:01:09. > :01:13.I'm Sam Smith and this is Inside For 65 years, the National Health
:01:13. > :01:18.Service has been there to look after us when we are ill but in 10
:01:18. > :01:23.years' time, the NHS will undergo the biggest reorganisation in its
:01:23. > :01:33.history. What all that need for patience. We asked Phil Hammond to
:01:33. > :01:38.
:01:38. > :01:41.investigate. This is lovely, madam, because this inhaler would actually
:01:41. > :01:45.go with your coat. And a free examination. Do you want to come
:01:45. > :01:47.here and cough, sir? I can give you those half price. Plus something
:01:47. > :01:49.for your water retention. I'm a GP. And today I'm taking
:01:49. > :01:52.healthcare into the community, where it's needed.
:01:52. > :01:54.All the sample bottles you could ever need and I'll throw in a
:01:54. > :01:58.crutch. It's all free. It's all paid for.
:01:58. > :02:01.This is what the biggest shake-up in the history of the NHS is all
:02:01. > :02:04.about - giving local doctors, nurses and patients the chance to
:02:04. > :02:08.call the shots and shop around for the best care. At least that's the
:02:08. > :02:10.Government's plan. But many doctors think the reforms are untested,
:02:10. > :02:16.expensive and over-complicated - a view I shared with the former
:02:16. > :02:19.health secretary Andrew Lansley. The difficulty with this is that
:02:19. > :02:23.it's 353 pages of wonk. It's absolutely impossible to understand
:02:23. > :02:26.it. I choose my words carefully. It is unreadable. What did you
:02:26. > :02:30.actually say? It's wonk But I've been wading through the jargon, and
:02:30. > :02:35.it's clear the reforms will affect us all. It's vital we put politics
:02:35. > :02:38.aside and try to understand exactly what they'll mean for patients.
:02:38. > :02:45.Until now the NHS has been like a big supermarket chain that only
:02:45. > :02:48.sells its own brands. It's a one stop shop where all the tricky
:02:48. > :02:53.decisions are made for you. In theory, you should get the same
:02:53. > :03:00.high quality care whether you live in Scunthorpe or Southend. But like
:03:00. > :03:03.any monopoly, it's far from perfect. The Government's bringing in the
:03:03. > :03:08.market place model instead - introducing more choice and
:03:08. > :03:13.competition, and putting GPs in charge instead of civil servants.
:03:13. > :03:17.But will it work? So if I just check your eyes there... I can
:03:17. > :03:21.confirm you have two eyes. We're doing two X-rays for the
:03:21. > :03:24.price of one. And I can throw in a free brain scan if you like.
:03:24. > :03:27.One change we're told patients should notice is care much closer
:03:27. > :03:31.to home. Hospitals and GPs will have more freedom to bring in
:03:31. > :03:36.innovative ideas. Technology might monitor your health at home and
:03:36. > :03:39.routine surgery could be done at high street clinics. Hospitals in
:03:39. > :03:45.Gloucestershire have already teamed up with a charity to send this
:03:45. > :03:50.mobile chemotherapy unit into rural communities. For cancer patients
:03:50. > :03:57.like Graham Freeman, it's a lifeline. The concept is great,
:03:57. > :04:03.moving the treatment to the person. Because it is a bit of a trauma,
:04:03. > :04:08.suffering from the chemotherapy and the travelling. Bringing the
:04:08. > :04:14.treatment closer to the person is a lot better. You do feel a little
:04:14. > :04:19.bit better. But could this shift towards more localised care mean
:04:19. > :04:21.hospitals will have to close? To find out I've come to London, to
:04:21. > :04:27.one of the world's most respected independent think tanks on health
:04:27. > :04:31.policy - the King's Fund. I don't think we'll see many hospitals
:04:31. > :04:33.closing as a result of care coming closer to home. It will mean
:04:33. > :04:41.hospitals changing their roles, perhaps fewer A&E departments,
:04:41. > :04:44.fewer maternity services provided But that could be to the benefit of
:04:44. > :04:48.patients if we're able to plan that in the appropriate way and get
:04:48. > :04:54.better outcomes by concentrating those services in fewer hospitals.
