:00:00. > :00:15.Denied, how were you live can seriously affect your health. The
:00:16. > :00:20.fact that I have to pay for my treatment, it is criminal, it is
:00:21. > :00:26.absolutely criminal. Sorry. In a special programme, we are asking, is
:00:27. > :00:29.the NHS really a National Health Service? If I lived in a different
:00:30. > :00:35.part of the country I would be entitled to some kind of funding and
:00:36. > :00:41.I would not have to sell my house. And surviving blue Monday. How
:00:42. > :00:48.having a laugh could save your life. I'm loving it already, I'm loving
:00:49. > :01:00.it! Welcome to the new series of Inside Out West.
:01:01. > :01:08.We have all seen the headlines, not enough money, too many patients, the
:01:09. > :01:12.NHS is under pressure like never before so is rationing health care
:01:13. > :01:19.the answer? Chris Jackson has been investigating. The NHS is facing the
:01:20. > :01:23.most significant financial challenge in its history.
:01:24. > :01:25.There are fears the service we have grown up with is
:01:26. > :01:29.Absolutely there is a postcode lottery.
:01:30. > :01:44.So is the NHS in danger of ceasing to be a national service?
:01:45. > :01:47.When everyone is entitled to the same care?
:01:48. > :01:49.It's treating more patients but is it becoming a postcode
:01:50. > :01:52.lottery, where access can depend on where you live?
:01:53. > :02:12.It feels like my bones are actually screaming at me at times.
:02:13. > :02:13.33-year-old Ben Franklin has hepatitis C.
:02:14. > :02:15.The virus can cause life-threatening liver damage.
:02:16. > :02:24.I've been off sick and could possibly lose the flat over my head.
:02:25. > :02:27.There are new drugs that could potentially cure Ben's hepatitis.
:02:28. > :02:37.All I got was "Wait", basically, because my liver wasn't bad enough.
:02:38. > :02:44.That made me want to go out and just get absolutely wasted
:02:45. > :02:46.and ruin my liver just so they would treat me.
:02:47. > :02:50.But I wouldn't be surprised if somebody else would.
:02:51. > :02:52.The money is there for just over 10,000 treatments.
:02:53. > :02:57.It is claimed that means there are no queues in parts
:02:58. > :03:03.of the North and long waits in places like London.
:03:04. > :03:06.Two people with exactly the same state of liver damage could present
:03:07. > :03:09.themselves in different parts of the country and in one they'll be
:03:10. > :03:13.able to walk in and get hepatitis C treatment immediately and get cured.
:03:14. > :03:16.In another part of the country they may go there and be told,
:03:17. > :03:17."Sorry, you're going to have to wait."
:03:18. > :03:23.NHS England told us it was regularly reallocating unused
:03:24. > :03:33.hepatitis C treatment to places with waiting lists.
:03:34. > :03:37.The number of patients treated will increase by 25% next year.
:03:38. > :03:41.The fact that it's down to money, that upsets me the most.
:03:42. > :03:49.So Ben is taking the risk of treating himself with cheaper
:03:50. > :04:05.The fact that I've had to pay for my treatment, it's criminal,
:04:06. > :04:22.I'm just tired of being tired, basically.
:04:23. > :04:26.Ben is hoping the generic drugs will cure him within a matter of weeks.
:04:27. > :04:34.The Hepatitis C Trust estimates around 1000 people in Britain may
:04:35. > :04:43.If you go outside there are halos around light.
:04:44. > :04:48.It's often hard to see things. They are distorted.
:04:49. > :04:50.Gloria MacShane has cataracts in both eyes.
:04:51. > :05:03.Go up or down stairs with any kind of confidence.
:05:04. > :05:10.Cataracts are supposed to be treated within 4 1/2 months of referral.
:05:11. > :05:13.Gloria lives in the North East and says she has been waiting seven.
:05:14. > :05:17.Because there's such potential for accidents and there is such
:05:18. > :05:21.If Gloria had lived in Luton, her weight could have been
:05:22. > :05:26.Absolutely, there is a postcode lottery.
