06/02/2017 Victoria Derbyshire

Good morning. It's nine o'clock. Welcome to the programme. This

morning till the state of the NHS in England has been described as

humanitarian crisis. This winter has seen a huge strain on hospital. In

one week last month, four out of ten hospitals were one major alert

status, and there are constant calls for more funding. A survey out today

says half of you think the quality of the NHS has been getting worse

over the last six months. This morning, we will hear your

experiences and ask if you have solutions. I am a full-time NHS

consultant in Anniston easier. I am representing the senior tier of

physicians on the shop them say we cannot give any better care to

patients and that we are seriously demoralised. I have been a clinician

for about ten years. We have been asked to deliver a lot of very

little money, very little resources, and to be honest, it is quite

demoralising. I am a patient in the NHS. I had great care before my

operation, but afterwards it has gone downhill. The staff are

demoralised and tired and it affects us as patients. My mum was diagnosed

with cancer not long ago. I think the NHS is absolutely fantastic. The

care is amazing. I would fight to keep it. With us this morning is an

audience of around 80 people who were all either work for the NHS or

have direct experience of it as a patient. You can share your

experiences. Here is how to get in touch:

Welcome to the programme. We are live until 11. Later, we will talk

about some of the really difficult decisions the NHS may need to make

in the future. Should it begin to charge for more services? Should we

pay more in National Insurance fund the NHS? Your views are welcome. NHS

hospitals in England will have a legal duty to charge overseas

patients upfront for nonurgent care if they are not eligible for free

treatment. From April, so-called health tourists could be refused

operations unless they cover their costs in advance. Emergency care

would still be provided immediately and charged later.

Hospitals are already supposed to charge those foreign patients

who don't qualify for free non-urgent care, but a report

by the National Audit Office found that money raised next year

would fall far short of a ?500 million target

Ministers have announced that, from April, NHS trusts in England

will have a legal duty to charge upfront for non-emergency

care, rather than send invoices after the event.

It's not clear how this would be enforced.

A UK-wide poll of just over 1000 adults by Ipsos Mori for the BBC

shows that 74% of respondents support increasing charges

for visitors from outside the UK to help fund the NHS.

40% said raising income tax to finance the NHS

37% said it would be acceptable for UK citizens to pay

for some health services which are currently free.

You were on the phone to the Department of Health up to the start

of the programme - what does this mean in practical terms? I asked if

it means new legislation, and the answer was no. We are told it will

involve so-called secondary regulation, things that have already

there, trying to make hospitals do more to charge people upfront who

come from outside the UK and don't qualify for free care. No detail on

how this will actually work. We are told it will be aimed at supporting

hospitals to chase up the money. Some hospitals already do it quite

effectively. Some ask for ID. When you go in, that shows whether you

are eligible for care or not. The Government and what it can do

remains unclear. It has been criticised for not raising the ?500

million per year they said they would next year. It has fallen far

short so far, according to the National audit office. Will it

affect EU nationals? If you come from another EU country to the UK

and you need health care, you have the card that everyone is familiar

with. Hospitals should take the details, send them to the Department

of Health, who then chase up the Government of the country from which

the visitor has come to get the money back. The Department of Health

have not been good at pursuing that, so there is inefficiency there. Some

will say that this is a couple of hundred million pounds a year, and

the NHS in England spends more than ?100 billion per year, and it is

about finding more funding generally. I view from Croydon says:

Should the UK taxpayer paid for the incompetence of other nations, often

because of corruption? Overseas players should pay, but how is the

challenge. Another view says the UK is a soft touch and we need

compulsory health insurance for visitors. We will talk about this

issue this morning. The rest of the morning's news now.

An NHS Trust has begun a formal inquiry into the case

of an 89-year-old woman who was kept in hospital for six

months despite being well enough to be discharged.

Iris Sibley was taken to the Bristol Royal Infirmary

after a fall at her residential care home last summer.

She recovered but no suitable nursing home place was found

The cost of keeping her in hospital is estimated at ?90,000.

The number of unexpected deaths of mental health patients has risen

That's according to new figures obtained by the BBC's

The findings are based on data from more than half of England's

The government says the increase was expected, because of changes

Thousands of low-income families who were stripped of their tax

credits after a mistake by the US out-sourcing firm Concentrix

A Committee of MPs says that Her Majesty's Revenue and Customs

has accepted their recommendations to review up to 23,000 new cases.

The company, Concentrix, was sacked by HMRC in September

following an investigation by this programme.

MPs will have the chance to amend the government's legislation

on Brexit when it returns to the Commons for three

A number of pro-Remain Conservative MPs are understood to be

considering voting with Labour and the SNP to try and give MPs more

of a say over what happens at the end of the negotiating

process, although Downing Street is understood to be confident

President Trump has stepped up his attacks on the judge

who blocked his travel ban on seven Muslim majority nations.

In a series of tweets, he said the American people should

blame the judge if anything happened to threaten national

security and that the courts were making his job very difficult.

The White House is expected to pursue its appeal

Prince William might be closer to the throne,

but it was Prince Harry who on this occasion crossed the finishing line

Harry, William and the Duchess of Cambridge raced against each

other in a 50 metre sprint at the Queen Elizabeth Olympic

Park, during a mental health charity event.

Cheered by track stars and amateur runners training

for April's London Marathon, Harry crossed the line a stride

That's a summary of the latest BBC News.

The New England Patriots produced the greatest comeback in Super Bowl

history to beat the Atlanta Falcons 34-28 in overtime.

The Falcons were in complete control having scored three

They were 25 points ahead before the spectacular fightback.

No team has come form that far behind before.

The Patriots drew level at 28 all with less than a minute left

And then, in overtime, a touchdown from James White

completed the comeback to take the title.

Quarterback Tom Brady named the Most Valuable Player

for a record fourth time - it's a fifth title for the Patriots.

As we know the half-time show as big as the game itself.

And this year it was Lady Gaga's turn to dazzle the crowds

as she leapt into the stadium, lowered 79 metres

Just the two costume changes in her 12 minute set.

Her next big moment came when she dropped her mic

at the end of the set, caught a glittery ball

There was an astonishing finish to Great Britain's Davis Cup tie

when Canada's Denis Shapovolov was disqualified after smashing

a tennis ball at the match umpire, handing the tie and a place

Kyle Edmund was two sets up in the decider.

And the Canadian in red after losing his serve,

And it struck the umpire square in the face.

It was a freak accident but still saw Canada default the match.

Great Britain will face France next in April.

It's a shame it has happened that way, and I feel for the young lad.

He is a great talent and he has learned a harsh lesson today. What I

would say is, I thought Kyle, from what we saw on Friday, he was

absolutely fantastic. Is not the result or the outcome of anyone was

expecting. This morning we're talking

about the state of the NHS - with you, and with an audience of 80

NHS staff and patients. The NHS is one of those institutions

that most of us cherish, but are the pressures

on its resources at breaking point? In recent weeks we've heard

claims that it's facing a humanitarian disaster,

hospitals on major alert status, visits to some A departments

being up 30% on last year, patients being treated in hospital

corridors because of lack of beds, A BBC Ipsos Mori survey out today

suggests over half of you think the NHS in England has got worse

in the last six months - just 8% You are very welcome to get in touch

with us. Good morning. I absolutely support what my colleagues are

saying, the NHS is in a devastating position. However, I am here because

of the commitment of the front-line staff. The commitment remains, and

it is not done to them, the state of the NHS. What is your job? I have

been Chief nurse in three acute hospitals, I have inspected

hospitals. Even the hospitals that go into special measures, they are

absolutely packed with incredible nurses, doctors, physiotherapist,

radiologists. What is going wrong? There are not many politicians here,

but there is something fundamentally going wrong and it is not with the

clinicians. What is it, in your view? A number of things. Funding

has gone wrong, there is not enough, and what is going in the wrong

places. We will talk about social care later, but there is an issue

with funding, access, inequality, it is different across the country.

There are issues in London, up north. Who agrees? My name is Emma.

I trained as a nurse back in 1985. I have worked as a hospital manager of

a good few years. I run a first aid training business, recruiting and

benefiting from the demoralisation in ambulance staff, because

paramedics want to be treated better. The NHS must be managed by

people that have been within the system and to know the system and

who understand it. Is that what is going wrong, poor managers?