:04:55. > :04:57.You might not be keen though, if it's your A&E that's closing. The
:04:57. > :05:02.second thing patients should notice is more choice.
:05:02. > :05:06.Three tomatoes for �1! Anybody? Three inhalers for the price of two.
:05:06. > :05:08.Come and get them! Two caulies, �1.50 over there! We've got a
:05:08. > :05:14.separate queue here for six symptoms or less. Competition in
:05:14. > :05:16.the NHS isn't new, but the reforms step it up a notch. The NHS will
:05:16. > :05:24.become a marketplace, with private companies competing with the NHS
:05:24. > :05:32.for business. So when your GP says you need a scan, your options may
:05:32. > :05:37.look less like this, and more like this. But it should be quality, not
:05:37. > :05:40.price, that will decide which are allowed to offer care. It's already
:05:40. > :05:47.happening here on the high street, where Specsavers are treating NHS
:05:47. > :05:51.patients in 218 of its hearing centres. When I came to Specsavers,
:05:51. > :06:01.they do private and NHS, which I find is better than going to the
:06:01. > :06:01.
:06:01. > :06:05.hospital. You know, you go to the hospital, there's a lot of
:06:05. > :06:10.travelling and I don't think you get such a personal attention. So
:06:10. > :06:13.this is much, much better. When you press the button in, you'll hear
:06:13. > :06:16.two beeps which will allow you to use the telephone then. The plan is
:06:16. > :06:20.for patients like Doreen to choose their provider by looking at new
:06:20. > :06:23.performance league tables. But companies must play by the rules
:06:23. > :06:27.and can't encourage NHS patients to go private. Ultimately, Specsavers
:06:27. > :06:31.want to protect the NHS work that we've managed to gain here and we
:06:31. > :06:34.don't want to do anything to try and jeopardise that. We're not
:06:34. > :06:44.going to try and sell a hearing aid, upsell a patient at all during that
:06:44. > :06:47.time. Market competition could drive up standards and lower costs.
:06:47. > :06:50.But if profits slip, companies could pull out or even go under,
:06:50. > :06:54.leaving patients in the lurch. Remember the collapse of Northern
:06:54. > :06:59.Rock? Imagine if its customers had been queuing not for their life
:06:59. > :07:01.savings but for life-saving surgery. If there is going to be a bigger
:07:01. > :07:04.role for private companies in delivering care to patients, then
:07:04. > :07:07.there is always a possibility, however remote, that that company
:07:07. > :07:11.will not be successful, that we will see something like Northern
:07:11. > :07:14.Rock in healthcare. The Government's anticipating that.
:07:14. > :07:17.It's putting in place what's called a "failure regime" so that the
:07:17. > :07:22.regulator can intervene and ensure continuity of services even if the
:07:22. > :07:25.organisations are not providing care to the right standard.
:07:25. > :07:31.third thing patients may notice is a shift in their relationship with
:07:31. > :07:35.their GP. So if I said, "Trust me, I know the best place to go to get
:07:35. > :07:40.your heart surgery." Would you say, "Yeah, you're the doctor. Dr Phil,
:07:40. > :07:44.you look like a ginger George Clooney. I love, I trust you."?
:07:44. > :07:48.Since the birth of the NHS, doctors have taken the trust of patients
:07:48. > :07:52.for granted. But as GPs offer more and more treatments, they could
:07:52. > :07:55.find themselves referring patients to their own services. Add private
:07:55. > :08:05.companies into the mix and there's real scope for a conflict of
:08:05. > :08:09.interest. But should we really be worried? In Bath, Jasmine Bishop is
:08:09. > :08:13.seeing a GP on the NHS. But believe it or not, he actually works for
:08:13. > :08:18.Virgin. Yup - they of planes, trains and super-fast broadband
:08:18. > :08:24.fame also run this walk-in centre, along with 170 other NHS services.