:05:27. > :05:33.having poor systems, budget pressures and
:05:34. > :05:38.That does not feel too national to me.
:05:39. > :05:45.Gloria expects to get her operation later this month.
:05:46. > :05:48.It really makes me angry because I think that it's almost
:05:49. > :05:55.Clinical Commissioning Groups, or CCGs, control health budgets.
:05:56. > :05:57.It is claimed some are delaying treatments like cataract surgery
:05:58. > :06:02.Others are requiring patients to lose weight
:06:03. > :06:09.before getting operations like hip replacements.
:06:10. > :06:10.Postponing an operation in these circumstances
:06:11. > :06:20.Whilst the CCGs say it can be clinically justified
:06:21. > :06:22.the Royal College of Surgeons says it can't.
:06:23. > :06:24.There is very good evidence people are now not getting
:06:25. > :06:26.elective operations, which they desperately
:06:27. > :06:29.sometimes require, simply because of financial restrictions.
:06:30. > :06:36.It is up to the clinicians to decide who should have what treatments.
:06:37. > :06:38.Therefore a bureaucratic system producing a blanket ban
:06:39. > :06:46.It is also claimed new systems for vetting appointments
:06:47. > :06:48.with specialists are another form of rationing.
:06:49. > :06:52.Why are they treating their patients with such contempt?
:06:53. > :06:57.Last month MPs complained about a private company
:06:58. > :07:00.being paid ?10 for every GP referral they stopped.
:07:01. > :07:11.and has the potential to compromise safety.
:07:12. > :07:13.The same private company oversees referrals in North Tyneside.
:07:14. > :07:15.We spoken to doctors who say the system is
:07:16. > :07:20.The GPs, who fear speaking out, have told us that cancer
:07:21. > :07:26.I tried to get a patient referred to a dermatologist.
:07:27. > :07:28.The referral Management service said it was
:07:29. > :07:32.a skin lesion and rejected it. That was a disaster.
:07:33. > :07:34.It was a nasty, invasive skin cancer.
:07:35. > :07:40.They are putting up barriers, using delaying tactics.
:07:41. > :07:45.It is getting between the doctor and the specialist.
:07:46. > :07:48.In a statement North Tyneside CCG said there was no evidence
:07:49. > :07:53.the system caused additional risk or delay.
:07:54. > :07:56.Cancer referrals do not go through the system
:07:57. > :08:06.The number of referrals knocked back the GPs in England has risen
:08:07. > :08:13.You can see the details of our research online.
:08:14. > :08:16.Shortage and regional difference have always been part of the NHS.
:08:17. > :08:18.Today the differences could get much worse.
:08:19. > :08:21.The NHS is under an unprecedented level of pressure at the moment.
:08:22. > :08:24.If it does not get more funding, waiting times
:08:25. > :08:30.and the quality of patient care is going to suffer.
:08:31. > :08:32.We will see different decisions taken in different parts
:08:33. > :08:34.of the country and different services being
:08:35. > :08:45.One of our most prominent medics is clear.
:08:46. > :08:48.No, it is not a national service. It is now a local health service.
:08:49. > :08:51.I think it matters because it leads to inequality in health care,
:08:52. > :08:55.Some people will get health care for free and others will not.
:08:56. > :08:58.In a statement, of the Department of Health told us that far
:08:59. > :09:06.from rationing more people than ever are getting prompt treatment
:09:07. > :09:08.3,261 cancer patients are being seen every day and that
:09:09. > :09:12.We asked the health secretary and NHS England for an interview.
:09:13. > :09:15.The people actually paying for NHS services,
:09:16. > :09:23.the clinical commissioners, did agree to speak.
:09:24. > :09:25.It is a national service with local variation based
:09:26. > :09:28.Demographically populations vary significantly from town to rural,
:09:29. > :09:33.It is very important we commission and respond to the needs of that
:09:34. > :09:40.It is about making sure the pathway is correct.
:09:41. > :09:42.We do not want to squander any money.
:09:43. > :09:44.We have limited resources so it is really important we spend
:09:45. > :09:48.most effectively and get the best value for our population.
