16/01/2017 Inside Out North West

In hello, welcome to a new series of Inside Out north-west with me, Diane

Oxbridge. Tonight, bed blocking, accusing is A We look for

answers. At the moment we've got every single cubicle bar one fault.

We investigate whether our NHS is still free to everyone, wherever

they live. It matters because it leads to

inequality and health care. That's the problem. Some people get health

care for free, but others won't. And we discover how a baby rhino is

helping save the endangered species from extinction.

When they are this more life as an adventure.

They are like puppies, aren't they? Yes.

Daily life in the emergency department at Furness General

Every day we hear another warning about the crisis within the NHS. Bed

blocking, cancelled operations, queues in accident and emergency.

The system is under strain. We've had exclusive access to one of the

busiest emergency department to see exactly what pressure staff are

facing and how they are innovating to cope. Peter Marshall reports.

Daily life in the emergency department at Furness General

But we need one for that one as well.

More and more patients are coming through the doors.

It s consultant Paul Grout s job to help treat them.

As you can see at the moment we ve got every single cubicle bar one

full of patients that have come in on ambulances needing

Absolutely, the problem we have at the moment is we haven t got

anywhere for those ambulance patients to be put.

Consequently, ambulances are backing up here waiting to be able to hand

You have a paediatric cubicle as well?

Yes, which at the moment we ve actually had to put an elderly

patient in because we ve run out of suitable cubicles for them.

Just an indication of how busy it is and it s only, what,

Well, it s now gone two in the afternoon and still all

So what do patients like 73-year-old Derek Parkin,

here with respiratory problems, make of it?

They are great, they re quite attentive to be

Does he feel patients are under pressure to move out quicker?

Well, I think it s all partly a question of education.

I mean, people are coming in unnecessarily.

I mean, I was reluctant to come in because it s been on the regional

news that patients have been asked not to attend both

So I ve left it until the last minute to come in today

and I couldn t leave it any longer and I had to succumb.

Well it's now gone two in the afternoon and still all

but one of the cubicles in the emergency

There are patients still waiting for beds and the ambulance crews

who brought them to the hospital have to wait with the patients

The University Hospitals of Morecambe Bay trust which runs

Furness, also runs the emergency department at Lancaster

where they ve introduced a so called corridor nurse to tackle queues.

Is it right in a civilised society that we have

In an ideal environment what we would have is a patient

coming through the front door, being appropriately triaged and then

moved earlier to an area where they can be seen by the right

And with all the changes that we are trying to make

we would hope that in the future that is what we will be achieving.

So what are they doing to ease pressures?

To find out we go deeper into the hospital.

We currently have over half the beds with people who are medically fit

to go elsewhere either home or nursing care.

Those patients are effectively trapped in, blocking hospital beds

while waiting for a bed in a nursing or care home.

Dena Mason's one of the trust's new discharge co-ordinators brought

Social workers also now work on the ward

And the hospital has just commissioned 12

Well, hopefully if the trust have beds that we can move people

to when they are waiting for a long term bed it means it would be able

to free up some of the acute beds that are needed for people

This is Faversham House nursing home in Greater Manchester,

one of over 40 homes and two hospitals, in the Trafford area

piloting a new system to reduce delays faced when searching

We used to have a team of people who used to ring the nursing homes

on a Friday morning, they d complete a spread sheet

with the available bed information and then email it out to the teams

of people who need to know what beds are available in Trafford.

It can be out of date by the time the phone call is finished.

This new Bed State Tracker app gives real time information on what beds

It can be updated every minute of the day.

And if beds are found sooner, patients leave hospital sooner.

Should the rest of the NHS be looking at this?

There's nothing worse than somebody sat in a hospital

If they can get the right in a nursing home they should be

moved out as soon as possible and that frees up that bed.

So anything we can do to help people moving out

Back to Furness General we've been allowed in to a patient safety

meeting, now held four times a day to head off potential crises.

And a spanner is about to be thrown into the works.

Ward seven is closed. We are presently have six patients out of a

population of 33 infected with no norovirus.

