16/09/2013 Inside Out South East

On

On the front line in A&E.

On the front line in A&E. Done.

On the front line in A&E. Done. When you

On the front line in A&E. Done. When you see what they do,

On the front line in A&E. Done. When you see what they do, it's amazing.

you see what they do, it's amazing. Jamie

you see what they do, it's amazing. Jamie Coulson examines the pressures

Jamie Coulson examines the pressures on A&E around

Jamie Coulson examines the pressures on A&E around the country.

Jamie Coulson examines the pressures on A&E around the country. We

on A&E around the country. We are in the worst

on A&E around the country. We are in the worst position we have ever

the worst position we have ever been.

the worst position we have ever been. We have a real

been. We have a real crisis in recruiting people

recruiting people into emergency medicine.

recruiting people into emergency medicine. And as GPs

recruiting people into emergency medicine. And as GPs now control the

medicine. And as GPs now control the budget, what does that

budget, what does that mean for us in Kent

budget, what does that mean for us in Kent and Sussex?

budget, what does that mean for us in Kent and Sussex? I

in Kent and Sussex? I am here today because I

in Kent and Sussex? I am here today because I am concerned about

because I am concerned about the creeping privatisation

creeping privatisation of the National Health

creeping privatisation of the National Health Service.

creeping privatisation of the National Health Service. I am

National Health Service. I am Natalie Graham, with untold

Natalie Graham, with untold stories closer to home.

Natalie Graham, with untold stories closer to home. From all around

closer to home. From all around the South East, this

closer to home. From all around the South East, this is Inside Out.

Hello.

Hello. Tonight we have

Hello. Tonight we have a special edition

Hello. Tonight we have a special edition of Inside Out from

edition of Inside Out from the Queen Elizabeth The

edition of Inside Out from the Queen Elizabeth The Queen Mother Hospital

Elizabeth The Queen Mother Hospital in Margate.

Elizabeth The Queen Mother Hospital in Margate. We are here for

Elizabeth The Queen Mother Hospital in Margate. We are here for a day in

in Margate. We are here for a day in the life of A&E,

in Margate. We are here for a day in the life of A&E, after a summer in

the life of A&E, after a summer in which the NHS

the life of A&E, after a summer in which the NHS hit the headlines on

which the NHS hit the headlines on an almost daily basis.

This A&E department

This A&E department sees 70,000 patients every

This A&E department sees 70,000 patients every year.

This A&E department sees 70,000 patients every year. Today, we

patients every year. Today, we are going to meet

patients every year. Today, we are going to meet a few of them.

patients every year. Today, we are going to meet a few of them. Sally

going to meet a few of them. Sally Shirley from Whitstable

Shirley from Whitstable has had an accident.

Shirley from Whitstable has had an accident. Hello.

Shirley from Whitstable has had an accident. Hello. Hello.

accident. Hello. Hello. This is Sally.

accident. Hello. Hello. This is Sally. This morning

Sally. This morning she was washing her

Sally. This morning she was washing her windows, stood on a

her windows, stood on a stool, and fell

her windows, stood on a stool, and fell off the chair onto

fell off the chair onto her outstretched right hand.

fell off the chair onto her outstretched right hand. How is the

outstretched right hand. How is the pain at the moment?

outstretched right hand. How is the pain at the moment? Coming alive.

pain at the moment? Coming alive. I'm starting to feel

pain at the moment? Coming alive. I'm starting to feel it now.

I'm starting to feel it now. Take her

I'm starting to feel it now. Take her down to this area

I'm starting to feel it now. Take her down to this area here.

I'm starting to feel it now. Take her down to this area here. What

her down to this area here. What are you doing cleaning

her down to this area here. What are you doing cleaning windows on a

you doing cleaning windows on a Sunday morning? I don't

Sunday morning? I don't know. But I was. And

Sunday morning? I don't know. But I was. And you just

was. And you just toppled over?I just went

was. And you just toppled over?I just went and I fell

was. And you just toppled over?I just went and I fell off the stool

just went and I fell off the stool and I broke the

just went and I fell off the stool and I broke the kitchen door and the

and I broke the kitchen door and the unit as well,

and I broke the kitchen door and the unit as well, as I went. Hello.

unit as well, as I went. Hello. You still in a

unit as well, as I went. Hello. You still in a lot of pain?

still in a lot of pain? Yes.What I am

still in a lot of pain? Yes.What I am going to

am going to do is make you comfortable first,

am going to do is make you comfortable first, and then we

comfortable first, and then we are going to x—ray

comfortable first, and then we are going to x—ray this to see what

going to x—ray this to see what is going on,

going to x—ray this to see what is going on, because it hasn't been

going on, because it hasn't been x—rayed yet. The BBC

going on, because it hasn't been x—rayed yet. The BBC filmed in ten

x—rayed yet. The BBC filmed in ten A&E departments in hospitals

A&E departments in hospitals across England on the

A&E departments in hospitals across England on the same day, so

England on the same day, so later we can compare

England on the same day, so later we can compare what the picture is

can compare what the picture is like across the

can compare what the picture is like across the country.

can compare what the picture is like across the country. The accident and

across the country. The accident and emergency department at the

emergency department at the QETQM in Margate today

emergency department at the QETQM in Margate today is under the

Margate today is under the control of Sister Anne

Margate today is under the control of Sister Anne Payne.

Margate today is under the control of Sister Anne Payne. It

Margate today is under the control of Sister Anne Payne. It can be very

of Sister Anne Payne. It can be very stressful, but being in

stressful, but being in charge, you kind of

stressful, but being in charge, you kind of learn to do

stressful, but being in charge, you kind of learn to do bed moves — it's

kind of learn to do bed moves — it's like a furniture

kind of learn to do bed moves — it's like a furniture shop sometimes.

like a furniture shop sometimes. You are

like a furniture shop sometimes. You are trying to move everyone

are trying to move everyone around in time to

are trying to move everyone around in time to get patients to

in time to get patients to the wards they need

in time to get patients to the wards they need to be in, in

they need to be in, in a timely manner.

they need to be in, in a timely manner. We have

they need to be in, in a timely manner. We have just been told

manner. We have just been told that a man has

manner. We have just been told that a man has been brought in who

a man has been brought in who has been sleeping rough

a man has been brought in who has been sleeping rough locally, so we

been sleeping rough locally, so we are going to find

been sleeping rough locally, so we are going to find out what is

are going to find out what is going on. I am

are going to find out what is going on. I am now going to take

on. I am now going to take your sock off, so

on. I am now going to take your sock off, so we can look

on. I am now going to take your sock off, so we can look at the extent of

off, so we can look at the extent of where the problems are.

where the problems are. The staff discover that

where the problems are. The staff discover that one of his

discover that one of his feet has been infested

discover that one of his feet has been infested with maggots.

discover that one of his feet has been infested with maggots. We are

been infested with maggots. We are going to get

been infested with maggots. We are going to get some special stuff to

going to get some special stuff to soak your foot in,

going to get some special stuff to soak your foot in, and what I'm

soak your foot in, and what I'm going to do

soak your foot in, and what I'm going to do is try and remove this

going to do is try and remove this from your foot

going to do is try and remove this from your foot at the moment. OK.

from your foot at the moment. OK. Steady! I'm steadying.They're

Steady! I'm steadying.They're sore. Very sore.