:09:49. > :09:50.For those forced to take their own action,
:09:51. > :10:07.One NHS treatment seriously under the cosh is IVF, and it could get
:10:08. > :10:12.worse here in the West. Doctor Dawn half has been to meet one couple was
:10:13. > :10:23.remodelled having a family is hanging in the balance -- Doctor
:10:24. > :10:27.Dawn Parker. It can be the happiest time of your life but not for
:10:28. > :10:31.everyone. I was lucky enough to have my children without difficulty but
:10:32. > :10:38.for those who do not conceive so easily, support for the NHS is
:10:39. > :10:45.disappearing fast. In some parts of the country, there is no funded IVF
:10:46. > :10:53.treatment offered at all. Is the west of England in danger of
:10:54. > :11:04.becoming the next IVF blackspot? I've come to Somerset to meet one
:11:05. > :11:07.couple trying for their first baby. Jade and her husband, Nathan, have
:11:08. > :11:13.been together four years and got married a year ago. When did you
:11:14. > :11:17.decide you wanted to start a family? When we first got together there was
:11:18. > :11:22.always an understanding that it would have to be soon because I am
:11:23. > :11:28.35, and after a year we started trying. And yes, nothing. You have
:11:29. > :11:36.been trying for three years now. Four years. And at what point did
:11:37. > :11:42.you start thinking it wasn't working? About 18 months ago,
:11:43. > :11:45.really. And I guess people around you were getting pregnant and that
:11:46. > :11:55.cannot have been easy. Yes, my friends started families in between
:11:56. > :11:58.the times that we have tried to start a family. Jade and Nathan went
:11:59. > :12:04.to their local NHS for fertility treatment. You have invested a lot
:12:05. > :12:10.of time and emotion into this now. Where are you at the moment? At the
:12:11. > :12:15.moment we have just started IVF treatment. I have just been on the
:12:16. > :12:26.tablets. I am just finished with those tablets. And this is funded by
:12:27. > :12:33.the NHS? It is. What will happen if this does not work? We're hoping
:12:34. > :12:40.that we have another go, because we have been accepted for two cycles of
:12:41. > :12:45.IVF. So we're hoping that we will get another go, after this, but I
:12:46. > :12:50.understand that the CCG have changed this, so I don't really know. So
:12:51. > :12:57.there is some doubt as to whether they can provide that. Yes. How does
:12:58. > :13:06.that feel? Heart-wrenching. Jade's concern comes from the fact that her
:13:07. > :13:11.local NHS Clinical Commissioning Group cut funding to ?3500 per
:13:12. > :13:17.patient, enough for just one IVF cycle, completely at odds with the
:13:18. > :13:24.recommendations. These are the NHS guidelines. They state that every
:13:25. > :13:32.woman between 23-39 should be offered three cycles of IVF, not
:13:33. > :13:37.one, not two, but three. To understand why that's so important,
:13:38. > :13:43.you need to go back to 1978 and the birth of the first test-tube baby,
:13:44. > :13:46.Louise Brown, two Bristolian parents. At that time doctors
:13:47. > :13:52.estimated one and a million chance of success. Since then the procedure
:13:53. > :14:01.has been refined but stayed largely the same. Eggs from the woman are
:14:02. > :14:05.fertilised with sperm, one fertilised egg is put back in the
:14:06. > :14:09.uterus and the rest are frozen and used if the first doesn't work. All
:14:10. > :14:15.of this is known as one cycle of IVF. Today, as many as 40% of IVF
:14:16. > :14:20.cycles result in the birth of a child. But there is a best case
:14:21. > :14:27.scenario, and for many couples, the success rates are much, much lower.
