21/01/2013 Inside Out South

Hello. Tonight we are on patrol with the volunteers providing vital

support to the West Midlands ambulance service. There were

around awful lot of poorly people yesterday. It will stop you getting

glaucoma. Which would you choose? And the secret to live in 10 years

longer. Does more wealth mean better health? Poorer people tend

to buy the Paul Auster -- strong staff. The kids tend to get as much

down their throat as they can for as much -- little money as possible.

First tonight, it is being called the biggest reorganisation of the

NHS since it started 65 years ago. It has been hugely controversial

and it is costing billions of pounds. But what exactly will

change when it happens in 10 weeks' time? 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 wonky. 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

in existing hospitals. But that could be to the benefit of patients

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

outcomes by concentrating those services in fewer hospitals.

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 customers had been queuing not for their life savings

but for life-saving surgery. 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. The third thing patients

may notice is a shift in their relationship with their GP. So if I

said, "Trust me, I know the best place to go to get your heart

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

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

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

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

themselves referring patients to their own services. Add private

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

interest. So just open really wide. Say "ahh." Ahh. That's great, thank

you. 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. Would 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 to go today. Last

chance! With changes in how we by health

provision is -- comes the hope that some of those age-old conditions

will be fixed. Things like alcohol abuse, obesity and smoking. We all

know what is bad for us but we just keep on doing it. In Portsmouth,

for decades, healthcare professionals have been trying to

work out a problem which just as not seem fair. Why people who are

less wealthy died much earlier than those just over the road with a bit

more money. Louisa Bennett is a mother of two

lively children and she's expecting a third. She does her best on a low

income and benefits, but there's a problem. She has diabetes, often

caused poor diet and lack of exercise. It's putting her and her

unborn baby at risk. I am 38 weeks pregnant but obviously because I

have type 2 diabetes, I am going in tomorrow to be induced early

because obviously I have got quite a big baby. I am getting very

nervous but I cannot wait to meet him. With each pregnancy I have had,

I have then had to have insulin through my pregnancy. I have to

inject myself three times a day and also check my blood sugar levels.

Any normal pregnancy, you're only go to see the midwife sort of five

times throughout your pregnancy. Whereas I have to go to the

hospital every fortnight to see the diabetic team. And every four weeks

to be scanned. Steve has other problems. He needs to lose 12 stone.

That's half his body weight. In Portsmouth, if you're overweight

and live in a poor area, you are likely to die ten years sooner than

your rich neighbours. I have always been big. I have always been the

size really. This is the bigger -- I am not really a big eater. I

cannot eat three curries. I'd pick foot through the day and I drink

quite a bit of a cult. 15 pts quite easily which does not help. Hello

the road in Portsmouth. Food shops are everywhere. -- London Road.

This is where you shop for yourself and your children. In it is easy to

give your children chocolate and crisps. They have got to have that

in their diet even though it is not ideal. Do not give them this and

that... People do not. It is about their kids. In many deprived areas,

health problems are passed down generations. What was it? Lung

disease, but I have had none at all. It's just carries on and you do

what you want to do. I do smoke but not as much as he smokes. I do not

want too much stress at the moment. But I do smoke because it is easier

than not it's making. Hello life is stressful. We have both got young

kids. I think it is important that you do get something for yourself

at the end of it. I think a cigarette every now and then is not

the end of the world. Everybody has got a choice about what to eat and

drink. But money is tight and fast food is cheap and it is easy to

make unhealthy choices. The new GP group in Portsmouth said that

living in poor areas does push people into making dangerous

decisions. Especially in Portsmouth, low income affects the way in which

people access services. It is not just help but they behave

differently. It is different. Some people in lower social and economic

groups drink and smoke more and their diets might not be what we

would want. And also the environment in which they live is

challenging. That is the housing side of things and also aspects of

their education. We tend to find patients in Portsmouth where public

-- the public ignore symptoms. But also, maybe because of their need

to carry on working and providing for family, as a result of that,

when they present the conditions that we are presented with, they

are more advanced. Especially conditions such as cancer. That

tends to be at a more advanced state and challenging to treat.

Louisa is at the Queen Alexandra Hospital. She is being induced

because of her diabetes. It means that there should as might be

raised during pregnancy. If there sugars are raised it will affect

the baby and they are likely to put on more weight on the trunk of the

body, including extra padding around the shoulders and stomach.

This can make for difficult deliveries. The shoulders can get

stuck or a difficult delivery with a Caesarean section. A Because I am

eating so much and diabetes as well is generally for larger people

anyway... Obviously if I looked back at my time now, eating

healthier back then, you know, are quite would not have been so big. I

would have exercised more and not been as big. I would have

definitely changed my lifestyle. Drinking lots of the air, going to

the kebab shop on by way home. I was not healthy at all. There was a

time when I could not even run properly, after having children. It

is not what you want for your family. You want to be able to go

out and play with them and be a mother. I am losing weight and I am

going to continue doing that. notice that type one is pretty

static. We have not had any big increases with type 1 diabetes with

ladies. We have definitely noticed an increase in typed it. And these

are ladies under 45. -- type two. We should not be seeing that and we

are. Some times, three generations of the same family are getting

diabetes, one after each other and diet is usually to blame. Steve

Nelson's days of eating too much are about to come to an end. He is

having an operation to shrink his stomach and it will cost the NHS

�10,000. If it works it will pay for itself in three years as his

health improves. Today's I am doing an operation which should help him

Roose significant weight. His weight has become a real problem

for him. -- Louis significant weight. -- get rid of. He knows he

has to lose weight. Surgery is the only way that is going to happen.

am overweight. I am down as being overweight. In 2000 I had pneumonia

and was taken to hospital. I have not smoked since 2000. I had a

problem with my lung which came from pneumonia and being laid up in

bed. It was a bit of a shock and it scares me a bit. A unfortunately,

as a country and as a society, we are facing an increase in obesity

severe enough to cause illness. And while prevention has to be the main

thrust, unless we treat the people that have found themselves in the

obesity trap, we will not make headway and the NHS will always be

under pressure from people with illness caused by their weight.

