we can expect the waiting list to continue to grow and the people who are waiting, unfortunately, being asked to wait longer. we meet some of the patients turning their backs on the nhs to go private. £7,000 is not a light amount of money. we, as a family, we don't have that type of money. ifeel like i'm begging for money, but i don't have a choice. i need the nurse to confirm that so let me get you a call back. it's early morning in this north london gp surgery — the busiest time of the day here, when patients call in trying to get an appointment. next thursday, would you like him to phone on your landline or mobile? for most, the gp is the first person they turn to when they get sick. when is he due? not for the next couple of months. this scene is being played out across the uk as surgeries struggle to cope with unprecedented levels of pressure. this is non—stop, answering the phone, then someone comes in, face to face. at the height of the pandemic, many held back from going to their gp. now they're seeking treatment, but face—to—face appointments are still limited. here, depending on clinical need, a quarter of patients get to see a doctor. the rest receive a consultation via phone or a video call. ok, so nobody is available at the moment so you can call back later. there's only so much we can do. and we work hard to achieve what we can, we get a lot of abuse regularly. we do have staff who are very upset, in tears quite often, it's not an unknown thing. so, yeah, it's hard. outside the surgery, it's even busier. ok, so what have we got going on here, then? so this is our annual outdoor flu clinic for the over—65s. here you go, done. thank you. dr leora harverd is struggling to keep up with increasing demands. how is your workload at the moment, and how has it been? it is overwhelming, completely and utterly overwhelming. there's probably not been a day whereby you can probably switch off, definitely since covid. i feel at the moment we are so overwhelmed that i cannot deliver medicine and the care to the level that i would like to. and it's notjust the demand on her time that's putting pressure on dr harverd. it's also the worries from her patients who are struggling to get to see a hospital consultant. hello, it's leora harverd here, the gp — is that the carer? one patient who says she can't wait any longer has written to dr harverd. so this lady is worried about waiting to be seen on the nhs and might be going privately. i just want to phone her just to see if there's anything i can do to help. it's not unusual that they would go privately, but it's not how it should be. 0h, hello, it's leora harverd phoning from the surgery. this time dr harverd thinks she can help. you shouldn't have to go privately for this one, i'm sure i can help you with this one. 0k, thank you, bye—bye. the workload here is just kind of absurd, i mean, it's overwhelming. from the other end, if you're a patient, you get to see a gp like dr harverd, and you then get referred, chances are you willjoin a very long waiting list — there are over 5.6 million people queuing for treatment in england right now. that's 1.3 million more than at the start of the pandemic. this month the government announced they'll be investing £36 billion on nhs and social care for all four home nations up to 2025. 10 billion of that has been committed to address the backlog in england. we need to pay for those missed operations and treatments. and we need to go beyond the record funding we already provided for the nhs. i have to level with people — waiting lists will get worse before they get better. what does that mean? i think it means two things. number one, we can expect the waiting list to continue to grow as more people come forward to gp services requesting treatment. and the second thing is, once you're on the waiting list, how long do you wait? the problem is the scale of the backlog. the government is spending more. but more is not the same as enough. and if we want the waiting list to come down by the next election, we would need to spend at least 13 billion. if we wanted to meet the target to treat people within 18 weeks, we need to be spending 17 billion and the government has committed 10. but for the millions currently on the waiting lists, they need help now. these are just a few of the stories i've come across. this is from a woman who says she was in so much pain she was passing out regularly. she's waited over a year. somebody here is waiting for open heart surgery. there are around 260,000 people waiting for heart treatment in england — nearly one in four have waited more than 18 weeks, the national target. someone else is waiting for a knee replacement operation. they say we're the forgotten ones, it seems. and i'm looking at £20,000 per knee. this isn't money i have sitting in my bank account, says this patient, i can assure you. they are one of over 680,000 people on the trauma and orthopaedic waiting list. it is the longest in england. i don't know how you cope with that, i don't know how you get on with your life, while you're waiting for something as significant as that to help, to help you live normally. for a growing number of people, waiting for six, 12, even 2a months is just too much to cope with — both physically and mentally. so they're looking for other ways to get treatment. hi, everyone. phew, nervous. sofia jones is in a private hospital near edinburgh about to have surgery to treat endometriosis — a condition that can lead to debilitating pelvic pain. that's the surgery done, it was a success. i had a little bit of a freak—out when i woke up, i couldn't breathe, ijust had a bit of a difficult