21/01/2013 Inside Out South West

I'm Sam Smith and this is Inside For 65 years, the National Health

Service has been there to look after us when we are ill but in 10

years' time, the NHS will undergo the biggest reorganisation in its

history. What all that need for patience. We asked Phil Hammond to

investigate. This is lovely, madam, because this inhaler would actually

go with your coat. And a free examination. Do you want to come

here and cough, sir? I can give you those half price. Plus something

for your water retention. I'm a GP. And today I'm taking

healthcare into the community, where it's needed.

All the sample bottles you could ever need and I'll throw in a

crutch. It's all free. It's all paid for.

This is what the biggest shake-up in the history of the NHS is all

about - giving local doctors, nurses and patients the chance to

call the shots and shop around for the best care. At least that's the

Government's plan. But many doctors think the reforms are untested,

expensive and over-complicated - a view I shared with the former

health secretary Andrew Lansley. The difficulty with this is that

it's 353 pages of wonk. It's absolutely impossible to understand

it. I choose my words carefully. It is unreadable. What did you

actually say? It's wonk But I've been wading through the jargon, and

it's clear the reforms will affect us all. It's vital we put politics

aside and try to understand exactly what they'll mean for patients.

Until now the NHS has been like a big supermarket chain that only

sells its own brands. It's a one stop shop where all the tricky

decisions are made for you. In theory, you should get the same

high quality care whether you live in Scunthorpe or Southend. But like

any monopoly, it's far from perfect. The Government's bringing in the

market place model instead - introducing more choice and

competition, and putting GPs in charge instead of civil servants.

But will it work? So if I just check your eyes there... I can

confirm you have two eyes. We're doing two X-rays for the

price of one. And I can throw in a free brain scan if you like.

One change we're told patients should notice is care much closer

to home. Hospitals and GPs will have more freedom to bring in

innovative ideas. Technology might monitor your health at home and

routine surgery could be done at high street clinics. Hospitals in

Gloucestershire have already teamed up with a charity to send this

mobile chemotherapy unit into rural communities. For cancer patients

like Graham Freeman, it's a lifeline. The concept is great,

moving the treatment to the person. Because it is a bit of a trauma,

suffering from the chemotherapy and the travelling. Bringing the

treatment closer to the person is a lot better. You do feel a little

bit better. But could this shift towards more localised care mean

hospitals will have to close? To find out I've come to London, to

one of the world's most respected independent think tanks on health

policy - the King's Fund. I don't think we'll see many hospitals

closing as a result of care coming closer to home. It will mean

hospitals changing their roles, perhaps fewer A&E departments,

fewer maternity services provided But that could be to the benefit of

patients if we're able to plan that in the appropriate way and get

better outcomes by concentrating those services in fewer hospitals.

You might not be keen though, if it's your A&E that's closing. The

second thing patients should notice is more choice.

Three tomatoes for �1! Anybody? Three inhalers for the price of two.

Come and get them! Two caulies, �1.50 over there! We've got a

separate queue here for six symptoms or less. Competition in

the NHS isn't new, but the reforms step it up a notch. The NHS will

become a marketplace, with private companies competing with the NHS

for business. So when your GP says you need a scan, your options may

look less like this, and more like this. But it should be quality, not

price, that will decide which are allowed to offer care. It's already

happening here on the high street, where Specsavers are treating NHS

patients in 218 of its hearing centres. When I came to Specsavers,

they do private and NHS, which I find is better than going to the

hospital. You know, you go to the hospital, there's a lot of

travelling and I don't think you get such a personal attention. So

this is much, much better. When you press the button in, you'll hear

two beeps which will allow you to use the telephone then. The plan is

for patients like Doreen to choose their provider by looking at new

performance league tables. But companies must play by the rules

and can't encourage NHS patients to go private. Ultimately, Specsavers

want to protect the NHS work that we've managed to gain here and we

don't want to do anything to try and jeopardise that. We're not

going to try and sell a hearing aid, upsell a patient at all during that

time. Market competition could drive up standards and lower costs.