Steady! I'm steadying.They're sore. Very sore. The maggots are

Very sore. The maggots are actually in the

Very sore. The maggots are actually in the skin itself. His

in the skin itself. His name is Phil Adams, and

in the skin itself. His name is Phil Adams, and he is a

in the skin itself. His name is Phil Adams, and he is a regular in A&E.

Adams, and he is a regular in A&E. After he was

Adams, and he is a regular in A&E. After he was cleaned up, I was

After he was cleaned up, I was able to speak to

After he was cleaned up, I was able to speak to him. I am

After he was cleaned up, I was able to speak to him. I am in a lot of

to speak to him. I am in a lot of pain with it. It

to speak to him. I am in a lot of pain with it. It has just started

pain with it. It has just started running down my leg

pain with it. It has just started running down my leg as well.

running down my leg as well. And I need help

running down my leg as well. And I need help to get it sorted

running down my leg as well. And I need help to get it sorted out.

need help to get it sorted out. Can you tell

need help to get it sorted out. Can you tell me where you slept

you tell me where you slept last night?

you tell me where you slept last night? Yeah,

you tell me where you slept last night? Yeah, the top of

night? Yeah, the top of a multistorey car park.

night? Yeah, the top of a multistorey car park. Rhys is one

multistorey car park. Rhys is one of the doctors on

multistorey car park. Rhys is one of the doctors on duty. Today he

the doctors on duty. Today he is doing a

the doctors on duty. Today he is doing a 12—hour shift, seven until

doing a 12—hour shift, seven until seven.

doing a 12—hour shift, seven until seven. I

doing a 12—hour shift, seven until seven. I suppose that is the

seven. I suppose that is the thing about the nature

seven. I suppose that is the thing about the nature of your job,

about the nature of your job, you do not know

about the nature of your job, you do not know until you get here

not know until you get here and while you are

not know until you get here and while you are here, you don't

while you are here, you don't know what will happen

while you are here, you don't know what will happen in the next

what will happen in the next hour. They are very

They are very much an unfiltered population, that

They are very much an unfiltered population, that is partly why

population, that is partly why I like the

population, that is partly why I like the job, it is unpredictable,

like the job, it is unpredictable, it is free of

like the job, it is unpredictable, it is free of protocols, to a

it is free of protocols, to a degree. And every individual

degree. And every individual is different and every

different and every patient is different.

different and every patient is different. For instance,

different. For instance, Jason from Ramsgate has

different. For instance, Jason from Ramsgate has arrived with a

Ramsgate has arrived with a partially collapsed lung.

Ramsgate has arrived with a partially collapsed lung. We will

partially collapsed lung. We will draw off the air,

partially collapsed lung. We will draw off the air, hope that it stays

draw off the air, hope that it stays up, x—ray you again

draw off the air, hope that it stays up, x—ray you again and if you

up, x—ray you again and if you are well enough, we

up, x—ray you again and if you are well enough, we will let you go

well enough, we will let you go home.

well enough, we will let you go home. Sound

well enough, we will let you go home. Sound like a plan? Go

home. Sound like a plan? Go for it. You seem

home. Sound like a plan? Go for it. You seem very relaxed. We

You seem very relaxed. We like patients like you.

You seem very relaxed. We like patients like you. Well done.

patients like you. Well done. In another

patients like you. Well done. In another part of A&E, Sally

another part of A&E, Sally is about to find

another part of A&E, Sally is about to find out if her

another part of A&E, Sally is about to find out if her arm is broken.

to find out if her arm is broken. Hello. Me

to find out if her arm is broken. Hello. Me again. Right,

Hello. Me again. Right, the x—ray is back and

Hello. Me again. Right, the x—ray is back and it shows that

Hello. Me again. Right, the x—ray is back and it shows that you have got

back and it shows that you have got a fracture of your

back and it shows that you have got a fracture of your distal radius.

a fracture of your distal radius. It is displaced.

a fracture of your distal radius. It is displaced. It has

a fracture of your distal radius. It is displaced. It has moved out, it

is displaced. It has moved out, it has fractured and it

has fractured and it has impacted a bit

has fractured and it has impacted a bit on it as

has fractured and it has impacted a bit on it as well, so what we

bit on it as well, so what we are going to have

bit on it as well, so what we are going to have to do is

going to have to do is pull that bone into

going to have to do is pull that bone into a better position and

bone into a better position and then re—plaster it to

bone into a better position and then re—plaster it to hold it in

re—plaster it to hold it in a good position. As

re—plaster it to hold it in a good position. As Sally heads off

position. As Sally heads off to see the surgeon,

the surgeon, the A&E department starts to

the surgeon, the A&E department starts to get busy.

the surgeon, the A&E department starts to get busy. Stomach

the surgeon, the A&E department starts to get busy. Stomach trouble.

starts to get busy. Stomach trouble. I have been

I have been having pains right there.

I have been having pains right there. I have just lay

I have been having pains right there. I have just lay down on the

there. I have just lay down on the floor and that was

there. I have just lay down on the floor and that was it.

there. I have just lay down on the floor and that was it. It's

floor and that was it. It's my jaw. I got

floor and that was it. It's my jaw. I got pains in my

floor and that was it. It's my jaw. I got pains in my chest when I stood

I got pains in my chest when I stood in Tesco's.

I got pains in my chest when I stood in Tesco's. The dog came along

in Tesco's. The dog came along with the master

in Tesco's. The dog came along with the master and just came straight

the master and just came straight at me. And beat

the master and just came straight at me. And beat you? I do

the master and just came straight at me. And beat you? I do enjoy my job.

me. And beat you? I do enjoy my job. I often feel

me. And beat you? I do enjoy my job. I often feel I don't have

I often feel I don't have the opportunity to do

I often feel I don't have the opportunity to do my job.

I often feel I don't have the opportunity to do my job. I

opportunity to do my job. I certainly do not have

certainly do not have enough time with my

certainly do not have enough time with my patients, and some patients

with my patients, and some patients need more time

with my patients, and some patients need more time and sometimes I feel

need more time and sometimes I feel a bit rushed.

need more time and sometimes I feel a bit rushed. It is like a

a bit rushed. It is like a second family here, you

a bit rushed. It is like a second family here, you spend more time

family here, you spend more time here sometimes than you

family here, you spend more time here sometimes than you do at home.

here sometimes than you do at home. Now Sally is

here sometimes than you do at home. Now Sally is about to have her

Now Sally is about to have her bone reset.

Now Sally is about to have her bone reset. It will

Now Sally is about to have her bone reset. It will be painful, because

reset. It will be painful, because basically the surgeon is

basically the surgeon is going to pull it

basically the surgeon is going to pull it back into place.

pull it back into place. We always have

pull it back into place. We always have an idea about the

have an idea about the force exerted to produce

have an idea about the force exerted to produce the deformity.

have an idea about the force exerted to produce the deformity. And our

to produce the deformity. And our action is to counteract

action is to counteract that force so we

action is to counteract that force so we have to push

so we have to push the bone the opposite

so we have to push the bone the opposite way.

so we have to push the bone the opposite way. Would you like

opposite way. Would you like to have some gas

opposite way. Would you like to have some gas and air?

opposite way. Would you like to have some gas and air? Yes.

opposite way. Would you like to have some gas and air? Yes. I like

opposite way. Would you like to have some gas and air? Yes. I like that.

some gas and air? Yes. I like that. You like that, do

some gas and air? Yes. I like that. You like that, do you?