The fight to clear cubicles just got tougher.

The battle to tackle the queues and free up beds won t be won

There s also a war being waged out in local communities.

The hospital trust is working with other trusts, GPs

and councils in a project called Better Care Together,

one of its aims is to treat more patients in their homes.

In Kendal, nurse Alison Nicholson helps that happen.

Today visiting the family of a former patient 95-year-old

Granddad didn't like the hospitals, didn t want to go in a home,

That's all he ever wanted was to die at home.

I can only speak on behalf of the frail and the very

old, and the evidence base for the frail and old

is that hospital isn t always the right place.

It s full of germs, unfortunately, it s full of opportunities to slip

over, and we know that older people really de-condition in a matter

of days from being in hospital, so the bigger picture for us

is to start planning with our community and our population

about bringing their care and services closer to home now.

With Alison co-ordinating his care Miles was able to spend the final

Without that care plan and that early intervention I think Miles

would have continued on his little journey round various hospitals.

Out patients, ambulances, but we were able to break the cycle

Another community, another innovation.

Millom, 50 minutes from Furness General is piloting Tele-health,

a direct video link to the emergency department at Furness General.

It s helped cut emergency admissions to the hospital from Millom

From being one of the most isolated places in the whole of Cumbria this

technology stops people having to travel.

What I would like to see very soon is that if you are waiting

for a diagnosis, a serious diagnosis like cancer, is that you don t

have to travel somewhere like Manchester or Newcastle,

that you can come into the surgery, you can ink up to Tele-health

with your doctor to that consultant and the you can sort out a care plan

and that to me is just a fantastic idea for our future.

Two years ago local residents here had to fight to save their local

health services now they are equal partners with the NHS

Education is a key part of their work.

We all know that the NHS is under pressure, we see it

on the news every day, we see it in the newspapers.

When resources are limited you have to be more careful

You have to use them appropriately and get the best value for money.

And we have a bit of a slogan, think before you act.

Just take a couple of seconds to think do I really need to access

that service or do I need to think about using another service.

The NHS will change over the next few years.

On the front line, theyll do what they've always done, offer

What would you say to those who say the answer is more beds?

The answer isn't more beds in hospitals.

The answer is looking at ways of getting patients

back to their own home with appropriate support.

One of the problems of keeping people in any institution

is when you do that you reduce their ability to look

If you keep people at home, you can keep them at home

with much smaller inputs into their health care needs.

It s better for everyone including the health economy.

As we've seen NHS budgets are tightening. Patient numbers are

rocketing. This adds pressure to Russia and treatment. So, is the NHS

still a National Service? Does where you live matter more than ever when

it comes to clear an offer? -- rationed treatment. The NHS is

affecting the most significant financial challenge in its history.

There are fears the service we've grown up with is beginning to

fragment. It's not a National Service. It's criminal. Absolutely

criminal. This is going to get worse. On a bad day it ruins your

life,. It feels like my bones are screaming at times. 33-year-old Ben

has hepatitis C. A virus that caused life-threatening liver damage. --

can cause. I'm about to my job. I've been off sick. And I could possibly

lose the flat. There are drugs that could queue the hepatitis, but they

are expensive and rationed. Then has been denied them.

All I got was, wait, basically, because my liver wasn't bad enough.

And that made me want to go out and just get absolutely wasted, Andrew

with my liver. Just so that they would treat me. I wouldn't do that,

but it wouldn't surprise me if but it wouldn't surprise me if

anyone else wouldn't. The money is there for 10,000 treatments. Each

area has a target to meet. It is claimed that means there are no

queues in parts of the North and long waits in London. To people with

exactly the same state of limit damage could present themselves in

different parts of the country. In one they can walk and get hepatitis

treatment immediately, and get skewered. In another part of the

country they may go there and be told, I'm sorry, you have to wait.

NHS England told us it regularly reallocated and used treatments to

places with waiting lists. But the number of patients treated will

increase by 25% next year. So Ben is taking the risk of treating himself

with cheaper copies of the new drugs. How much have you spent on a

box? ?1300. ?1300. But I don't really have. The fact that I've had

to pay for my treatment, it's criminal. It is absolutely criminal.