Incompetent managers, managers who are snowed under completely? It is a

horrendous job. As a hospital manager, we had a lot of external

consultants coming in with amazing solutions that just don't work in a

very oversubscribed situation. Your own experiences? I am a patient. I

was diagnosed with cancer during pregnancy. I underwent chemotherapy,

had my baby. She is fine. I had a mastectomy in my care was fantastic

throughout. My problem is that after all of that, I was told the drugs I

would need are not funded by the NHS in Wales. They are currently funded

in England, but they are being withdrawn there too. How much money

do you need to raise drugs? My target is ?150,000. That's for one

year on different drugs. Wow... The care has been brilliant and I can't

complain, but to get to the end of that process and reach a point where

you think you had the worst news possible and to the told you have

incurable cancer and then discover that the drugs that are available,

that are proven to be effective, you are not going to be given access to

them. Because they are too expensive. What is your frame of

mind about this situation? I don't know who to be angry with about

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

within ridiculous budgets. I can only lay the blame with the

Government. We have a Conservative MP here. We

will talk to him in a moment. We asked England's Health Secretary

Jeremy Hunt to join us. He wasn't availablement hello sir. I'm a

patient. Steve, bring that microphone closer to your mouth. I'm

a patient and last July I was diagnosed with an enlarged prostate.

As of today's date, I don't know why the prostate is enlarged. I'm

waiting for a different diagnosis, is it cancerous, if it isn't. Why do

you think about that? If it is cancerous, I would like the

treatment to start soon. It can't be for the number of people to trying

to find out? I have had a number of non-invasive tests. The next test is

the biopsy. Thank you, Steve. Hello. We're going to pause for just a

moment to look at the overall information budget and the pressures

on it. Have a look at this. The NHS is the second-biggest

area of public spending Well, here's how health

expenditure in England has In 2015-2016, it stood

at around ?117 billion. It's set to rise in

the coming years, but, taking account of inflation,

at a less impressive rate. It's also worth noting that the UK

population has increased And it's an ageing population, too,

putting extra stress on the system. If we take the health budget

in England in 2015-2016, The biggest expenditure

was on hospitals and ambulances. Many experts say the budgets

for mental health services and care in the community

are not great enough. In 2010-2011, NHS trusts in England

overall had ?458 million left That figure rose in successive

years, but since then Trusts have rapidly fallen into deficit,

which means they spend And in 2015-2016 the deficit stood

at just under ?2.5 billion. With us is our Health Editor

Hugh Pym, Jeremy Lefroy, a Conservative MP

for Stafford, Jon Ashworth, a Labour MP who is their

spokesperson on health. The President of the Royal College

of Paediatrics and Child Health, The Chair of the Royal College

of GPs Helen Stokes-Lampard. Dr Chaand Nagpaul from

the British Medical Association. We asked England's Health Secretary

Jeremy Hunt and other ministers from the Department

of Health to take part They said no, but did tell us,

"Across the country we know the NHS is very busy,

but hospitals are performing well -- why the laughter? It is obvious

the NHS is to busy. It seems like a ridiculous statement from the

Ministry of Health to have to tell us that.

It goes on. "But hospitals are per

fortunatelying well with steps in place to cope with the extra demands

winter brings, supported by an extra ?400 million worth of funding. "

It sounds like a lot of money, Hugh. Well, if you think the overall

budget for the NHS is more than ?100 billion a year in England it puts it

into prospective. I'm not totally clear about the ?400 million, I

think it is recurring money that's spent every year for winter rather

than being something extra this year. And what we have been told is

the NHS was allocated extra money in successive years by this Government

and it basically needs to get on with what it has got even though it

had to cope with extremely high patient demand as we've heard, but

there is a big question which I'm sure we will be talking about

throughout the programme, does the NHS need more money, if so, where

does it come from? Are people prepared to pay more tax? There

needs to be a debate about health and social care and whether they

should be more integrated in England. Social care paid for by

local authorities, how do you deal with that? There is some big

questions about the future here. Hello, sir. Introduce yourself? I'm

Simon. I'm a cln i in the NHS. No one disagrees with Hugh, the NHS

does need more money, always has needed more money and I think we

live in this world now the Prost Trump world with alternative facts,

sometimes I wonder if the DH comes up with alternative facts on their

funding and how much they're given. I would like like to say also

successive governments, one can blame this Government now, but

successive governments because of the tax burden that is the NHS, they

bring in so-called efficiency measures and every time there is

efficiency measure ultimately that means money has to be removed from

the budget. There is nothing efficient about treating anybody.

That lady who has the cancer, there is nothing efficient about treating

that lady. She needs the money. We should be able to give T I'm sure

she gave taxes for the NHS. APPLAUSE

Thank you. What I didn't mention is that I am not unique. I'm not even

unusual. There are a lot of women who are fund-raising and men

presumably fund-raising for cancer drugs in this country and just this

week on the BBC it was reported that there has been a seven fold increase

from 2015 to 2016 in people on fund-raising sites who are raising

money for life-saving or life extending treatments and I think

that's a ridiculous situation to be in. We can afford this. We have the

money available, but the money is being spent in ways that we don't

want it to be spent. APPLAUSE

Well, I was just saying we have got two ministers here, one shadow

minister and a very brave member from the Conservative Party from

Stafford. Would they like to make some comments? I would like them not

to say if we were in power we would give more money or we have given

more money to the NHS. Everyone in this room likes the NHS. They want

to keep the NHS. They want the NHS properly funded. What would they say

to us who have come here today to ask you that question specifically?

APPLAUSE As a Conservative MP, Conservative

Government, what are you going to say to that? I agree. I have been, I

declare an interest in that my wife is a GP, my daughter is a medical

student. As a family we are extremely committed to the National

Health Service. I have been saying since as you rightly say, my, what

was the Mid-Staffordshire trust is in my constituency. I have to say

that there have been great improvements there thanks to the

dedication of the staff, it is now part of the university hospitals of

the North Midlands. Still a great deal of pressure there. There is no

doubt if you look at the amount that we as a nation spend on health, it

is probably about 2% of GDP less than say in France and Germany. And

frankly unless we are prepared and I heard people behind say they were

prepared to do this and certainly when I talk to my constituents,

unless you're prepared to say we will up the amount that we spend,

which means, higher taxes, I am afraid, there isn't anywhere else to

go. If we're going to have a system funded based on need and from a

progressive source of income, that's the only way to go. And it's

interesting that I think people are beginning to see that. I have been

saying that for the last three or four years. I've written about it.

We have seen cross party work done in the last few weeks. Can you see a

Conservative Government just before the 2020 election... We have got a

microphone or fader open. We will ignore that. Promising in a

manifesto, we will put your taxes up in order to fund properly the NHS?

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

this... That's your job. Your job is to advocate for us. You're

representing the people of this country. I'm a patient... Turn

around and look at the lady wh WHO is talking to you. Sorry, I still

can't see you. I want to look at your eyes. Your job is to advocate

for us. That's your job as our MP. One of the MPs in this Government at

the moment. And if we're saying and a lot of people are, I have seen

lots of Question Time, it is the only programme I watch, we are

willing to pay the extra two pence on the tax, why not? Forget the eye

eology of low tax. Let us have our NHS free at the point of delivery so

we can stay alive. APPLAUSE

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

hospice. There is no great mystery why hospices work. They have enough

staff. The funding for the NHS, by the way I'm sorry to see there are

no nurse leaders here, I wish the Royal College of Nursing had been

invited. The funding sources, my area in South-East London spent ?5.3

million in the last three years on external management consultants to

advice how to reorganise services in our area and the second thing is

that... Let's stay on the money issue if we may. The admin costs

have gone up by 10% over the last 20 years since the NHS became a market

commissioning and provision of service separated.

Go ahead. I'm Ben Harris. Ben, can you move that microphone closer. I'm

glad sir you said you wanted more answers than just throw more money

at it. This debate rarely gets beyond that because Labour say the

answer is throw more money at it. I'm not saying the NHS doesn't need

funding, but it is extraordinary, isn't it, that Jeremy Hunt is one of

the longest serving Health Secretaries. He has been in post for

just four years and really the problem with the NHS or indeed a big

problem with the NHS is the fact that this country for at least the

last 20 years has been governed on the basis of winning an election,

not on the basis of long-term planning. To the point about the...