You like that, do you? I did like that.

You like that, do you? I did like that. Just relax.

You like that, do you? I did like that. Just relax. That is better.

that. Just relax. That is better. Are you OK?

that. Just relax. That is better. Are you OK? Mr

that. Just relax. That is better. Are you OK? Mr Tanani gives the nod

Are you OK? Mr Tanani gives the nod to the junior sister

Are you OK? Mr Tanani gives the nod to the junior sister to help him

to the junior sister to help him pull Sally's arm.

Done!

Done! It's

Done! It's quite an eye opener

Done! It's quite an eye opener when you see

Done! It's quite an eye opener when you see what they do.

you see what they do. It is an amazing.

you see what they do. It is an amazing. Now, when

amazing. Now, when you have recovered from

amazing. Now, when you have recovered from the gas, we

recovered from the gas, we will send you for

recovered from the gas, we will send you for the x—ray.

recovered from the gas, we will send you for the x—ray. Thank you.

you for the x—ray. Thank you. Well, we have

you for the x—ray. Thank you. Well, we have been here for the

we have been here for the whole day. The time

we have been here for the whole day. The time has flown. We

The time has flown. We have seen a wide range

The time has flown. We have seen a wide range of patients, but

wide range of patients, but how did the day

wide range of patients, but how did the day go in numbers?

wide range of patients, but how did the day go in numbers? On

wide range of patients, but how did the day go in numbers? On the day we

the day go in numbers? On the day we visited, there were 204

the day go in numbers? On the day we visited, there were 204 patients.

visited, there were 204 patients. The government

The government guidelines say that on average

The government guidelines say that on average at least 95%

on average at least 95% of people should

on average at least 95% of people should be dealt with within

should be dealt with within four hours.

should be dealt with within four hours. On the

should be dealt with within four hours. On the day that we

hours. On the day that we visited, the figure was

hours. On the day that we visited, the figure was 95.1%.

hours. On the day that we visited, the figure was 95.1%. From the point

the figure was 95.1%. From the point of view of a

the figure was 95.1%. From the point of view of a doctor, working in

of view of a doctor, working in A&E is an unusual

of view of a doctor, working in A&E is an unusual job. You

is an unusual job. You only see your patients on

is an unusual job. You only see your patients on one day, before

patients on one day, before they are taken off

patients on one day, before they are taken off your hands.

patients on one day, before they are taken off your hands. I

taken off your hands. I don't mind if I

taken off your hands. I don't mind if I never see them

if I never see them again, as long as

if I never see them again, as long as they haven't died,

as they haven't died, I've done well so that

as they haven't died, I've done well so that is OK.

as they haven't died, I've done well so that is OK. So that is

so that is OK. So that is an average day in

so that is OK. So that is an average day in A&E in Margate.

day in A&E in Margate. And even Phil, the

day in A&E in Margate. And even Phil, the homeless man, is keeping

Phil, the homeless man, is keeping his chin up in

Phil, the homeless man, is keeping his chin up in front of the

his chin up in front of the camera. I hope

his chin up in front of the camera. I hope you feel better,

I hope you feel better, Philip. Hopefully. I

I hope you feel better, Philip. Hopefully. I might become shy, you

Hopefully. I might become shy, you never know!

Hopefully. I might become shy, you never know! You never know.

never know! You never know. And you can hear

never know! You never know. And you can hear more on the state

can hear more on the state of our A&E units

can hear more on the state of our A&E units on The Mark Forrest can hear more on the state of our A&E units

can hear more on the state of our A&E units on The Mark Forrest Show. can hear more on the state of our A&E units

can hear more on the state of our A&E units on The Mark Just tune can hear more on the state of our A&E units

A&E units on The Mark Just tune into Radio Kent or can hear more on the state of our A&E units

A&E units on The Mark Just tune into Radio Kent or BBC Sussex after the can hear more on the state of our A&E units

Radio Kent or BBC Sussex after the programme. Coming up, on Inside Out.

Radio Kent or BBC Sussex after the programme. Coming up, on We are told

programme. Coming up, on We are told all the time that

all the time that competition is going to

all the time that competition is going to be good for the

going to be good for the health service.

going to be good for the health service. However, we don't

service. However, we don't hear it from people

service. However, we don't hear it from people who are in the

from people who are in the possession of any actual

possession of any actual evidence to that effect,

possession of any actual evidence to that effect, because there isn't

that effect, because there isn't any. I think there

that effect, because there isn't any. I think there is no doubt

any. I think there is no doubt that competition can improve

competition can improve health care, and competition

competition can improve health care, and competition encourages people to

and competition encourages people to try harder.

try harder. Right across England, A&E departments

try harder. Right across England, A&E departments are dealing with

A&E departments are dealing with one million more

A&E departments are dealing with one million more people every year than

million more people every year than they were three years

they were three years ago. Jamie Coulson now

they were three years ago. Jamie Coulson now takes a look

Coulson now takes a look at the bigger picture.

The prospect

The prospect of arriving here

The prospect of arriving here at accident and emergency

The prospect of arriving here at accident and emergency is never a

accident and emergency is never a pleasant one. But what

pleasant one. But what can make it seem even

pleasant one. But what can make it seem even more daunting for

seem even more daunting for people is the

seem even more daunting for people is the length of time you

is the length of time you may have to wait

is the length of time you may have to wait to see a

is the length of time you may have to wait to see a doctor.

is the length of time you may have to wait to see a doctor. We are in

to wait to see a doctor. We are in the worst position that

the worst position that we have ever been.

the worst position that we have ever been. We have a

been. We have a real crisis in recruiting

recruiting people into emergency medicine.

recruiting people into emergency medicine. You just find yourself

medicine. You just find yourself thinking "how long

medicine. You just find yourself thinking "how long can we carry on

thinking "how long can we carry on working like this?" There

working like this?" There needs to be light

working like this?" There needs to be light at the end

be light at the end of the tunnel and

be light at the end of the tunnel and at the moment there

be light at the end of the tunnel and at the moment there isn't. So

and at the moment there isn't. So how did such a

and at the moment there isn't. So how did such a vital organ of the

how did such a vital organ of the NHS become such a

how did such a vital organ of the NHS become such a problem, and what

NHS become such a problem, and what can be done to

NHS become such a problem, and what can be done to fix it?