But if profits slip, companies could pull out or even go under,

leaving patients in the lurch. Remember the collapse of Northern

Rock? Imagine if its customers had been queuing not for their life

savings but for life-saving surgery. If there is going to be a bigger

role for private companies in delivering care to patients, then

there is always a possibility, however remote, that that company

will not be successful, that we will see something like Northern

Rock in healthcare. The Government's anticipating that.

It's putting in place what's called a "failure regime" so that the

regulator can intervene and ensure continuity of services even if the

organisations are not providing care to the right standard.

third thing patients may notice is a shift in their relationship with

their GP. So if I said, "Trust me, I know the best place to go to get

your heart surgery." Would you say, "Yeah, you're the doctor. Dr Phil,

you look like a ginger George Clooney. I love, I trust you."?

Since the birth of the NHS, doctors have taken the trust of patients

for granted. But as GPs offer more and more treatments, they could

find themselves referring patients to their own services. Add private

companies into the mix and there's real scope for a conflict of

interest. But should we really be worried? In Bath, Jasmine Bishop is

seeing a GP on the NHS. But believe it or not, he actually works for

Virgin. Yup - they of planes, trains and super-fast broadband

fame also run this walk-in centre, along with 170 other NHS services.

Although you wouldn't know it from the branding. As Virgin takes over

more of the NHS, what's to stop you referring patients on to another

Virgin service to make money for the company, rather than in the

best interests of the patient? of our GPs, like any GP in the

country, have to offer patients a choice when they're being referred

for another service. So in the end, it's down to the patient to choose

where they go. And of course, GPs and other clinical staff have a

professional responsibility too to make sure that they're finding the

best care for their patients. That doesn't differ because those GPs

are employed by us. And you have to ask if patients really mind who

provides their care. Did you know that this health

centre was run by Virgin? No. it make any difference to you as a

patient whether it's run by an ordinary NHS GP or a private

company? No. So all that matters to you is what? What do you care about

in your treatment? That I get the best treatment I possibly can get

really. Which of these sample bottles would you like, madam?

We've got three on choice today. The bottom line is that if you have

a good idea to improve your care, tell your GP. If he or she can make

it happen, we know the reforms are working. It's been a huge upheaval

just to get the NHS to listen to patients. And I hope for all our

sakes it works. I can't lug all this back again. Come on, it's got

The promise of care closer to home and more choice but what is the

reality in the south-west, where big changes are already under way?

We have been in Cornwall finding out.

When 87-year-old Edie became ill on Christmas Eve, she went straight

into her community hospital. This has been great because it is two

minutes up the road. alternative would have been a long

drive to Barnstaple hospital. an hour to and from Constable, and

a lot more of the struggle of fiercely. Getting a bed so close to

home has been invaluable. They were nice to me in Barnstaple or but if

I had a choice, this would be my first choice. Because it is more

like light and not so noisy. Why have got no complaints about being

here at all. Rosemary is also grateful to have a community

hospital on her doorstep. She runs would working classes for adults

with learning disabilities. We have staff that tap into this. We are

using tools. The hospital is very close and it means if there is a

cut that needs a little bit more than a plaster, it is very quick

Foster run him in and get it seemed to and we are back. -- very quick

for us to run them in. Cornwall's community hospitals are valued by

many and they are at the forefront of the seismic change of the NHS.

For decades, 14 community hospitals were part of the NHS but in October

2011 they were handed to peninsula Community Health, a not-for-profit

but private social enterprise company. It is one of the biggest

in the region, with 2200 Staffs. Such changes have proved highly

controversial. One leading academic says the National Health Service as

we know it has gone for good. April, there will be no National

Health Service. The duty on the Secretary of State to secure and

provide comprehensive healthcare in England is abolished. And so what

is taking its place is a number of quangos and bodies which have

extraordinary new powers to decide what k you will get and what care

you are entitled to -- what care. Over time people will come to

realise we have fewer and fewer entitlements to health care and

they are expected to pay for more out of pocket so it is an

absolutely terrifying time for the local community and they need to

really galvanise and understand that the implications of this Act,

in April, will end the National Health Service as we know it.

government denies this is the case. It says care will remain free at

the point of delivery and that the changes will increase choice and

efficiency but in Cornwall, critics say their fears about what they see

as the market position of the NHS already been realised. Since

peninsula community health tip over, beds in several hospitals have been

shut. 48 remain closed last month. This hospital near Penzance has

been shut entirely to impatience four times and remains closed today.

