21/01/2013 Inside Out South East

The biggest re-organisation of the National Health Service. What will

it mean for us? Giving everyone the chance to shop around for the best

care. Will monitoring ourselves at home

unblock the beds in our local hospitals? We know it has a

fantastic benefits, reducing admissions to hospital. It manages

to produce premature death as well. I am not sure GPs have the capacity

in their surgeries, analysing remote information.

And we're living longer and that is great, but can you be too old to

drive? I was banging on my bedroom door and I woke up. It was my son,

saying, there was a policeman downstairs. There has been an

accident. I'm Natalie Graham with untold

stories, closer to home. From all round the South and South East,

Hello, I'm on the White Cliffs of Dover. We're back later but, first

up, the National Health Service. It's been around for 65 years. But

in just ten weeks' time the NHS will undergo the biggest re-

organisation in its history. So what will it mean for us patients?

We sent TV doctor and comedian Phil Hammond round England to

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. 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 The difficulty with this is that

It only sells its own brands. It is a one-stop shop where all the

tricky decisions are made for you. You should get the same quality

care whether you are living Scunthorpe or Southend. So 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.

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

You might not be keen though if The second thing patients should

notice is more choice. Three tomatoes for a pound! Anybody?

Three inhalers for the price of two. Come and get them! Two caulis,

�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 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

It's already happening here on the high street where Specsavers are

treating NHS patients in 218 of its When I came to Specsavers, they do

private and NHS which I find is better than going to the hospital.

I don't think you get such a personal attention. So this is much,

much better. The plan is for patients like Doreen to choose

their provider by looking at new performance league tables.

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 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 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.

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. 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. Yes, they of planes, trains and

superfast 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? All 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 Did you know that this health

centre was run by Virgin? No. 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

On the day of the collision, we found he had no sight in one eye

and below the legal limit in the other. He could hardly see where he

was going when he was driving along Now, one of the problems facing the

NHS is how to care for people with long term illnesses. So using

technology to monitor patients at home - rather than hospital - could

well be a good idea. But will telehealth as it's called really

catch on, particularly in the new There are tens of thousands of

people living in the South East with long term health problems.

Conditions such as diabetes, heart conditions, or people with chronic

lung problems. They make up around 30% of NHS patients yet account for

70% of the total NHS bill, a These people are in and out of

hospital to-ing and fro-ing from their GPs, being visited by

district nurses, but what if there was a way of slowing their lives

down and getting them to monitor their own health from home? There

is. Kent is at the forefront of a government drive to change the way

the NHS cares for its most expensive patients, using

What it allowed us to do was to monitor patients on a daily basis

from our office or wherever we were without having to visit them daily.

It's so much more convenient to be in my own home, than appointments.

But not all doctors are fans of telehealth. GPs are at the moment

quite overloaded with work. And I'm not sure that GPs have the capacity

to be in their surgeries, analysing remote information, et cetera.

others say the new NHS reforms will make it harder to get telehealth to

happen. The NHS reforms are going in one direction, and the need for

this to work is going in the other direction. So will the government's

grand plan to get more people on to telehealth succeed? Kent was one of

the first local authorities to experiment with telehealth in this

country. In November, the government appointed it as a

pathfinder authority to find a way of making teleheath work across the

nation. We first got involved by introductions from America.

Telehealth and telecare has been a popular thing in the States for

rather more years than it has in the UK. And as a result of these

introductions, it was decided that we would do work in Kent, and it

was very successful. Using American technology Kent was able to forge

ahead. It now has 800 patients on telehealth. Those we spoke to were

very happy with the service. That's good. Ann Fagg is a retired

assistant head teacher living with husband Ian in Dover. She has

complicated problems with her lungs and was extremely ill four years

ago with pneumonia. Every day from her own bedroom, she takes her own

blood pressure, temperature, heart rate and crucial oxygen levels. She

enters the data into the monitor and the results are read remotely

at a nearby health centre. I feel it's like an insurance policy, that

someone will be at the end of the line to pick up any problems I've

got. I don't need to worry so much about my own condition. Anne's data

is monitored by a team at the nearby Dover Health centre. The

lead nurse for long term conditions is Hayley Mullan. What it allows us

to do is monitor them remotely then to prioritise who needs to be seen

rather than to visit everyone routinely. It allows us to monitor

trends in their condition and hopefully pick up small trends very

quickly that means we are able to have less hospital admissions.