NHS become such a problem, and what can be done to fix it? These

can be done to fix it? These patients are seeing their

patients are seeing their GP, all at the

patients are seeing their GP, all at the same time.

the same time. Maureen Lloyd was once very

the same time. Maureen Lloyd was once very likely to have

once very likely to have become a regular at

once very likely to have become a regular at her local A&E

once very likely to have become a regular at her local A&E department.

regular at her local A&E department. Along with her

regular at her local A&E department. Along with her fellow patients at

Along with her fellow patients at risk of diabetes, she

risk of diabetes, she faced a future of

risk of diabetes, she faced a future of chronic health problems.

of chronic health problems. But hopefully that

of chronic health problems. But hopefully that is no longer

hopefully that is no longer the case.

hopefully that is no longer the case. I started

case. I started watching my diet better.

case. I started watching my diet better. And then from

case. I started watching my diet better. And then from the practice I

better. And then from the practice I was encouraged to try

was encouraged to try exercise on prescription.

was encouraged to try exercise on prescription. She has gone from

prescription. She has gone from being a poorly

being a poorly controlled diabetic to being

being a poorly controlled diabetic to being no diabetes, in the

to being no diabetes, in the pre—diabetes stage.

to being no diabetes, in the pre—diabetes stage. Emergency

pre—diabetes stage. Emergency hospital admissions from patients

hospital admissions from patients with chronic illnesses here

with chronic illnesses here at this GP's

with chronic illnesses here at this GP's surgery in the West

GP's surgery in the West Midlands are set to

GP's surgery in the West Midlands are set to have reduced by

are set to have reduced by 40% in 18 months.

are set to have reduced by 40% in 18 months. I simply

are set to have reduced by 40% in 18 months. I simply won't have an

months. I simply won't have an hour or two hours

months. I simply won't have an hour or two hours to spend with every

or two hours to spend with every patient and that

or two hours to spend with every patient and that is what they need.

patient and that is what they need. Do you

patient and that is what they need. Do you think you would

Do you think you would have done this anyway?

Do you think you would have done this anyway? I doubt it.

this anyway? I doubt it. I don't think I

this anyway? I doubt it. I don't think I would. What we

think I would. What we have seen with Maureen

think I would. What we have seen with Maureen is a bit unusual

with Maureen is a bit unusual and a different approach,

different approach, but ultimately it is

different approach, but ultimately it is about trying to

it is about trying to keep people out of

it is about trying to keep people out of here. The patient,

out of here. The patient, the person, has

out of here. The patient, the person, has to manage themselves 24

person, has to manage themselves 24 hours a day, so

person, has to manage themselves 24 hours a day, so if we can

hours a day, so if we can get people to understand

hours a day, so if we can get people to understand their disease and look

to understand their disease and look after themselves, it

after themselves, it makes a huge difference.

after themselves, it makes a huge difference. Generally

difference. Generally speaking, where access to

difference. Generally speaking, where access to GPs' surgeries are

where access to GPs' surgeries are good, attendances at A&E

good, attendances at A&E can be lower.

good, attendances at A&E can be lower. So it seems

lower. So it seems the family doctor can

lower. So it seems the family doctor can play a role

can play a role in reducing the pressure.

can play a role in reducing the pressure. The last Department

pressure. The last Department of Health figures show

Health figures show that annually over one

Health figures show that annually over one million more people

over one million more people visited A&E, compared to

over one million more people visited A&E, compared to three years ago.

A&E, compared to three years ago. This recent report

A&E, compared to three years ago. This recent report by A&E England

This recent report by A&E England admits that A&E performance

admits that A&E performance has deteriorated significantly.

deteriorated significantly. —— recent report by

recent report by NHS England. The number of

recent report by NHS England. The number of hospitals failing to

number of hospitals failing to treat and discharge 95%

number of hospitals failing to treat and discharge 95% of patients within

and discharge 95% of patients within four hours has doubled

and discharge 95% of patients within four hours has doubled in 12 months.

four hours has doubled in 12 months. Inside Out

four hours has doubled in 12 months. Inside Out filmed at ten

Inside Out filmed at ten A&Es across England on

Inside Out filmed at ten A&Es across England on the same day.

England on the same day. Five of those failed

England on the same day. Five of those failed to reach the

those failed to reach the government's waiting time target.

government's waiting time target. Our figures

government's waiting time target. Our figures are just a

Our figures are just a snapshot, and hospital trusts

Our figures are just a snapshot, and hospital trusts are measured weekly,

hospital trusts are measured weekly, monthly and annually.

Great

Great Yarmouth in Norfolk.

Great Yarmouth in Norfolk. A few miles

Great Yarmouth in Norfolk. A few miles from the seafront, the

miles from the seafront, the local A&E struggles to

miles from the seafront, the local A&E struggles to cope with the

A&E struggles to cope with the demands of the town's

demands of the town's population, even before the

demands of the town's population, even before the seasonal influx of

even before the seasonal influx of tourists.

even before the seasonal influx of tourists. This hospital is

even before the seasonal influx of tourists. This hospital is in a part

of England that really struggles to recruit

of England that really struggles to recruit enough Accident and

recruit enough Accident and Emergency doctors.

recruit enough Accident and Emergency doctors. But there is

Emergency doctors. But there is no respite with winter just

respite with winter just around the corner.

respite with winter just around the corner. Staff shortages

corner. Staff shortages in Accident and Emergency

corner. Staff shortages in Accident and Emergency have become a way

and Emergency have become a way of life here

and Emergency have become a way of life here at the James Paget

life here at the James Paget Hospital.

life here at the James Paget Hospital. We have

Hospital. We have got eight posts filled out

Hospital. We have got eight posts filled out of 42 posts

filled out of 42 posts this year, which means

filled out of 42 posts this year, which means 34 gaps on

which means 34 gaps on the rotas across the

which means 34 gaps on the rotas across the east of England,

across the east of England, from Peterborough to Southend,

Peterborough to Southend, including us.

Peterborough to Southend, including us. Consultants are

Peterborough to Southend, including us. Consultants are having to work

us. Consultants are having to work a lot harder to

us. Consultants are having to work a lot harder to fill those gaps so

lot harder to fill those gaps so the junior doctors

lot harder to fill those gaps so the junior doctors who are here as

junior doctors who are here as part of their rotations

of their rotations and they look at these

of their rotations and they look at these guys who

these guys who are working to breaking

these guys who are working to breaking point to keep things

breaking point to keep things ticking over.

breaking point to keep things ticking over. They say, "I

ticking over. They say, "I don't want to be

ticking over. They say, "I don't want to be doing that for the

want to be doing that for the rest of my

want to be doing that for the rest of my career", so they find

of my career", so they find themselves something that is

themselves something that is less stressful.

themselves something that is less stressful. At

themselves something that is less stressful. At the College of

Emergency Medicine's London headquarters, there

Emergency Medicine's London headquarters, there is alarm about

headquarters, there is alarm about the situation in

the situation in A&E departments up and down

the situation in A&E departments up and down the country.

the situation in A&E departments up and down the country. How concerned

and down the country. How concerned should patients be?

and down the country. How concerned should patients be? We are coming

should patients be? We are coming to the point where

should patients be? We are coming to the point where the situation will

the point where the situation will destabilise and there will

destabilise and there will be episodes in which

destabilise and there will be episodes in which patient safety is

episodes in which patient safety is compromised due to a

compromised due to a lack of emergency medicine

compromised due to a lack of emergency medicine doctors.

compromised due to a lack of emergency medicine doctors. I

emergency medicine doctors. I can't move my wrist

emergency medicine doctors. I can't move my wrist very well.

emergency medicine doctors. I can't move my wrist very well. Dr

move my wrist very well. Dr Tamer Okasha divides his

Okasha divides his working week between

Okasha divides his working week between shifts as an A&E

between shifts as an A&E consultant at Great Yarmouth

between shifts as an A&E consultant at Great Yarmouth and a GP

at Great Yarmouth and a GP in Norwich, so he

Norwich, so he simultaneously specialises in primary

specialises in primary care and emergency medicine.