:08:24. > :08:27.Although you wouldn't know it from the branding. As Virgin takes over
:08:27. > :08:30.more of the NHS, what's to stop you referring patients on to another
:08:30. > :08:35.Virgin service to make money for the company, rather than in the
:08:35. > :08:38.best interests of the patient? of our GPs, like any GP in the
:08:38. > :08:44.country, have to offer patients a choice when they're being referred
:08:44. > :08:49.for another service. So in the end, it's down to the patient to choose
:08:49. > :08:51.where they go. And of course, GPs and other clinical staff have a
:08:51. > :08:55.professional responsibility too to make sure that they're finding the
:08:55. > :09:01.best care for their patients. That doesn't differ because those GPs
:09:01. > :09:05.are employed by us. And you have to ask if patients really mind who
:09:05. > :09:10.provides their care. Did you know that this health
:09:10. > :09:13.centre was run by Virgin? No. it make any difference to you as a
:09:13. > :09:18.patient whether it's run by an ordinary NHS GP or a private
:09:18. > :09:22.company? No. So all that matters to you is what? What do you care about
:09:22. > :09:25.in your treatment? That I get the best treatment I possibly can get
:09:25. > :09:29.really. Which of these sample bottles would you like, madam?
:09:29. > :09:33.We've got three on choice today. The bottom line is that if you have
:09:34. > :09:37.a good idea to improve your care, tell your GP. If he or she can make
:09:37. > :09:42.it happen, we know the reforms are working. It's been a huge upheaval
:09:42. > :09:47.just to get the NHS to listen to patients. And I hope for all our
:09:47. > :09:57.sakes it works. I can't lug all this back again. Come on, it's got
:09:57. > :10:03.
:10:03. > :10:07.The promise of care closer to home and more choice but what is the
:10:07. > :10:12.reality in the south-west, where big changes are already under way?
:10:12. > :10:18.We have been in Cornwall finding out.
:10:18. > :10:23.When 87-year-old Edie became ill on Christmas Eve, she went straight
:10:23. > :10:27.into her community hospital. This has been great because it is two
:10:27. > :10:34.minutes up the road. alternative would have been a long
:10:34. > :10:39.drive to Barnstaple hospital. an hour to and from Constable, and
:10:39. > :10:46.a lot more of the struggle of fiercely. Getting a bed so close to
:10:46. > :10:53.home has been invaluable. They were nice to me in Barnstaple or but if
:10:53. > :10:57.I had a choice, this would be my first choice. Because it is more
:10:57. > :11:06.like light and not so noisy. Why have got no complaints about being
:11:06. > :11:10.here at all. Rosemary is also grateful to have a community
:11:10. > :11:17.hospital on her doorstep. She runs would working classes for adults
:11:17. > :11:22.with learning disabilities. We have staff that tap into this. We are
:11:22. > :11:26.using tools. The hospital is very close and it means if there is a
:11:26. > :11:31.cut that needs a little bit more than a plaster, it is very quick
:11:31. > :11:36.Foster run him in and get it seemed to and we are back. -- very quick
:11:36. > :11:41.for us to run them in. Cornwall's community hospitals are valued by
:11:41. > :11:49.many and they are at the forefront of the seismic change of the NHS.
:11:49. > :11:55.For decades, 14 community hospitals were part of the NHS but in October
:11:55. > :11:58.2011 they were handed to peninsula Community Health, a not-for-profit
:11:58. > :12:06.but private social enterprise company. It is one of the biggest
:12:06. > :12:13.in the region, with 2200 Staffs. Such changes have proved highly
:12:13. > :12:20.controversial. One leading academic says the National Health Service as
:12:20. > :12:25.we know it has gone for good. April, there will be no National
:12:26. > :12:29.Health Service. The duty on the Secretary of State to secure and
:12:30. > :12:36.provide comprehensive healthcare in England is abolished. And so what
:12:36. > :12:40.is taking its place is a number of quangos and bodies which have
:12:40. > :12:45.extraordinary new powers to decide what k you will get and what care
:12:45. > :12:49.you are entitled to -- what care. Over time people will come to
:12:49. > :12:53.realise we have fewer and fewer entitlements to health care and
:12:53. > :12:58.they are expected to pay for more out of pocket so it is an
:12:58. > :13:02.absolutely terrifying time for the local community and they need to
:13:02. > :13:06.really galvanise and understand that the implications of this Act,
:13:06. > :13:12.in April, will end the National Health Service as we know it.