:14:28. > :14:32.For them, more than one cycle is essential but, even though the NHS
:14:33. > :14:42.recommends three cycles, in most of the West of England you now only get
:14:43. > :14:44.one. Treatments vary, with Wiltshire the most generous. In
:14:45. > :14:52.Gloucestershire you can get up to three cycles but only Cliveden does
:14:53. > :14:58.the full recommended package. That is about to change, though. Swinton
:14:59. > :15:03.will be reducing IVF revision from three fresh cycles to one fresh
:15:04. > :15:07.cycle plus two frozen embryo transfers. This has been a difficult
:15:08. > :15:11.decision but it puts us into line with our local partners including
:15:12. > :15:17.Wiltshire and helps us to stay within our spending budget. If the
:15:18. > :15:24.NHS is not paying for IVF treatment, who does? This is Paula, with her
:15:25. > :15:30.eight-month daughter Anna, a sister Julie, was five. Paula was advised
:15:31. > :15:33.by her gynaecologist that she might not conceive without extra help but
:15:34. > :15:39.when she made inquiries about IVF she discovered she did not meet the
:15:40. > :15:43.criteria, because her husband had children from a previous
:15:44. > :15:48.relationship. I was absolutely devastated. I could not understand
:15:49. > :15:52.why I could be turned down when somebody with no children, like me
:15:53. > :15:56.but with a partner who had no children, code, and it also depends
:15:57. > :16:00.where you are in the country. In some parts of the country even
:16:01. > :16:04.though people have partners with children they are still being funded
:16:05. > :16:09.for IVF and fertility treatment whereas in Somerset, their criteria
:16:10. > :16:15.is different to elsewhere in the UK. It is really difficult to deal with.
:16:16. > :16:21.So we sold the house, we were lucky, it soared straightaway, and we moved
:16:22. > :16:24.to a nearby town to fund the IVF treatment. That was in August and we
:16:25. > :16:30.started fertility treatment the following January, 2007. How much
:16:31. > :16:35.did you end up spending on the treatment? In total, ?33,000 over
:16:36. > :16:42.nine years. What to think of the current system 's it's completely
:16:43. > :16:48.unfair. I would like to see, across England, there is just guidance on a
:16:49. > :16:53.set amount for each person, so not the postcode lottery, but just two
:16:54. > :16:58.or three rounds giving out to everybody. I know that if I lived in
:16:59. > :17:01.a different part of the country I would have more rounds funded for me
:17:02. > :17:04.and it wouldn't have mattered if my husband had children from a previous
:17:05. > :17:09.marriage but I would have been entitled the funding and I would not
:17:10. > :17:13.have had to sell my house. Back with Jade. She's on her way to Bristol,
:17:14. > :17:20.one hour from home, for what could be her only funded cycle of IVF. It
:17:21. > :17:31.is really exciting, obviously, having waited so long, but also,
:17:32. > :17:44.apprehensive. We hope that we're going to get our other go.
:17:45. > :17:52.What Jade really wants to know is why the rules have changed. I have
:17:53. > :17:53.come to Yeovil to talk to the people responsible for funding treatment.
:17:54. > :17:58.The provision has been reduced from The provision has been reduced from
:17:59. > :18:01.three cycles down to one. Can you tell me how that happened? We
:18:02. > :18:06.started the process of reviewing what we would commission in Somerset
:18:07. > :18:11.and actually, the budget for the provision stayed the same so we took
:18:12. > :18:16.the important step of reducing the number of years woman had to wait
:18:17. > :18:20.from three years down to two. And we would get more live births for the
:18:21. > :18:23.same amount of money than unfortunately funding two cycles
:18:24. > :18:29.compared to one. There is always a limited pool of money and you have
:18:30. > :18:34.to do describe, we have to decide which services we want to continue
:18:35. > :18:37.to commission. We have more of an elderly population with more health
:18:38. > :18:48.needs, and they all, along with increased costs. -- they all come
:18:49. > :18:52.along. There you have it, the NHS has a limited pot of money, and
:18:53. > :19:00.someone has to decide how best it is spent. What would you do?