Hayley's team also helped John Richards, putting him on telehealth

to monitor his condition when he came out of hospital. He had severe

liver disease and at one time thought he was going to die. It was

very serious. I consider myself lucky to be here and with the use

of telehalth to be fair to it as a system I do consider myself lucky

to be here. So it's working locally in Kent, but now the government has

high hopes of making telehealth available for all who need it.

think that telehealth and telecare has enormous power, potentially, to

remain independent in their own homes. And we know that most people

either in old age, or if they're suffering from a disability prefer

to stay in their own home if they possibly can do, and this helps to

facilitate that. But it's part of a bigger shift towards supporting

people in their own home. This is one critical element of it. But we

know it has fantastic potential benefits reducing the number of

crisis admissions to hospital. Everything goes wrong, which

happens too often at the moment. It also manages to reduce premature

death as well. So we have to have the power of this very seriously.

Last year the government launched Three Million Lives, a campaign

which aims to get three million people signed up to home monitoring

within five years. But Roy Lilley, who is an expert on telehealth and

a former NHS Trust chairman, says in his view the Three Million Lives

project is unlikely to succeed. I've been big fan of telehealth,

telecare, tele everything since the early 90s. And I've seen all sorts

of initiatives come and go. You see local initiatives run by

enthusiasts. But for telecare and telehealth to scale up, you need

the numbers to make it work. Because if you work as it is now,

with a few local bits of kit that get plugged in in some way or

another to the local GPs' surgery, it doesn't decrease workload, it

If this is going to work, it has to work at scale so you have to have

enough people to make it work and call centres a proper call centre,

that works 24/7. But the government believes it has a solution to

scaling up telehealth and that is getting industry involved.

Government believes that the solution is to get industry and

ball. -- involved. One of the issues is the up-front cost. So

we're working together with industry to arrange new models,

where industry can make the up- front payment, and then the costs

could be re-paid on a continuing basis. We know that this both saves

money, and improves lives. So it's very powerful, as I say. There are

20 companies involved in Three Million Lives, all vying for

potential business. But they have to work out whether any money they

put in will pay off. One of them has just bought this call centre in

Wiltshire, staffed by former nurses and health workers. Are you

wheezing at all? Here they will monitor patients' data on a daily

basis, only contacting GPs when they detect a problem. Their first

contract is running telehealth services for a scheme in Medway.

What are your plans and visions? Do you think it's really going to take

off now? Absolutely. We have huge ambitions. The ambition over the

next 5 years is to have 1.5 million patients on telehealth. But under

the new, reformed NHS, GPs will have far more say over what

services they buy and so far doctors have been far from sure

about the benefits of telehealth. Dr Chaand Nagpaul is a practising

GP and a spokesman for the British Medical Association. He says one of

the concerns is that some patients won't be able to use the computer

technology. Patients who are hard of hearing, visually impaired,

patients with disabilities, patients who can't use the

computers, et cetera, who are actually perhaps going to be

disadvantaged in a system which is tailored towards those who are able

to benefit. Dr Nagpaul also believes the government figures

simply don't stand up to scrutiny. Even the government's own study

showed that the cost of telehealth in health economic terms - is

�80,000 per quality-adjusted life year. The government has a

threshold of about �30,000 per quality-adjusted life year.

Political ideology is running ahead all the evidence. Somebody has to

pay for it. You can only pay for it out of savings. Who are the people

that would most save out of the telly health and telly care? It is

not GPS. The people that delay will save money our hospitals. Hospitals,

of course, will not have so many customers, fight and put it like

that, if we can look after people in their own homes. The problem

with that is hospitals get paid by the number of patients that go

through their beds. For patients like Ann Fagg, telehealth has

transformed her life allowing her to spend more time from the comfort

of home with the reassurance of daily medical surveillance. The

government wants telehealth to roll out to improve lives and reduce the

health bill. But the case for telehealth has to be made to the

new GP commissioning groups, because they are the ones that now

hold the purse strings. And that's an argument that still has to be

Now, many of us would like keep driving for as long as we can into

our older years to stay as independent and mobile as possible.

