06/02/2017

:00:14. > :00:18.Good morning. It's nine o'clock. Welcome to the programme. This

:00:19. > :00:24.morning till the state of the NHS in England has been described as

:00:25. > :00:29.humanitarian crisis. This winter has seen a huge strain on hospital. In

:00:30. > :00:32.one week last month, four out of ten hospitals were one major alert

:00:33. > :00:36.status, and there are constant calls for more funding. A survey out today

:00:37. > :00:41.says half of you think the quality of the NHS has been getting worse

:00:42. > :00:43.over the last six months. This morning, we will hear your

:00:44. > :00:53.experiences and ask if you have solutions. I am a full-time NHS

:00:54. > :01:01.consultant in Anniston easier. I am representing the senior tier of

:01:02. > :01:08.physicians on the shop them say we cannot give any better care to

:01:09. > :01:11.patients and that we are seriously demoralised. I have been a clinician

:01:12. > :01:14.for about ten years. We have been asked to deliver a lot of very

:01:15. > :01:19.little money, very little resources, and to be honest, it is quite

:01:20. > :01:25.demoralising. I am a patient in the NHS. I had great care before my

:01:26. > :01:29.operation, but afterwards it has gone downhill. The staff are

:01:30. > :01:35.demoralised and tired and it affects us as patients. My mum was diagnosed

:01:36. > :01:40.with cancer not long ago. I think the NHS is absolutely fantastic. The

:01:41. > :01:52.care is amazing. I would fight to keep it. With us this morning is an

:01:53. > :01:58.audience of around 80 people who were all either work for the NHS or

:01:59. > :02:03.have direct experience of it as a patient. You can share your

:02:04. > :02:27.experiences. Here is how to get in touch:

:02:28. > :02:34.Welcome to the programme. We are live until 11. Later, we will talk

:02:35. > :02:38.about some of the really difficult decisions the NHS may need to make

:02:39. > :02:43.in the future. Should it begin to charge for more services? Should we

:02:44. > :02:50.pay more in National Insurance fund the NHS? Your views are welcome. NHS

:02:51. > :02:56.hospitals in England will have a legal duty to charge overseas

:02:57. > :03:01.patients upfront for nonurgent care if they are not eligible for free

:03:02. > :03:05.treatment. From April, so-called health tourists could be refused

:03:06. > :03:09.operations unless they cover their costs in advance. Emergency care

:03:10. > :03:23.would still be provided immediately and charged later.

:03:24. > :03:25.Hospitals are already supposed to charge those foreign patients

:03:26. > :03:27.who don't qualify for free non-urgent care, but a report

:03:28. > :03:30.by the National Audit Office found that money raised next year

:03:31. > :03:32.would fall far short of a ?500 million target

:03:33. > :03:35.Ministers have announced that, from April, NHS trusts in England

:03:36. > :03:38.will have a legal duty to charge upfront for non-emergency

:03:39. > :03:40.care, rather than send invoices after the event.

:03:41. > :03:42.It's not clear how this would be enforced.

:03:43. > :03:45.A UK-wide poll of just over 1000 adults by Ipsos Mori for the BBC

:03:46. > :03:47.shows that 74% of respondents support increasing charges

:03:48. > :03:52.for visitors from outside the UK to help fund the NHS.

:03:53. > :03:54.40% said raising income tax to finance the NHS

:03:55. > :04:00.37% said it would be acceptable for UK citizens to pay

:04:01. > :04:09.for some health services which are currently free.

:04:10. > :04:16.You were on the phone to the Department of Health up to the start

:04:17. > :04:21.of the programme - what does this mean in practical terms? I asked if

:04:22. > :04:25.it means new legislation, and the answer was no. We are told it will

:04:26. > :04:30.involve so-called secondary regulation, things that have already

:04:31. > :04:35.there, trying to make hospitals do more to charge people upfront who

:04:36. > :04:38.come from outside the UK and don't qualify for free care. No detail on

:04:39. > :04:43.how this will actually work. We are told it will be aimed at supporting

:04:44. > :04:47.hospitals to chase up the money. Some hospitals already do it quite

:04:48. > :04:56.effectively. Some ask for ID. When you go in, that shows whether you

:04:57. > :04:59.are eligible for care or not. The Government and what it can do

:05:00. > :05:03.remains unclear. It has been criticised for not raising the ?500

:05:04. > :05:07.million per year they said they would next year. It has fallen far

:05:08. > :05:13.short so far, according to the National audit office. Will it

:05:14. > :05:17.affect EU nationals? If you come from another EU country to the UK

:05:18. > :05:22.and you need health care, you have the card that everyone is familiar

:05:23. > :05:26.with. Hospitals should take the details, send them to the Department

:05:27. > :05:31.of Health, who then chase up the Government of the country from which

:05:32. > :05:36.the visitor has come to get the money back. The Department of Health

:05:37. > :05:40.have not been good at pursuing that, so there is inefficiency there. Some

:05:41. > :05:46.will say that this is a couple of hundred million pounds a year, and

:05:47. > :05:49.the NHS in England spends more than ?100 billion per year, and it is

:05:50. > :05:56.about finding more funding generally. I view from Croydon says:

:05:57. > :06:00.Should the UK taxpayer paid for the incompetence of other nations, often

:06:01. > :06:06.because of corruption? Overseas players should pay, but how is the

:06:07. > :06:09.challenge. Another view says the UK is a soft touch and we need

:06:10. > :06:16.compulsory health insurance for visitors. We will talk about this

:06:17. > :06:20.issue this morning. The rest of the morning's news now.

:06:21. > :06:23.An NHS Trust has begun a formal inquiry into the case

:06:24. > :06:26.of an 89-year-old woman who was kept in hospital for six

:06:27. > :06:27.months despite being well enough to be discharged.

:06:28. > :06:29.Iris Sibley was taken to the Bristol Royal Infirmary

:06:30. > :06:32.after a fall at her residential care home last summer.

:06:33. > :06:34.She recovered but no suitable nursing home place was found

:06:35. > :06:41.The cost of keeping her in hospital is estimated at ?90,000.

:06:42. > :06:46.The number of unexpected deaths of mental health patients has risen

:06:47. > :06:57.That's according to new figures obtained by the BBC's

:06:58. > :07:00.The findings are based on data from more than half of England's

:07:01. > :07:04.The government says the increase was expected, because of changes

:07:05. > :07:08.Thousands of low-income families who were stripped of their tax

:07:09. > :07:10.credits after a mistake by the US out-sourcing firm Concentrix

:07:11. > :07:14.A Committee of MPs says that Her Majesty's Revenue and Customs

:07:15. > :07:17.has accepted their recommendations to review up to 23,000 new cases.

:07:18. > :07:19.The company, Concentrix, was sacked by HMRC in September

:07:20. > :07:29.following an investigation by this programme.

:07:30. > :07:31.MPs will have the chance to amend the government's legislation

:07:32. > :07:34.on Brexit when it returns to the Commons for three

:07:35. > :07:37.A number of pro-Remain Conservative MPs are understood to be

:07:38. > :07:40.considering voting with Labour and the SNP to try and give MPs more

:07:41. > :07:43.of a say over what happens at the end of the negotiating

:07:44. > :07:46.process, although Downing Street is understood to be confident

:07:47. > :07:52.President Trump has stepped up his attacks on the judge

:07:53. > :07:55.who blocked his travel ban on seven Muslim majority nations.

:07:56. > :07:57.In a series of tweets, he said the American people should

:07:58. > :08:00.blame the judge if anything happened to threaten national

:08:01. > :08:04.security and that the courts were making his job very difficult.

:08:05. > :08:06.The White House is expected to pursue its appeal

:08:07. > :08:12.Prince William might be closer to the throne,

:08:13. > :08:16.but it was Prince Harry who on this occasion crossed the finishing line

:08:17. > :08:19.Harry, William and the Duchess of Cambridge raced against each

:08:20. > :08:22.other in a 50 metre sprint at the Queen Elizabeth Olympic

:08:23. > :08:24.Park, during a mental health charity event.

:08:25. > :08:26.Cheered by track stars and amateur runners training

:08:27. > :08:29.for April's London Marathon, Harry crossed the line a stride

:08:30. > :08:34.That's a summary of the latest BBC News.

:08:35. > :08:42.The New England Patriots produced the greatest comeback in Super Bowl

:08:43. > :08:46.history to beat the Atlanta Falcons 34-28 in overtime.

:08:47. > :08:49.The Falcons were in complete control having scored three

:08:50. > :08:55.They were 25 points ahead before the spectacular fightback.

:08:56. > :08:59.No team has come form that far behind before.

:09:00. > :09:02.The Patriots drew level at 28 all with less than a minute left

:09:03. > :09:06.And then, in overtime, a touchdown from James White

:09:07. > :09:08.completed the comeback to take the title.

:09:09. > :09:11.Quarterback Tom Brady named the Most Valuable Player

:09:12. > :09:16.for a record fourth time - it's a fifth title for the Patriots.

:09:17. > :09:19.As we know the half-time show as big as the game itself.

:09:20. > :09:23.And this year it was Lady Gaga's turn to dazzle the crowds

:09:24. > :09:25.as she leapt into the stadium, lowered 79 metres

:09:26. > :09:33.Just the two costume changes in her 12 minute set.

:09:34. > :09:37.Her next big moment came when she dropped her mic

:09:38. > :09:40.at the end of the set, caught a glittery ball

:09:41. > :09:47.There was an astonishing finish to Great Britain's Davis Cup tie

:09:48. > :09:49.when Canada's Denis Shapovolov was disqualified after smashing

:09:50. > :09:52.a tennis ball at the match umpire, handing the tie and a place

:09:53. > :09:59.Kyle Edmund was two sets up in the decider.

:10:00. > :10:01.And the Canadian in red after losing his serve,

:10:02. > :10:11.And it struck the umpire square in the face.

:10:12. > :10:14.It was a freak accident but still saw Canada default the match.

:10:15. > :10:21.Great Britain will face France next in April.

:10:22. > :10:27.It's a shame it has happened that way, and I feel for the young lad.

:10:28. > :10:33.He is a great talent and he has learned a harsh lesson today. What I

:10:34. > :10:45.would say is, I thought Kyle, from what we saw on Friday, he was

:10:46. > :10:46.absolutely fantastic. Is not the result or the outcome of anyone was

:10:47. > :10:50.expecting. This morning we're talking

:10:51. > :10:53.about the state of the NHS - with you, and with an audience of 80

:10:54. > :11:00.NHS staff and patients. The NHS is one of those institutions

:11:01. > :11:05.that most of us cherish, but are the pressures

:11:06. > :11:07.on its resources at breaking point? In recent weeks we've heard

:11:08. > :11:11.claims that it's facing a humanitarian disaster,

:11:12. > :11:14.hospitals on major alert status, visits to some A departments

:11:15. > :11:18.being up 30% on last year, patients being treated in hospital

:11:19. > :11:21.corridors because of lack of beds, A BBC Ipsos Mori survey out today

:11:22. > :11:28.suggests over half of you think the NHS in England has got worse

:11:29. > :11:52.in the last six months - just 8% You are very welcome to get in touch

:11:53. > :11:56.with us. Good morning. I absolutely support what my colleagues are

:11:57. > :12:01.saying, the NHS is in a devastating position. However, I am here because

:12:02. > :12:05.of the commitment of the front-line staff. The commitment remains, and

:12:06. > :12:16.it is not done to them, the state of the NHS. What is your job? I have

:12:17. > :12:19.been Chief nurse in three acute hospitals, I have inspected

:12:20. > :12:28.hospitals. Even the hospitals that go into special measures, they are

:12:29. > :12:31.absolutely packed with incredible nurses, doctors, physiotherapist,

:12:32. > :12:37.radiologists. What is going wrong? There are not many politicians here,

:12:38. > :12:40.but there is something fundamentally going wrong and it is not with the

:12:41. > :12:45.clinicians. What is it, in your view? A number of things. Funding

:12:46. > :12:50.has gone wrong, there is not enough, and what is going in the wrong

:12:51. > :12:55.places. We will talk about social care later, but there is an issue

:12:56. > :12:59.with funding, access, inequality, it is different across the country.

:13:00. > :13:07.There are issues in London, up north. Who agrees? My name is Emma.

:13:08. > :13:12.I trained as a nurse back in 1985. I have worked as a hospital manager of

:13:13. > :13:19.a good few years. I run a first aid training business, recruiting and

:13:20. > :13:21.benefiting from the demoralisation in ambulance staff, because

:13:22. > :13:25.paramedics want to be treated better. The NHS must be managed by

:13:26. > :13:30.people that have been within the system and to know the system and

:13:31. > :13:35.who understand it. Is that what is going wrong, poor managers?

:13:36. > :13:42.Incompetent managers, managers who are snowed under completely? It is a

:13:43. > :13:50.horrendous job. As a hospital manager, we had a lot of external

:13:51. > :13:57.consultants coming in with amazing solutions that just don't work in a

:13:58. > :14:04.very oversubscribed situation. Your own experiences? I am a patient. I

:14:05. > :14:12.was diagnosed with cancer during pregnancy. I underwent chemotherapy,

:14:13. > :14:17.had my baby. She is fine. I had a mastectomy in my care was fantastic

:14:18. > :14:20.throughout. My problem is that after all of that, I was told the drugs I

:14:21. > :14:27.would need are not funded by the NHS in Wales. They are currently funded

:14:28. > :14:37.in England, but they are being withdrawn there too. How much money

:14:38. > :14:43.do you need to raise drugs? My target is ?150,000. That's for one

:14:44. > :14:50.year on different drugs. Wow... The care has been brilliant and I can't

:14:51. > :14:52.complain, but to get to the end of that process and reach a point where

:14:53. > :14:56.you think you had the worst news possible and to the told you have

:14:57. > :15:01.incurable cancer and then discover that the drugs that are available,

:15:02. > :15:05.that are proven to be effective, you are not going to be given access to

:15:06. > :15:09.them. Because they are too expensive. What is your frame of

:15:10. > :15:14.mind about this situation? I don't know who to be angry with about

:15:15. > :15:18.this. I can't blame the NHS. It's not their fault. They are working

:15:19. > :15:20.within ridiculous budgets. I can only lay the blame with the

:15:21. > :15:29.Government. We have a Conservative MP here. We

:15:30. > :15:33.will talk to him in a moment. We asked England's Health Secretary

:15:34. > :15:38.Jeremy Hunt to join us. He wasn't availablement hello sir. I'm a

:15:39. > :15:44.patient. Steve, bring that microphone closer to your mouth. I'm

:15:45. > :15:49.a patient and last July I was diagnosed with an enlarged prostate.