:19:01. > :19:08.We're here to tell your story. If you've had an experience of hospital
:19:09. > :19:17.treatment that you want us to look into, it is easy to get in touch,
:19:18. > :19:20.either on Facebook or Twitter. If you have not heard, today is blue
:19:21. > :19:26.Monday, officially the most depressing day of the year. Someone
:19:27. > :19:35.who really needs cheering up is Mark Millar, from DIY SOS, so we sent him
:19:36. > :19:41.to try an unusual way of tackling stress. I know what it looks like. I
:19:42. > :19:47.am in a room with a bunch of strangers doing an impersonation of
:19:48. > :20:00.an orangutan cat a rave. What on earth am I doing here? If someone's
:20:01. > :20:04.planning comes in for the next job, we can get moving on that, but we
:20:05. > :20:09.haven't got any more time and we don't have any more money. This is
:20:10. > :20:13.me at the day job, trying to get impossibly big projects finished on
:20:14. > :20:19.time. We have to have that surface on their on budget. A lot of money,
:20:20. > :20:23.thousands of pounds. You drop the meat fridge, and put a few passed
:20:24. > :20:29.in. It does not come without cost. That is a no. I am incredibly
:20:30. > :20:32.stressed much of the time and sometimes I feel like it is getting
:20:33. > :20:38.on top of me. But I'm also a person who likes to have a laugh. And that
:20:39. > :20:44.brings me to the challenge I have been set. I have agreed to be a
:20:45. > :20:49.guinea pig for Inside Out to see if laughter will do anything for my
:20:50. > :20:57.stress levels. I'm going to take part in a session of laughter Yoga.
:20:58. > :21:03.Something I've never tried before, and I know very little about. Before
:21:04. > :21:07.I go any further, I want to get proper medical opinion on my stress.
:21:08. > :21:13.I'm not sleeping very well. I'm getting a lot of panic attacks. My
:21:14. > :21:20.chest is a bit tight. I cannot relax. I feel dreadful in the
:21:21. > :21:28.mornings. You're not sleeping well and you are feeling a bit, roughly
:21:29. > :21:33.how long is that been a problem? It has been going on for about 18
:21:34. > :21:37.months. One common consequence of stress is high blood pressure.
:21:38. > :21:46.Doctor Anderson is keen to measure mine. I know that you will say that
:21:47. > :21:55.it is two numbers. Yes. What should mine be before you look at it?
:21:56. > :22:00.Ideally it should be something like 140/80. Would you like to see what
:22:01. > :22:07.it is? That is a bit higher than it should be. That is not going to help
:22:08. > :22:13.with the stress. As it is a bit high, we'll give it five minutes and
:22:14. > :22:17.it again and see if it does come down under. Sometimes it comes down
:22:18. > :22:26.if you have a bit of a rest. My BP is all the place. Laughter is good
:22:27. > :22:30.for everybody. I cannot imagine it would do any harm. We can do more
:22:31. > :22:34.detailed checks into your weight and your cholesterol, so that we can be
:22:35. > :22:46.sure that you are, that they are all as good as they should be. And look
:22:47. > :22:50.how happy you are. I am. I'm not sure that Doctor Anderson is
:22:51. > :22:56.convinced that my stress will be fixed by laughter, alone. So I am
:22:57. > :23:01.off to meet an academic who has studied laughter it self. He starts
:23:02. > :23:17.by plainly some of his favourite laughs. This is a man laughing. And
:23:18. > :23:22.this is... The next example really is a human woman laughing. She would
:23:23. > :23:41.not be making these sounds. HIGH PITCHED CACKLING. So, you can
:23:42. > :23:47.get to quite an extreme place with laughter. It is something that
:23:48. > :23:51.changes the physiology of your body, and it does so in a way that relaxes
:23:52. > :23:56.you, so when you have been laughing, you get an immediate reduction in
:23:57. > :24:00.adrenaline and adrenaline is your fight or flight hormone, so the
:24:01. > :24:07.stress levels come down when you have been laughing, and you also get
:24:08. > :24:11.a reduction in cortisol, which is the hormone that makes you feel
:24:12. > :24:16.really stress. You also get endorphins. So laughter is something
:24:17. > :24:23.that in the medium to short-term is something that makes you feel
:24:24. > :24:28.better. I have been invited to take part in a session of laughter Yoga.