APPLAUSE The percentage of GDP spending,

Japan spends 1% less than we do on its healthcare and has better

healthcare outcomes and that's because they have a different

approach. So, whilst I'm not here to say we need to cut funding to the

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

hear what a Labour representative has to say. John Ashworth, I don't

know what Jeremy Corbyn will promise in his manifesto before 2020 if he's

still the leader, will it be more money or yeah, we'll put your taxes

up two pence in the pound, what? Certainly the NHS needs more money.

I mean it is going through the largest financial squeeze in its

history and head for head next year NHS investment will actually be cut

in England. So you're right, sir, to say it is not just about money, but

we cannot ignore the reality that this huge financial squeeze is

putting this incredible burden and pressure on the system at every

level now so we can't just dismiss that out of hand.

Firstly, how do you account for the fact that Japan has better

healthcare outcomes by spending less money? Are you willing to

acknowledge as many of your colleagues at least have, that this

country is out of money. We're told we have an austerity budget in

place. No, I'm afraid it is. We're told we have an austerity budget in

place. This Government is borrowing ?70 billion more than it is taking

into the ex-trekker. We are ?1.5 trillion in debt. When there is

another recession we will be in big, big trouble. The kind of trouble

Greece has been in. I work in a coastal NHS. I'm afraid that's

rubbish. We are the sixth richest country in the world. Let me finish

my point. I'm afraid the Government gave and it is Tories and liberals

and the Labour, gave when the bankers bail out 109, not million,

not billion, but trillion pounds, that could have funded the social

care for 100 years and done the NHS for 50 years. It is all about

ideology and the fact that the Tory Government don't want to do it and

we should stand up against it. We didn't spend ?109 billion bailing

out the banks. We didn't spend ?109 trillion. No, no, sorry sir, we

didn't spend ?109 trillion. This Government has found billions to cut

tax for big corporations, has found billions to cut share transaction

tax and in the recent November Budget it found millions to build

new grammar schools and not an extra penny for the NHS. So what would

Labour do? To say there is no money available is a nonsense. We need to

put investment... Please. Please. If you don't have a microphone, don't

speak. Government is about choices. It doesn't need to choose to cut

corporation tax for billions. It doesn't need to choose to put

millions into building new grammar schools.

What would Labour do? We would put more investment into the NHS. I have

outlined suggestions about what the Government doesn't need to be doing,

but I think the country needs to engage in a big debate about the

future financing of the NHS, because as we get older as our population,

with more complex needs, which is a good thing that we are living

longer, and we have more expectations on the NHS, we will

have to debate and face up to some big questions about how we fund it,

but let's not go for the nonsense and believe that the NHS cannot have

extra investment now. It could if the Government took a different set

of decisions. I am an orthopaedic surgeon in my last year of training,

so I have been privy to budgets and cuts over the last few years from a

front-line point of view. The gentleman from the conservative

think tank, bravo, you argued your alternative facts very vehemently

and presented a convincing case, but the fact of the matter is, you are

talking about not putting in extra funding. This is a political

decision. It is the cuts you are making every single day. The purpose

of the NHS is like a bucket with holes in it, and the holes are

increasing daily. We see money being siphoned off to private finance

initiatives. ?80 billion for private finance initiatives for buildings

that were supposed to cost ?11 billion. That was the previous

Government. I am not talking about funding but about loss. You can keep

putting water into a bucket, but if you put holes in it and you are

siphoning off money, since this health and social at -- health and

social care act, hospitals were forced into private initiatives, and

money is being lost through ridiculous means every single day. I

see this as a doctor, because we're having to ration services. Like

what? For example, certain people can be offered -- certain people can

no longer be offered hip and knee replacements who could have got them

five years ago. We heard the story about drugs available for cancer.

The next thing will be that people who are obese should not be allowed

certain treatments, smokers shouldn't be allowed certain

treatments. It will go on and on. Private companies are looking at

profits, and they are beholden to shareholders before the public.

Compared to the whole, the propulsion of private companies is

not that much. I don't think that more money is necessarily just the

way forward. We are spending a 0.9% increase. But we are seeing a real

cut every year. On the figure about banks... There are various reports,

but it is round -- but it is around ?1 trillion. Not 109 trillion. It is

around ?1 trillion. I am a consultant anaesthetist and I want

to make a couple of points. People talk about absolute numbers. I am

not a health academic, but you need to talk about the percentage of GDP,

the head-to-head spend, the fact that we are accommodating and

increasing, ageing population, there are more sick people around. If you

give me numbers, I don't know what that means. In your job, you said

you were making dangerous decisions - what do you mean? I speak on

behalf of every consultant and GP, and we have written an open letter

to the Prime Minister, signed by around 2000 consultants and GPs from

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

a seasonal pinch. We have never been in such dangerous territory. The

decisions we have to make are unfathomable. Give an example. We

are run black alert every day. I don't know what that means any more.

It is a permanent fixture. I have to tell people daily that their

operation for stomach cancer is cancelled for the third time because

there is bed blocking due to medically fit patients who cannot

access social services and because there are more sick people in the

acute services. GPs are at us in point, as our acute services. The

real worry is the brain drain. Nurses and doctors are starting to

leave. Sorry to interrupt. The dangerous decision is, it saying to

a patient that they cannot have an operation because there is nowhere

to put them, and that is dangerous. You like it is dangerous and

heartbreaking for me. I didn't train to do that. Secondly, the fact that

there are fewer doctors and nurses. The doctor and nurse- patient ratio,

you cannot imagine the stresses. We are looking after patients who are

very sick in unsafe areas of the hospital. You hear about trolleys.

We make decisions where we go home at night and frankly we don't sleep.

Did I do the right thing? Did I discharge that patient to hourly? My

junior doctors are acting as nurses and doctors at the same time because

there are not enough staff. -- bid I discharge that patient too early?

Staff are talking about going to do buy, to Canada. That never happened

before. I agree with Anita. I am a front-line nurse and I have seen

services getting increasingly more pressured, increasingly more

dangerous situations where we are having to make life changing

decisions for patients. It also feels really demoralising as a

member of staff to be tell continuously by Jeremy Hunt and the

Department of Health that they are putting more money into the NHS when

in reality it is a ?22 billion cut to services. We are not stupid. Stay

there. The gentleman here, do join us. I am a GP from Doncaster and I

want to echo what my colleague in the hospital is saying. It is

similar in general practice - there are not enough doctors. Patients are

getting more sick, living longer, and there are more of them. I go to

work at 7:30am, and there will be 100 pieces of paper work to do

before patients start phoning at 8:30am. Between 8:30am and

lunchtime, I can consult with approximately 50 patients. There

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

brain is fried and I can't think any more. I advise them at 11am, you

know you're not getting the best of me any more. It is dangerous to

phone from here on in. I don't know what to do because there are not

enough staff for the number of patients. That would be my other

point. What have we been doing about workforce planning for the future?

By 2020, we will have a complete shortage of nurses, unable to cope

with the demands we experienced on the public. In addition, the NHS

bursaries have been cut for nursing, so we're not recruiting them. This

year alone, more than ever before, Moore foundation doctors, junior

doctors about to embark on a career in speciality training, have left.

More than any other year. Personally, I am covering more gaps

in the junior doctor wrote than I ever thought would be the case. I

didn't think it was part of my job plan, but there are holes. We come

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

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

ample funds in the NHS and it is about bad management and bad

procurement practices. Another viewer says: Nurses and doctors are

excellent. The problems are elsewhere. Too many chiefs, not

enough beds. Another viewer says: Resources cannot keep up with

demand. Should demand due to self-indulgence, like obesity, be

given a lower place in the queue? It is something we will definitely talk

about through the morning. We are going to bring you the latest news

and sport. Here is Joanna. The number of patients on hospital

wards has been at unsafe levels in nine out of ten NHS trusts

in England this winter, according to figures

obtained by the BBC. A report by MPs said the system for

recovering costs was chaotic. NHS Improvement says it has to improve

the way that money is collected. The number of patients on hospital

wards has been at unsafe levels in nine out of ten NHS trusts

in England this winter, according to figures

obtained by the BBC. The results show some

hospitals were operating at close to full capacity,

putting increased pressure NHS England says more

beds would be freed up if there was greater focus

on the link with social The number of unexpected deaths

of mental health patients has risen That's according to new figures

obtained by the BBC's The findings are based on data

from more than half of England's The government says the increase

was expected because of changes Thousands of low-income families

who were stripped of their tax credits after a mistake by the US

out-sourcing firm Concentrix A Committee of MPs says

that Her Majesty's Revenue Customs has accepted their recommendations

to review up to 23,000 new cases. The company, Concentrix,

was sacked by HMRC in September following an investigation

by this programme. That's a summary of the latest BBC

News, more at 10.00. Some breaking news: Alastair Cook

has stood down as England captain. The England and Wales Cricket board

has announced that. We will bring you more at 10am.