specialises in primary care and emergency medicine. How

emergency medicine. How many patients do

emergency medicine. How many patients do you see here in

patients do you see here in an A&E that perhaps

patients do you see here in an A&E that perhaps you could have

that perhaps you could have dealt with as a

that perhaps you could have dealt with as a GP in practice?

that perhaps you could have dealt with as a GP in practice? Up to

with as a GP in practice? Up to 60% of any presentations

with as a GP in practice? Up to 60% of any presentations could have been

of any presentations could have been dealt with in primary

of any presentations could have been dealt with in primary care.

dealt with in primary care. Many patients who come to the

patients who come to the emergency department simply don't need

patients who come to the emergency department simply don't need to be

department simply don't need to be here.

department simply don't need to be here. A&Es were never

here. A&Es were never designed to be the access

here. A&Es were never designed to be the access point for

the access point for every illness or injury.

the access point for every illness or injury. The

the access point for every illness or injury. The 111 phone line was

or injury. The 111 phone line was introduced, in part, to

introduced, in part, to filter out those patients but,

introduced, in part, to filter out those patients but, in some

those patients but, in some cases, it had the

those patients but, in some cases, it had the opposite effect.

those patients but, in some cases, it had the opposite effect. Call

it had the opposite effect. Call centre staff with

centre staff with minimal training ended up

ended up despatching ambulances too readily.

ended up despatching ambulances too readily. Make sure you don't

readily. Make sure you don't use any medication that's

medication that's been prescribed for anybody

medication that's been prescribed for anybody else, OK?

for anybody else, OK? In Derby, the new service

for anybody else, OK? In Derby, the new service has been a

for anybody else, OK? In Derby, the new service has been a success.

new service has been a success. Nonclinical phone

new service has been a success. Nonclinical phone handlers who have

Nonclinical phone handlers who have received six weeks' training

received six weeks' training have medical experts

received six weeks' training have medical experts on hand to intervene

medical experts on hand to intervene at any stage of

medical experts on hand to intervene at any stage of a call.

at any stage of a call. The 111 service has

at any stage of a call. The 111 service has to be aware

service has to be aware of the effect on the

service has to be aware of the effect on the A&E departments and

effect on the A&E departments and the effects on the

the effects on the ambulance services and

the effects on the ambulance services and work with them.

services and work with them. The Secretary of State

services and work with them. The Secretary of State for Health claims

Secretary of State for Health claims that 111 is now

Secretary of State for Health claims that 111 is now starting to work.

that 111 is now starting to work. We did have some

that 111 is now starting to work. We did have some teething problems with

did have some teething problems with the 111 service, but

did have some teething problems with the 111 service, but you are always

the 111 service, but you are always going to have some

going to have some people who are not doctors

going to have some people who are not doctors and nurses who

not doctors and nurses who will hand the call

not doctors and nurses who will hand the call right at

not doctors and nurses who will hand the call right at the very start of

the call right at the very start of the process.

the call right at the very start of the process. What we need to

the process. What we need to do is make sure

the process. What we need to do is make sure if you need

the process. What we need to do is make sure if you need to speak to a

make sure if you need to speak to a doctor or nurse,

make sure if you need to speak to a doctor or nurse, you are put through

doctor or nurse, you are put through to one of them

doctor or nurse, you are put through to one of them very quickly.

to one of them very quickly. A&E departments will be

departments will be given an additional £500

departments will be given an additional £500 million over the

additional £500 million over the next two years to

next two years to deal with seasonal pressures.

next two years to deal with seasonal pressures. Jeremy Hunt recently

pressures. Jeremy Hunt recently announced a short—term fix

announced a short—term fix for A&E departments but

announced a short—term fix for A&E departments but a report on

departments but a report on the future shape of

departments but a report on the future shape of urgent and emergency

future shape of urgent and emergency care provision is due

future shape of urgent and emergency care provision is due out soon.

care provision is due out soon. This man is

care provision is due out soon. This man is helping to redesign the

man is helping to redesign the service across England.

man is helping to redesign the service across England. What we have

service across England. What we have to do with those

service across England. What we have to do with those moneys that have

to do with those moneys that have come is optimise this

come is optimise this current model of care

come is optimise this current model of care that we have

of care that we have to reduce the pressures over

of care that we have to reduce the pressures over the next two

of care that we have to reduce the pressures over the next two years.

pressures over the next two years. Are things

pressures over the next two years. Are things safe at the moment?

Are things safe at the moment? At the moment,

Are things safe at the moment? At the moment, our figures for

the moment, our figures for this summer period look

the moment, our figures for this summer period look very good.

the moment, our figures for this summer period look very good. We are

summer period look very good. We are monitoring safety.

summer period look very good. We are monitoring safety. I can't give

monitoring safety. I can't give you a prediction of

monitoring safety. I can't give you a prediction of what will happen.

a prediction of what will happen. What

a prediction of what will happen. What I can guarantee is

What I can guarantee is that the local areas

What I can guarantee is that the local areas are doing everything

local areas are doing everything they can to create

local areas are doing everything they can to create a system going

they can to create a system going forward that has as

forward that has as many safeguards in it

forward that has as many safeguards in it as possible.

forward that has as many safeguards in it as possible. The

in it as possible. The report into the future

in it as possible. The report into the future of emergency care

the future of emergency care in England is

the future of emergency care in England is due out this autumn.

Jamie Coulson

Jamie Coulson reporting.

Jamie Coulson reporting. The

Jamie Coulson reporting. The government's recent Health and

government's recent Health and Social Care Act set

government's recent Health and Social Care Act set off a massive

Social Care Act set off a massive debate and brought with

debate and brought with it far reaching

reaching changes to the Health Service.

reaching changes to the Health Service. The upshot

reaching changes to the Health Service. The upshot is that GPs

Service. The upshot is that GPs now manage the budgets,

Service. The upshot is that GPs now manage the budgets, but what do

manage the budgets, but what do these changes actually mean

manage the budgets, but what do these changes actually mean for us?

these changes actually mean for us? Emma

these changes actually mean for us? Emma Thomas has been finding

these changes actually mean for us? Emma Thomas has been finding out.

Emma Thomas has been finding out. On July

Emma Thomas has been finding out. On July 5th, the new

On July 5th, the new National Health Service starts.

Service starts. It's a

Service starts. It's a comforting thought that

It's a comforting thought that when you are sick,

It's a comforting thought that when you are sick, your GP will

you are sick, your GP will always be there to

you are sick, your GP will always be there to look after you.

there to look after you. It has been this way

there to look after you. It has been this way since the NHS

this way since the NHS was founded in 1948.

this way since the NHS was founded in 1948. But now what your

in 1948. But now what your GP actually does

actually does has changed and worried patients

actually does has changed and worried patients have taking to

worried patients have taking to the streets in

worried patients have taking to the streets in protest.

worried patients have taking to the streets in protest. I

worried patients have taking to the streets in protest. I am here today

streets in protest. I am here today because I am concerned

because I am concerned about the creeping privatisation

creeping privatisation of the National Health

creeping privatisation of the National Health Service.

creeping privatisation of the National Health Service. It

National Health Service. It affects everybody in Britain

everybody in Britain and if everybody in

everybody in Britain and if everybody in Britain does not

everybody in Britain does not begin to take action

everybody in Britain does not begin to take action about it, it will

to take action about it, it will be far too

to take action about it, it will be far too late.

to take action about it, it will be far too late. The Health and

far too late. The Health and Social Care Act which

far too late. The Health and Social Care Act which came into force this

Care Act which came into force this year has brought

Care Act which came into force this year has brought one of the biggest

year has brought one of the biggest changes to the NHS

year has brought one of the biggest changes to the NHS in its history.

changes to the NHS in its history. Some GPs like Dr

changes to the NHS in its history. Some GPs like Dr Patel who works in

Some GPs like Dr Patel who works in East Grinstead are

Some GPs like Dr Patel who works in East Grinstead are now in control of

East Grinstead are now in control of their own budgets.