:15:50. > :15:56.As of today's date, I don't know why the prostate is enlarged. I'm

:15:57. > :16:01.waiting for a different diagnosis, is it cancerous, if it isn't. Why do

:16:02. > :16:06.you think about that? If it is cancerous, I would like the

:16:07. > :16:11.treatment to start soon. It can't be for the number of people to trying

:16:12. > :16:17.to find out? I have had a number of non-invasive tests. The next test is

:16:18. > :16:21.the biopsy. Thank you, Steve. Hello. We're going to pause for just a

:16:22. > :16:22.moment to look at the overall information budget and the pressures

:16:23. > :16:28.on it. Have a look at this. The NHS is the second-biggest

:16:29. > :16:30.area of public spending Well, here's how health

:16:31. > :16:36.expenditure in England has In 2015-2016, it stood

:16:37. > :16:43.at around ?117 billion. It's set to rise in

:16:44. > :16:45.the coming years, but, taking account of inflation,

:16:46. > :16:50.at a less impressive rate. It's also worth noting that the UK

:16:51. > :16:58.population has increased And it's an ageing population, too,

:16:59. > :17:05.putting extra stress on the system. If we take the health budget

:17:06. > :17:07.in England in 2015-2016, The biggest expenditure

:17:08. > :17:14.was on hospitals and ambulances. Many experts say the budgets

:17:15. > :17:16.for mental health services and care in the community

:17:17. > :17:26.are not great enough. In 2010-2011, NHS trusts in England

:17:27. > :17:29.overall had ?458 million left That figure rose in successive

:17:30. > :17:38.years, but since then Trusts have rapidly fallen into deficit,

:17:39. > :17:39.which means they spend And in 2015-2016 the deficit stood

:17:40. > :17:56.at just under ?2.5 billion. With us is our Health Editor

:17:57. > :17:59.Hugh Pym, Jeremy Lefroy, a Conservative MP

:18:00. > :18:03.for Stafford, Jon Ashworth, a Labour MP who is their

:18:04. > :18:05.spokesperson on health. The President of the Royal College

:18:06. > :18:08.of Paediatrics and Child Health, The Chair of the Royal College

:18:09. > :18:13.of GPs Helen Stokes-Lampard. Dr Chaand Nagpaul from

:18:14. > :18:19.the British Medical Association. We asked England's Health Secretary

:18:20. > :18:21.Jeremy Hunt and other ministers from the Department

:18:22. > :18:24.of Health to take part They said no, but did tell us,

:18:25. > :18:31."Across the country we know the NHS is very busy,

:18:32. > :18:42.but hospitals are performing well -- why the laughter? It is obvious

:18:43. > :18:44.the NHS is to busy. It seems like a ridiculous statement from the

:18:45. > :18:51.Ministry of Health to have to tell us that.

:18:52. > :18:53.It goes on. "But hospitals are per

:18:54. > :18:59.fortunatelying well with steps in place to cope with the extra demands

:19:00. > :19:05.winter brings, supported by an extra ?400 million worth of funding. "

:19:06. > :19:09.It sounds like a lot of money, Hugh. Well, if you think the overall

:19:10. > :19:13.budget for the NHS is more than ?100 billion a year in England it puts it

:19:14. > :19:17.into prospective. I'm not totally clear about the ?400 million, I

:19:18. > :19:21.think it is recurring money that's spent every year for winter rather

:19:22. > :19:28.than being something extra this year. And what we have been told is

:19:29. > :19:31.the NHS was allocated extra money in successive years by this Government

:19:32. > :19:37.and it basically needs to get on with what it has got even though it

:19:38. > :19:40.had to cope with extremely high patient demand as we've heard, but

:19:41. > :19:43.there is a big question which I'm sure we will be talking about

:19:44. > :19:47.throughout the programme, does the NHS need more money, if so, where

:19:48. > :19:51.does it come from? Are people prepared to pay more tax? There

:19:52. > :19:54.needs to be a debate about health and social care and whether they

:19:55. > :19:58.should be more integrated in England. Social care paid for by

:19:59. > :20:01.local authorities, how do you deal with that? There is some big

:20:02. > :20:06.questions about the future here. Hello, sir. Introduce yourself? I'm

:20:07. > :20:10.Simon. I'm a cln i in the NHS. No one disagrees with Hugh, the NHS

:20:11. > :20:15.does need more money, always has needed more money and I think we

:20:16. > :20:19.live in this world now the Prost Trump world with alternative facts,

:20:20. > :20:23.sometimes I wonder if the DH comes up with alternative facts on their

:20:24. > :20:27.funding and how much they're given. I would like like to say also

:20:28. > :20:31.successive governments, one can blame this Government now, but

:20:32. > :20:36.successive governments because of the tax burden that is the NHS, they

:20:37. > :20:39.bring in so-called efficiency measures and every time there is

:20:40. > :20:43.efficiency measure ultimately that means money has to be removed from

:20:44. > :20:47.the budget. There is nothing efficient about treating anybody.

:20:48. > :20:50.That lady who has the cancer, there is nothing efficient about treating

:20:51. > :20:57.that lady. She needs the money. We should be able to give T I'm sure

:20:58. > :21:04.she gave taxes for the NHS. APPLAUSE

:21:05. > :21:09.Thank you. What I didn't mention is that I am not unique. I'm not even

:21:10. > :21:13.unusual. There are a lot of women who are fund-raising and men

:21:14. > :21:16.presumably fund-raising for cancer drugs in this country and just this

:21:17. > :21:23.week on the BBC it was reported that there has been a seven fold increase

:21:24. > :21:27.from 2015 to 2016 in people on fund-raising sites who are raising

:21:28. > :21:30.money for life-saving or life extending treatments and I think

:21:31. > :21:36.that's a ridiculous situation to be in. We can afford this. We have the

:21:37. > :21:44.money available, but the money is being spent in ways that we don't

:21:45. > :21:47.want it to be spent. APPLAUSE

:21:48. > :21:50.Well, I was just saying we have got two ministers here, one shadow

:21:51. > :21:59.minister and a very brave member from the Conservative Party from

:22:00. > :22:05.Stafford. Would they like to make some comments? I would like them not

:22:06. > :22:10.to say if we were in power we would give more money or we have given

:22:11. > :22:13.more money to the NHS. Everyone in this room likes the NHS. They want

:22:14. > :22:18.to keep the NHS. They want the NHS properly funded. What would they say

:22:19. > :22:28.to us who have come here today to ask you that question specifically?

:22:29. > :22:31.APPLAUSE As a Conservative MP, Conservative

:22:32. > :22:38.Government, what are you going to say to that? I agree. I have been, I

:22:39. > :22:43.declare an interest in that my wife is a GP, my daughter is a medical

:22:44. > :22:46.student. As a family we are extremely committed to the National

:22:47. > :22:52.Health Service. I have been saying since as you rightly say, my, what

:22:53. > :22:56.was the Mid-Staffordshire trust is in my constituency. I have to say

:22:57. > :23:00.that there have been great improvements there thanks to the

:23:01. > :23:07.dedication of the staff, it is now part of the university hospitals of

:23:08. > :23:11.the North Midlands. Still a great deal of pressure there. There is no

:23:12. > :23:17.doubt if you look at the amount that we as a nation spend on health, it

:23:18. > :23:22.is probably about 2% of GDP less than say in France and Germany. And

:23:23. > :23:25.frankly unless we are prepared and I heard people behind say they were

:23:26. > :23:29.prepared to do this and certainly when I talk to my constituents,

:23:30. > :23:34.unless you're prepared to say we will up the amount that we spend,

:23:35. > :23:41.which means, higher taxes, I am afraid, there isn't anywhere else to

:23:42. > :23:45.go. If we're going to have a system funded based on need and from a

:23:46. > :23:49.progressive source of income, that's the only way to go. And it's

:23:50. > :23:52.interesting that I think people are beginning to see that. I have been

:23:53. > :23:57.saying that for the last three or four years. I've written about it.

:23:58. > :24:07.We have seen cross party work done in the last few weeks. Can you see a

:24:08. > :24:13.Conservative Government just before the 2020 election... We have got a

:24:14. > :24:18.microphone or fader open. We will ignore that. Promising in a

:24:19. > :24:23.manifesto, we will put your taxes up in order to fund properly the NHS?

:24:24. > :24:32.The answer is I don't know. I would hope that we would have, we've got

:24:33. > :24:35.this... That's your job. Your job is to advocate for us. You're

:24:36. > :24:42.representing the people of this country. I'm a patient... Turn

:24:43. > :24:47.around and look at the lady wh WHO is talking to you. Sorry, I still

:24:48. > :24:51.can't see you. I want to look at your eyes. Your job is to advocate

:24:52. > :24:55.for us. That's your job as our MP. One of the MPs in this Government at

:24:56. > :24:59.the moment. And if we're saying and a lot of people are, I have seen

:25:00. > :25:03.lots of Question Time, it is the only programme I watch, we are

:25:04. > :25:11.willing to pay the extra two pence on the tax, why not? Forget the eye

:25:12. > :25:21.eology of low tax. Let us have our NHS free at the point of delivery so

:25:22. > :25:24.we can stay alive. APPLAUSE

:25:25. > :25:31.My name is Gaye Lee and I have been a nurse for 37 years. I work in a

:25:32. > :25:35.hospice. There is no great mystery why hospices work. They have enough

:25:36. > :25:40.staff. The funding for the NHS, by the way I'm sorry to see there are

:25:41. > :25:48.no nurse leaders here, I wish the Royal College of Nursing had been

:25:49. > :25:56.invited. The funding sources, my area in South-East London spent ?5.3

:25:57. > :25:59.million in the last three years on external management consultants to

:26:00. > :26:07.advice how to reorganise services in our area and the second thing is

:26:08. > :26:12.that... Let's stay on the money issue if we may. The admin costs

:26:13. > :26:18.have gone up by 10% over the last 20 years since the NHS became a market

:26:19. > :26:25.commissioning and provision of service separated.

:26:26. > :26:30.Go ahead. I'm Ben Harris. Ben, can you move that microphone closer. I'm

:26:31. > :26:33.glad sir you said you wanted more answers than just throw more money

:26:34. > :26:37.at it. This debate rarely gets beyond that because Labour say the

:26:38. > :26:41.answer is throw more money at it. I'm not saying the NHS doesn't need

:26:42. > :26:44.funding, but it is extraordinary, isn't it, that Jeremy Hunt is one of

:26:45. > :26:49.the longest serving Health Secretaries. He has been in post for

:26:50. > :26:52.just four years and really the problem with the NHS or indeed a big

:26:53. > :26:56.problem with the NHS is the fact that this country for at least the

:26:57. > :26:59.last 20 years has been governed on the basis of winning an election,

:27:00. > :27:04.not on the basis of long-term planning. To the point about the...

:27:05. > :27:10.APPLAUSE The percentage of GDP spending,

:27:11. > :27:13.Japan spends 1% less than we do on its healthcare and has better

:27:14. > :27:18.healthcare outcomes and that's because they have a different

:27:19. > :27:23.approach. So, whilst I'm not here to say we need to cut funding to the

:27:24. > :27:27.NHS, absolutely not. That can only ever be part of the solution. Let's

:27:28. > :27:33.hear what a Labour representative has to say. John Ashworth, I don't

:27:34. > :27:37.know what Jeremy Corbyn will promise in his manifesto before 2020 if he's

:27:38. > :27:40.still the leader, will it be more money or yeah, we'll put your taxes

:27:41. > :27:44.up two pence in the pound, what? Certainly the NHS needs more money.

:27:45. > :27:48.I mean it is going through the largest financial squeeze in its

:27:49. > :27:53.history and head for head next year NHS investment will actually be cut

:27:54. > :27:57.in England. So you're right, sir, to say it is not just about money, but

:27:58. > :28:01.we cannot ignore the reality that this huge financial squeeze is

:28:02. > :28:04.putting this incredible burden and pressure on the system at every

:28:05. > :28:09.level now so we can't just dismiss that out of hand.

:28:10. > :28:13.Firstly, how do you account for the fact that Japan has better

:28:14. > :28:15.healthcare outcomes by spending less money? Are you willing to

:28:16. > :28:21.acknowledge as many of your colleagues at least have, that this

:28:22. > :28:26.country is out of money. We're told we have an austerity budget in

:28:27. > :28:32.place. No, I'm afraid it is. We're told we have an austerity budget in

:28:33. > :28:37.place. This Government is borrowing ?70 billion more than it is taking

:28:38. > :28:41.into the ex-trekker. We are ?1.5 trillion in debt. When there is

:28:42. > :28:46.another recession we will be in big, big trouble. The kind of trouble

:28:47. > :28:53.Greece has been in. I work in a coastal NHS. I'm afraid that's

:28:54. > :28:59.rubbish. We are the sixth richest country in the world. Let me finish

:29:00. > :29:05.my point. I'm afraid the Government gave and it is Tories and liberals

:29:06. > :29:12.and the Labour, gave when the bankers bail out 109, not million,

:29:13. > :29:16.not billion, but trillion pounds, that could have funded the social

:29:17. > :29:22.care for 100 years and done the NHS for 50 years. It is all about

:29:23. > :29:29.ideology and the fact that the Tory Government don't want to do it and

:29:30. > :29:33.we should stand up against it. We didn't spend ?109 billion bailing

:29:34. > :29:41.out the banks. We didn't spend ?109 trillion. No, no, sorry sir, we

:29:42. > :29:46.didn't spend ?109 trillion. This Government has found billions to cut

:29:47. > :29:49.tax for big corporations, has found billions to cut share transaction

:29:50. > :29:54.tax and in the recent November Budget it found millions to build

:29:55. > :29:59.new grammar schools and not an extra penny for the NHS. So what would

:30:00. > :30:05.Labour do? To say there is no money available is a nonsense. We need to

:30:06. > :30:09.put investment... Please. Please. If you don't have a microphone, don't

:30:10. > :30:12.speak. Government is about choices. It doesn't need to choose to cut

:30:13. > :30:16.corporation tax for billions. It doesn't need to choose to put

:30:17. > :30:20.millions into building new grammar schools.

