21/01/2013 Inside Out South


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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


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