'm going to drop the guys
:27:40. > :27:42.Barcroft and safety. Over. It's predicted that deaths from poaching
:27:43. > :27:49.these animals could soon overtake births. If the traders and stopped.
:27:50. > :27:53.So this rhino will be cared for here before moving to a new home to
:27:54. > :27:59.continue the breeding programme. That will be a sad day for Jason. It
:28:00. > :28:03.is very emotional. When you have to say goodbye to one of them it really
:28:04. > :28:11.does tail at your heartstrings a little bit. Do you love your job?
:28:12. > :28:25.Absolutely, yes. 15 years on every day is magnificent. It really is.
:28:26. > :28:30.I cannot understand why anyone would want to harm such a beautiful
:28:31. > :28:38.creature. See you next week, goodbye.
:28:39. > :28:43.Next week the Manchester illustrator who has gone from doodling large
:28:44. > :28:51.paper to drawing Donald Trump for the New York Times. He's got a
:28:52. > :29:07.comedic face, you know. I think I've got him.
:29:08. > :29:10.Hello, I'm Louisa Preston with your 90 second update.
:29:11. > :29:12.30 British tourists shot dead in Tunisia in 2015.
:29:13. > :29:15.Today, an inquest was told that security forces
:29:16. > :29:20.Donald Trump provokes a mixed reaction.
:29:21. > :29:23.Downing Street welcomes the promise of a "quick and fair" trade deal.
:29:24. > :29:25.But foreign ministers are concerned by his comments
:29:26. > :29:32.It follows the collapse of the power-sharing Government.
:29:33. > :29:35.Sinn Fein refused to nominate a new deputy first minister.