Clinical commissioning groups all CCG 's control has budgets. It's

claimed some are delaying treatment is like cataract surgeries by

slowing down referrals. Others require patients to lose weight

before getting operations like hip replacements. This bowling an

operation in these circumstances can save money in the short term. And

while these CCG 's fate can be clinically justified the Royal

College of surgeons say it can't. There is very good evidence that

people are now not getting elective operations which they desperately,

sometimes, require, simply because of the financial restriction. It is

up to the commission is to decide who should have what treatment. And

therefore, a bureaucratic system, which produces a blanket wrapped, we

think it is morally wrong. It's claimed that new systems for vetting

appointments are another form of rationing. Why are they treating

their patients with such contempt? Last month MPs complained about a

private company being paid ?10 for every GP referral they stopped. This

is rationing by the back door and has the potential to compromise

patient safety. The same private company overseas referrals in

Tyneside. We spoke to doctors who say the system is putting patients

at risk. The GPs who there speaking out her told us that cancer

diagnoses are being held up. I tried to get a patient referred to a

dermatologist. The Management service said it was a skin lesion

and rejected it. That was a disaster. It was a nasty embraces

skin cancer. The system's dangerous. They are putting up barriers. They

are using delaying tactics. It's getting between the doctor and the

specialist. In a statement North Tyneside CCG said there was no

evidence the system caused additional risk will delay. Cancer

referrals to not go through the system and are made directly to

hospital. The number of referrals not bad to GPs in England has risen

to about 30% in the last two years. The details are available online.

Shortage and regional difference have always been part of the NHS.

Today the differences could get much worse. So is the NHS still a

National Service? One of our most prominent medics is clear. No, it's

not a National Service. It's now a local health service. It matters

because it leads to inequality and health care. Some people get health

care for free, others won't. Statement the Department of Health

said that far from rationing more people than ever are getting prompt

treatment. 3261 more cancer patients are being seen every day and

standards of care are improving. We asked the Health Secretary and NHS

England for interview. Both declined. The people actually paying

for NHS services, the clinical commissioners, did agree to speak.

It's a National Service. With local variation based on the need of the

population. Demographically populations vary significantly from

county. It's really important that county. It's really important

we commission and respond to the we commission and respond to the

needs of our population by local basis. It's about making sure the

par three is correct. We don't want to squander money. We have limited

resources. It's important that we spend most effectively and get the

best value for our population. For those forced to take their own

action rationing appears all too real.

It s a year since a baby white rhino was born at Knowlsey Safari.

Rhinos face uncontrolled poaching for huge profits.

As a top European breeding centre it plays a vital role in keeping

I was given exclusive access behind the scenes to the calves first

I m not sure what I was expecting when I went to Knowsley safari

I d heard she weighed 7 stone at one week!

We are looking at a proud mum but you seem a bit

Yeah, she's phenomenal any rhino birth

But this girl just seems to have captured the hearts of everybody

we have actually had 11 born in the last decade.