A bizarre Davis Cup victory for Great Britain.

After Canada are disqualified when one of their players,

Denis Shapovalov, accidentally hits a ball straight into

It was the deciding match of the tie and sees GB

New England Patriots won a dramatic super bowl last night,

as they came from 25 points behind to beat the Atalanta Falcons 34-28.

No side has ever come from that far down.

It's a fifth title for the Patriots and a fourth for MVP Tom Brady.

The Quarter back instrumental in the comeback Manchester United

beat Leicester three nil, in what was another defeat

for the champions who are now one point above the relegation zone.

United remain on course for a top four finish.

Wales beat Italy in the last match of the opening weekend

George North with his side's third try.

Wales making a winning start but missed out on scoring a fourth

try which would have earned them a bonus point victory.

That is all the sport for now. Victoria, back to you.

This morning we're talking about the state of the NHS with you,

and with an audience of 80 NHS workers and patients.

For the next 15 mins or so we're going to talk about social care

and the impact that stretched resources there have on the NHS.

Health care is provided by the NHS in doctors' surgeries and hospitals.

Social care is provided in the community to help people

who need support due to illness, disability or old age.

And because so many more people are living longer,

it's really putting pressure on the social care budget,

which in 2016 stood at just under ?20 billion in England.

The social care system is designed to provide care

in the community for the elderly, sick and disabled.

It encompasses anything from help in the home with washing

and dressing to care homes, and has remained more-or-less

unchanged since it was created after World War II.

Nowadays people live on average ten years longer and with more

complex conditions that require additional care.

But support is not rising - it's falling.

The Local Government Association estimates the gap between the care

budget councils receive will be ?4 billion short of

Some experts have called for the care system to be

merged with the NHS, but it's known the Government has

little appetite for more structural upheaval.

The result is that councils are left to limp on.

Many people with care needs are forced to pay for it themselves,

rely on friends and family, or go without.

The Prime Minister has, however, promised a long-term

By the end of this Parliament, local authorities will have

?3.5 billion more to spend on social care, and of course

we're putting more money into the health service as well.

The Government's offered local authorities the opportunity to bring

forward council tax rises to help cover social care costs,

and money redistributed from the new homes bonus scheme.

Over the next two years, the Government says it could mean

an extra ?900 million is pumped into the social care system.

But charities have called it a drop in the ocean.

This morning an NHS Trust has apologised after an elderly woman

remained on a ward for six months at a cost of more than ?80,000

89-year-old Iris Sibley was initially admitted to hospital

She and her family were left "distressed and let down"

after multiple attempts to move her into a nursing home

failed, leaving her in isolation at the Bristol Royal Infirmary.

name is Barry. My mother had to go into social care through dementia

which she was paying for. Through a nursing home, a care home? Care

home. One Saturday morning she had this bout of sickness and the home

kept us informed through the day up until Saturday evening, they said

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

was the last call we got until 7am Sunday morning when the hospital

phoned us to say she had passed away. She was discharged from

hospital without any of her medical records. The hospital tried to phone

the home and couldn't get any answer. The police went down and

couldn't get any answer. When the morning shift came on at 7am, that's

when the police got some response from the night staff. We found out

that, you know, if we had been informed that my mother was in

hospital, one of the family could have sat with her. She choked on her

own vomit and died in A Oh, my goodness. We were paying for 24 hour

care, but any member of the family would have willingly sat with her in

A How does your family respond to what happened to your mum? What

could you do? I got in touch with the solicitor to sue the home for

negligence. He said forget it, you're not going to get anywhere

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

not dependant on her, but the thing was, we wanted to take it further to

prevent it happening again, but he just said it would cost you

thousands to prove a point and it won't get you any further. Yeah,

yeah understood. My name is Lindsey. I am a home care support worker. I

work with people who are discharged from hospital enabling them to

remain in their own homes following a period of illness. I work with a

caring compassionate team who go above and beyond what's asked of

them. I think our concerns are the shutting of the community hospitals,

there is nowhere for these patients to go once they have left hospital,

therefore due to bed-blocking they are being discharged too soon and

ending up in being re-admitted to hospital. I wonder what needs to

change? Hello. I'm chair of the Royal College of GPs, but I am a GP

myself. This is bringing back examples that I have seen in my

practise and I was there to late on Friday and I will be there late this

afternoon. People are trapped in hospital unable to go to a safe

place because there aren't the places there. The NHS is entirely

dependant on social care. If you think of it as a three-legged stool,

you have got the community care and the social care and the hospital

care. We have to work together and if the system isn't tunded and

support, we all fall down, so we're all in it together. It breaks my

heart when I have a patient at home and I can see them deteriorating and

needing care and I know with the right care package in place they

wouldn't need to go to hospital. The joy of being a GP, we can save

people getting to hospital if we have the right support structures,

we can conduct this orchestra of wonderful people, and family

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

amazing, amazing work. APPLAUSE

What's your view when it comes to social care? I think this debate is

about the health and social care system being part of a single

organisation which is as we've heard before woefully under funded and

coming back to the hard facts, the real facts, the truth is we have

fewer hospital beds than any other European nation. Germany has three

times as many hospital beds. Three times as many. We have the lowest

number of doctors, social care funding has been cut year-on-year

for the last six years and therefore, when you actually try and

look after an older population with multiple health problems you simply

can't deliver that whilst you have a social care system that is cutting

costs year-on-year so there has to be this has to be addressed as a

global issue about looking at the total resource... Well, I don't know

about a global issue. Surrey County Council is having a referendum

amongst households to see if they would pay 15% extra on their bills

to pay for social care? This is a National Health Service. The minute

we leave it to local areas to sort out a national problem, we've lost

it. Good morning. Thank you very much, Victoria. I'm a frontline

clinician, I look after sick newborn babies and last year 1,000 sick

babies were transferred unnecessarily between hospitals

because there were insufficient cots. That's just one fact that I

want to put out there. But I also want to pick up on the point of the

ageing population. Let's talk about the healthy ageing population

because, of course, the burdens that are placed upon the Health Service

has come because we're having an ageing population with complex

needs, but what is it that would help us all live long and healthy as

opposed to unhealthy lifestyles? Tell us, please. It is about

prevention, isn't it? It is about healthy eating and we have not yet

spoken about the, we have only spoken about the acute Health

Services, we have not spoken about the terrible cuts that have been

inflicted on public health. Most of which burden is I have to say being

imposed upon children. 14% of the ?200 million in public health cuts

last year are falling directly upon children's services, health

visiting, is sexual health for young people, obesity prevention,

antismoking. All these things are the things that will lead to chronic

lung disease, obesity, dementia, many cancers further down the line.

It would be really good to talk about prevention when we talk about

the Health Services as well. John Ashworth? I'm pleased we're having a

debate about social care because you won't solve the problems and the

pressures facing the NHS unless we solve the social care crisis in this

country. Does that come from the top or do you think county councils who

are responsible or councils responsible for social care can make

their own arrangements? It has to come from the top. 400,000 elderly

and vulnerable people are not getting the kind of social care

packages that they would have done. That's putting huge pressures on the

NHS itself. It has to come from the top. In the Budget in March, the

Chancellor has to do what he failed to do in his mini Budget in

November, bring forward emergency funding for social care because the

way we treat elderly people is a disgrace in this country at the

moment. Jeremy, as a Conservative MP was it short-sighted of the

coalition Government to make the kind of cuts they did to social

care? I think we have seen this increase over the last couple of

years when there has been a lot of pressure... Was it short-sighted

then? Yes, I would say, it is short-sighted. I think social care

has always been the poor relation. Would you back Mr Ashworth's call

for your chancellor to bring forward emergency funding to help councils

pay for social care or are you happy to see councils put council tax

bills up as many will do? We do need emergency funding. I don't see a

problem with councils putting their, we've had council tax freezes more

about four or five years. I think it is important that those council tax

bills starting to up again in a measured way which is what they are

doing in my county, but also I think we need some emergency social care

funding because what we're seeing as everybody here has said is people

staying far too long, I have seen that in hospital beds, I have seen

that in my constituency surgeries and I'm sure every colleague in

Parliament has seen the same. When you say emergency funding, how much

money are you asking that the Chancellor put in? There is

estimates about what is needed. They were talking about ?2 billion, I

have suggested there is an extra 700 million allocated in 2019, why not

bring that forward? We need some money.