:24:29. > :24:33.Can someone standing room and tell me how to laugh, and raise my
:24:34. > :24:38.endorphins? Will that help? It seems too. Certainly, the endorphin
:24:39. > :24:39.changes with laughter happen, it doesn't matter how you get the
:24:40. > :24:41.laughter. Even if it starts being laughter. Even if it starts
:24:42. > :24:46.unnatural and fate, that can lead to unnatural and fate, that can lead to
:24:47. > :24:50.real laughter, because laughter is highly contagious and you can laugh,
:24:51. > :24:54.just because you're laughing, and the more you laugh, the more you
:24:55. > :25:01.will continue laughing, so that seems weird at the start but that is
:25:02. > :25:12.crucial to laughter Yoga. I tell you what, that was great. All I want is
:25:13. > :25:15.a life full of laughter, now. Right, it's time for my laughter Yoga
:25:16. > :25:30.session. I have no idea what to expect. All I know is, when and
:25:31. > :25:34.where. This is being hosted by Joe, who describes himself as a laughter
:25:35. > :25:39.facilitator. First he puts everyone into a relaxed frame of mind and we
:25:40. > :25:44.are encouraged to move around. This is nothing to do with jokes being
:25:45. > :25:50.funny, it is about the act of laughing itself. It is the laughter
:25:51. > :26:01.that does it. It doesn't take long for me to lose it. I am loving it
:26:02. > :26:05.already, I am loving it! What are we laughing at? Absolutely nothing. We
:26:06. > :26:11.are just laughing. And sooner or later, it turns into the real thing.
:26:12. > :26:15.I am not laughing so much my face is starting to hurt! -- I am now
:26:16. > :26:39.laughing so much. GALES OF LAUGHTER. It is infectious,
:26:40. > :26:47.it is really silly. Before long you're all just cackling and crying.
:26:48. > :26:53.Is just great. And you can work your eye muscles with this, as well. I
:26:54. > :26:57.used to take light relief Nursery, seriously, I'd worry about what
:26:58. > :27:00.people thought, I'd have trouble expressing myself and now I am able
:27:01. > :27:09.to let go and find the fun in life, you see the beauty in life, as well.
:27:10. > :27:15.I was a laughter is the opposite distress. It is stress buster. Some
:27:16. > :27:20.table like a dance or write or play table like a dance or write or play
:27:21. > :27:29.an instrument or sing to get rid of stress, I think the most immediate
:27:30. > :27:32.way to do it is to laugh. That was amazing. I didn't know what to
:27:33. > :27:37.expect, I didn't know what was going to happen to me. I was shocked at
:27:38. > :27:43.how brilliant it was. Once I let myself go it was really good fun. It
:27:44. > :27:47.filled me up. I felt all of these different muscles in my head, neck
:27:48. > :27:57.and chest and stomach, I feel lovely. I feel quite soporific, you
:27:58. > :28:02.know? It is really, really nice. That night, I got a perfect night's
:28:03. > :28:09.sleep and the next morning my BP was much lower. Laughter Yoga might not
:28:10. > :28:11.be the only way to combat stress, but it certainly made me feel a lot
:28:12. > :28:25.happier. Seriously, though, what did happier. Seriously, though, what did
:28:26. > :28:29.you all think? Don't worry, they are not ignoring me, they are on our
:28:30. > :28:36.Facebook page. You should check out our social media. The details are on
:28:37. > :28:43.your screen. That is it for this week. Thank you for watching.
:28:44. > :28:50.Goodbye. Next week, we investigate abuse claims at a youth football
:28:51. > :28:56.Academy. He groomed me to make me feel that this was normal, he would
:28:57. > :28:58.ask questions about how much I loved and trusted him and how dedicated I
:28:59. > :29:07.was 30, a Hello, I'm Louisa Preston
:29:08. > :29:09.with your 90 second update. 30 British tourists shot
:29:10. > :29:11.dead in Tunisia in 2015. Today, an inquest was told
:29:12. > :29:15.that security forces Donald Trump provokes
:29:16. > :29:19.a mixed reaction. Downing Street welcomes the promise
:29:20. > :29:22.of a "quick and fair" trade deal. But foreign ministers
:29:23. > :29:25.are concerned by his comments