That goes along with social and economic class and access to good

food and good habits. What I am going to do is I am going to take

what should be going into your stomach and create a short cut so

that the food goes straight into his intestine. Unfortunately, it

means I am operating on a perfectly normal digest its system in order

to stop people eating. About half of obese patients have lost their

jobs because they are so big and three-quarters come from low-income

families. He is now doing to hand and 50 operations per year. -- 250.

I'm wish I did not have to do that. But it is the only thing that works

for people severely overweight and there are more each year. He is

reducing his stomach from the size of a melon to the size of an egg.

Alcohol, all social classes drink it but you are four times more

likely to die from it if you are poor. Cliftons is well known in

Portsmouth and he is dancing with the cheapest alcohol that he can

buy. I am happy with no alcohol. Alcohol is nothing. It ruins my

life and it ruins eternity. I have had alcohol for 26 years. It is not

in my family. I am the alcoholic! I do not need alcohol! I am addicted.

White cider is a popular drink. There is almost as much alcohol in

three litres as in a bottle of vodka. It is a very high-strength

cider and we have got high-strength lagers and it varies. The poorest

people tend to by the strong drinks and other people by strong drinks

as well because of stress and the children get as much as they can

for as little as possible. You can buy a couple of bottles for as low

as �2.50 and a 1 litre bottle for one pound 59p. Very cheap.

river bus has turned up to offer free scams but it is often not be

able that they need to reach that turn up. -- the liver baas has

turned up for free scanning. More people die of liver disease in

Portsmouth than almost anywhere else in the country. The main thing

we try to do is make people aware that it is important to keep your

liver healthy. We have got increasing liver disease in this

country and more people are dying of liver cancer and related issues.

We are trying to change that. not going to hurt... It is not

invasive. It takes a few moments. It is like an ultrasound. It shows

when the liver is scarred and damaged. The amount of drinking is

what could be considered a harmful level and it could endanger your

help. As a step is advice on how to keep your leather healthy. It does

not seem to be damaging your liver. Especially keep away from saturated

fat and look at carbohydrates. If like myself you are a bit

overweight you can start to reduce that. Likewise with alcohol, people

might be buying some of the cheaper alcoholic drinks, certainly some of

the cheap cider and lager, they are eight big issue, because they are

packed full of units. Consultant Richard Aspinall sees many people

with liver damage. On average they drink nine bottles of vodka every

week, or 20 bottles of wine. Just 10% of them have jobs. For some

people it is about getting away from alcohol. You have got them

advertised on billboards and bust shelters and buses driving past and

it is in every convenience store and petrol station and if you turn

on your television, all set operas are centred around a pub at

lunchtime. And I turned on my radio on the weighty work this morning at

half past six and we had an advert for cider and it is impossible to

get away crumpet. We must be aware about the -- it is impossible to

get away from it. The youngsters drink these and they are very

strong. They drop them inside drinks, these sized classes in a

pint and knock it down. It is binge drinking. It is not my generation

at all. It has definitely changed. These are very popular. The

youngsters are not drinking because they liked the taste of it. They

are drinking it because they want to get drunk. It is as simple as

that and that is why the market is full of these new shops and that

sort of things with different coloured fibres, mint, hazelnut, it

takes that Labour out of the drink. -- flavour. I had got people that I

drank and some people are trying to make a living. I am not saying that

it is right that people did that but it is not my place to police it.

Without a doubt it is strong alcoholic staff causing problems.

Interestingly up in Suffolk they have got a scheme asking all off-

licences in a certain area to take certain drinks away from shells of

and terribly. I think they found out that out of 120 off-licence

shops, 80 agreed. I think that is a great way forward. It are I was

told to stop selling a certain type of drink and everybody agreed, that

would be fine but you cannot have 10 people doing it and 20 not doing

it. That would be great. The end NHS is changing but the challenge

of low income as and poor health is not. At the end of the day we have

to appreciate people have a choice. People can choose to do the wrong

thing but we have to get them the opportunity to do the right thing.

Louisa has had her baby. Jack weighed almost �10 and had problems

with his breathing and was taken straight To neonatal care and 10

days later she left hospital without him. It was not nice him

being taken away from me but he is in the best place and I feel fine.

As long as he is being looked after that is my main concern and he will

be home I hope in 80 days. -- in a few days. He is operation was

successful and his small stomach means he will be on a strict diet

for the rest of his life. A couple of spoonfuls of porridge. 1

teaspoon of yoghurt, for Breakfast. Totally filled up. They make time

for exercise. Mashed potato and gravy, three spoonfuls and I felt

bloated but builders do not. Maybe it is a class thing. Maybe it is

when he won on a nice job and it is part of your lifestyle to go to the

gymnasium and had a flash car. But council estate people, it is not

part of their lifestyle. It is going down to the park. And if you

are thinking of changing your life and becoming healthier this year I

would like to hear from you. We are looking to hear from a ball that

are cutting back on cigarettes, alcohol, or kebabs. Contact me...

That is it for now. I will see you next time. Next week, a crash

course in the classics for one group of children. Its 200 years