I'm going to ask you to pretend that you are residents of Surrey County

Council. They are having this referendum, they're going to ask

their own householders do you want to pay an extra 15% on your council

tax bill which will go to social care? Sorry residents, would you say

yes, I will go for the 15%, if you would, put your hand in the air. The

problem is with referendums and asking the question, putting

questions to the public is we're not given enough information. We're not

educated enough to make a choice. There are people who put their hand

up to say yes, I would pay the extra 15%? How can you guarantee that that

15% is going to go to the frontline services? Yes, introduce yourself?

Wendy Preston head of nursing practise from the Royal College of

Nursing. It is the wrong question to ask. They're asking it whether we

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

we going to spend it? How are we suddenly going to be able to have

the services? Our members have been telling us this is not isolated

incidents, they are telling us that day in and day out nurses and

doctors are having to send patients home from hospitals into their home

when there is not enough care and we know that there are, we have got

less community nurses, there is a 40% drop in district nurses. We have

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

not just about throwing money at this problem.

Welcome. You said you would pay an extra 15% on your council tax bill.

I don't live in Surrey, but I would, the problem is going to be poorer

parts of the country, Newcastle, Middlesbrough, 15% is a significant

amount of money. It is all very well in Surrey from prosperity is higher,

but it is not right for the Government to push this problem on

to local councils. It needs to be funded properly. You would pay that

extra on your council tax bill? No, I'm from the Taxpayers' Alliance and

Surrey is an outrageous example. There are lots of councils who are

coping with this far, far better than Surrey. It is not a good

example: There are lots of councils who will increase bills? 15% is

quite absurd and it is clear that some councils are better at this

than others and some councils are better at keeping people in their

homes and out of care homes than others. There does need to be a

learning from best practise across councils because some are opening

far, far better than others. Yes, Hugh. This is a really crucial

point here and it is interesting to see in Scotland health and social

care is now integrated, but it will take time to actually get social

care run by local authorities and the NHS working closely together. So

they started in Scotland. It hasn't happened in England. It happened in

Northern Ireland a while ago. But the big point that's being made

here, how can you treat social care funded by local authorities as

something very different from the NHS when you have a patient with

dementia for example who lives in their own home and who needs care,

but is means-tested for it, whereas your cancer care is paid for in a

hospital? I think all the big questions are coming up. There are

examples around England certainly that I've looked at where local

authorities and local NHS GPs are working now together to try to make

the best of what they've got which I think can be done, but ultimately,

money is involved and is it right it should fall on council tax payers in

areas that maybe can afford it, whereas others can't raise council

tax because their local population can't afford it? Does it need a

bigger long-term plan to be drawn up?

I'm June Gray and I am a practise nurse working in East London. My

father of 84 years of age passed away sometime ago and in the bed

opposite to him on the ward was one of his best friends who

unfortunately had had his leg amputated and had been in hospital

for a year because he didn't figure in the local authority radar, he

didn't have any housing, he had no income, except for his pension and

his nearest relative lived in Wales n Swansea, but the authority there

didn't want to take him on and couldn't find a nursing home that

was suitable for him and so he spent virtually a year in hospital with

people passing the buck and saying we don't want to fund this, we can't

find a place for you. Eventually it was sorted out, but the difficulties

for his family. The difficulties for him and the deterioration in his

mental state through lying in hospital for all that amount of time

and not getting the proper rehabilitation that he could have

had. This is why it needs to be a National Service, it is a three

legged stool. When I was a district nurse, if I went into a home, and

someone was deteriorating, I could say this person needs more help. We

need more visits. When my father was deteriorating, and we said to the

carers, can we get more help? We had to go back to the care co-ordinator,

they had to go to the agency... Let me read this message. Brendan texts,

"Families need to take far more responsible for their ablinging

parents and relatives." Great, fine, are you going to pay me to give up

my full-time job in order to look after my elderly relatives?

APPLAUSE Because that's the reality. My

mother, who is in her 80s now and I were having to look after my father

and pick up the shortfall. My sisters helped where they could, but

they live far away. Families are not unwilling to do this, but we can't

all just drop everything and be there.

I work in a care home and in the only past few weeks we have had

residents sent home too early from hospital and then they have had to

be re-admitted. Karen says pay relatives to look after the

relatives, it must be cheaper than care homes. Good morning. I'm the

mum of two junior doctors. What's your name? Leeash. The pressures on

the NHS are also being increased because of cutbacks in the social

sector, the social funding. I have a brother who has spent an extra five

weeks in hospital and an extra five weeks in a nursing home when he has

got a home of his own. He just needs his social care package to be able

to go back to where he wants to be, back in the home.

It must be so frustrating. Very. The thing is, if they had better funding

for the social side, these patients don't want to be in the hospital,

where they can pick up more infections, they want to go back to

their houses and have some dignity and care within their houses, which

would release lots of beds. That's the main thing I wanted to say. And

the NHS is great. Thank you. The news and sport is on the way, then

more discussion. Sally texted to say, remember that the elderly are

the ones who have paid tax all their lives, so why should they be

sidelined when it comes to treatment? Coming up, we will ask

you paying for care will become inevitable. First, the weather.

It has started Chile, and the end of the week will be very cold indeed.

We have a wet and windy interlude, which is on its way later on today.

We have some fog patches lingering in Central and eastern areas, but at

West it is all change. Cloud is increasing and outbreaks of heavy

rain are working in. A pretty poor rush-hour in these areas,

particularly in Belfast. This evening and overnight, the wet and

windy weather sweeps to the east. Snow on the high ground of Scotland

and northern England, potentially some disruption to trans-Pennine

routes. There could be icy stretches by the end of the night at West. A

bright day tomorrow, but the chance of some hefty showers in the

south-west. The weather front never really moves through and there will

be outbreaks of rain. Towards the end of the week, the cloud and rain

continues to work its way to the west, bringing colder air with it.

It is cloudy at the end of the week, and at times, some of us could see

some snow flurries. Hello, it's Wednesday,

it's 10 o'clock, I'm Victoria Derbyshire,

good morning and This morning, the Government's

announced that from April hospitals in England will have a legal duty

to charge overseas patients who We'll ask our audience here of NHS

workers and patients whether the NHS Let's get a quick snapshot.

treatments and procedures. I think if you charge, it

fundamentally alters the relationship between the doctors and

patients. I agree with the GP over there that if you start charging, it

is a slippery slope. You are a final year medical student. I have to

agree with the other guys. Is there enough money to do that? I don't

know if there is. You have been telling us your experiences of the

state of the NHS this morning. We have never been in such dangerous

territory. The decisions we have been asked to make our unfathomable.

I was told the drugs I need are not funded in Wales. They are being

withdrawn from England too. I am having to raise funds to paper the

drugs to keep me alive to be here for my children. Day in, day out,

nurses and doctors are having to send patients home from hospitals to

their home, weather is not enough care. We will also talk about

Government plans for a seven-day NHS. Here is how you can get in

touch. And wherever you are in the UK,

do get in touch with your own experiences and we'll feed those

into our conversatoin this morning. You can E-mail us at

[email protected]. We're on Facebook, just search

Victoria Derbyshire. Texts will be charged

at the standard network rate. Here's Joanna in the BBC Newsroom

with a summary of todays news. The number of patients on hospital

wards has been at unsafe levels in nine out of ten NHS trusts

in England this winter, according to figures

obtained by the BBC. The results show some

hospitals were operating at close to full capacity,

putting increased pressure NHS England says more beds would be

freed up if there was greater focus on the link with social care

providers. This programme has been debating the

state of the NHS in England, which has been described by some as a

humanitarian crisis. We need to engage in a big debate about the

future financing of the NHS, because as we get older as a population,

with more complex needs, and we have more expectations on the NHS, we

will have to debate and face up to big questions about how we fund it.