:13:12. > :13:16.government denies this is the case. It says care will remain free at
:13:16. > :13:20.the point of delivery and that the changes will increase choice and
:13:20. > :13:26.efficiency but in Cornwall, critics say their fears about what they see
:13:26. > :13:29.as the market position of the NHS already been realised. Since
:13:29. > :13:36.peninsula community health tip over, beds in several hospitals have been
:13:36. > :13:42.shut. 48 remain closed last month. This hospital near Penzance has
:13:42. > :13:46.been shut entirely to impatience four times and remains closed today.
:13:46. > :13:51.-- impatience. Campaigner Graham Webster says closing this hospital
:13:51. > :13:57.has put pressure on others, resulting in overcrowding.
:13:57. > :14:01.Something peninsula deny us. 2013 will be a significant year of
:14:01. > :14:07.change for the health service, some good and some bad. We have recently
:14:07. > :14:11.received this evidence which indicates that nearly all of our
:14:11. > :14:15.community hospitals are operating above the national standard of 85%,
:14:15. > :14:20.which is considered to be the optimum figure for delivering safe
:14:20. > :14:26.and high quality care. These up occupancy rates. Many of our
:14:26. > :14:33.hospitals are exceeding 90% and former hospital is operating at
:14:33. > :14:36.nearly 96%. The company says these patients are transferred under
:14:36. > :14:43.clear criteria, do not be specialist care, there is no
:14:43. > :14:46.problem with this. We do not accept that. Any figure above 85% is
:14:46. > :14:51.compromising patient care and we believe that patients are being put
:14:51. > :14:55.at risk. What of the elderly patients who would have been
:14:55. > :15:00.admitted to the currently closed beds? Peninsula Community Health
:15:00. > :15:05.says some are being cared for at home, others in hospital elsewhere.
:15:05. > :15:10.But Carolyn, who used to run at hospital and is still closely
:15:10. > :15:17.involved as chair of the league of friends, it is a worried. How do
:15:17. > :15:22.you feel about the fact the hospital is closed? I feel a bit
:15:22. > :15:31.apprehensive about the care they are getting in the community. There
:15:31. > :15:35.are some very vulnerable people out there. They need to be looked after
:15:35. > :15:42.occasionally and looked at. I am afraid that is not happening. So
:15:42. > :15:45.yes, it worries me to think that there are vulnerable people there.
:15:45. > :15:50.Peninsula blames a shortage of nurses for the bed closures and
:15:50. > :15:54.says it is recruiting hard and hopes to fill the vacancies. But
:15:54. > :16:00.one key reason why nurses may not want to move into private companies
:16:00. > :16:03.like this is that they can't take their NHS pension with them. The
:16:03. > :16:08.Royal College of Nursing said it warned the government this would
:16:08. > :16:13.cause staffing problem has. It is still important immerses to know
:16:13. > :16:19.that they have a particular amount and a particular support to look
:16:19. > :16:26.forward to -- important to nurses. The new pension arrangements to
:16:26. > :16:30.people moving in a substantially less. We do not have figures yet
:16:30. > :16:34.that will indicate how much people will receive at the end of it but
:16:34. > :16:39.substantially less is clearly the answer. Some campaigners believe
:16:39. > :16:42.the bed closures are deliberate, bringing in private companies can
:16:42. > :16:51.mean higher overheads and when the changes happened in Cornwall,
:16:51. > :16:54.Graham Webster predicted services will be cut as a result. Health
:16:54. > :16:59.initiative Cornwall at the time forecast that peninsula community
:16:59. > :17:04.help could not continue to provide the same level of services as they
:17:04. > :17:08.did when they were in the NHS. The reason is evidence to suggest an
:17:08. > :17:12.increase in overhead charges such as corporation tax, professional
:17:12. > :17:16.services, which meant that a significant proportion of their
:17:16. > :17:26.budget would be reduced to meet those costs. And you put a figure
:17:26. > :17:30.
:17:30. > :17:33.on that. We estimated at the time �3.5 million additional costs.