It s fascinating when you think of a rhino you think of the size,

But for me for the first time to be this close to one you see

playfulness and elegance it s a completely different animal

Absolutely, obviously, when there this small life is just

Yes, absolutely I mean you ve seen the way that she runs around

Once that calf's born, it's her soul purpose to protect

She's so giddy, isn't she. Yes, she is just absolutely off the wall

sometimes. Rhino horn is now worth more

than gold on the black market. This makes white rhinos one

of the most hunted animals in the wild especially

in South Africa. The slaughter is fuelled

by the mistaken belief that rhino horn cures anything

from cancer to hangovers. With such huge profits,

criminal syndicates Poaching in the wild is literally

desolating these numbers we estimated just on 20,000

surviving in the wild and when you re looking

at up 1400, 1500 of these It is absolutely vital

that we try our hardest to make sure Unfortunately, with these

guys its not sport a lot Traditional medicine markets

in the far east also what we have found out now

is that there is a growing number of poachers that are taking

these for status symbol. One of the most frightening

situations that has occurred with them, is that its showing

peoples expendable wealth, you'll get people grinding it up

and putting it into drinks. Absolutely, it has no medicinal

purposes what so ever. At Knowsley there s enough space

for rhinos to live and breed She just wants a bit of sun

on her back, A bit of warm weather. A bit of warm weather a bit of sun

on her back, when the wind Then the public will

be able to see her. And for Jason, everything

is going to plan. And the calf has been named

Nom voo la which means She is, she s a star,

and she s perfect. She s been a massive

hit with the public, And how has she settled

because she was indoors This big wide world has got

to be so alien to them, Yes, absolutely, it does

take her a bit of time to get used to all the sights and sounds

and smells, moreso the sounds and smells than the actual sight

but her Mum shows her the way And it's amazing to watch

you with these truly wild animals, call them by their name and one

by one they get up by their name Yeah, we try to keep them as wild

as we possibly can in this environment but there are certain

things we need to do for them every now and again we may need

to intervene with medical care so to be on friendly

terms with the rhino And has anything

taken her by surprise? So when she came out full

of beams and energy, I think it took them more

by surprise because it was like wow, what s this,

we haven t seen one like this So she s not just an attraction

for the visitors here at Knowsley, she s actually an attraction

for the animals? Yeah, and it s all

part of what we do. And I ve just been given a rare

opportunity to meet this star It s not something the public should

try these animals are dangerous. But I m in safe hands

with Eveline de Wolfe, the Head of animal management

and her trusted team of keepers. So all the time you are

reassuring Mum we re ok, Yeah, but they have built up a very

good trust relationship They are very trustworthy,

they work very closely And I remember from last time,

they do like being touched. They are very tactile

amongst themselves as well. The next big step

is meeting her Dad. Because they are

separated, aren t they? We try to imitate what

happens in the wild. So the next big life step

for her is meeting her dad. These girls are very experienced,

the Mum has done it Nomvula is finally

meeting her father. It could be a very good introduction

or he could not be very pleasant when he comes out or the females

vice versa could not be But, touch wood, most times it

goes according to plan. All you can do is leave it up to

them. We have a couple of vehicles in places and if anything does get

out of hand when we are in a position where we can intervene and

separate them, and potentially take it from there. Roger, John, ready

when you are. We're ready. Standing by. It's time to let her out. An

orphaned bull from Africa this rhino was fined wondering by his mother's

dead body. She had been shot by poachers, and her horn removed. His

nose is right to the ground. What is he smelling? Detecting the centre of

the females. I wouldn't be surprised if when he does come out he follows

the exact route the females talk when they out. This is a smart he

hasn't come across yet. The opportunity for a calf and for a

mother to experience a ball with a young calf, it's all very much part

of that, you know, that life cycle. It's what would happen in the wild.

That's what we are trying to replicate within the captive

environment. The rhinos sees her father for the first time. Cheeky

Madame! She's not afraid of anything. That nose to nose greeting

is really, sort of, significant. It really is a way of communicating,

sort of, saying hello, really. The fact he backed away as good. Wherein

a good here. Yeah, this introduction couldn't have gone better. I'm

really so glad you're here to see it and see exactly what we can do with

these guys. That went brilliantly, mate. I'm going to drop the guys

Barcroft and safety. Over. It's predicted that deaths from poaching

these animals could soon overtake births. If the traders and stopped.

So this rhino will be cared for here before moving to a new home to

continue the breeding programme. That will be a sad day for Jason. It

is very emotional. When you have to say goodbye to one of them it really

does tail at your heartstrings a little bit. Do you love your job?

Absolutely, yes. 15 years on every day is magnificent. It really is.

I cannot understand why anyone would want to harm such a beautiful

creature. See you next week, goodbye.

Next week the Manchester illustrator who has gone from doodling large

paper to drawing Donald Trump for the New York Times. He's got a

comedic face, you know. I think I've got him.

Hello, I'm Louisa Preston with your 90 second update.

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