Let's not go to the nonsense and believe that the NHS could not have

extra investment now. It could if this Government took a different set

of decisions. The Conservative MP for Stafford disagrees and thinks

that extra tax should be raised. If you look at the amount we spend on

health, it is probably about 2% GDP less than in France and Germany, and

frankly, unless we are prepared, and I heard people behind say they were

prepared to do this, and certainly when I talk to my constituents,

unless we are prepared to say we will increase the amount we spend,

which means higher taxes, I'm afraid, there isn't anywhere else to

go if we are going to have a... System funded based on need and from

a progressive source of income, that is the only way to go.

The Government plans to impose a legal duty on hospitals in England

to charge overseas patients up front if they are not eligible for free

Last week, a report by MPs said the system for recovering costs

NHS Improvement, which oversees trusts, said the new approach

would save hospitals having to chase money they are owed.

Emergency treatment will continue to be provided immediately

Thousands of low-income families who were stripped of their tax

credits after a mistake by the US out-sourcing firm Concentrix

A Committee of MPs says that Her Majesty's Revenue Customs

has accepted their recommendations to review up to 23,000 new cases.

The company, Concentrix, was sacked by HMRC in September

following an investigation by this programme.

MP's will have the chance to amend the Government's legislation

on Brexit when it returns to the Commons for three

A number of pro-Remain Conservative MPs are understood to be

considering voting with Labour and the SNP to try and give MPs more

of a say over what happens at the end of the negotiating

process - although Downing Street is understood to be confident

President Trump has stepped up his attacks on the judge

who blocked his travel ban on seven Muslim majority nations.

In a series of tweets, he said the American people should

blame the judge if anything happened to threaten national

security and that the courts were making his job very difficult.

The White House is expected to pursue its appeal

That's a summary of the latest BBC News.

We're going to start with breaking news from the last hour

and the announcement that Alastair Cook has stepped down

Cook was appointed nearly five years ago and has led England

He helped England to two Ashes series wins but leaves in the wake

The 32-year-old has told the ECB he wants to continue as a test

player, but leaves England looking for a new test captain

with a home series to come against South Africa this summer.

Ears very strong mentally, he knows his game, knows what he wants. He is

stubborn at times. He has worked feverishly hard on his technique to

improve it through the years, and he is a fantastic test cricketer, the

rock of England's batting for the last decade. There was an argument

for Cook to continue for another year, to get through this summer,

get through the ashes, and then hand over to Joe Root. That would allow

Joe Root to settle in as captain. It seems, after the discussion, that he

has had enough. history to beat the Atlanta Falcons

34-28 in overtime. The Falcons were in complete

control having scored three They were 25 points ahead before

the spectacular fight-back - no team has come form that

far behind before. The Patriots drew level at 28

all with less than a minute left And then, in overtime,

a touchdown from James White completed the comeback

to take the title. Quarter-back Tom Brady named

the Most Valuable Player for a record fourth time -

it's a fifth title for the Patriots. The NHS was created after the Second

World War with the guiding principle that it should be free to all and

open to anyone at any point in their lives, that is, that it would look

after you from cradle to grave. How many of those principles hold true

nearly 70 years later? I got pain in the top

of my legs, really bad. The ambulance came

and took me to A, I didn't know I was

pregnant until I got into the delivery suite,

so they were very supportive,

helped me with baby clothes, because I had nothing,

and just generally felt that home because of their support and how

welcoming they were. My name is Rachel,

I live in London and I've had mental health problems

for about three years since I had a breakdown in my last

year at university. My experiences with

NHS services have I have had some that

were really helpful, but often, the right services aren't

there when you need them, so you can end up waiting a really

long time, and that can mean things get really bad

before you get any help. I'm Lisa Stevenson,

and in April 2011, my life changed forever,

when I was diagnosed out of the blue with multiple myeloma,

cancer of the The NHS, for me, is made up

because of the incredible people who work within it - the

doctors, the nurses, the porters, Every interaction I have

had has been absolutely My name is Jo Horton, and less

than a year ago I was involved in an accident in a bus that

resulted in me losing my leg, so I Thanks to the NHS, I am here,

running my own business I am a former Olympian,

and judo has been my life The NHS literally pieced me back

together, physically, emotionally and mentally to get me

back here on this journey. Everyone from the bottom

to the top has made My husband died in May 2014

from pancreatic cancer, and throughout that process, we were put

through the palliative care route and support by the

palliative care team. We went from him being OK

to suddenly dying overnight. Lots of the care along

the way wasn't the It didn't really meet the kind

of person-centred agenda that the NHS talk about,

people being at the centre of the decision-making,

so I am keen to share the story that Seth and I went through to improve

things for others and to create a

compassionate legacy in Seth's name. Labour opened up the NHS

to independent, private providers in 2002 in a system where money

follows the patient. Ten years ago 2.8% of the NHS budget

was spent on independent providers. Privatisation means opening the door

to private providers. It's different to charging for some

services which we already do for things like dentists,

eye care and so on. But with a finite pot of money,

a growing and ageing population is it time to start

looking again at charging A BBC Ipsos Mori survey of over 1000

adults in the UK suggests that half of you think that would be

unacceptable, but around a third Let's get a snapshot

of views in the audience. Put your hands up and keep them up,

if you think it would be acceptable I'm just going to net over here. I

spent 28 years in the ambulance sector. I would look at charging for

people who choose to get drunk. They put a huge strain on services and

they'd like BAe NDE -- they blight the A How much would you charge?

In the United States, they are locked in a safe place, cared for,

and the next day, there is a release fee. Who agrees or disagrees?

What's it called? The drunk recovery service. This is a trojan horse

argument. The NHS has been... Tell the gentleman here. I will explain

to him. They might seem like an easy target, but once you introduce the

infrastructure for charging this will gradually be extended to other

groups like overweight people, people who smoke, people who injure

themselves through skiing, the immigrants are being used to

introduce charging. Charging patients is classified as a zombie

policy. It refuses to die and what our Tory MP should be telling us

they are setting us up for an American-style insurance system

either you can, there is two-ways to pay charges, you pay out of pocket

or take out top-up insurance and our politicians are afraid to tell us

where they're taking us. I'm going to ask our Conservative MP

in a second. I want you to argue the case for what you have talked about

with this gentleman here. What's your name and what do you do? I'm Dr

Bob Gill and I am a GP and I'm producing a documentary to explain

this scam that's taking place. I think it is demoralising for

ambulance staff having to deal with drunk people on Friday and Saturday

night. You ask about the morale of the NHS, they are having to deal

with people because there is no disincentive for them to go out and

get drunk? Is that something we want to put up with? I take your point

about it being a trojan horse potentially, but that's a specific

instance where it causes misery for NHS and money. I am not advocating

that people get drunk and waste people's time. Has anyone here had

an ambulance called after having one too many or two too many or three

too many? What thz is a spurious argument. We are having demonising

of certain patients and this will be extended and we're falling into a

trap. My name is Jess and I am an A doctor. I stand on the

frontline, I'm the person who gets assaulted and gets sexually

assaulted in A by drunk people. I was a medical student, you have seen

us on TV, we go out and get drunk all the time, I have never ended up

in A None of us have ever ended up in A and I've never left my

friends behind on the side of the road drunk which people do now. We

should be charging them. It costs huge sums of money. It is ?300 every

time we spend LAS to go and pick somebody up off the side of the road

and then the money you get charged, just talking into A is ?100 to

register you, it is a waste of money and it is ridiculous. Can I ask you

the nature of the assaults upon you? I have been punched in the face and

held up against the wall, I have had nurses who are awesome dragging

people off me. I had someone grab me by the breast in the waiting room

and that's going to court and that's because I work on the frontline in

A and all of those people were drunk, none of them were mentally

unwell, but all of those people were drunk and not in control of them

sefrs, that doesn't make their behaviour acceptable in anyway.

You would charge ?400? In Cardiff they have a drunk time. The LAS who

are highly trained professionals say, "You are a drunk person. Go and

lie on that bed and a matron will kick you out in two hours when you

wake up and feel sorry for yourself." Three-quarters of people

support the idea of charging visitors from outside the UK for

health visitors. Who agrees with that? My name is

Joanne Smith. I'm a medical secretary in the hospital for 23

years. I have also been a patient over the last two years through

breast cancer, chemo, radiotherapy, and two operations as well as

supporting my dad with lung cancer and as a family, the money that we

have had out of the NHS and my brother broke his kneecap as well,

we were all in hospital at the same time at one point. All going to

theatre. Me and me dad were on the cancer ward having chemo together.