:17:33. > :17:37.man in charge of peninsula Community Health says staff
:17:37. > :17:43.vacancies and bed closures are not part of a deliberate plan to save
:17:43. > :17:49.money. Have you had to close beds because of increased costs because
:17:49. > :17:53.you are private companies? No. When we were set up there was an
:17:53. > :17:57.acknowledgement there would be some increased costs. There are issues
:17:57. > :18:02.which apply to non NHS organisations and in particular the
:18:02. > :18:06.taxation system, which works in such a way we are liable for tax.
:18:06. > :18:11.The critics are saying the only way you are going to achieve that
:18:11. > :18:15.financial position is as a result of having these beds closed and not
:18:15. > :18:20.recruiting staff in a timely manner. That you have done it deliberately
:18:20. > :18:25.to balance the books. We have not done that, I assure you. We had to
:18:25. > :18:31.take a decision to run as safe serve as. Anti- insists that
:18:31. > :18:35.hospital wards are not overcrowded. -- and he insists. Rock critics are
:18:35. > :18:39.saying you are not delivering a safe service because you have too
:18:39. > :18:44.many people in your community hospitals -- your critics. We try
:18:44. > :18:49.and make sure that we have the appropriate staffing levels on all
:18:49. > :18:54.of our hospital wards at all times. But you have a staff shortage.
:18:54. > :19:00.had a shortage at a time which came together for a variety of reasons.
:19:00. > :19:05.We took decisive action to resolve that. A review team led by GPs is
:19:05. > :19:09.now looking at all community health services in Cornwall and that is
:19:09. > :19:15.likely to decide the future of the sort of facilities patients like
:19:15. > :19:25.the devalue so much. The future shape of the NHS is one we were
:19:25. > :19:30.
:19:30. > :19:34.also discovered in the months and Next tonight, the story of a former
:19:34. > :19:38.soldier from Devon who is not letting injury stand in the way of
:19:38. > :19:46.his dream. We have been following Chris Jones as he discovers the ups
:19:46. > :19:52.and downs of bringing the daredevil sport of extreme biking to everyone.
:19:52. > :19:56.It's fast, its furious and for Chris Jones, it's the ultimate kick.
:19:56. > :20:03.You look at the speed these guys are going down the tracks at and it
:20:03. > :20:11.is the adrenalin rush. The feeling you get flying around these corners.
:20:11. > :20:15.And getting airborne. You are not going to get it everywhere else.
:20:15. > :20:20.But the leg injury he suffered in an accident in the Army means Chris
:20:20. > :20:24.can't take part. Only help out. can lift your weight off the bike
:20:24. > :20:27.to make it light, you can push it down to compress into corners so
:20:27. > :20:33.you bounce up with more speed and it is all stuff you do with your
:20:33. > :20:37.legs and I just cannot do it. very frustrated at the moment. It
:20:37. > :20:41.is dealing with that that is quite hard for him. It is hard work
:20:41. > :20:45.sitting and watching but he is still involved.
:20:45. > :20:50.There is an off-road option for people with disabilities. For
:20:50. > :20:59.�3,500, you get one of these. But it's not designed for the extreme
:20:59. > :21:03.courses Chris and others want to tackle. I guess really I am looking
:21:03. > :21:08.to come up with a bike that I want to ride but in the knowledge that
:21:08. > :21:13.there must be other people out there who want to ride the same way
:21:13. > :21:19.that I do and just because their legs don't work properly any more,
:21:19. > :21:22.why should we have to put up with second best, not even that? Chris
:21:22. > :21:26.has come up with a radical new design - putting two wheels at the
:21:26. > :21:35.front one at the back. Today he's go to find out what else needs
:21:35. > :21:38.changing. This is the start of the open track. This is the easiest
:21:38. > :21:44.track that the riders have got and I am going to go down it and
:21:44. > :21:49.hopefully show you what it is like to do it on this bike and point out
:21:49. > :21:54.some of the problems that I have. The biggest problem really is that
:21:54. > :21:59.I have got one wheel at the front and two at the back and that makes
:21:59. > :22:04.the bike really quite unstable. Cornering is one of the biggest
:22:04. > :22:08.problems so my bikes will be the other way round but also this has
:22:08. > :22:12.got no suspension, it only has one caliper brakes on the front, and
:22:12. > :22:17.you can see where we have had to brace it up because they were not
:22:17. > :22:21.strong enough to do this kind of writing. Because I have sat near
:22:21. > :22:31.the back axle it is fairly stable but very easy to get it wrong.