-- impatience. Campaigner Graham Webster says closing this hospital

has put pressure on others, resulting in overcrowding.

Something peninsula deny us. 2013 will be a significant year of

change for the health service, some good and some bad. We have recently

received this evidence which indicates that nearly all of our

community hospitals are operating above the national standard of 85%,

which is considered to be the optimum figure for delivering safe

and high quality care. These up occupancy rates. Many of our

hospitals are exceeding 90% and former hospital is operating at

nearly 96%. The company says these patients are transferred under

clear criteria, do not be specialist care, there is no

problem with this. We do not accept that. Any figure above 85% is

compromising patient care and we believe that patients are being put

at risk. What of the elderly patients who would have been

admitted to the currently closed beds? Peninsula Community Health

says some are being cared for at home, others in hospital elsewhere.

But Carolyn, who used to run at hospital and is still closely

involved as chair of the league of friends, it is a worried. How do

you feel about the fact the hospital is closed? I feel a bit

apprehensive about the care they are getting in the community. There

are some very vulnerable people out there. They need to be looked after

occasionally and looked at. I am afraid that is not happening. So

yes, it worries me to think that there are vulnerable people there.

Peninsula blames a shortage of nurses for the bed closures and

says it is recruiting hard and hopes to fill the vacancies. But

one key reason why nurses may not want to move into private companies

like this is that they can't take their NHS pension with them. The

Royal College of Nursing said it warned the government this would

cause staffing problem has. It is still important immerses to know

that they have a particular amount and a particular support to look

forward to -- important to nurses. The new pension arrangements to

people moving in a substantially less. We do not have figures yet

that will indicate how much people will receive at the end of it but

substantially less is clearly the answer. Some campaigners believe

the bed closures are deliberate, bringing in private companies can

mean higher overheads and when the changes happened in Cornwall,

Graham Webster predicted services will be cut as a result. Health

initiative Cornwall at the time forecast that peninsula community

help could not continue to provide the same level of services as they

did when they were in the NHS. The reason is evidence to suggest an

increase in overhead charges such as corporation tax, professional

services, which meant that a significant proportion of their

budget would be reduced to meet those costs. And you put a figure

on that. We estimated at the time �3.5 million additional costs.

man in charge of peninsula Community Health says staff

vacancies and bed closures are not part of a deliberate plan to save

money. Have you had to close beds because of increased costs because

you are private companies? No. When we were set up there was an

acknowledgement there would be some increased costs. There are issues

which apply to non NHS organisations and in particular the

taxation system, which works in such a way we are liable for tax.

The critics are saying the only way you are going to achieve that

financial position is as a result of having these beds closed and not

recruiting staff in a timely manner. That you have done it deliberately

to balance the books. We have not done that, I assure you. We had to

take a decision to run as safe serve as. Anti- insists that

hospital wards are not overcrowded. -- and he insists. Rock critics are

saying you are not delivering a safe service because you have too

many people in your community hospitals -- your critics. We try

and make sure that we have the appropriate staffing levels on all

of our hospital wards at all times. But you have a staff shortage.

had a shortage at a time which came together for a variety of reasons.

We took decisive action to resolve that. A review team led by GPs is

now looking at all community health services in Cornwall and that is

likely to decide the future of the sort of facilities patients like

the devalue so much. The future shape of the NHS is one we were

also discovered in the months and Next tonight, the story of a former

soldier from Devon who is not letting injury stand in the way of

his dream. We have been following Chris Jones as he discovers the ups

and downs of bringing the daredevil sport of extreme biking to everyone.