:30:21. > :30:27.What would Labour do? We would put more investment into the NHS. I have

:30:28. > :30:30.outlined suggestions about what the Government doesn't need to be doing,

:30:31. > :30:33.but I think the country needs to engage in a big debate about the

:30:34. > :30:39.future financing of the NHS, because as we get older as our population,

:30:40. > :30:42.with more complex needs, which is a good thing that we are living

:30:43. > :30:46.longer, and we have more expectations on the NHS, we will

:30:47. > :30:51.have to debate and face up to some big questions about how we fund it,

:30:52. > :30:55.but let's not go for the nonsense and believe that the NHS cannot have

:30:56. > :30:59.extra investment now. It could if the Government took a different set

:31:00. > :31:03.of decisions. I am an orthopaedic surgeon in my last year of training,

:31:04. > :31:09.so I have been privy to budgets and cuts over the last few years from a

:31:10. > :31:13.front-line point of view. The gentleman from the conservative

:31:14. > :31:17.think tank, bravo, you argued your alternative facts very vehemently

:31:18. > :31:20.and presented a convincing case, but the fact of the matter is, you are

:31:21. > :31:27.talking about not putting in extra funding. This is a political

:31:28. > :31:33.decision. It is the cuts you are making every single day. The purpose

:31:34. > :31:38.of the NHS is like a bucket with holes in it, and the holes are

:31:39. > :31:44.increasing daily. We see money being siphoned off to private finance

:31:45. > :31:49.initiatives. ?80 billion for private finance initiatives for buildings

:31:50. > :31:54.that were supposed to cost ?11 billion. That was the previous

:31:55. > :31:58.Government. I am not talking about funding but about loss. You can keep

:31:59. > :32:01.putting water into a bucket, but if you put holes in it and you are

:32:02. > :32:11.siphoning off money, since this health and social at -- health and

:32:12. > :32:14.social care act, hospitals were forced into private initiatives, and

:32:15. > :32:19.money is being lost through ridiculous means every single day. I

:32:20. > :32:25.see this as a doctor, because we're having to ration services. Like

:32:26. > :32:32.what? For example, certain people can be offered -- certain people can

:32:33. > :32:36.no longer be offered hip and knee replacements who could have got them

:32:37. > :32:41.five years ago. We heard the story about drugs available for cancer.

:32:42. > :32:45.The next thing will be that people who are obese should not be allowed

:32:46. > :32:48.certain treatments, smokers shouldn't be allowed certain

:32:49. > :32:52.treatments. It will go on and on. Private companies are looking at

:32:53. > :33:02.profits, and they are beholden to shareholders before the public.

:33:03. > :33:09.Compared to the whole, the propulsion of private companies is

:33:10. > :33:19.not that much. I don't think that more money is necessarily just the

:33:20. > :33:27.way forward. We are spending a 0.9% increase. But we are seeing a real

:33:28. > :33:33.cut every year. On the figure about banks... There are various reports,

:33:34. > :33:44.but it is round -- but it is around ?1 trillion. Not 109 trillion. It is

:33:45. > :33:47.around ?1 trillion. I am a consultant anaesthetist and I want

:33:48. > :33:54.to make a couple of points. People talk about absolute numbers. I am

:33:55. > :34:04.not a health academic, but you need to talk about the percentage of GDP,

:34:05. > :34:07.the head-to-head spend, the fact that we are accommodating and

:34:08. > :34:11.increasing, ageing population, there are more sick people around. If you

:34:12. > :34:18.give me numbers, I don't know what that means. In your job, you said

:34:19. > :34:23.you were making dangerous decisions - what do you mean? I speak on

:34:24. > :34:29.behalf of every consultant and GP, and we have written an open letter

:34:30. > :34:33.to the Prime Minister, signed by around 2000 consultants and GPs from

:34:34. > :34:37.around the country. It says that, first, we are in a crisis. It is not

:34:38. > :34:43.a seasonal pinch. We have never been in such dangerous territory. The

:34:44. > :34:47.decisions we have to make are unfathomable. Give an example. We

:34:48. > :34:52.are run black alert every day. I don't know what that means any more.

:34:53. > :34:57.It is a permanent fixture. I have to tell people daily that their

:34:58. > :35:01.operation for stomach cancer is cancelled for the third time because

:35:02. > :35:05.there is bed blocking due to medically fit patients who cannot

:35:06. > :35:10.access social services and because there are more sick people in the

:35:11. > :35:17.acute services. GPs are at us in point, as our acute services. The

:35:18. > :35:22.real worry is the brain drain. Nurses and doctors are starting to

:35:23. > :35:28.leave. Sorry to interrupt. The dangerous decision is, it saying to

:35:29. > :35:31.a patient that they cannot have an operation because there is nowhere

:35:32. > :35:35.to put them, and that is dangerous. You like it is dangerous and

:35:36. > :35:42.heartbreaking for me. I didn't train to do that. Secondly, the fact that

:35:43. > :35:53.there are fewer doctors and nurses. The doctor and nurse- patient ratio,

:35:54. > :35:56.you cannot imagine the stresses. We are looking after patients who are

:35:57. > :36:00.very sick in unsafe areas of the hospital. You hear about trolleys.

:36:01. > :36:07.We make decisions where we go home at night and frankly we don't sleep.

:36:08. > :36:12.Did I do the right thing? Did I discharge that patient to hourly? My

:36:13. > :36:18.junior doctors are acting as nurses and doctors at the same time because

:36:19. > :36:32.there are not enough staff. -- bid I discharge that patient too early?

:36:33. > :36:40.Staff are talking about going to do buy, to Canada. That never happened

:36:41. > :36:45.before. I agree with Anita. I am a front-line nurse and I have seen

:36:46. > :36:48.services getting increasingly more pressured, increasingly more

:36:49. > :36:54.dangerous situations where we are having to make life changing

:36:55. > :36:57.decisions for patients. It also feels really demoralising as a

:36:58. > :36:59.member of staff to be tell continuously by Jeremy Hunt and the

:37:00. > :37:04.Department of Health that they are putting more money into the NHS when

:37:05. > :37:10.in reality it is a ?22 billion cut to services. We are not stupid. Stay

:37:11. > :37:17.there. The gentleman here, do join us. I am a GP from Doncaster and I

:37:18. > :37:20.want to echo what my colleague in the hospital is saying. It is

:37:21. > :37:25.similar in general practice - there are not enough doctors. Patients are

:37:26. > :37:30.getting more sick, living longer, and there are more of them. I go to

:37:31. > :37:34.work at 7:30am, and there will be 100 pieces of paper work to do

:37:35. > :37:39.before patients start phoning at 8:30am. Between 8:30am and

:37:40. > :37:42.lunchtime, I can consult with approximately 50 patients. There

:37:43. > :37:48.might be another 25-30 patients for the rest of the day. By 10:30am, my

:37:49. > :37:58.brain is fried and I can't think any more. I advise them at 11am, you

:37:59. > :38:01.know you're not getting the best of me any more. It is dangerous to

:38:02. > :38:04.phone from here on in. I don't know what to do because there are not

:38:05. > :38:07.enough staff for the number of patients. That would be my other

:38:08. > :38:10.point. What have we been doing about workforce planning for the future?

:38:11. > :38:14.By 2020, we will have a complete shortage of nurses, unable to cope

:38:15. > :38:20.with the demands we experienced on the public. In addition, the NHS

:38:21. > :38:25.bursaries have been cut for nursing, so we're not recruiting them. This

:38:26. > :38:29.year alone, more than ever before, Moore foundation doctors, junior

:38:30. > :38:34.doctors about to embark on a career in speciality training, have left.

:38:35. > :38:37.More than any other year. Personally, I am covering more gaps

:38:38. > :38:41.in the junior doctor wrote than I ever thought would be the case. I

:38:42. > :38:45.didn't think it was part of my job plan, but there are holes. We come

:38:46. > :38:52.to work and there is not a medical registrar or a surgeon. Sue says: I

:38:53. > :38:58.can't praise them enough, let's keep it, please. Jeff says: There are

:38:59. > :39:02.ample funds in the NHS and it is about bad management and bad

:39:03. > :39:06.procurement practices. Another viewer says: Nurses and doctors are

:39:07. > :39:11.excellent. The problems are elsewhere. Too many chiefs, not

:39:12. > :39:20.enough beds. Another viewer says: Resources cannot keep up with

:39:21. > :39:23.demand. Should demand due to self-indulgence, like obesity, be

:39:24. > :39:28.given a lower place in the queue? It is something we will definitely talk

:39:29. > :39:30.about through the morning. We are going to bring you the latest news

:39:31. > :39:36.and sport. Here is Joanna. The number of patients on hospital

:39:37. > :39:39.wards has been at unsafe levels in nine out of ten NHS trusts

:39:40. > :39:41.in England this winter, according to figures

:39:42. > :39:55.obtained by the BBC. A report by MPs said the system for

:39:56. > :39:59.recovering costs was chaotic. NHS Improvement says it has to improve

:40:00. > :40:03.the way that money is collected. The number of patients on hospital

:40:04. > :40:06.wards has been at unsafe levels in nine out of ten NHS trusts

:40:07. > :40:09.in England this winter, according to figures

:40:10. > :40:11.obtained by the BBC. The results show some

:40:12. > :40:12.hospitals were operating at close to full capacity,

:40:13. > :40:14.putting increased pressure NHS England says more

:40:15. > :40:18.beds would be freed up if there was greater focus

:40:19. > :40:20.on the link with social The number of unexpected deaths

:40:21. > :40:24.of mental health patients has risen That's according to new figures

:40:25. > :40:27.obtained by the BBC's The findings are based on data

:40:28. > :40:32.from more than half of England's The government says the increase

:40:33. > :40:36.was expected because of changes Thousands of low-income families

:40:37. > :40:42.who were stripped of their tax credits after a mistake by the US

:40:43. > :40:45.out-sourcing firm Concentrix A Committee of MPs says

:40:46. > :40:52.that Her Majesty's Revenue Customs has accepted their recommendations

:40:53. > :40:55.to review up to 23,000 new cases. The company, Concentrix,

:40:56. > :40:57.was sacked by HMRC in September following an investigation

:40:58. > :41:03.by this programme. That's a summary of the latest BBC

:41:04. > :41:18.News, more at 10.00. Some breaking news: Alastair Cook

:41:19. > :41:22.has stood down as England captain. The England and Wales Cricket board

:41:23. > :41:29.has announced that. We will bring you more at 10am.

:41:30. > :41:31.A bizarre Davis Cup victory for Great Britain.

:41:32. > :41:33.After Canada are disqualified when one of their players,

:41:34. > :41:35.Denis Shapovalov, accidentally hits a ball straight into

:41:36. > :41:38.It was the deciding match of the tie and sees GB

:41:39. > :41:42.New England Patriots won a dramatic super bowl last night,

:41:43. > :41:45.as they came from 25 points behind to beat the Atalanta Falcons 34-28.

:41:46. > :41:47.No side has ever come from that far down.

:41:48. > :41:50.It's a fifth title for the Patriots and a fourth for MVP Tom Brady.

:41:51. > :41:53.The Quarter back instrumental in the comeback Manchester United

:41:54. > :41:55.beat Leicester three nil, in what was another defeat

:41:56. > :42:00.for the champions who are now one point above the relegation zone.

:42:01. > :42:05.United remain on course for a top four finish.

:42:06. > :42:08.Wales beat Italy in the last match of the opening weekend

:42:09. > :42:16.George North with his side's third try.

:42:17. > :42:19.Wales making a winning start but missed out on scoring a fourth

:42:20. > :42:25.try which would have earned them a bonus point victory.

:42:26. > :42:30.That is all the sport for now. Victoria, back to you.

:42:31. > :42:35.This morning we're talking about the state of the NHS with you,

:42:36. > :42:38.and with an audience of 80 NHS workers and patients.

:42:39. > :42:41.For the next 15 mins or so we're going to talk about social care

:42:42. > :42:45.and the impact that stretched resources there have on the NHS.

:42:46. > :42:48.Health care is provided by the NHS in doctors' surgeries and hospitals.

:42:49. > :42:51.Social care is provided in the community to help people

:42:52. > :42:57.who need support due to illness, disability or old age.

:42:58. > :42:59.And because so many more people are living longer,

:43:00. > :43:01.it's really putting pressure on the social care budget,

:43:02. > :43:07.which in 2016 stood at just under ?20 billion in England.

:43:08. > :43:10.The social care system is designed to provide care

:43:11. > :43:13.in the community for the elderly, sick and disabled.

:43:14. > :43:17.It encompasses anything from help in the home with washing

:43:18. > :43:20.and dressing to care homes, and has remained more-or-less

:43:21. > :43:23.unchanged since it was created after World War II.

:43:24. > :43:26.Nowadays people live on average ten years longer and with more

:43:27. > :43:30.complex conditions that require additional care.

:43:31. > :43:33.But support is not rising - it's falling.

:43:34. > :43:36.The Local Government Association estimates the gap between the care

:43:37. > :43:38.budget councils receive will be ?4 billion short of

:43:39. > :43:45.Some experts have called for the care system to be

:43:46. > :43:47.merged with the NHS, but it's known the Government has

:43:48. > :43:50.little appetite for more structural upheaval.

:43:51. > :43:54.The result is that councils are left to limp on.

:43:55. > :43:57.Many people with care needs are forced to pay for it themselves,

:43:58. > :43:59.rely on friends and family, or go without.