:22:31. > :22:36.
:22:36. > :22:41.Straight away you can see the first problem with this bike, because it
:22:41. > :22:51.is driven at the front wheel, it is very difficult to get traction on
:22:51. > :23:01.any up slopes. Although these are downhill tracks, there are sections
:23:01. > :23:20.
:23:20. > :23:25.That looks so fun. We were down earlier on the wooden bit and you
:23:25. > :23:30.jump off, have you done that? can't do that. There are some
:23:30. > :23:40.places I can't get to because it is quite wide and I have three wheels.
:23:40. > :23:51.
:23:51. > :23:58.Delving down here, this is the corkscrew, a continuation of the
:23:58. > :24:08.open track. It disappears to the left and drops very sharply. It is
:24:08. > :24:09.
:24:09. > :24:16.If you are going to slow, you crash. If you go too fast, you crash. You
:24:16. > :24:26.have to get it just bang on. This is probably the most difficult part
:24:26. > :24:59.
:24:59. > :25:09.A are you all right? What happened? I went to High And I clipped the
:25:09. > :25:14.
:25:14. > :25:20.top of the Bank and it got the back -- I went too high. Ouch.
:25:20. > :25:24.You can see the line that my wheel took. There is a little bump and it
:25:24. > :25:29.flicked me up and out. That is the way the course is. It is the bike,
:25:29. > :25:33.up the bike is wide and so it is not stable and so as soon as the
:25:33. > :25:40.baccy and comes up, I am effectively trying to write down on
:25:40. > :25:45.one wheel. -- the back end comes up. As much as I want to go and do It
:25:45. > :25:52.again, the chances are that I will crash it again and either break the
:25:52. > :25:55.bike properly or break myself properly, so we will call it a day
:25:55. > :26:04.there. So where do you go when you're down
:26:04. > :26:08.but not out? Chris has come to London. To a Dragons Den-style
:26:08. > :26:16.event for social entrepreneurs. Up for grabs - �50,000 worth of
:26:16. > :26:20.business funding and support. not looking for someone who is
:26:20. > :26:25.super slick. I am looking for somebody who has thought carefully
:26:25. > :26:28.about their business proposition, who understands the markets,
:26:28. > :26:31.understands the customers and the competitiveness, and applies some
:26:31. > :26:34.common sense and have thought through what might work and what
:26:34. > :26:42.might go wrong. Like his rivals, Chris will have to pitch his idea
:26:42. > :26:46.to three experts. He has already invested �7,000 of his own cash in
:26:46. > :26:54.the idea so it there is a lot at stake.
:26:54. > :26:58.How big a deal is this? It is huge. The pitches are under way. But an
:26:58. > :27:05.audience vote will decide the winner. Not the panel. Rockets mean
:27:05. > :27:09.yes. Flying pigs, no. I am going to show you the bike I bought for
:27:09. > :27:14.myself last year when I decided I wanted to go mountain biking with
:27:14. > :27:20.my wife and son. This is a video clip of me riding a trail that my
:27:20. > :27:30.wife and my son right, I have watched 11-year-old kids write down
:27:30. > :27:32.
:27:32. > :27:35.I need �49,000 to be able to get this design into production and to
:27:35. > :27:41.start selling bikes to people who need them and I have got people
:27:41. > :27:51.queuing up. But are the Dragons and the audience queuing up to back his
:27:51. > :27:53.
:27:53. > :27:58.idea? It's an overwhelming yes. I think
:27:58. > :28:03.Chris de it stand out as having such a clear sense of purpose. --
:28:03. > :28:08.Chris did stand-up. For me it I was glad it was one the audience went
:28:08. > :28:13.with. I am blown away. The money and support that will come with it,
:28:13. > :28:17.fingers crossed. This is it. We will be on our way now. So it's
:28:17. > :28:21.goodbye to the bone shaker. Chris hopes to start production on his