time, but i'm all settled now, back in my room. 0nce home, sofia's recovery continues, but at the front of her mind is the £7,000 she and her partner andrew have borrowed to pay for the treatment. it was a really tough decision to go private because we were having to put ourselves essentially into financial debt to get the surgery, we had to take out a loan to get it. and, i mean, that's a lot of money. £7,000 is not a light amount of money to be taken out for medical, but you have to have some kind of quality of life. before her operation, sofia struggled with chronic pain. so being told she'd have to wait two years for surgery on the nhs was devastating. some days were so bad that my partner would have to take me to the bathroom and back, help me shower, and i'd be in bed all day. that is not a life. i'm only 36 years old. like sofia, during the pandemic, one in five people have paid for private treatment. i'm quite proud that we have a country with an nhs, but they've completely let me down. and to be honest, ifeel really bitter about it. my endometriosis is not taken seriously by them and, as a result, ifeel completely abandoned by them. nhs scotland says the "women's health plan sets out a number of actions to improve access to appropriate support, speedy diagnosis and the best treatment" for endometriosis. and that their "nhs recovery plan sets out commitments over the next five years, backed by more than £1 billion worth of funding to address backlogs". the nhs is there both to provide care, but also to protect people from the crippling cost if you have to go it alone. the big worry about these long waits leading people to have to go private is, one, that it will increase inequalities, but that also many people will be forced to make awful trade—offs over their finances in order to be able to get access to the care that they need when they need it. and that goes against every grain of why we set up that health service. 61—year old brenda pugh lives in constant agony. she was diagnosed with arthritis five years ago. early in the pandemic, brenda was told she needed a double hip replacement. that was 11; months ago, and she's still waiting. i can't live with this pain. when you try and move it's like... it's like walking onjagged glass and it takes your breath away. i need to get my life back, but ijust don't know when or if that will ever happen. before the first lockdown, around 400 people had been waiting more than 12 months for orthopaedic surgery in england. now there are 62,000, including brenda. one of my daughter's friends hasjust come back from latvia, he went over there to have his done. why are people having to go to latvia to get their hips done? i'm getting that desperate, but that's something i may consider. come on, girls. over half of people with arthritis waiting for an operation during the pandemic report being in pain every day. and many are spending vast amounts trying to relieve that pain — on average £1,700 a year while waiting for surgery. almost £700 goes on physiotherapy. going private isn't cheap. an initial appointment with a private consultant can cost around £200. the average cost of a chest x—ray, £100. an ultrasound of the abdomen, around £360. and a total hip replacement, like brenda's, could be around £11,000 for each hip. for replacing a heart valve, you're looking at more than £20,000. one in 10 people in the uk have private health insurance to cover some of those charges. for those who don't, the options are limited. the independent think—tank, the king's fund researched the impact of covid on some of the poorest people in the country. is there a concern that we are seeing the beginnings of a serious two—tier health system? i think that's one of the risks that the government and national bodies in the nhs are absolutely going to have to manage because we have a choice as a society where we go after this pandemic. it can either be the pandemic that exposed health inequalities and made us make hard decisions over who we prioritise for treatment, or we can ignore it and keep doing almost what we were doing before and focus on things like the headline number of how many people are being treated, without really realising if that's leading to widening health inequalities or not. according to their research, shared with panorama, since the pandemic began, people waiting for treatment in the most deprived parts of england are nearly twice as likely to wait more than a yearfor care. those parts of the country that are the most deprived are the areas that are seeing waiting lists grow the most and also people who are waiting on those lists, a higher proportion are waiting for longer periods of time. and in a way that probably isn't a surprise. but it should be, it should be one of those wake up calls that depending on what part of the country you live, it really does affect how long you're waiting for care. for those who feel they can not wait any longer, using savings is the most common way of financing their treatment. others might be able to rely on their pensions, friends orfamily. but for people who don't have those options, many are turning to crowd—funding. there are so many crowdfunding campaigns online for people who are talking about waiting lists, trying to raise money for private surgery. i mean i'vejust printed out some here. "help raise money forjune�*s hip operation," target of £12,000, "lucy's endometriosis surgery," £600 raised of an 8500 goal. "amber—lily's op." "help antony get a new hip," i mean itjust goes on and on. 0ne site — gofundme — has told us that since last year, they've seen a big increase in the number of campaigns that mention