The money as a family that we have had out of the NHS, I would not like

to know, but my dad is 70. He run his own company. He has worked every

single day since he left school. The same with me and the same with my

brother. And we owe our lives to the hospital. I work as a medical

secretary. I give above and beyond... And you support this move

that's been brought in? I support. A legal duty on staff to charge? I do,

yes because... Who disagrees with that? Where is Amber. I'm Oliver. To

be honest I disagree that people who come to this country should have to

pay to receive care if they fall ill. While they're here they're

contributing to the economy, you know, they're spending money,

investing in the country, you never know when you're going to become

ill. So I think, I'd like to think if I was in a foreign country I'd

receive... What do we mean by non-urgent care? Nobody in

Government is proposing that if you come over from another country and

you have to be picked up by an ambulance and taken to A that you

will be charged. This policy that developed today, we need it get more

details, refers to routine and non-urgent care. There is a bit of a

grey area around that, but it is being interpreted if you go for an

appointment which in a hospital, an outpatient appointment leading to

some form of routine surgery, that would be something where they'd

check your ID and see if you are entitled to free NHS care. I don't

think anybody wants to stop emergencies being treated whichever

country you km from. But you get a bill afterwards under these plans.

Jeremy Lefroy might have more details. There was a plan to extend

it so that if you went into A and needed to stay a few nights and

needed surgery as a result of that, would you have to pay for that, but

Jeremy Hunt announced that was put on hold for now. Today's policy is

all about dealing with the routine and non-urgent care and whether

hospitals are being effective at charging. You think that's a good

idea. You disagree. You should only be able to get access to it if you

put money into the system. My stepson came from America, he was

charged ?50 at A when he hurt his arm. We didn't mind paying for it.

He's not paying into the system. You could afford it though? There are

other things, you don't need to go to doctor for everything. Sometimes

the pharmacy can cover lots of things, you know, I think sometimes

charging them might make them think twice do I really need to go?

Urgency I understand. Let's ask the next question. Four in ten in

England would support increasing income tax to fund the NHS. And more

than half in the UK would support increasing national insurance to

fund the NHS. Stick your hand up if you agree with that and haven't yet

spoken. Hi, good morning. Good morning.

What's your names? James Welling. I hopefully can speak for a lot of

folks here. If we can get guarantees from the Government that it would be

ring-fenced and it would be spent on extra staff, extra services, and not

put into another department for helping with future wars, whatever

else, if it is ring-fenced I think people will be willing to pay extra.

So would you, a penny on income tax? Yes. Five pence? But, but we need to

know where it is going. Yes, OK. Thank you.

Hi. Agree or disagree? I'm Mike Foster and I'm from Huddersfield.

This is the wrong question again. Unfortunately we have the money in

the NHS system. The Government has a lot of money, the minister or the MP

needs to answer the question that's been put to him, ?22 billion more is

going to be cut from the NHS budget by 2020 by this Government. That

money should be refunded. We have a ?3 billion deficit and someone has

talked about a PFI debt. We need to cancel all the PFI debts and then

the NHS will be awash with money instead of us having to pay more.

OK. Hello. Do you agree or disagree, madam in terms of increasing income

tax or national insurance? I agree with increasing income tax, but not

national insurance. We've paid national insurance, the older people

have throughout our worker years and we shouldn't have to do that again.

Let me say, I'm chairman of the Lewisham Pensioners' Forum and we

were instrumental in campaigning to save the NHS as well as to save

Lewisham Hospital. I just had to get that one in. Well, you did it and

you did it very well and we barely noticed! I want to comment on what

the GP said. We need more GPs. We need more doctors. We need more

funding. I mean, especially in my case, talking for older people, we

shouldn't have to go and queue for half an hour or an hour to get to

see a GP. We would like consistency, stability, we don't want to be

changing doctors every time we go to the surgery. We would like to see

the same GP to get accustomed, to build confidence, feel comfortable

with that GP rather than seeing different people every time that we

go to the hospital. OK. Do you agree or disagree in

terms of putting up income tax, if it was ring-fenced? Yes, agree with

that as well. You would do it? You would vet for a party that had that

in its manifesto at next general election? Yes and I'll tell you why.

I have been in an NHS patient for 39 years. I'm celebrating 21 years as a

transplant patient. APPLAUSE

Thank you. The reason that I agree is because I

owe my life to the NHS. I will owe my life to the NHS for the rest of

my life and I will need another transplant one day. This won't last

forever, I realise that. If you have ever been ill and ever known a

family member that's been ill in my opinion, you will change your view

on whether you think that it should be increased in income tax or

anything else. In my view, the, you have to look at where the money is

going. There is no good in pumping the money into the NHS if we're

going to be overcharged with managers getting six figure

salaries, even the quality xharks, six figure salaries, they're not

dharg jobs correctly. We need to have people doing their jobs

correctly. I'm Lesley Channon. I guess I really

lf the NHS. It has helped me -- love the NHS. It has helped me. I had

really severe postnatal depression and I agree with raising taxes for

everyone. I've experienced the healthcare system in America where I

had to pay $300 a month just to be insured. I had a spinal cord injury

and it ended up costing my insurance company, I was in hot a week,

$150,000, I was in rehab for nine months, I didn't know if I was going

to be able to have children. If I hadn't had insurance, I would have

been responsible for that debt and George W Bush wrote into legislation

that people cannot file bankruptcy on medical bills so people are

losing their homes when they get sick. So I think as a society, this

precious NHS that we have, we shouldn't be blaming one person

because they get cancer or one person because they need a

transplant. As a society we have agreed with this NHS to share the

cost equally. OK, thank you. APPLAUSE

Good morning. I'm a GP from Hackney. I just just

want to talk about charging and about where the money goes and it

was interesting you quoted that figure of private involvement in the

NHS. That's a massive under estimate. The NHS spends millions

and millions and millions of pounds every year on consultant

managements, high fees for general managers within the NHS and also

there is a lot of back office functions such as the CSUs, they're

kind of people that run the, I don't know, back office functions behind a

lot of, they're being amalgamated so there is more costs all the time and

the Government's very sponse to chronic funding in the NHS is to say

we need a complete upheaval called the sustainability and

transformation programmes. The NHS is going to be divided up into 44

areas, my area has spent ?7 million just on the reorganisation and

nothing has happened yet! It is not even a 1259try body. And

these reorganisations are going to to lead to a disguise for cuts.

The aim of this is to cut funding, close A, close others is, not ill

hospitals that are needed. Let's bring in Jeremy Lefroy, the

Conservative MP. Speaking as a constituency MP, but it is your

Government, your party in Government. Some people think the

Government is on a secret part to eventually privatise the NHS, and

this programme of efficiency savings, cuts, whatever term you

want to use, is a way of breaking the system so that when they reach

the day when they go, we're going to privatise Everton, people will go,

thank God for that because it is such a mess at the moment. --

privatise everything. Is there any truth in that? Know is the answer.

-- no is the answer. Absolutely not, and if there was, I wouldn't be a

Conservative MP, simple as that. The gentle man also spoke about the ?22

billion. Where that figure has come from is that before the last

election, the NHS produced its own plan saying we need an additional

?30 billion in real terms over the coming five years, and the NHS

itself, Simon Stephens, said, we will find efficiency savings of ?22

billion, but we need an additional ?8 billion in real terms to meet

this target. That is where the figure comes from. It is not about

cutting money, it is about additional money, but the increased

pressures the NHS is facing meant that those savings had to be found.

Personally, I think that the 2020 plan was ambitious. If I can just

finished, we need to get into our heads that this ?22 billion is not

money that has some come -- as somehow come out of the NHS. Bee it

is. I think Hugh can explain that. -- it is. Where does the money come

from? The Government says it will chip in ?8 billion, so the

Government has pledged more money, but the debate is over how you get

to ?30 billion. Does it need more Government money does it need the

NHS using the ?22 billion more efficiently to close that gap? That

is partly what the sustainability of transformation plan is about. Just

part of this is about treating more people in their local community

rather than being in hospital. Is there a better use of the money?

That is the logic, but there is scepticism about whether anything

like ?22 billion can be found. Jeromy is absolutely right. If the

Conservatives privatise the NHS, they will be voted out of office.

Jeromy is saying, as a Conservative MP, if they privatise the NHS, I

won't continue. Do you believe this Conservative MP when he says that?

No. I disagree with what you are saying, Victoria. Use the leg-mac

you asked if they were privately trying to -- -- you asked if they

were secretly trying to privatise, but it is not even secret any more.