East Grinstead are now in control of their own budgets. The benefit is

their own budgets. The benefit is that you have

their own budgets. The benefit is that you have a membership of a

that you have a membership of a very wide array of

that you have a membership of a very wide array of GPs and other health

wide array of GPs and other health professionals within the

professionals within the community who are able

professionals within the community who are able to use their clinical

who are able to use their clinical knowledge and their experience

knowledge and their experience to plan and

knowledge and their experience to plan and improve service at a

plan and improve service at a level that has

plan and improve service at a level that has not existed before.

plan and improve service at a level that has not existed before. We have

that has not existed before. We have not had this level

not had this level of clinical involvement and

involvement and engagement in commissioning

involvement and engagement in commissioning in the NHS ever.

involvement and engagement in commissioning in the NHS ever. But

commissioning in the NHS ever. But not everyone is happy.

commissioning in the NHS ever. But not everyone is happy. Gareth

not everyone is happy. Gareth Tomlinson is a

not everyone is happy. Gareth Tomlinson is a member of an NHS

Tomlinson is a member of an NHS patients group covering West

patients group covering West Kent, who are

patients group covering West Kent, who are there to keep an

patients group covering West Kent, who are there to keep an eye on the

who are there to keep an eye on the changes.

who are there to keep an eye on the changes. I am being

changes. I am being sold by the government the

changes. I am being sold by the government the idea that this

government the idea that this will actually improve

actually improve patient choice and improve quality

actually improve patient choice and improve quality of service and

improve quality of service and bring down costs

improve quality of service and bring down costs in the NHS.

improve quality of service and bring down costs in the NHS. None of

down costs in the NHS. None of which, I believe, is

down costs in the NHS. None of which, I believe, is true.

down costs in the NHS. None of which, I believe, is true. So what

which, I believe, is true. So what does Gareth think is

which, I believe, is true. So what does Gareth think is the problem?

which, I believe, is true. So what does Gareth think is the problem? He

does Gareth think is the problem? He thinks the most

thinks the most worrying thing about the new

thinks the most worrying thing about the new act is the

thinks the most worrying thing about the new act is the new system of

the new act is the new system of clinical commissioning groups.

clinical commissioning groups. GPs and other

and other health professionals have been

and other health professionals have been organised into these CCGS,

been organised into these CCGS, as they are

been organised into these CCGS, as they are known.

been organised into these CCGS, as they are known. They

been organised into these CCGS, as they are known. They have access to

they are known. They have access to money to buy some

money to buy some services from private companies,

private companies, services that could be

private companies, services that could be provided within the

private companies, services that could be provided within the NHS.

could be provided within the NHS. Things like ambulances,

Things like ambulances, hip operations and

Things like ambulances, hip operations and district nurses, for

operations and district nurses, for example.

operations and district nurses, for example. Some health

example. Some health experts like Roy Lilley

example. Some health experts like Roy Lilley are not happy

Roy Lilley are not happy with Section 75 of

Roy Lilley are not happy with Section 75 of the new act.

Roy Lilley are not happy with Section 75 of the new act. It is the

Section 75 of the new act. It is the bit which lays out

Section 75 of the new act. It is the bit which lays out exactly how CCGs

bit which lays out exactly how CCGs should put services out

bit which lays out exactly how CCGs should put services out to tender.

should put services out to tender. If the cake was

should put services out to tender. If the cake was the NHS, Section 75

If the cake was the NHS, Section 75 is the knife, effectively,

If the cake was the NHS, Section 75 is the knife, effectively, that

is the knife, effectively, that allows it to be cut up and

is the knife, effectively, that allows it to be cut up and sliced.

allows it to be cut up and sliced. And Roy says slicing

allows it to be cut up and sliced. And Roy says slicing up the cake

And Roy says slicing up the cake and giving bits to

And Roy says slicing up the cake and giving bits to the private sector is

giving bits to the private sector is a bad idea.

giving bits to the private sector is a bad idea. The NHS is

giving bits to the private sector is a bad idea. The NHS is a whole cake.

a bad idea. The NHS is a whole cake. It is

a bad idea. The NHS is a whole cake. It is what we call

It is what we call an integrated service.

It is what we call an integrated service. It

It is what we call an integrated service. It is a whole system.

service. It is a whole system. You carve a

service. It is a whole system. You carve a piece out of the

carve a piece out of the cake, however tempting that

carve a piece out of the cake, however tempting that is, you have

however tempting that is, you have still got to put

however tempting that is, you have still got to put it back in to

still got to put it back in to make the whole

still got to put it back in to make the whole system work.

the whole system work. When you break them

the whole system work. When you break them up and put

break them up and put them in the hands

hands of different operators, however good they are,

hands of different operators, however good they are, you

however good they are, you create more service

however good they are, you create more service interfaces, more costs

more service interfaces, more costs and more possibility for

and more possibility for things to go wrong.

and more possibility for things to go wrong. David Worksett runs an

go wrong. David Worksett runs an alliance called the

alliance called the NHS Confederation which represents

Confederation which represents some private healthcare providers.

private healthcare providers. He says there

private healthcare providers. He says there won't be a problem

says there won't be a problem with expensive administration

expensive administration of the new system.

expensive administration of the new system. That

expensive administration of the new system. That is a very

system. That is a very minor point and it

system. That is a very minor point and it is largely irrelevant.

and it is largely irrelevant. The interesting thing

and it is largely irrelevant. The interesting thing about the NHS over

interesting thing about the NHS over the last couple of

interesting thing about the NHS over the last couple of decades is how

the last couple of decades is how poor it has been

poor it has been as an almost entirely

poor it has been as an almost entirely state—run system.

poor it has been as an almost entirely state—run system. Don't

entirely state—run system. Don't forget, even with

forget, even with these reform, the independent sector

independent sector is only delivering 5%

independent sector is only delivering 5% or 6% of

delivering 5% or 6% of NHS services and that

delivering 5% or 6% of NHS services and that is probably not

and that is probably not even going to double

and that is probably not even going to double over the next

and that is probably not even going to double over the next decade.

to double over the next decade. Let's keep this in

to double over the next decade. Let's keep this in perspective.

Let's keep this in perspective. The man

Let's keep this in perspective. The man who is ultimately in

man who is ultimately in charge of the NHS

man who is ultimately in charge of the NHS is the Secretary

the NHS is the Secretary of State for Health,

the NHS is the Secretary of State for Health, Jeremy Hunt.

the NHS is the Secretary of State for Health, Jeremy Hunt. What will

for Health, Jeremy Hunt. What will the cost of

for Health, Jeremy Hunt. What will the cost of the reorganisation be?

the cost of the reorganisation be? And in terms of

the cost of the reorganisation be? And in terms of admin, how much will

And in terms of admin, how much will that cost?