It's fast, its furious and for Chris Jones, it's the ultimate kick.

You look at the speed these guys are going down the tracks at and it

is the adrenalin rush. The feeling you get flying around these corners.

And getting airborne. You are not going to get it everywhere else.

But the leg injury he suffered in an accident in the Army means Chris

can't take part. Only help out. can lift your weight off the bike

to make it light, you can push it down to compress into corners so

you bounce up with more speed and it is all stuff you do with your

legs and I just cannot do it. very frustrated at the moment. It

is dealing with that that is quite hard for him. It is hard work

sitting and watching but he is still involved.

There is an off-road option for people with disabilities. For

�3,500, you get one of these. But it's not designed for the extreme

courses Chris and others want to tackle. I guess really I am looking

to come up with a bike that I want to ride but in the knowledge that

there must be other people out there who want to ride the same way

that I do and just because their legs don't work properly any more,

why should we have to put up with second best, not even that? Chris

has come up with a radical new design - putting two wheels at the

front one at the back. Today he's go to find out what else needs

changing. This is the start of the open track. This is the easiest

track that the riders have got and I am going to go down it and

hopefully show you what it is like to do it on this bike and point out

some of the problems that I have. The biggest problem really is that

I have got one wheel at the front and two at the back and that makes

the bike really quite unstable. Cornering is one of the biggest

problems so my bikes will be the other way round but also this has

got no suspension, it only has one caliper brakes on the front, and

you can see where we have had to brace it up because they were not

strong enough to do this kind of writing. Because I have sat near

the back axle it is fairly stable but very easy to get it wrong.

Straight away you can see the first problem with this bike, because it

is driven at the front wheel, it is very difficult to get traction on

any up slopes. Although these are downhill tracks, there are sections

That looks so fun. We were down earlier on the wooden bit and you

jump off, have you done that? can't do that. There are some

places I can't get to because it is quite wide and I have three wheels.

Delving down here, this is the corkscrew, a continuation of the

open track. It disappears to the left and drops very sharply. It is

If you are going to slow, you crash. If you go too fast, you crash. You

have to get it just bang on. This is probably the most difficult part

A are you all right? What happened? I went to High And I clipped the

top of the Bank and it got the back -- I went too high. Ouch.

You can see the line that my wheel took. There is a little bump and it

flicked me up and out. That is the way the course is. It is the bike,

up the bike is wide and so it is not stable and so as soon as the

baccy and comes up, I am effectively trying to write down on

one wheel. -- the back end comes up. As much as I want to go and do It

again, the chances are that I will crash it again and either break the

bike properly or break myself properly, so we will call it a day

there. So where do you go when you're down

but not out? Chris has come to London. To a Dragons Den-style

event for social entrepreneurs. Up for grabs - �50,000 worth of

business funding and support. not looking for someone who is

super slick. I am looking for somebody who has thought carefully

about their business proposition, who understands the markets,

understands the customers and the competitiveness, and applies some

common sense and have thought through what might work and what

might go wrong. Like his rivals, Chris will have to pitch his idea

to three experts. He has already invested �7,000 of his own cash in

the idea so it there is a lot at stake.

How big a deal is this? It is huge. The pitches are under way. But an

audience vote will decide the winner. Not the panel. Rockets mean

yes. Flying pigs, no. I am going to show you the bike I bought for

myself last year when I decided I wanted to go mountain biking with

my wife and son. This is a video clip of me riding a trail that my

wife and my son right, I have watched 11-year-old kids write down

I need �49,000 to be able to get this design into production and to

start selling bikes to people who need them and I have got people

queuing up. But are the Dragons and the audience queuing up to back his

idea? It's an overwhelming yes. I think

Chris de it stand out as having such a clear sense of purpose. --

Chris did stand-up. For me it I was glad it was one the audience went

with. I am blown away. The money and support that will come with it,

fingers crossed. This is it. We will be on our way now. So it's

goodbye to the bone shaker. Chris hopes to start production on his