I work at the Royal London, a major trauma centre, and we cannot cope

with elective work any more because they have closed down A Who

would vote for a party that would promise to privatise the NHS? They

won't explicitly, but they will if they show the NHS is a service in

failure. Then the Whitewater privatisation comes in and says,

actually, we have an alternative, then they will vote for it. We need

to look at money is going. How many MPs and consultants have links to

the Conservative party? The care quality commission is made up of

people with links. They are the wrong people. You've got to look at

where money is being lost. This is money being siphoned off. John

Ashford, do you think there is a plan from the Conservatives to

slowly privatise the NHS? To be fair to John, he is not a typical Tory.

We should not gang up on him. The health and social care rack which

the Conservatives brought in has put rocket boosters under the exercise.

In Durham, there is a private firm stepping in when GPs have made a

referral. The private firm checks whether the GP was correct or not to

make that referral. It is absolutely disgraceful, isn't it? On the point

about STPs, there was an eloquent explanation on the economics of it,

but the row Letty is that across the country we will see beds cut, A

departments close. Maternity units will be closed, hospitals will be

close. That is what this ?22 billion is about - huge cuts to local

services. I want to ask the panel, what would you charge for, if

anything? I represent doctors in the BMA. I think this is completely the

wrong question. Just answer the question and then say why you think

it is wrong. I agree that charging is an unhealthy distraction. The

amount of money we could reclaim is so small as to make a major

distraction, because the people who would pay other people who are

really struggling at the moment. Those who are unemployed and fully

resourced through social care would not pay anything anyway. Those who

are vulnerable, elderly, they would not pay. It is the people working

and contributing via tax. People say to me, of these two drugs, which is

most urgent? They can't afford prescription fee. Adding fees beyond

that will make the sick even more set. -- sick. Children have no voice

and I speak for them. This is a huge distraction. There is money in the

system. Let's take the internal market, abolished in Scotland and

Wales. It would free up around ?5 billion per year.

What about the external market? The Department of Health was my own

figures, ?6.6 billion going into profit-making companies. Add that up

and you've already got about ?12 billion a year that could be getting

into the NHS. Talking about charging for services, which is less than

0.5% of the NHS budget, is a huge distraction. It is not a question we

should be addressing. Right, we are going to have more stories. I want

to hear from this lady. Good morning. My name is Sylvia Parks. I

worshipped the NHS up until the 8th of October 20 15. Before that, two

of my daughters had twins and they were in the special care unit and

the nurses were fabulous. On the 8th of October, my daughter, 26 years

old, went into hospital to have her baby, and she died during

childbirth. They wanted us to switch the machine off on the same day that

my daughter died. The baby survived, she is 16 months. She has a great

three brain injury and she is blind. I just want to say that we didn't

anticipate that happening. She walked into hospital. She went on

the 7th of October and was sent home. We were told that ever the

leg-mac if everyone came in when they were one centimetre dilator,

the hospital would be full. She had a problem that was seen on three

scans and not acted upon because they were not sure what it was. That

cost her her life. I would like to say, how many lives are going to go

like my daughter's before something is done about the NHS? We paid

dearly, and we are still paying dearly, still having problems

accessing services for my granddaughter, of whom we have legal

custody now. We were told the other day that they have to be careful how

they spend public funds. The baby doesn't sleep at night. She

sustained brain injury and doesn't sleep as a result. I am about to

give up work. I am working my notice to take care of my granddaughter.

Who is going to help us? Wow... We are so sorry, so sorry. I know this

lady would like to talk to. Firstly, my sincere condolences. I know the

pain of loss. I speak and write on perinatal mental health. I have done

that for the last 12 years. I was very ill 20 years ago and could have

been one of those very sad cases of a new mother's body found on a

railway line. I survived, thanks to the NHS and everyone who supports

me. Now I speak on behalf of other ladies and families who had been

left without a mother or father because of poor mental health care

around childbirth. I spoke to midwives last week on a training

day, and one lady said there are two midwives coping for 27 people at any

one time. People... Midwives do an incredible job, I think they really

do, and yet they are pressured. Our society is based on new lives.

Mothers and fathers need supporting, and I think as a society we have

forgotten to nurture our families. We are not remembering how precious

new life is, especially when we have treatment of a loved one at the same

time as Joy, we have to put more into perinatal head mental health

services. -- into perinatal mental health services. I am a big fan of

the NHS. I had a stroke two years ago and I can honestly say the

support I got from the NHS was superb. In my recent role as a

volunteer, I speak to a lot of stroke survivors, and a lot of them

say they have not had that same experience, particularly when they

are discharged from hospital. When we did a survey, 48% of stroke

survivors felt alone and totally unconsidered after being discharged.

It is a postcode lottery. Some areas are really good, other areas, you

get nothing. There are 1.2 million stroke survivors out there, and for

so many of those, they end up with permanent, life changing

differences. They need support, whether it be mental, physical,

speech. A lot of the clinical commissioning groups, when they

start looking at funding, they take away some of that funding. The

Stroke Association, whom I help with, they go out and help support

those survivors. That funding is slowly being taken away, so they

can't do that for that cancel any more. Thank you. Hello. My name is

Chris. Three years ago I was diagnosed with depression and

anxiety, and the NHS couldn't do anything for me. I had to spend

?4000 of my own money. If I had not, I don't know if I would be here

today. The concept of charging is already happening. I paid a lot of

money. 6000 people are killing themselves every year. We have got

to start taking mental health more seriously and commit and spend the

money we say we are going to come because we're not doing it. For the

last 15 minutes or so of the programme, we are going to talk

about Government plans for a seven-day NHS. Should you be able to

book an appointment at the GP surgery in the evening or at

weekends? Should routine operations take place outside office hours's

look at this. One of the Government's most

ambitious plans is to make the NHS in England a seven-day

service by 2020. It was a key pledge of former

Prime Minister David Cameron. With a future Conservative

Government, we would Now it's been taken

on by Theresa May. The Government envisages people

having access to local It recently announced that GP

surgeries that fail to open at evenings and on weekends

could lose their funding. Patients, the Government say,

should also receive the same level of urgent and emergency care

in hospitals in England at weekends CHANTING: Save our

NHS, save our NHS! This was at the centre of the junior

doctors' contract dispute last year. Junior doctors already work

on weekends, and in fact represent the bulk of medical

professionals on shift. Tweets targ'1eted at

Health Secretary last year in work, Jeremy" were keen

to prove this point. But while emergency care

is available at weekends, Health Secretary Jeremy Hunt has

caused controversy by suggesting a lack of staff was behind

the higher weekend death rate. He said 6000 deaths a year

were caused by a lack of a proper seven-day service,

citing an unpublished But e-mails show one of its authors

was unhappy with how Some experts believe other factors

must be considered when analysing the higher death rate,

such as how patients admitted at weekends tend to be sicker

than those admitted during the week, and that there's no evidence

to suggest extra staff would prevent Staffing concerns, however,

haven't been limited to England. The Public Services Ombudsman

in Wales called for a systematic review of out-of-hours hospital

care last year. While Scotland's First Minister

Nicola Sturgeon announced in 2016 that minimum staffing levels

in Scotland's NHS will In May 2016 it was announced a deal

had been struck with the Government But whether this will lead

to a truly seven-day NHS is unclear. Leaked Department of Health

documents released in August last year worried that a lack

of available GPs, hospital consultants and other health

professionals would mean the full Government sources said this

was a normal risk assessment. Hugh Pym our health editor is here.

What does seven day a week mean in practical terms. People say we

already have a seven day a week NHS? It has become a massively

contentious issue. It was at the centre of the junior doctors

dispute. Junior doctors were angry to be told there were changes in the

contract, they were already working several weekends, well one in two,

one in three or whatever. There was the issue of getting more consul

tonight's. Consultants. There are talks on going with the BMA about

that. There is GPs, that's proved controversial as well. Attempts to

get more GP access after office hours during the week and at

weekends when GPs are saying well, we're already doing that and we

sometimes open at a weekend and offer appointments and nobody wants

them. It is highly controversial, but there is a lot of different

aspects to it. Hi. My name is Dave. I'm a staff nurse in A I think

the Government deliberately deflects from what the issue is. This issue

of a seven day NHS, I don't think the public really want an elective

seven day NHS, what they want is a fully funded seven day emergency