And in terms of admin, how much will that cost? Well, I can get

that cost? Well, I can get you the exact figures

that cost? Well, I can get you the exact figures but, net, that

exact figures but, net, that reorganisation is saving £5.5

reorganisation is saving £5.5 billion over the

billion over the course of this Parliament and

billion over the course of this Parliament and that means we

Parliament and that means we are able to

Parliament and that means we are able to employ more people on

able to employ more people on the front line. 4,500

front line. 4,500 more doctors, 400,000 more

front line. 4,500 more doctors, 400,000 more operatiosn every year,

400,000 more operatiosn every year, a million more people

a million more people going through A&E.

a million more people going through A&E. That is

a million more people going through A&E. That is why I think they

A&E. That is why I think they have been a success.

A&E. That is why I think they have been a success. The NHS

been a success. The NHS budget is worth billions

been a success. The NHS budget is worth billions and the reforms

worth billions and the reforms mean that private healthcare

that private healthcare companies are going

that private healthcare companies are going to be able to

are going to be able to take a bigger slice

are going to be able to take a bigger slice of it.

are going to be able to take a bigger slice of it. But according

bigger slice of it. But according to Roy

bigger slice of it. But according to Roy Lilley, another problem is that

Roy Lilley, another problem is that if GPs decide to

Roy Lilley, another problem is that if GPs decide to buy a service

if GPs decide to buy a service from a private supplier,

if GPs decide to buy a service from a private supplier, the danger is

a private supplier, the danger is that they will put

that they will put profits ahead of patients.

that they will put profits ahead of patients. So

that they will put profits ahead of patients. So this is a

patients. So this is a piece of cake that

patients. So this is a piece of cake that represents a private company

that represents a private company that has taken

that represents a private company that has taken over.

that has taken over. What is the problem with

that has taken over. What is the problem with that?

that has taken over. What is the problem with that? If this is

problem with that? If this is the value of

problem with that? If this is the value of the contract, the problem

value of the contract, the problem they will find

value of the contract, the problem they will find is that they won't

they will find is that they won't be able to make

they will find is that they won't be able to make a profit and operate

able to make a profit and operate safely.

able to make a profit and operate safely. They will start slicing

safely. They will start slicing staffing costs.

safely. They will start slicing staffing costs. They will start

staffing costs. They will start slicing administration costs.

slicing administration costs. They will start

will start taking our operating costs, because

will start taking our operating costs, because they will have

costs, because they will have to reduce their costs

costs, because they will have to reduce their costs in order to

reduce their costs in order to create some wiggle room

create some wiggle room to create enough of

create some wiggle room to create enough of the cake to

create some wiggle room to create enough of the cake to make a profit.

enough of the cake to make a profit. I think

enough of the cake to make a profit. I think that is an

I think that is an old chestnut which is

I think that is an old chestnut which is fairly easily dismissed.

which is fairly easily dismissed. One of

which is fairly easily dismissed. One of the interesting things, it

One of the interesting things, it does not matter

One of the interesting things, it does not matter if it is private

does not matter if it is private companies or charities who

companies or charities who deliver healthcare, if they

companies or charities who deliver healthcare, if they fail to look

healthcare, if they fail to look after their patients

healthcare, if they fail to look do go out

healthcare, if they fail to look do go out of business.

do go out of business. Of course, the

do go out of business. Of course, the reason GPs are being

the reason GPs are being given these powers to

the reason GPs are being given these powers to buy services is

powers to buy services is to increase competition.

powers to buy services is to increase competition. If

increase competition. If the doctors offer a

increase competition. If the doctors offer a contract for a service,

offer a contract for a service, they will be

offer a contract for a service, they will be able to choose which

will be able to choose which provider does the

will be able to choose which provider does the best job for the

provider does the best job for the best

provider does the best job for the best price. That would appear to be

best price. That would appear to be a good thing.

best price. That would appear to be a good thing. But

a good thing. But some academics like

a good thing. But some academics like Lucy Reynolds disagree.

a good thing. But some academics like Lucy Reynolds disagree. We do

like Lucy Reynolds disagree. We do hear all the time

hear all the time that competition is

hear all the time that competition is going to be good

is going to be good for the Health Service.

is going to be good for the Health Service. However,

is going to be good for the Health Service. However, we don't hear it

Service. However, we don't hear it from people who are

from people who are in the possession

from people who are in the possession of any actual evidence

possession of any actual evidence to that effect because

possession of any actual evidence to that effect because there isn't any.

that effect because there isn't any. I think

that effect because there isn't any. I think there is no doubt

I think there is no doubt that competition can

I think there is no doubt that competition can improve healthcare.

competition can improve healthcare. People talk about

People talk about healthcare being different

People talk about healthcare being different to other sectors and,

different to other sectors and, in certain key respects it is

different to other sectors and, in certain key respects it is very

certain key respects it is very different, but in others,

different, but in others, the same things we

different, but in others, the same things we all know in

things we all know in our everyday lives still

things we all know in our everyday lives still apply and competition

lives still apply and competition encourages people to try

encourages people to try harder, it encourages

encourages people to come up with innovation.

encourages people to come up with innovation. In

encourages people to come up with innovation. In terms of the academic

innovation. In terms of the academic evidence and indeed

evidence and indeed the practical evidence, the

evidence, the evidence that isn't inconclusive

evidence, the evidence that isn't inconclusive about it, which

inconclusive about it, which is some, is overwhelmingly

inconclusive about it, which is some, is overwhelmingly negative.

some, is overwhelmingly negative. There

some, is overwhelmingly negative. There are both theoretical reasons

There are both theoretical reasons and a mountain

There are both theoretical reasons and a mountain of practical evidence

and a mountain of practical evidence that competition is bad

that competition is bad for healthcare.

that competition is bad for healthcare. I have nothing against

healthcare. I have nothing against the idea of working

healthcare. I have nothing against the idea of working with the private

the idea of working with the private sector, and many hospitals

sector, and many hospitals do it very successfully.

sector, and many hospitals do it very successfully. But to

very successfully. But to open up the NHS

very successfully. But to open up the NHS broadly to competition

the NHS broadly to competition in all aspects of

the NHS broadly to competition in all aspects of what it does, I

the NHS broadly to competition in all aspects of what it does, I do

understand the enthusiasts who say it will improve quality and

understand the enthusiasts who say it will improve quality and it

it will improve quality and it will cut

it will improve quality and it will cut costs.

it will improve quality and it will cut costs. But I don't think

cut costs. But I don't think there is any

cut costs. But I don't think there is any evidence of that.

cut costs. But I don't think there is any evidence of that. Critics

is any evidence of that. Critics say the government

the government simply haven't thought it

the government simply haven't thought it through.

the government simply haven't thought it through. Is this a

thought it through. Is this a badly thought out

thought it through. Is this a badly thought out and ill researched bill?

thought out and ill researched bill? I think you have

thought out and ill researched bill? I think you have got to look

I think you have got to look at the evidence as

I think you have got to look at the evidence as to what the bill

evidence as to what the bill has actually achieved.