:44:00. > :44:01.The Prime Minister has, however, promised a long-term

:44:02. > :44:06.By the end of this Parliament, local authorities will have

:44:07. > :44:08.?3.5 billion more to spend on social care, and of course

:44:09. > :44:12.we're putting more money into the health service as well.

:44:13. > :44:15.The Government's offered local authorities the opportunity to bring

:44:16. > :44:20.forward council tax rises to help cover social care costs,

:44:21. > :44:24.and money redistributed from the new homes bonus scheme.

:44:25. > :44:27.Over the next two years, the Government says it could mean

:44:28. > :44:30.an extra ?900 million is pumped into the social care system.

:44:31. > :44:37.But charities have called it a drop in the ocean.

:44:38. > :44:41.This morning an NHS Trust has apologised after an elderly woman

:44:42. > :44:46.remained on a ward for six months at a cost of more than ?80,000

:44:47. > :44:57.89-year-old Iris Sibley was initially admitted to hospital

:44:58. > :45:01.She and her family were left "distressed and let down"

:45:02. > :45:04.after multiple attempts to move her into a nursing home

:45:05. > :45:08.failed, leaving her in isolation at the Bristol Royal Infirmary.

:45:09. > :45:29.name is Barry. My mother had to go into social care through dementia

:45:30. > :45:33.which she was paying for. Through a nursing home, a care home? Care

:45:34. > :45:38.home. One Saturday morning she had this bout of sickness and the home

:45:39. > :45:41.kept us informed through the day up until Saturday evening, they said

:45:42. > :45:45.she is no worse. She will be fine. She'll get through the night. That

:45:46. > :45:49.was the last call we got until 7am Sunday morning when the hospital

:45:50. > :45:54.phoned us to say she had passed away. She was discharged from

:45:55. > :45:58.hospital without any of her medical records. The hospital tried to phone

:45:59. > :46:02.the home and couldn't get any answer. The police went down and

:46:03. > :46:06.couldn't get any answer. When the morning shift came on at 7am, that's

:46:07. > :46:12.when the police got some response from the night staff. We found out

:46:13. > :46:15.that, you know, if we had been informed that my mother was in

:46:16. > :46:20.hospital, one of the family could have sat with her. She choked on her

:46:21. > :46:27.own vomit and died in A Oh, my goodness. We were paying for 24 hour

:46:28. > :46:32.care, but any member of the family would have willingly sat with her in

:46:33. > :46:36.A How does your family respond to what happened to your mum? What

:46:37. > :46:41.could you do? I got in touch with the solicitor to sue the home for

:46:42. > :46:45.negligence. He said forget it, you're not going to get anywhere

:46:46. > :46:48.with it. He gave me a figure of less than ?1,000 we'd get because we're

:46:49. > :46:52.not dependant on her, but the thing was, we wanted to take it further to

:46:53. > :46:56.prevent it happening again, but he just said it would cost you

:46:57. > :47:01.thousands to prove a point and it won't get you any further. Yeah,

:47:02. > :47:08.yeah understood. My name is Lindsey. I am a home care support worker. I

:47:09. > :47:11.work with people who are discharged from hospital enabling them to

:47:12. > :47:18.remain in their own homes following a period of illness. I work with a

:47:19. > :47:23.caring compassionate team who go above and beyond what's asked of

:47:24. > :47:26.them. I think our concerns are the shutting of the community hospitals,

:47:27. > :47:31.there is nowhere for these patients to go once they have left hospital,

:47:32. > :47:36.therefore due to bed-blocking they are being discharged too soon and

:47:37. > :47:45.ending up in being re-admitted to hospital. I wonder what needs to

:47:46. > :47:48.change? Hello. I'm chair of the Royal College of GPs, but I am a GP

:47:49. > :47:52.myself. This is bringing back examples that I have seen in my

:47:53. > :47:59.practise and I was there to late on Friday and I will be there late this

:48:00. > :48:01.afternoon. People are trapped in hospital unable to go to a safe

:48:02. > :48:05.place because there aren't the places there. The NHS is entirely

:48:06. > :48:09.dependant on social care. If you think of it as a three-legged stool,

:48:10. > :48:12.you have got the community care and the social care and the hospital

:48:13. > :48:15.care. We have to work together and if the system isn't tunded and

:48:16. > :48:19.support, we all fall down, so we're all in it together. It breaks my

:48:20. > :48:22.heart when I have a patient at home and I can see them deteriorating and

:48:23. > :48:26.needing care and I know with the right care package in place they

:48:27. > :48:29.wouldn't need to go to hospital. The joy of being a GP, we can save

:48:30. > :48:36.people getting to hospital if we have the right support structures,

:48:37. > :48:41.we can conduct this orchestra of wonderful people, and family

:48:42. > :48:48.support, we can work miracles. I feel for you guys, but you've done

:48:49. > :48:50.amazing, amazing work. APPLAUSE

:48:51. > :48:54.What's your view when it comes to social care? I think this debate is

:48:55. > :49:01.about the health and social care system being part of a single

:49:02. > :49:04.organisation which is as we've heard before woefully under funded and

:49:05. > :49:08.coming back to the hard facts, the real facts, the truth is we have

:49:09. > :49:13.fewer hospital beds than any other European nation. Germany has three

:49:14. > :49:17.times as many hospital beds. Three times as many. We have the lowest

:49:18. > :49:21.number of doctors, social care funding has been cut year-on-year

:49:22. > :49:26.for the last six years and therefore, when you actually try and

:49:27. > :49:29.look after an older population with multiple health problems you simply

:49:30. > :49:33.can't deliver that whilst you have a social care system that is cutting

:49:34. > :49:38.costs year-on-year so there has to be this has to be addressed as a

:49:39. > :49:42.global issue about looking at the total resource... Well, I don't know

:49:43. > :49:48.about a global issue. Surrey County Council is having a referendum

:49:49. > :49:53.amongst households to see if they would pay 15% extra on their bills

:49:54. > :49:57.to pay for social care? This is a National Health Service. The minute

:49:58. > :50:04.we leave it to local areas to sort out a national problem, we've lost

:50:05. > :50:10.it. Good morning. Thank you very much, Victoria. I'm a frontline

:50:11. > :50:14.clinician, I look after sick newborn babies and last year 1,000 sick

:50:15. > :50:16.babies were transferred unnecessarily between hospitals

:50:17. > :50:21.because there were insufficient cots. That's just one fact that I

:50:22. > :50:25.want to put out there. But I also want to pick up on the point of the

:50:26. > :50:30.ageing population. Let's talk about the healthy ageing population

:50:31. > :50:33.because, of course, the burdens that are placed upon the Health Service

:50:34. > :50:36.has come because we're having an ageing population with complex

:50:37. > :50:40.needs, but what is it that would help us all live long and healthy as

:50:41. > :50:45.opposed to unhealthy lifestyles? Tell us, please. It is about

:50:46. > :50:49.prevention, isn't it? It is about healthy eating and we have not yet

:50:50. > :50:52.spoken about the, we have only spoken about the acute Health

:50:53. > :50:57.Services, we have not spoken about the terrible cuts that have been

:50:58. > :51:03.inflicted on public health. Most of which burden is I have to say being

:51:04. > :51:08.imposed upon children. 14% of the ?200 million in public health cuts

:51:09. > :51:14.last year are falling directly upon children's services, health

:51:15. > :51:18.visiting, is sexual health for young people, obesity prevention,

:51:19. > :51:23.antismoking. All these things are the things that will lead to chronic

:51:24. > :51:27.lung disease, obesity, dementia, many cancers further down the line.

:51:28. > :51:30.It would be really good to talk about prevention when we talk about

:51:31. > :51:35.the Health Services as well. John Ashworth? I'm pleased we're having a

:51:36. > :51:39.debate about social care because you won't solve the problems and the

:51:40. > :51:46.pressures facing the NHS unless we solve the social care crisis in this

:51:47. > :51:49.country. Does that come from the top or do you think county councils who

:51:50. > :51:55.are responsible or councils responsible for social care can make

:51:56. > :51:59.their own arrangements? It has to come from the top. 400,000 elderly

:52:00. > :52:03.and vulnerable people are not getting the kind of social care

:52:04. > :52:06.packages that they would have done. That's putting huge pressures on the

:52:07. > :52:12.NHS itself. It has to come from the top. In the Budget in March, the

:52:13. > :52:15.Chancellor has to do what he failed to do in his mini Budget in

:52:16. > :52:18.November, bring forward emergency funding for social care because the

:52:19. > :52:25.way we treat elderly people is a disgrace in this country at the

:52:26. > :52:27.moment. Jeremy, as a Conservative MP was it short-sighted of the

:52:28. > :52:30.coalition Government to make the kind of cuts they did to social

:52:31. > :52:33.care? I think we have seen this increase over the last couple of

:52:34. > :52:38.years when there has been a lot of pressure... Was it short-sighted

:52:39. > :52:43.then? Yes, I would say, it is short-sighted. I think social care

:52:44. > :52:48.has always been the poor relation. Would you back Mr Ashworth's call

:52:49. > :52:52.for your chancellor to bring forward emergency funding to help councils

:52:53. > :52:56.pay for social care or are you happy to see councils put council tax

:52:57. > :53:01.bills up as many will do? We do need emergency funding. I don't see a

:53:02. > :53:06.problem with councils putting their, we've had council tax freezes more

:53:07. > :53:09.about four or five years. I think it is important that those council tax

:53:10. > :53:14.bills starting to up again in a measured way which is what they are

:53:15. > :53:18.doing in my county, but also I think we need some emergency social care

:53:19. > :53:22.funding because what we're seeing as everybody here has said is people

:53:23. > :53:26.staying far too long, I have seen that in hospital beds, I have seen

:53:27. > :53:30.that in my constituency surgeries and I'm sure every colleague in

:53:31. > :53:33.Parliament has seen the same. When you say emergency funding, how much

:53:34. > :53:37.money are you asking that the Chancellor put in? There is

:53:38. > :53:43.estimates about what is needed. They were talking about ?2 billion, I

:53:44. > :53:46.have suggested there is an extra 700 million allocated in 2019, why not

:53:47. > :53:51.bring that forward? We need some money.

:53:52. > :53:54.I'm going to ask you to pretend that you are residents of Surrey County

:53:55. > :53:58.Council. They are having this referendum, they're going to ask

:53:59. > :54:04.their own householders do you want to pay an extra 15% on your council

:54:05. > :54:10.tax bill which will go to social care? Sorry residents, would you say

:54:11. > :54:23.yes, I will go for the 15%, if you would, put your hand in the air. The

:54:24. > :54:27.problem is with referendums and asking the question, putting

:54:28. > :54:31.questions to the public is we're not given enough information. We're not

:54:32. > :54:35.educated enough to make a choice. There are people who put their hand

:54:36. > :54:40.up to say yes, I would pay the extra 15%? How can you guarantee that that

:54:41. > :54:45.15% is going to go to the frontline services? Yes, introduce yourself?

:54:46. > :54:48.Wendy Preston head of nursing practise from the Royal College of

:54:49. > :54:53.Nursing. It is the wrong question to ask. They're asking it whether we

:54:54. > :54:58.like it or not, they're asking it. If we get the extra money, how are

:54:59. > :55:01.we going to spend it? How are we suddenly going to be able to have

:55:02. > :55:04.the services? Our members have been telling us this is not isolated

:55:05. > :55:10.incidents, they are telling us that day in and day out nurses and

:55:11. > :55:14.doctors are having to send patients home from hospitals into their home

:55:15. > :55:18.when there is not enough care and we know that there are, we have got

:55:19. > :55:23.less community nurses, there is a 40% drop in district nurses. We have

:55:24. > :55:26.got 24,000 nurse vacancies so we need some long-term solutions. It is

:55:27. > :55:33.not just about throwing money at this problem.

:55:34. > :55:37.Welcome. You said you would pay an extra 15% on your council tax bill.

:55:38. > :55:42.I don't live in Surrey, but I would, the problem is going to be poorer

:55:43. > :55:47.parts of the country, Newcastle, Middlesbrough, 15% is a significant

:55:48. > :55:50.amount of money. It is all very well in Surrey from prosperity is higher,

:55:51. > :55:54.but it is not right for the Government to push this problem on

:55:55. > :56:01.to local councils. It needs to be funded properly. You would pay that

:56:02. > :56:07.extra on your council tax bill? No, I'm from the Taxpayers' Alliance and

:56:08. > :56:10.Surrey is an outrageous example. There are lots of councils who are

:56:11. > :56:15.coping with this far, far better than Surrey. It is not a good

:56:16. > :56:21.example: There are lots of councils who will increase bills? 15% is

:56:22. > :56:25.quite absurd and it is clear that some councils are better at this

:56:26. > :56:27.than others and some councils are better at keeping people in their

:56:28. > :56:31.homes and out of care homes than others. There does need to be a

:56:32. > :56:35.learning from best practise across councils because some are opening

:56:36. > :56:41.far, far better than others. Yes, Hugh. This is a really crucial

:56:42. > :56:45.point here and it is interesting to see in Scotland health and social

:56:46. > :56:50.care is now integrated, but it will take time to actually get social

:56:51. > :56:53.care run by local authorities and the NHS working closely together. So

:56:54. > :56:57.they started in Scotland. It hasn't happened in England. It happened in

:56:58. > :57:01.Northern Ireland a while ago. But the big point that's being made

:57:02. > :57:04.here, how can you treat social care funded by local authorities as

:57:05. > :57:07.something very different from the NHS when you have a patient with

:57:08. > :57:12.dementia for example who lives in their own home and who needs care,

:57:13. > :57:15.but is means-tested for it, whereas your cancer care is paid for in a

:57:16. > :57:19.hospital? I think all the big questions are coming up. There are

:57:20. > :57:24.examples around England certainly that I've looked at where local

:57:25. > :57:28.authorities and local NHS GPs are working now together to try to make

:57:29. > :57:33.the best of what they've got which I think can be done, but ultimately,

:57:34. > :57:37.money is involved and is it right it should fall on council tax payers in

:57:38. > :57:40.areas that maybe can afford it, whereas others can't raise council

:57:41. > :57:43.tax because their local population can't afford it? Does it need a

:57:44. > :57:48.bigger long-term plan to be drawn up?