But are there safeguards enough to make sure elderly people are still

fit to drive safely? Jon Cuthill reports. My son, Neil, was all

lovely man. He was very conscientious, very close to his

family, and his brothers. He had so many plans for the future. March

colleagues celebrating his first girls wanted to go back to her car,

and my son, being the gentleman he was, I would like to think he was a

gentleman, escorted her back to her car, and he was going to go back to

the others, then he thought better of it so he texted us and said, put

Pizza on, get the beers out, I am coming home, no. But Neil was never

to make it home. His route back took him along the A30 dual

carriageway. During the journey, Neil safely overtook a BMW. All of

sudden he was confronted by a car travelling the wrong way down the

carriageway. The two cars smashed together in a head on collision.

was banging on my bedroom door, and it was my son, saying that there

was a policeman downstairs to wants to speak to you. He said, I am

afraid that there has been an accident. The driver of the other

vehicle was 89 year old Dr Turner Wadell. Turner and his wife were

badly injured were pulled away from their vehicle. But Neil remained

trapped in his car. My son was in the car and they had his head back

and they thought he was dead. They could not open the door and get

them out. And there was nothing left to me identify my son, after

The offer the the seatbelt but all that was was just melted plastic.

It was hard. It just breaks you up. The tragic part of this crash was

that the accident could have been completely avoided as Waddell was

not fit to drive. On the day of the Commission and subsequent

investigations we found he had no could hardly see what he was going

as he drove along the road. Turner Waddell received a nine-

month suspended sentence after admitting causing death by careless

driving. The judge urged family members of elderly drivers to think

"very, very carefully" whether their relatives should still be on

the road. Dr Turner Waddell's son Tony did try and stop his father

from driving but he couldn't convince him. As we get older, we

all think we're perfect drivers and we can keep going for ever, but it

is not. At the age of 70 anyone driving has to reapply for their

licence every three years. But It's a self-certifying system and one

that allowed motorists like Dr Waddell to continue to drive. When

Julia Langdon's 90 year old father started having car accidents, she

felt like she had a responsibility as a family member to stop him from

driving. He regarded any other car on the road as an indication to

overtake. He completely disregarded speed limits and the thought of

these men were young boys who should be out catching criminals.

The family got anxious and thought we should stop and driving before

he killed someone, possibly our mother. Unable to convince her

father to stop driving, Julia took direct action. I contacted DVLA.

They said that if he feels he can go on driving, he can go on driving,

and I said he's dangerous, I they sit I am infringing his human

rights. They did not even ask him to do and eye test. And the Max of

the fight my father for another three years. Julia's father died

three years later, two days after his 93rd birthday party, from which

he had driven his wife 200 miles home. PACTS, the Parliamentary

Advisory Council for Transport Safety recently published a paper

looking into how to keep elderly people safe on the road. One of

their recommendations was that GPs should play more of an integral

part in the system. If you think they are not physically able to

drive a car, you should ask them whether they are still driving,

because it is a key role you have as a health professional, to help

save lives of others as well as the light in front of you, but it is

very hard, because it requires the doctor to say, should be sentenced

this person to leave behind their front door, unable to get out?

Older driver deaths and serious injuries are falling, but not as

fast as other reach Rangers. We are living longer saw more of us a

driving later in life. One of the PACTS recommendations is for a

national driving assessment scheme. At the moment appraisals exist but

differ from county to county. 83 year-old Dennis Hilditch from

Southampton is worried about his driving as he grows older. I am

very concerned about it, because I don't know what I would do without

a car, it seems almost impossible to imagine. But it will happen in

due course. How long have you been driving? Since I have been 17, you

do the maths! I am now 83. Do you worry about him? Is he a good

driver? Very, yes. I don't look for the pedal. Today Dennis is taking

an experience driversassessment run by RoSPA, the Royal Society for the

Prevention of Accidents. At the end of your Road we will be turning

right. Being your own critic is not good because you will always say,

yes, I am perfectly safe, and you need somebody else to be strong

enough to say, it is time you stopped. It's hoped the

recommendations by PACT for a nationwide driving assessment

scheme should help older people like Dennis make that difficult

decision of when to stop driving. When is too old to drive? When you

can no longer drive, when you are no longer fit to drive, that is too

old, and until then, you are still fit to drive, and age does not come

into it, as far as I am concerned. But Patricia Colquhoun is hoping

that people's right to move around doesn't come at the cost of other

people lives. I don't hold the driver that took my son responsible

for my son's death. It is the system. It is the system that

Now, if you want any more information on tonight's show, you

can visit our local Kent or Sussex websites, and even watch the whole

show again by clicking on iPlayer Coming up next week: The family

that ended up over �400,000 in debt. You must have been under immense

pressure. How have you cope? It is horrible. I have lost six years of

my life through worry, and I cannot see In a end in sight. And Jan

Leeming uncovers the mystery of the life and death of a hero of the