evidence as to what the bill has actually achieved. The

actually achieved. The NHS is holding up

actually achieved. The NHS is holding up under a great

holding up under a great deal of pressure extremely

pressure extremely well and the reforms

pressure extremely well and the reforms have helped to

reforms have helped to make that possible because

reforms have helped to make that possible because they have meant we

possible because they have meant we are spending less

are spending less money on bureaucracy and

are spending less money on bureaucracy and the back office and

bureaucracy and the back office and more money on frontline

bureaucracy and the back office and more money on frontline staff.

more money on frontline staff. The NHS

more money on frontline staff. The NHS is certainly a world—renowned

NHS is certainly a world—renowned state—run asset, but some

state—run asset, but some critics say the

state—run asset, but some critics say the Health and Social Care

say the Health and Social Care Act is privatisation by

say the Health and Social Care Act is privatisation by the back door.

is privatisation by the back door. Section 75 of the

is privatisation by the back door. Section 75 of the act allows GPs in

Section 75 of the act allows GPs in the form of

Section 75 of the act allows GPs in the form of CCGs to buy in

the form of CCGs to buy in private companies to do

the form of CCGs to buy in private companies to do various jobs, but

companies to do various jobs, but it is

companies to do various jobs, but it is feared some GPs will have

companies to do various jobs, but it is feared some GPs will have to

is feared some GPs will have to do that, whether they like it or not.

that, whether they like it or not. If a CCG

that, whether they like it or not. If a CCG does not put a

If a CCG does not put a service out to tender,

If a CCG does not put a service out to tender, for example, and

to tender, for example, and let's say a private

to tender, for example, and let's say a private company says, "I think

say a private company says, "I think I could provide

say a private company says, "I think I could provide that service just as

I could provide that service just as well and probably at a

I could provide that service just as well and probably at a better price,

well and probably at a better price, I want to tender

well and probably at a better price, I want to tender for it", if the

I want to tender for it", if the CCG have not done

I want to tender for it", if the CCG have not done that, it is

have not done that, it is possible for that company

have not done that, it is possible for that company to go to the

for that company to go to the Competition Commission and

Competition Commission and complain and, at the

Competition Commission and complain and, at the end of the day,

Competition Commission and complain and, at the end of the day, it is

and, at the end of the day, it is possible for them to go

and, at the end of the day, it is possible for them to go to court and

possible for them to go to court and ask for a judicial

possible for them to go to court and ask for a judicial review.

ask for a judicial review. There are a lot

ask for a judicial review. There are a lot of people who

ask for a judicial review. There are a lot of people who are saying now

a lot of people who are saying now the NHS is going to end

a lot of people who are saying now the NHS is going to end up being

the NHS is going to end up being run by the lawyers

the NHS is going to end up being run by the lawyers and not by

the NHS is going to end up being run by the lawyers and not by doctors.

by the lawyers and not by doctors. Mike O'Brien QC is a former

by the lawyers and not by doctors. Mike O'Brien QC is a former Labour

Mike O'Brien QC is a former Labour Health Minister and is

Health Minister and is now a barrister

barrister specialising in procurement.

barrister specialising in procurement. He says

procurement. He says Section 75 regulations are confusing and

regulations are confusing and could open the

regulations are confusing and could open the door to private

open the door to private services against a doctor's

open the door to private services against a doctor's wishes.

open the door to private services against a doctor's wishes. You have

against a doctor's wishes. You have got this sort

got this sort of conflict between what

got this sort of conflict between what the Minister says the

what the Minister says the clause means and what the

what the Minister says the clause means and what the words within

means and what the words within the clause say.

means and what the words within the clause say. What they

clause say. What they say is that pretty much

clause say. What they say is that pretty much everything except

pretty much everything except where you have got

you have got one provider of something, so

you have got one provider of something, so you have

something, so you have got a product which will only be

something, so you have got a product which will only be provided

which will only be provided by one business, everything

business, everything else, pretty much, has

business, everything else, pretty much, has got to go

business, everything else, pretty much, has got to go out to

much, has got to go out to competition.

much, has got to go out to competition. The government says

competition. The government says that is not what

competition. The government says that is not what it means.

competition. The government says that is not what it means. It may

that is not what it means. It may say that, but that

that is not what it means. It may say that, but that is not what it

say that, but that is not what it means.

say that, but that is not what it means. The lawyers are

means. The lawyers are saying, if this goes

means. The lawyers are saying, if this goes to court, the judge

this goes to court, the judge will have to

this goes to court, the judge will have to look at the words

have to look at the words in the regulations and

have to look at the words in the regulations and they will have

regulations and they will have to say, "We will

say, "We will apply that because that is

say, "We will apply that because that is the law".

say, "We will apply that because that is the law". But

that is the law". But Jeremy Hunt insists this

that is the law". But Jeremy Hunt insists this is not the

that is the law". But Jeremy Hunt insists this is not the case.

that is the law". But Jeremy Hunt insists this is not the case. I

insists this is not the case. I think there are

insists this is not the case. I think there are a lot of myths

think there are a lot of myths around Section 75 regulations

around Section 75 regulations but let's be

around Section 75 regulations but let's be absolutely clear, local GPs

let's be absolutely clear, local GPs do not have to

let's be absolutely clear, local GPs do not have to tender out

do not have to tender out every service.

do not have to tender out every service. They only have to

do not have to tender out every service. They only have to do it if

service. They only have to do it if it is in the

service. They only have to do it if it is in the interests of patients.

it is in the interests of patients. If they judge the

If they judge the interests of patients are

If they judge the interests of patients are to have

patients are to have a joined up service, an integrated

patients are to have a joined up service, an integrated service, they

service, an integrated service, they don't have to put

don't have to put those services out to

don't have to put those services out to tender and that is

to tender and that is really important because

important because we need integrated joined

important because we need integrated joined up services.

joined up services. Gareth Tomlinson from the

joined up services. Gareth Tomlinson from the patients' group

from the patients' group in Kent knows exactly what he

from the patients' group in Kent knows exactly what he wants from his

knows exactly what he wants from his GP.

knows exactly what he wants from his GP. As a patient, I

knows exactly what he wants from his GP. As a patient, I go to my

GP. As a patient, I go to my doctor for a treatment

GP. As a patient, I go to my doctor for a treatment and I rely on

for a treatment and I rely on my doctor to

for a treatment and I rely on my doctor to provide me with the

doctor to provide me with the best treatment possible.

doctor to provide me with the best treatment possible. I

doctor to provide me with the best treatment possible. I don't go there

treatment possible. I don't go there to purchase a product.

treatment possible. I don't go there to purchase a product. The people

to purchase a product. The people who matter are

to purchase a product. The people who matter are patients.

who matter are patients. The best people

who matter are patients. The best people to make the right

people to make the right decisions for patients

people to make the right decisions for patients are doctors, so what

for patients are doctors, so what these reforms do is

these reforms do is put those budgets in

these reforms do is put those budgets in the hands of

budgets in the hands of local doctors.

budgets in the hands of local doctors. It

budgets in the hands of local doctors. It is a mess.

budgets in the hands of local doctors. It is a mess. Section 75

doctors. It is a mess. Section 75 does need to be

doctors. It is a mess. Section 75 does need to be repealed and we need

does need to be repealed and we need some clarification from ministers

some clarification from ministers in the law

some clarification from ministers in the law itself about what they

the law itself about what they intend here.

the law itself about what they intend here. Do they

intend here. Do they intend substantial privatisation, which

substantial privatisation, which I think most of