:57:49. > :57:54.I'm June Gray and I am a practise nurse working in East London. My

:57:55. > :57:58.father of 84 years of age passed away sometime ago and in the bed

:57:59. > :58:02.opposite to him on the ward was one of his best friends who

:58:03. > :58:06.unfortunately had had his leg amputated and had been in hospital

:58:07. > :58:12.for a year because he didn't figure in the local authority radar, he

:58:13. > :58:18.didn't have any housing, he had no income, except for his pension and

:58:19. > :58:21.his nearest relative lived in Wales n Swansea, but the authority there

:58:22. > :58:26.didn't want to take him on and couldn't find a nursing home that

:58:27. > :58:31.was suitable for him and so he spent virtually a year in hospital with

:58:32. > :58:36.people passing the buck and saying we don't want to fund this, we can't

:58:37. > :58:40.find a place for you. Eventually it was sorted out, but the difficulties

:58:41. > :58:43.for his family. The difficulties for him and the deterioration in his

:58:44. > :58:47.mental state through lying in hospital for all that amount of time

:58:48. > :58:51.and not getting the proper rehabilitation that he could have

:58:52. > :58:54.had. This is why it needs to be a National Service, it is a three

:58:55. > :58:58.legged stool. When I was a district nurse, if I went into a home, and

:58:59. > :59:03.someone was deteriorating, I could say this person needs more help. We

:59:04. > :59:06.need more visits. When my father was deteriorating, and we said to the

:59:07. > :59:12.carers, can we get more help? We had to go back to the care co-ordinator,

:59:13. > :59:17.they had to go to the agency... Let me read this message. Brendan texts,

:59:18. > :59:20."Families need to take far more responsible for their ablinging

:59:21. > :59:24.parents and relatives." Great, fine, are you going to pay me to give up

:59:25. > :59:28.my full-time job in order to look after my elderly relatives?

:59:29. > :59:33.APPLAUSE Because that's the reality. My

:59:34. > :59:37.mother, who is in her 80s now and I were having to look after my father

:59:38. > :59:41.and pick up the shortfall. My sisters helped where they could, but

:59:42. > :59:45.they live far away. Families are not unwilling to do this, but we can't

:59:46. > :59:49.all just drop everything and be there.

:59:50. > :59:52.I work in a care home and in the only past few weeks we have had

:59:53. > :59:55.residents sent home too early from hospital and then they have had to

:59:56. > :59:58.be re-admitted. Karen says pay relatives to look after the

:59:59. > :00:03.relatives, it must be cheaper than care homes. Good morning. I'm the

:00:04. > :00:14.mum of two junior doctors. What's your name? Leeash. The pressures on

:00:15. > :00:22.the NHS are also being increased because of cutbacks in the social

:00:23. > :00:27.sector, the social funding. I have a brother who has spent an extra five

:00:28. > :00:33.weeks in hospital and an extra five weeks in a nursing home when he has

:00:34. > :00:37.got a home of his own. He just needs his social care package to be able

:00:38. > :00:44.to go back to where he wants to be, back in the home.

:00:45. > :00:52.It must be so frustrating. Very. The thing is, if they had better funding

:00:53. > :00:55.for the social side, these patients don't want to be in the hospital,

:00:56. > :01:01.where they can pick up more infections, they want to go back to

:01:02. > :01:08.their houses and have some dignity and care within their houses, which

:01:09. > :01:14.would release lots of beds. That's the main thing I wanted to say. And

:01:15. > :01:18.the NHS is great. Thank you. The news and sport is on the way, then

:01:19. > :01:23.more discussion. Sally texted to say, remember that the elderly are

:01:24. > :01:26.the ones who have paid tax all their lives, so why should they be

:01:27. > :01:30.sidelined when it comes to treatment? Coming up, we will ask

:01:31. > :01:40.you paying for care will become inevitable. First, the weather.

:01:41. > :01:45.It has started Chile, and the end of the week will be very cold indeed.

:01:46. > :01:51.We have a wet and windy interlude, which is on its way later on today.

:01:52. > :01:57.We have some fog patches lingering in Central and eastern areas, but at

:01:58. > :02:01.West it is all change. Cloud is increasing and outbreaks of heavy

:02:02. > :02:10.rain are working in. A pretty poor rush-hour in these areas,

:02:11. > :02:13.particularly in Belfast. This evening and overnight, the wet and

:02:14. > :02:17.windy weather sweeps to the east. Snow on the high ground of Scotland

:02:18. > :02:21.and northern England, potentially some disruption to trans-Pennine

:02:22. > :02:26.routes. There could be icy stretches by the end of the night at West. A

:02:27. > :02:32.bright day tomorrow, but the chance of some hefty showers in the

:02:33. > :02:35.south-west. The weather front never really moves through and there will

:02:36. > :02:39.be outbreaks of rain. Towards the end of the week, the cloud and rain

:02:40. > :02:44.continues to work its way to the west, bringing colder air with it.

:02:45. > :02:45.It is cloudy at the end of the week, and at times, some of us could see

:02:46. > :02:53.some snow flurries. Hello, it's Wednesday,

:02:54. > :02:54.it's 10 o'clock, I'm Victoria Derbyshire,

:02:55. > :02:55.good morning and This morning, the Government's

:02:56. > :03:06.announced that from April hospitals in England will have a legal duty

:03:07. > :03:09.to charge overseas patients who We'll ask our audience here of NHS

:03:10. > :03:14.workers and patients whether the NHS Let's get a quick snapshot.

:03:15. > :03:38.treatments and procedures. I think if you charge, it

:03:39. > :03:43.fundamentally alters the relationship between the doctors and

:03:44. > :03:50.patients. I agree with the GP over there that if you start charging, it

:03:51. > :03:55.is a slippery slope. You are a final year medical student. I have to

:03:56. > :04:02.agree with the other guys. Is there enough money to do that? I don't

:04:03. > :04:03.know if there is. You have been telling us your experiences of the

:04:04. > :04:25.state of the NHS this morning. We have never been in such dangerous

:04:26. > :04:30.territory. The decisions we have been asked to make our unfathomable.

:04:31. > :04:34.I was told the drugs I need are not funded in Wales. They are being

:04:35. > :04:38.withdrawn from England too. I am having to raise funds to paper the

:04:39. > :04:43.drugs to keep me alive to be here for my children. Day in, day out,

:04:44. > :04:47.nurses and doctors are having to send patients home from hospitals to

:04:48. > :04:53.their home, weather is not enough care. We will also talk about

:04:54. > :04:55.Government plans for a seven-day NHS. Here is how you can get in

:04:56. > :05:00.touch. And wherever you are in the UK,

:05:01. > :05:03.do get in touch with your own experiences and we'll feed those

:05:04. > :05:05.into our conversatoin this morning. You can E-mail us at

:05:06. > :05:08.victoria@bbc.co.uk. We're on Facebook, just search

:05:09. > :05:11.Victoria Derbyshire. Texts will be charged

:05:12. > :05:20.at the standard network rate. Here's Joanna in the BBC Newsroom

:05:21. > :05:23.with a summary of todays news. The number of patients on hospital

:05:24. > :05:26.wards has been at unsafe levels in nine out of ten NHS trusts

:05:27. > :05:29.in England this winter, according to figures

:05:30. > :05:32.obtained by the BBC. The results show some

:05:33. > :05:36.hospitals were operating at close to full capacity,

:05:37. > :05:38.putting increased pressure NHS England says more beds would be

:05:39. > :05:45.freed up if there was greater focus on the link with social care

:05:46. > :05:56.providers. This programme has been debating the

:05:57. > :06:03.state of the NHS in England, which has been described by some as a

:06:04. > :06:06.humanitarian crisis. We need to engage in a big debate about the

:06:07. > :06:15.future financing of the NHS, because as we get older as a population,

:06:16. > :06:19.with more complex needs, and we have more expectations on the NHS, we

:06:20. > :06:24.will have to debate and face up to big questions about how we fund it.

:06:25. > :06:27.Let's not go to the nonsense and believe that the NHS could not have

:06:28. > :06:34.extra investment now. It could if this Government took a different set

:06:35. > :06:40.of decisions. The Conservative MP for Stafford disagrees and thinks

:06:41. > :06:45.that extra tax should be raised. If you look at the amount we spend on

:06:46. > :06:51.health, it is probably about 2% GDP less than in France and Germany, and

:06:52. > :06:54.frankly, unless we are prepared, and I heard people behind say they were

:06:55. > :06:59.prepared to do this, and certainly when I talk to my constituents,

:07:00. > :07:03.unless we are prepared to say we will increase the amount we spend,

:07:04. > :07:10.which means higher taxes, I'm afraid, there isn't anywhere else to

:07:11. > :07:14.go if we are going to have a... System funded based on need and from

:07:15. > :07:16.a progressive source of income, that is the only way to go.

:07:17. > :07:18.The Government plans to impose a legal duty on hospitals in England

:07:19. > :07:22.to charge overseas patients up front if they are not eligible for free

:07:23. > :07:26.Last week, a report by MPs said the system for recovering costs

:07:27. > :07:31.NHS Improvement, which oversees trusts, said the new approach

:07:32. > :07:34.would save hospitals having to chase money they are owed.

:07:35. > :07:36.Emergency treatment will continue to be provided immediately

:07:37. > :07:43.Thousands of low-income families who were stripped of their tax

:07:44. > :07:45.credits after a mistake by the US out-sourcing firm Concentrix

:07:46. > :07:51.A Committee of MPs says that Her Majesty's Revenue Customs

:07:52. > :07:54.has accepted their recommendations to review up to 23,000 new cases.

:07:55. > :07:57.The company, Concentrix, was sacked by HMRC in September

:07:58. > :08:03.following an investigation by this programme.

:08:04. > :08:05.MP's will have the chance to amend the Government's legislation

:08:06. > :08:08.on Brexit when it returns to the Commons for three

:08:09. > :08:11.A number of pro-Remain Conservative MPs are understood to be

:08:12. > :08:14.considering voting with Labour and the SNP to try and give MPs more

:08:15. > :08:17.of a say over what happens at the end of the negotiating

:08:18. > :08:20.process - although Downing Street is understood to be confident

:08:21. > :08:26.President Trump has stepped up his attacks on the judge

:08:27. > :08:29.who blocked his travel ban on seven Muslim majority nations.

:08:30. > :08:31.In a series of tweets, he said the American people should

:08:32. > :08:34.blame the judge if anything happened to threaten national

:08:35. > :08:36.security and that the courts were making his job very difficult.

:08:37. > :08:38.The White House is expected to pursue its appeal

:08:39. > :08:45.That's a summary of the latest BBC News.

:08:46. > :08:53.We're going to start with breaking news from the last hour

:08:54. > :08:55.and the announcement that Alastair Cook has stepped down

:08:56. > :08:59.Cook was appointed nearly five years ago and has led England

:09:00. > :09:03.He helped England to two Ashes series wins but leaves in the wake

:09:04. > :09:08.The 32-year-old has told the ECB he wants to continue as a test

:09:09. > :09:11.player, but leaves England looking for a new test captain

:09:12. > :09:17.with a home series to come against South Africa this summer.

:09:18. > :09:24.Ears very strong mentally, he knows his game, knows what he wants. He is

:09:25. > :09:32.stubborn at times. He has worked feverishly hard on his technique to

:09:33. > :09:36.improve it through the years, and he is a fantastic test cricketer, the

:09:37. > :09:40.rock of England's batting for the last decade. There was an argument

:09:41. > :09:46.for Cook to continue for another year, to get through this summer,

:09:47. > :09:56.get through the ashes, and then hand over to Joe Root. That would allow

:09:57. > :10:01.Joe Root to settle in as captain. It seems, after the discussion, that he

:10:02. > :10:03.has had enough. history to beat the Atlanta Falcons

:10:04. > :10:08.34-28 in overtime. The Falcons were in complete

:10:09. > :10:10.control having scored three They were 25 points ahead before

:10:11. > :10:16.the spectacular fight-back - no team has come form that

:10:17. > :10:19.far behind before. The Patriots drew level at 28

:10:20. > :10:22.all with less than a minute left And then, in overtime,

:10:23. > :10:26.a touchdown from James White completed the comeback

:10:27. > :10:29.to take the title. Quarter-back Tom Brady named

:10:30. > :10:31.the Most Valuable Player for a record fourth time -

:10:32. > :11:01.it's a fifth title for the Patriots. The NHS was created after the Second

:11:02. > :11:05.World War with the guiding principle that it should be free to all and

:11:06. > :11:12.open to anyone at any point in their lives, that is, that it would look

:11:13. > :11:13.after you from cradle to grave. How many of those principles hold true

:11:14. > :11:22.nearly 70 years later? I got pain in the top

:11:23. > :11:25.of my legs, really bad. The ambulance came

:11:26. > :11:30.and took me to A, I didn't know I was

:11:31. > :11:41.pregnant until I got into the delivery suite,

:11:42. > :11:44.so they were very supportive,

:11:45. > :11:47.helped me with baby clothes, because I had nothing,

:11:48. > :11:51.and just generally felt that home because of their support and how

:11:52. > :11:57.welcoming they were. My name is Rachel,

:11:58. > :11:59.I live in London and I've had mental health problems

:12:00. > :12:02.for about three years since I had a breakdown in my last

:12:03. > :12:06.year at university. My experiences with

:12:07. > :12:10.NHS services have I have had some that

:12:11. > :12:14.were really helpful, but often, the right services aren't

:12:15. > :12:17.there when you need them, so you can end up waiting a really

:12:18. > :12:20.long time, and that can mean things get really bad

:12:21. > :12:27.before you get any help. I'm Lisa Stevenson,

:12:28. > :12:32.and in April 2011, my life changed forever,

:12:33. > :12:35.when I was diagnosed out of the blue with multiple myeloma,

:12:36. > :12:36.cancer of the The NHS, for me, is made up

:12:37. > :12:45.because of the incredible people who work within it - the

:12:46. > :12:49.doctors, the nurses, the porters, Every interaction I have

:12:50. > :12:57.had has been absolutely My name is Jo Horton, and less

:12:58. > :13:07.than a year ago I was involved in an accident in a bus that

:13:08. > :13:11.resulted in me losing my leg, so I Thanks to the NHS, I am here,

:13:12. > :13:17.running my own business I am a former Olympian,

:13:18. > :13:25.and judo has been my life The NHS literally pieced me back

:13:26. > :13:30.together, physically, emotionally and mentally to get me

:13:31. > :13:35.back here on this journey. Everyone from the bottom

:13:36. > :13:37.to the top has made My husband died in May 2014

:13:38. > :13:46.from pancreatic cancer, and throughout that process, we were put

:13:47. > :13:51.through the palliative care route and support by the

:13:52. > :13:54.palliative care team. We went from him being OK

:13:55. > :13:59.to suddenly dying overnight. Lots of the care along

:14:00. > :14:01.the way wasn't the It didn't really meet the kind

:14:02. > :14:08.of person-centred agenda that the NHS talk about,

:14:09. > :14:11.people being at the centre of the decision-making,

:14:12. > :14:14.so I am keen to share the story that Seth and I went through to improve

:14:15. > :14:20.things for others and to create a

:14:21. > :14:28.compassionate legacy in Seth's name. Labour opened up the NHS

:14:29. > :14:30.to independent, private providers in 2002 in a system where money

:14:31. > :14:34.follows the patient. Ten years ago 2.8% of the NHS budget

:14:35. > :14:38.was spent on independent providers. Privatisation means opening the door

:14:39. > :14:48.to private providers. It's different to charging for some

:14:49. > :14:51.services which we already do for things like dentists,

:14:52. > :14:54.eye care and so on. But with a finite pot of money,

:14:55. > :14:59.a growing and ageing population is it time to start

:15:00. > :15:03.looking again at charging A BBC Ipsos Mori survey of over 1000

:15:04. > :15:09.adults in the UK suggests that half of you think that would be

:15:10. > :15:12.unacceptable, but around a third Let's get a snapshot

:15:13. > :15:16.of views in the audience. Put your hands up and keep them up,

:15:17. > :15:33.if you think it would be acceptable I'm just going to net over here. I

:15:34. > :15:40.spent 28 years in the ambulance sector. I would look at charging for

:15:41. > :15:48.people who choose to get drunk. They put a huge strain on services and

:15:49. > :15:58.they'd like BAe NDE -- they blight the A How much would you charge?

:15:59. > :16:01.In the United States, they are locked in a safe place, cared for,

:16:02. > :16:10.and the next day, there is a release fee. Who agrees or disagrees?

:16:11. > :16:18.What's it called? The drunk recovery service. This is a trojan horse

:16:19. > :16:23.argument. The NHS has been... Tell the gentleman here. I will explain

:16:24. > :16:26.to him. They might seem like an easy target, but once you introduce the

:16:27. > :16:30.infrastructure for charging this will gradually be extended to other

:16:31. > :16:38.groups like overweight people, people who smoke, people who injure

:16:39. > :16:45.themselves through skiing, the immigrants are being used to

:16:46. > :16:50.introduce charging. Charging patients is classified as a zombie

:16:51. > :16:55.policy. It refuses to die and what our Tory MP should be telling us

:16:56. > :16:59.they are setting us up for an American-style insurance system

:17:00. > :17:04.either you can, there is two-ways to pay charges, you pay out of pocket

:17:05. > :17:08.or take out top-up insurance and our politicians are afraid to tell us

:17:09. > :17:12.where they're taking us. I'm going to ask our Conservative MP

:17:13. > :17:14.in a second. I want you to argue the case for what you have talked about

:17:15. > :17:20.with this gentleman here. What's your name and what do you do? I'm Dr

:17:21. > :17:25.Bob Gill and I am a GP and I'm producing a documentary to explain

:17:26. > :17:29.this scam that's taking place. I think it is demoralising for

:17:30. > :17:32.ambulance staff having to deal with drunk people on Friday and Saturday

:17:33. > :17:36.night. You ask about the morale of the NHS, they are having to deal

:17:37. > :17:39.with people because there is no disincentive for them to go out and

:17:40. > :17:43.get drunk? Is that something we want to put up with? I take your point

:17:44. > :17:48.about it being a trojan horse potentially, but that's a specific

:17:49. > :17:53.instance where it causes misery for NHS and money. I am not advocating

:17:54. > :17:59.that people get drunk and waste people's time. Has anyone here had

:18:00. > :18:05.an ambulance called after having one too many or two too many or three

:18:06. > :18:10.too many? What thz is a spurious argument. We are having demonising

:18:11. > :18:17.of certain patients and this will be extended and we're falling into a

:18:18. > :18:21.trap. My name is Jess and I am an A doctor. I stand on the

:18:22. > :18:24.frontline, I'm the person who gets assaulted and gets sexually

:18:25. > :18:27.assaulted in A by drunk people. I was a medical student, you have seen

:18:28. > :18:32.us on TV, we go out and get drunk all the time, I have never ended up

:18:33. > :18:35.in A None of us have ever ended up in A and I've never left my

:18:36. > :18:40.friends behind on the side of the road drunk which people do now. We

:18:41. > :18:45.should be charging them. It costs huge sums of money. It is ?300 every

:18:46. > :18:50.time we spend LAS to go and pick somebody up off the side of the road

:18:51. > :18:54.and then the money you get charged, just talking into A is ?100 to

:18:55. > :18:58.register you, it is a waste of money and it is ridiculous. Can I ask you

:18:59. > :19:06.the nature of the assaults upon you? I have been punched in the face and

:19:07. > :19:09.held up against the wall, I have had nurses who are awesome dragging

:19:10. > :19:12.people off me. I had someone grab me by the breast in the waiting room

:19:13. > :19:16.and that's going to court and that's because I work on the frontline in

:19:17. > :19:20.A and all of those people were drunk, none of them were mentally

:19:21. > :19:23.unwell, but all of those people were drunk and not in control of them

:19:24. > :19:36.sefrs, that doesn't make their behaviour acceptable in anyway.

:19:37. > :19:42.You would charge ?400? In Cardiff they have a drunk time. The LAS who

:19:43. > :19:47.are highly trained professionals say, "You are a drunk person. Go and

:19:48. > :19:51.lie on that bed and a matron will kick you out in two hours when you

:19:52. > :20:00.wake up and feel sorry for yourself." Three-quarters of people

:20:01. > :20:05.support the idea of charging visitors from outside the UK for

:20:06. > :20:24.health visitors. Who agrees with that? My name is

:20:25. > :20:29.Joanne Smith. I'm a medical secretary in the hospital for 23

:20:30. > :20:35.years. I have also been a patient over the last two years through

:20:36. > :20:39.breast cancer, chemo, radiotherapy, and two operations as well as

:20:40. > :20:45.supporting my dad with lung cancer and as a family, the money that we

:20:46. > :20:50.have had out of the NHS and my brother broke his kneecap as well,

:20:51. > :20:56.we were all in hospital at the same time at one point. All going to

:20:57. > :20:59.theatre. Me and me dad were on the cancer ward having chemo together.

:21:00. > :21:08.The money as a family that we have had out of the NHS, I would not like

:21:09. > :21:13.to know, but my dad is 70. He run his own company. He has worked every

:21:14. > :21:19.single day since he left school. The same with me and the same with my

:21:20. > :21:25.brother. And we owe our lives to the hospital. I work as a medical

:21:26. > :21:31.secretary. I give above and beyond... And you support this move

:21:32. > :21:36.that's been brought in? I support. A legal duty on staff to charge? I do,

:21:37. > :21:50.yes because... Who disagrees with that? Where is Amber. I'm Oliver. To

:21:51. > :21:55.be honest I disagree that people who come to this country should have to

:21:56. > :22:01.pay to receive care if they fall ill. While they're here they're

:22:02. > :22:04.contributing to the economy, you know, they're spending money,

:22:05. > :22:07.investing in the country, you never know when you're going to become

:22:08. > :22:13.ill. So I think, I'd like to think if I was in a foreign country I'd

:22:14. > :22:18.receive... What do we mean by non-urgent care? Nobody in

:22:19. > :22:22.Government is proposing that if you come over from another country and

:22:23. > :22:26.you have to be picked up by an ambulance and taken to A that you

:22:27. > :22:30.will be charged. This policy that developed today, we need it get more

:22:31. > :22:36.details, refers to routine and non-urgent care. There is a bit of a

:22:37. > :22:42.grey area around that, but it is being interpreted if you go for an

:22:43. > :22:46.appointment which in a hospital, an outpatient appointment leading to

:22:47. > :22:49.some form of routine surgery, that would be something where they'd

:22:50. > :22:53.check your ID and see if you are entitled to free NHS care. I don't

:22:54. > :22:58.think anybody wants to stop emergencies being treated whichever

:22:59. > :23:03.country you km from. But you get a bill afterwards under these plans.

:23:04. > :23:08.Jeremy Lefroy might have more details. There was a plan to extend

:23:09. > :23:12.it so that if you went into A and needed to stay a few nights and

:23:13. > :23:15.needed surgery as a result of that, would you have to pay for that, but

:23:16. > :23:21.Jeremy Hunt announced that was put on hold for now. Today's policy is

:23:22. > :23:24.all about dealing with the routine and non-urgent care and whether

:23:25. > :23:29.hospitals are being effective at charging. You think that's a good

:23:30. > :23:34.idea. You disagree. You should only be able to get access to it if you

:23:35. > :23:38.put money into the system. My stepson came from America, he was

:23:39. > :23:42.charged ?50 at A when he hurt his arm. We didn't mind paying for it.

:23:43. > :23:46.He's not paying into the system. You could afford it though? There are

:23:47. > :23:49.other things, you don't need to go to doctor for everything. Sometimes

:23:50. > :23:54.the pharmacy can cover lots of things, you know, I think sometimes

:23:55. > :23:59.charging them might make them think twice do I really need to go?

:24:00. > :24:03.Urgency I understand. Let's ask the next question. Four in ten in

:24:04. > :24:09.England would support increasing income tax to fund the NHS. And more

:24:10. > :24:13.than half in the UK would support increasing national insurance to

:24:14. > :24:21.fund the NHS. Stick your hand up if you agree with that and haven't yet

:24:22. > :24:27.spoken. Hi, good morning. Good morning.

:24:28. > :24:32.What's your names? James Welling. I hopefully can speak for a lot of

:24:33. > :24:37.folks here. If we can get guarantees from the Government that it would be

:24:38. > :24:47.ring-fenced and it would be spent on extra staff, extra services, and not

:24:48. > :24:50.put into another department for helping with future wars, whatever

:24:51. > :24:55.else, if it is ring-fenced I think people will be willing to pay extra.

:24:56. > :25:04.So would you, a penny on income tax? Yes. Five pence? But, but we need to

:25:05. > :25:14.know where it is going. Yes, OK. Thank you.

:25:15. > :25:18.Hi. Agree or disagree? I'm Mike Foster and I'm from Huddersfield.

:25:19. > :25:21.This is the wrong question again. Unfortunately we have the money in

:25:22. > :25:25.the NHS system. The Government has a lot of money, the minister or the MP

:25:26. > :25:30.needs to answer the question that's been put to him, ?22 billion more is

:25:31. > :25:35.going to be cut from the NHS budget by 2020 by this Government. That

:25:36. > :25:40.money should be refunded. We have a ?3 billion deficit and someone has

:25:41. > :25:44.talked about a PFI debt. We need to cancel all the PFI debts and then

:25:45. > :25:52.the NHS will be awash with money instead of us having to pay more.

:25:53. > :25:57.OK. Hello. Do you agree or disagree, madam in terms of increasing income

:25:58. > :26:02.tax or national insurance? I agree with increasing income tax, but not

:26:03. > :26:05.national insurance. We've paid national insurance, the older people

:26:06. > :26:13.have throughout our worker years and we shouldn't have to do that again.

:26:14. > :26:20.Let me say, I'm chairman of the Lewisham Pensioners' Forum and we

:26:21. > :26:24.were instrumental in campaigning to save the NHS as well as to save

:26:25. > :26:29.Lewisham Hospital. I just had to get that one in. Well, you did it and

:26:30. > :26:34.you did it very well and we barely noticed! I want to comment on what

:26:35. > :26:40.the GP said. We need more GPs. We need more doctors. We need more

:26:41. > :26:45.funding. I mean, especially in my case, talking for older people, we

:26:46. > :26:51.shouldn't have to go and queue for half an hour or an hour to get to

:26:52. > :26:55.see a GP. We would like consistency, stability, we don't want to be

:26:56. > :27:02.changing doctors every time we go to the surgery. We would like to see

:27:03. > :27:07.the same GP to get accustomed, to build confidence, feel comfortable

:27:08. > :27:10.with that GP rather than seeing different people every time that we

:27:11. > :27:15.go to the hospital. OK. Do you agree or disagree in

:27:16. > :27:20.terms of putting up income tax, if it was ring-fenced? Yes, agree with

:27:21. > :27:24.that as well. You would do it? You would vet for a party that had that

:27:25. > :27:30.in its manifesto at next general election? Yes and I'll tell you why.

:27:31. > :27:36.I have been in an NHS patient for 39 years. I'm celebrating 21 years as a

:27:37. > :27:40.transplant patient. APPLAUSE

:27:41. > :27:45.Thank you. The reason that I agree is because I

:27:46. > :27:49.owe my life to the NHS. I will owe my life to the NHS for the rest of

:27:50. > :27:54.my life and I will need another transplant one day. This won't last

:27:55. > :27:57.forever, I realise that. If you have ever been ill and ever known a

:27:58. > :28:01.family member that's been ill in my opinion, you will change your view

:28:02. > :28:07.on whether you think that it should be increased in income tax or

:28:08. > :28:14.anything else. In my view, the, you have to look at where the money is

:28:15. > :28:17.going. There is no good in pumping the money into the NHS if we're

:28:18. > :28:22.going to be overcharged with managers getting six figure

:28:23. > :28:25.salaries, even the quality xharks, six figure salaries, they're not

:28:26. > :28:32.dharg jobs correctly. We need to have people doing their jobs

:28:33. > :28:39.correctly. I'm Lesley Channon. I guess I really

:28:40. > :28:44.lf the NHS. It has helped me -- love the NHS. It has helped me. I had

:28:45. > :28:49.really severe postnatal depression and I agree with raising taxes for

:28:50. > :28:53.everyone. I've experienced the healthcare system in America where I

:28:54. > :28:59.had to pay $300 a month just to be insured. I had a spinal cord injury

:29:00. > :29:05.and it ended up costing my insurance company, I was in hot a week,

:29:06. > :29:11.$150,000, I was in rehab for nine months, I didn't know if I was going

:29:12. > :29:17.to be able to have children. If I hadn't had insurance, I would have

:29:18. > :29:20.been responsible for that debt and George W Bush wrote into legislation

:29:21. > :29:24.that people cannot file bankruptcy on medical bills so people are

:29:25. > :29:33.losing their homes when they get sick. So I think as a society, this

:29:34. > :29:37.precious NHS that we have, we shouldn't be blaming one person

:29:38. > :29:41.because they get cancer or one person because they need a

:29:42. > :29:47.transplant. As a society we have agreed with this NHS to share the

:29:48. > :29:50.cost equally. OK, thank you. APPLAUSE

:29:51. > :29:55.Good morning. I'm a GP from Hackney. I just just

:29:56. > :29:58.want to talk about charging and about where the money goes and it

:29:59. > :30:01.was interesting you quoted that figure of private involvement in the

:30:02. > :30:06.NHS. That's a massive under estimate. The NHS spends millions

:30:07. > :30:10.and millions and millions of pounds every year on consultant

:30:11. > :30:14.managements, high fees for general managers within the NHS and also

:30:15. > :30:21.there is a lot of back office functions such as the CSUs, they're

:30:22. > :30:27.kind of people that run the, I don't know, back office functions behind a

:30:28. > :30:32.lot of, they're being amalgamated so there is more costs all the time and

:30:33. > :30:38.the Government's very sponse to chronic funding in the NHS is to say

:30:39. > :30:40.we need a complete upheaval called the sustainability and

:30:41. > :30:47.transformation programmes. The NHS is going to be divided up into 44

:30:48. > :30:49.areas, my area has spent ?7 million just on the reorganisation and

:30:50. > :30:57.nothing has happened yet! It is not even a 1259try body. And

:30:58. > :31:04.these reorganisations are going to to lead to a disguise for cuts.

:31:05. > :31:13.The aim of this is to cut funding, close A, close others is, not ill

:31:14. > :31:16.hospitals that are needed. Let's bring in Jeremy Lefroy, the

:31:17. > :31:21.Conservative MP. Speaking as a constituency MP, but it is your

:31:22. > :31:27.Government, your party in Government. Some people think the

:31:28. > :31:31.Government is on a secret part to eventually privatise the NHS, and

:31:32. > :31:36.this programme of efficiency savings, cuts, whatever term you

:31:37. > :31:40.want to use, is a way of breaking the system so that when they reach

:31:41. > :31:43.the day when they go, we're going to privatise Everton, people will go,

:31:44. > :31:49.thank God for that because it is such a mess at the moment. --

:31:50. > :31:59.privatise everything. Is there any truth in that? Know is the answer.

:32:00. > :32:04.-- no is the answer. Absolutely not, and if there was, I wouldn't be a

:32:05. > :32:08.Conservative MP, simple as that. The gentle man also spoke about the ?22

:32:09. > :32:12.billion. Where that figure has come from is that before the last

:32:13. > :32:19.election, the NHS produced its own plan saying we need an additional

:32:20. > :32:24.?30 billion in real terms over the coming five years, and the NHS

:32:25. > :32:30.itself, Simon Stephens, said, we will find efficiency savings of ?22

:32:31. > :32:35.billion, but we need an additional ?8 billion in real terms to meet

:32:36. > :32:39.this target. That is where the figure comes from. It is not about

:32:40. > :32:48.cutting money, it is about additional money, but the increased

:32:49. > :32:53.pressures the NHS is facing meant that those savings had to be found.

:32:54. > :33:01.Personally, I think that the 2020 plan was ambitious. If I can just

:33:02. > :33:07.finished, we need to get into our heads that this ?22 billion is not

:33:08. > :33:17.money that has some come -- as somehow come out of the NHS. Bee it

:33:18. > :33:24.is. I think Hugh can explain that. -- it is. Where does the money come

:33:25. > :33:26.from? The Government says it will chip in ?8 billion, so the

:33:27. > :33:32.Government has pledged more money, but the debate is over how you get

:33:33. > :33:36.to ?30 billion. Does it need more Government money does it need the

:33:37. > :33:42.NHS using the ?22 billion more efficiently to close that gap? That

:33:43. > :33:47.is partly what the sustainability of transformation plan is about. Just

:33:48. > :33:51.part of this is about treating more people in their local community

:33:52. > :33:55.rather than being in hospital. Is there a better use of the money?

:33:56. > :34:00.That is the logic, but there is scepticism about whether anything

:34:01. > :34:04.like ?22 billion can be found. Jeromy is absolutely right. If the

:34:05. > :34:11.Conservatives privatise the NHS, they will be voted out of office.

:34:12. > :34:21.Jeromy is saying, as a Conservative MP, if they privatise the NHS, I

:34:22. > :34:28.won't continue. Do you believe this Conservative MP when he says that?

:34:29. > :34:35.No. I disagree with what you are saying, Victoria. Use the leg-mac

:34:36. > :34:44.you asked if they were privately trying to -- -- you asked if they

:34:45. > :34:49.were secretly trying to privatise, but it is not even secret any more.

:34:50. > :34:54.I work at the Royal London, a major trauma centre, and we cannot cope

:34:55. > :35:00.with elective work any more because they have closed down A Who

:35:01. > :35:06.would vote for a party that would promise to privatise the NHS? They

:35:07. > :35:10.won't explicitly, but they will if they show the NHS is a service in

:35:11. > :35:14.failure. Then the Whitewater privatisation comes in and says,

:35:15. > :35:21.actually, we have an alternative, then they will vote for it. We need

:35:22. > :35:27.to look at money is going. How many MPs and consultants have links to

:35:28. > :35:33.the Conservative party? The care quality commission is made up of

:35:34. > :35:39.people with links. They are the wrong people. You've got to look at

:35:40. > :35:43.where money is being lost. This is money being siphoned off. John

:35:44. > :35:52.Ashford, do you think there is a plan from the Conservatives to

:35:53. > :35:58.slowly privatise the NHS? To be fair to John, he is not a typical Tory.

:35:59. > :36:02.We should not gang up on him. The health and social care rack which

:36:03. > :36:08.the Conservatives brought in has put rocket boosters under the exercise.

:36:09. > :36:13.In Durham, there is a private firm stepping in when GPs have made a

:36:14. > :36:18.referral. The private firm checks whether the GP was correct or not to

:36:19. > :36:23.make that referral. It is absolutely disgraceful, isn't it? On the point

:36:24. > :36:27.about STPs, there was an eloquent explanation on the economics of it,

:36:28. > :36:32.but the row Letty is that across the country we will see beds cut, A

:36:33. > :36:39.departments close. Maternity units will be closed, hospitals will be

:36:40. > :36:44.close. That is what this ?22 billion is about - huge cuts to local

:36:45. > :36:51.services. I want to ask the panel, what would you charge for, if

:36:52. > :36:56.anything? I represent doctors in the BMA. I think this is completely the

:36:57. > :37:09.wrong question. Just answer the question and then say why you think

:37:10. > :37:11.it is wrong. I agree that charging is an unhealthy distraction. The

:37:12. > :37:15.amount of money we could reclaim is so small as to make a major

:37:16. > :37:18.distraction, because the people who would pay other people who are

:37:19. > :37:22.really struggling at the moment. Those who are unemployed and fully

:37:23. > :37:25.resourced through social care would not pay anything anyway. Those who

:37:26. > :37:33.are vulnerable, elderly, they would not pay. It is the people working

:37:34. > :37:38.and contributing via tax. People say to me, of these two drugs, which is

:37:39. > :37:42.most urgent? They can't afford prescription fee. Adding fees beyond

:37:43. > :37:53.that will make the sick even more set. -- sick. Children have no voice

:37:54. > :37:56.and I speak for them. This is a huge distraction. There is money in the

:37:57. > :38:00.system. Let's take the internal market, abolished in Scotland and

:38:01. > :38:12.Wales. It would free up around ?5 billion per year.

:38:13. > :38:19.What about the external market? The Department of Health was my own

:38:20. > :38:25.figures, ?6.6 billion going into profit-making companies. Add that up

:38:26. > :38:29.and you've already got about ?12 billion a year that could be getting

:38:30. > :38:36.into the NHS. Talking about charging for services, which is less than

:38:37. > :38:40.0.5% of the NHS budget, is a huge distraction. It is not a question we

:38:41. > :38:43.should be addressing. Right, we are going to have more stories. I want

:38:44. > :38:55.to hear from this lady. Good morning. My name is Sylvia Parks. I

:38:56. > :39:05.worshipped the NHS up until the 8th of October 20 15. Before that, two

:39:06. > :39:10.of my daughters had twins and they were in the special care unit and

:39:11. > :39:16.the nurses were fabulous. On the 8th of October, my daughter, 26 years

:39:17. > :39:24.old, went into hospital to have her baby, and she died during

:39:25. > :39:29.childbirth. They wanted us to switch the machine off on the same day that

:39:30. > :39:33.my daughter died. The baby survived, she is 16 months. She has a great

:39:34. > :39:41.three brain injury and she is blind. I just want to say that we didn't

:39:42. > :39:45.anticipate that happening. She walked into hospital. She went on

:39:46. > :39:53.the 7th of October and was sent home. We were told that ever the

:39:54. > :39:58.leg-mac if everyone came in when they were one centimetre dilator,

:39:59. > :40:04.the hospital would be full. She had a problem that was seen on three

:40:05. > :40:17.scans and not acted upon because they were not sure what it was. That

:40:18. > :40:21.cost her her life. I would like to say, how many lives are going to go

:40:22. > :40:30.like my daughter's before something is done about the NHS? We paid

:40:31. > :40:33.dearly, and we are still paying dearly, still having problems

:40:34. > :40:38.accessing services for my granddaughter, of whom we have legal

:40:39. > :40:42.custody now. We were told the other day that they have to be careful how

:40:43. > :40:46.they spend public funds. The baby doesn't sleep at night. She

:40:47. > :40:52.sustained brain injury and doesn't sleep as a result. I am about to

:40:53. > :40:58.give up work. I am working my notice to take care of my granddaughter.

:40:59. > :41:08.Who is going to help us? Wow... We are so sorry, so sorry. I know this

:41:09. > :41:14.lady would like to talk to. Firstly, my sincere condolences. I know the

:41:15. > :41:19.pain of loss. I speak and write on perinatal mental health. I have done

:41:20. > :41:24.that for the last 12 years. I was very ill 20 years ago and could have

:41:25. > :41:28.been one of those very sad cases of a new mother's body found on a

:41:29. > :41:32.railway line. I survived, thanks to the NHS and everyone who supports

:41:33. > :41:35.me. Now I speak on behalf of other ladies and families who had been

:41:36. > :41:43.left without a mother or father because of poor mental health care

:41:44. > :41:47.around childbirth. I spoke to midwives last week on a training

:41:48. > :41:57.day, and one lady said there are two midwives coping for 27 people at any

:41:58. > :42:01.one time. People... Midwives do an incredible job, I think they really

:42:02. > :42:07.do, and yet they are pressured. Our society is based on new lives.

:42:08. > :42:13.Mothers and fathers need supporting, and I think as a society we have

:42:14. > :42:21.forgotten to nurture our families. We are not remembering how precious

:42:22. > :42:25.new life is, especially when we have treatment of a loved one at the same

:42:26. > :42:36.time as Joy, we have to put more into perinatal head mental health

:42:37. > :42:44.services. -- into perinatal mental health services. I am a big fan of

:42:45. > :42:47.the NHS. I had a stroke two years ago and I can honestly say the

:42:48. > :42:53.support I got from the NHS was superb. In my recent role as a

:42:54. > :42:58.volunteer, I speak to a lot of stroke survivors, and a lot of them

:42:59. > :43:01.say they have not had that same experience, particularly when they

:43:02. > :43:10.are discharged from hospital. When we did a survey, 48% of stroke

:43:11. > :43:16.survivors felt alone and totally unconsidered after being discharged.

:43:17. > :43:23.It is a postcode lottery. Some areas are really good, other areas, you

:43:24. > :43:29.get nothing. There are 1.2 million stroke survivors out there, and for

:43:30. > :43:30.so many of those, they end up with permanent, life changing

:43:31. > :43:40.differences. They need support, whether it be mental, physical,

:43:41. > :43:42.speech. A lot of the clinical commissioning groups, when they

:43:43. > :43:51.start looking at funding, they take away some of that funding. The

:43:52. > :43:55.Stroke Association, whom I help with, they go out and help support

:43:56. > :43:58.those survivors. That funding is slowly being taken away, so they

:43:59. > :44:07.can't do that for that cancel any more. Thank you. Hello. My name is

:44:08. > :44:10.Chris. Three years ago I was diagnosed with depression and

:44:11. > :44:15.anxiety, and the NHS couldn't do anything for me. I had to spend

:44:16. > :44:20.?4000 of my own money. If I had not, I don't know if I would be here

:44:21. > :44:24.today. The concept of charging is already happening. I paid a lot of

:44:25. > :44:29.money. 6000 people are killing themselves every year. We have got

:44:30. > :44:33.to start taking mental health more seriously and commit and spend the

:44:34. > :44:41.money we say we are going to come because we're not doing it. For the

:44:42. > :44:44.last 15 minutes or so of the programme, we are going to talk

:44:45. > :44:50.about Government plans for a seven-day NHS. Should you be able to

:44:51. > :44:54.book an appointment at the GP surgery in the evening or at

:44:55. > :44:55.weekends? Should routine operations take place outside office hours's

:44:56. > :45:00.look at this. One of the Government's most

:45:01. > :45:03.ambitious plans is to make the NHS in England a seven-day

:45:04. > :45:04.service by 2020. It was a key pledge of former

:45:05. > :45:07.Prime Minister David Cameron. With a future Conservative

:45:08. > :45:09.Government, we would Now it's been taken

:45:10. > :45:12.on by Theresa May. The Government envisages people

:45:13. > :45:14.having access to local It recently announced that GP

:45:15. > :45:17.surgeries that fail to open at evenings and on weekends

:45:18. > :45:19.could lose their funding. Patients, the Government say,

:45:20. > :45:24.should also receive the same level of urgent and emergency care

:45:25. > :45:26.in hospitals in England at weekends CHANTING: Save our

:45:27. > :45:33.NHS, save our NHS! This was at the centre of the junior

:45:34. > :45:36.doctors' contract dispute last year. Junior doctors already work

:45:37. > :45:38.on weekends, and in fact represent the bulk of medical

:45:39. > :45:40.professionals on shift. Tweets targ'1eted at

:45:41. > :45:45.Health Secretary last year in work, Jeremy" were keen

:45:46. > :45:51.to prove this point. But while emergency care

:45:52. > :45:52.is available at weekends, Health Secretary Jeremy Hunt has

:45:53. > :45:58.caused controversy by suggesting a lack of staff was behind

:45:59. > :46:02.the higher weekend death rate. He said 6000 deaths a year

:46:03. > :46:05.were caused by a lack of a proper seven-day service,

:46:06. > :46:07.citing an unpublished But e-mails show one of its authors

:46:08. > :46:13.was unhappy with how Some experts believe other factors

:46:14. > :46:18.must be considered when analysing the higher death rate,

:46:19. > :46:23.such as how patients admitted at weekends tend to be sicker

:46:24. > :46:26.than those admitted during the week, and that there's no evidence

:46:27. > :46:28.to suggest extra staff would prevent Staffing concerns, however,

:46:29. > :46:35.haven't been limited to England. The Public Services Ombudsman

:46:36. > :46:39.in Wales called for a systematic review of out-of-hours hospital

:46:40. > :46:44.care last year. While Scotland's First Minister

:46:45. > :46:46.Nicola Sturgeon announced in 2016 that minimum staffing levels

:46:47. > :46:48.in Scotland's NHS will In May 2016 it was announced a deal

:46:49. > :46:56.had been struck with the Government But whether this will lead

:46:57. > :47:04.to a truly seven-day NHS is unclear. Leaked Department of Health

:47:05. > :47:09.documents released in August last year worried that a lack

:47:10. > :47:12.of available GPs, hospital consultants and other health

:47:13. > :47:14.professionals would mean the full Government sources said this

:47:15. > :47:28.was a normal risk assessment. Hugh Pym our health editor is here.

:47:29. > :47:33.What does seven day a week mean in practical terms. People say we

:47:34. > :47:37.already have a seven day a week NHS? It has become a massively

:47:38. > :47:42.contentious issue. It was at the centre of the junior doctors

:47:43. > :47:48.dispute. Junior doctors were angry to be told there were changes in the

:47:49. > :47:54.contract, they were already working several weekends, well one in two,

:47:55. > :48:02.one in three or whatever. There was the issue of getting more consul

:48:03. > :48:07.tonight's. Consultants. There are talks on going with the BMA about

:48:08. > :48:12.that. There is GPs, that's proved controversial as well. Attempts to

:48:13. > :48:15.get more GP access after office hours during the week and at

:48:16. > :48:19.weekends when GPs are saying well, we're already doing that and we

:48:20. > :48:22.sometimes open at a weekend and offer appointments and nobody wants

:48:23. > :48:27.them. It is highly controversial, but there is a lot of different

:48:28. > :48:33.aspects to it. Hi. My name is Dave. I'm a staff nurse in A I think

:48:34. > :48:37.the Government deliberately deflects from what the issue is. This issue

:48:38. > :48:44.of a seven day NHS, I don't think the public really want an elective

:48:45. > :48:51.seven day NHS, what they want is a fully funded seven day emergency

:48:52. > :48:55.care and five day lekive care. -- elective care.

:48:56. > :48:59.APPLAUSE? The problem is we have been under funded for the last six

:49:00. > :49:04.years as one of our contributors said earlier, it used to be 4% to 4%

:49:05. > :49:10.added on every year to account for things like increase pharmacology

:49:11. > :49:17.costs, technology improving, and people getting older. And that was

:49:18. > :49:21.stopped in 2010. So we have been defunded for the last six years.

:49:22. > :49:26.What is going to come up is what has been said about this cliff edge of

:49:27. > :49:30.the STPs, the 44 areas that, we're not going to have an NHS in two or

:49:31. > :49:34.three years because what is happening we're being divided up

:49:35. > :49:38.into 44 steps, mine is Oxfordshire, west Berkshire and Buckinghamshire,

:49:39. > :49:42.where I am, they're looking at cutting mental health services by ?4

:49:43. > :49:48.million. They are talking about cutting staffing which is most staff

:49:49. > :49:54.are nurses, so the majority of these cuts will come to nursing. ?34

:49:55. > :49:57.million in cuts. And that's going to significantly affect the number of

:49:58. > :50:02.beds we have. Social care, it is going to affect everything and we're

:50:03. > :50:07.going to fall over. Are you a final year medical student? I am a final

:50:08. > :50:11.year medical student. There is a couple of points. Firstly, in

:50:12. > :50:17.relation to that, the seven day NHS, what we need is more health

:50:18. > :50:22.professionals, radio ographers and pharmacist to have a fully staffed

:50:23. > :50:28.emergency cover seven day as week. What we don't need is people to have

:50:29. > :50:34.elective operations on a Sunday. Give our audience an example of an

:50:35. > :50:44.elective operation? Carpel tunnel decompression.

:50:45. > :50:49.What? I a hip replacement. This is kind of circular, we are saying

:50:50. > :50:53.there aren't enough doctors, the morale is so low, you said two years

:50:54. > :50:56.ago you had a stroke and the care was excellent and people aren't

:50:57. > :51:00.having that same level of care. When I started at medical school six

:51:01. > :51:04.years ago, the morale, the way it felt to be in the NHS was different

:51:05. > :51:09.and actually the first thing that goes is teaching because that's not

:51:10. > :51:14.urgent. So, we're not getting, you see and junior doctors aren't

:51:15. > :51:18.getting the same level of teaching which will have an impact for a long

:51:19. > :51:21.time. People are talking about leaving and many junior doctors and

:51:22. > :51:29.consultants say to us, get out. Get out. They say it to us every single

:51:30. > :51:35.day. What are you going to do? I'm not sure if I'm going to leave the

:51:36. > :51:40.country and still be a doctor. Maybe management, maybe, you know, I've

:51:41. > :51:44.got friends who have taken years out to work in pharmaceutical companies.

:51:45. > :51:48.My friends who are junior doctors, they are working one in two weekends

:51:49. > :51:57.of the there is a seven day a week NHS and it's exhausting. What's your

:51:58. > :52:00.name again? Tall, a. Are you not bothered about a hip op at the

:52:01. > :52:08.weekend, you want the emergency care over the weekend? Decent emergency

:52:09. > :52:12.care, is that what... Yes. Hello. I used to work for the NHS, but

:52:13. > :52:23.unfortunately, I can't continue working for the NHS through the

:52:24. > :52:29.operation I had. I had an operation in 2004, after that, I am still

:52:30. > :52:34.having problems of locals yum, magnesium, potassium. I'm in and out

:52:35. > :52:43.of hospital. I go to my GP today, my GP says I go to hospital to get the

:52:44. > :52:51.infusion. I go to the Hospital and they say go to the infusion. I go to

:52:52. > :52:55.the GP, they say go to the hospital. I don't know what to do. My GP

:52:56. > :53:01.phoned me last week and said, "Can you go to hospital?" I can't because

:53:02. > :53:05.I'm tired. Every week I'm in and out of hospital. My hands are hurting

:53:06. > :53:11.because of needles. It is now ten years I have been going through

:53:12. > :53:16.this. Really? Yes. This is my life. They say this is your life. I said

:53:17. > :53:20.can you arrange something, I don't mind having the infusion in my

:53:21. > :53:24.house, there is nothing new, I have got the drugs, they are giving me, I

:53:25. > :53:28.have got the injections and morphine, I have got it in my house,

:53:29. > :53:32.I won't kill myself, I won't do any harm to my children, why don't you

:53:33. > :53:38.send a nurse once a week just to do the infusion. I don't mind. I'm

:53:39. > :53:44.going to A and every time I go, I have to join the queue in A

:53:45. > :53:48.Sometimes you spend two nights in A on a trolley and the next day go

:53:49. > :53:54.home. Go home again. Go back to the hospital. I'm like, why? I want to

:53:55. > :54:03.know, I mean, if they can do something to keep my like in one

:54:04. > :54:08.place. Whatever is happening? Last year they called me on 20th October

:54:09. > :54:13.saying when you were in hospital we did an MRI scan and we found you've

:54:14. > :54:18.got a big lump, your liver has got all this. I'm OK, fine. Go and see

:54:19. > :54:23.your GP. This is a phone call. I went to my GP and I said this is the

:54:24. > :54:28.message I got from the hospital. My GP was like, I don't have any

:54:29. > :54:33.report. So it was like I'm going back and forth. When I was in my

:54:34. > :54:40.GP's, one of the nurse called from my hospital. I talked to him, "I

:54:41. > :54:46.don't know anything. I'm appearing stupid in front of her because what

:54:47. > :54:50.you're saying is different." This case is really, really sad,

:54:51. > :54:54.unbelievably frustrating for this lady. Is that the kind of thing,

:54:55. > :54:59.that tooing and froing that you're seeing and do you have demand from

:55:00. > :55:02.your patients to see them on Saturday and Sunday? There are so

:55:03. > :55:05.many things in this case. First of all, the joined up working is

:55:06. > :55:08.something that we can all do better, but we need a better IT

:55:09. > :55:13.infrastructure, there is no way we should be waiting for phone calls

:55:14. > :55:16.and faxes when we are trying to convey information in an efficient

:55:17. > :55:20.way. That's a no brainer. It could be better with resources of the

:55:21. > :55:23.seven day argument is so powerful. Of course, in an ideal world we

:55:24. > :55:27.would love to have our blood pressure checked on a Monday

:55:28. > :55:33.afternoon if we could. I'm not sure I'm bothered about that? A lot of

:55:34. > :55:36.money has been put into opening GPs surgeries on a Sunday afternoon and

:55:37. > :55:40.people don't turn upment people want a livment there are some people who

:55:41. > :55:46.are working hard in the week who would like more routine access at

:55:47. > :55:51.the week, but if we cannot provide a safe, comprehensive in-hour service,

:55:52. > :55:54.plus a comprehensive safe emergency service four our patients in the

:55:55. > :56:02.community and in hospitals, then the seven day argument for rue toon care

:56:03. > :56:08.is spurious and it's a distraction. -- routine care is spurious and it's

:56:09. > :56:16.a distraction. You work for Pulse magazine. What is the evidence? The

:56:17. > :56:21.evidence does show that it reduces people's tendency to go to A, but

:56:22. > :56:24.it doesn't reduce the more serious patients, the more serious patients

:56:25. > :56:30.will still end up in A and if you look at the attendances on a Sunday

:56:31. > :56:34.afternoon, let's be honest patients have something better to do than

:56:35. > :56:40.turn up at their GP surgery. And it costs twice as much than routine GP

:56:41. > :56:45.care and... What at the weekend? Yes, for the weekend care. So if you

:56:46. > :56:50.think about, we've looked at the numbers, it will cost ?1.5 billion

:56:51. > :56:53.for this policy by 2020. Think about, how that money could have

:56:54. > :56:57.been used during the five days during the week to reduce the

:56:58. > :57:02.waiting times for a routine GP appointment. There is a fallacy, the

:57:03. > :57:07.Government says you will see your GP seven days a week, it is not your

:57:08. > :57:10.GP, it is a hub, often quite a distance away and that lady there

:57:11. > :57:15.that was talking about, she wants to see her GP, she wants to get the

:57:16. > :57:20.care from someone she knows, that, if we are talking about cost versus

:57:21. > :57:23.value it is better to see your GP, in the long run, you get better care

:57:24. > :57:27.and it will be cheaper in the long run.

:57:28. > :57:30.You have got 30 seconds because we're coming to the end of the

:57:31. > :57:33.programme. Well, I have a long-term condition and I have been treated

:57:34. > :57:40.over the years by the NHS at Christmas and at New Year and we not

:57:41. > :57:43.only have a seven day NHS, we have a 365 day NHS, they will treat you all

:57:44. > :57:48.times of the year and the one last thing I wanted to say is that the

:57:49. > :57:52.charity that works on be of half of my condition, they're really pushing

:57:53. > :57:54.for more specialist nurses for long-term conditions which would

:57:55. > :58:02.help a lot of other people as well. Thank you very much. Thank you.

:58:03. > :58:07.At 12.30 today, we will be taking your questions on so-called health

:58:08. > :58:13.tourism and how we should handle pressures in the NHS. Do get in

:58:14. > :58:19.touch. Thank you very much all of you. Thank you. You have been

:58:20. > :58:25.magnificent. Plenty more on the state of the NHS across the day on

:58:26. > :58:34.BBC News. You can give yourself another round of applause actually.

:58:35. > :58:36.Oh, my goodness me, I don't like the look of that.

:58:37. > :58:41.The Robshaws are going back in time again...

:58:42. > :58:44.Feel a little bit overwhelmed at the moment.