nhs waiting lists. hayden, do you want me to cut these up for you? the kildea family from strabane, in northern ireland, felt crowdfunding was their only option. last year, 12—year—old hayden was diagnosed with severe scoliosis, a condition where the spine twists and curves to the side. so one shoulder higher and then one shoulder more prominent, so there's a gap, a funny gap here. like, i'llactually show you the picture. so you can actually see his curve there and you can see his shoulder blade sitting out more, and it's actually got worse than it was before. shauna says she was told that hayden, who also has autism, would have to wait more than two years to get the operation. this is how it progresses. the more it curves, the more it interferes with his organs, stuff like that. so that's actually really scary. desperate to get hayden the help he needs, shauna found a clinic in turkey able to do the surgery immediately, but it would cost £50,000 — money the family didn't have. so in the summer they started campaigning to raise the cash. thank you so much, thank you. it's really, really frustrating that we're in our own country and we can't get hayden the surgery that he needs. like, i have to travel all over the world with hayden during covid and whatnot. so there is a lot of anxiety and worry about doing that. so we are going to the localfishing shop. so they've offered a donation to hayden's appeal so we are just going to pick that up. we have a few of them to do today so that is what we are going to do now. me and hayden are fighting over the umbrella. right, let me put this down. to add to the money being raised online, local businesses are chipping in. it's absolutely amazing. i hope everything works. thank you so much. thank you. that's amazing. northern ireland's health and social care board says that before the pandemic the number of people waiting longer than the target waiting times was already increasing. it says it's just set out a five—year plan to tackle the backlog and additional funding has been confirmed to help reduce waiting lists for a range of time—critical surgical treatments, including scoliosis. it's now a month since sofia's surgery and she's recovering well. so it's nice to get my life back. nice to be able i to go for a walk. exactly. i couldn't do that before. but that £7,000 loan is weighing heavily on their minds. sofia's a student and andrew has just started a tour guide service, so money's really tight. it's going to be difficult, i especially the next couple of years having to take out a £7000 loan to pay- for surgery, i could have done without that but it needed - to be done. otherwise, i don't honestly know if sofia would have i survived because, you know, you can't live in that - constant pain forever. you give up hope eventually. it's just not fair at all. and i mean, we took the decision to take that loan so that i could have a better quality of life. but not everyone's in that position. brenda's not been able to work for nearly two years because of her arthritis. almost half of the patients who face lengthy delays for treatment are in a similar position. the ballpark figure for hips, and i need both done, it's about £10,000 per hip. i don't have the financial means. some days ijust think i can't see myself ever working again or being financially independent and self—sufficient again. if there was a plan, i probably would say yes. in six months�* time, i can have an operation, i can recover, i can walk again and i can work again. therefore, i'm going to take out a loan because i'll be able to pay that back then. and i can't make those plans. one in five people with arthritis whose surgery has been delayed by covid often go without food or heating in order to fund treatment to manage the pain. brenda says the last thing she heard is that she'll be lucky if the surgery happens this side of christmas. i do have better days and i have bad days. and everybody with this condition understands that the bad days are bad. and it was a bad day... getting emotional now. it was a very bad day. and i just thought... i can't carry on like this. i just cannot carry on. my life just isn't worth living, quite frankly. brenda decided to write to her surgeon. this is the email that i sent. "i desperately need your help. i would like to make another appeal. in fact i would beg you to please change my miserable life for me. it is no life at all at the moment. i have lost everything. there's no joy in anything. unable to walk, i am a prisoner in my own home, and relying on others to get through from one day to the next. please help me." she got a response, but not the one she was hoping for. the letter reads, "we are working desperately hard in very trying circumstances to address a massive backlog of cases. i'm trying my level best to deliver service for you and i'm sorry for the delays, but regrettably i can only operate on one person at a time. that letter, it's a nice letter, but it doesn't help me in any way, shape or form. itjust says, you know, it doesn't even tell me on a timescale again, but it's the waiting and it's the lack of any signposting which is really very difficult to accept. nhs england says, "caring for more than 450,000 seriously ill covid patients has inevitably had a knock—on effect on non—urgent care." it says, "nhs staff have stepped up and made effective use of additional resources, helping carry out millions more tests, checks, treatments and operations this summer compared to last. " with waiting lists set to get worse before they get better, hospital a&e departments are feeling the pressure. i got here at 11:30 last night. i spent the whole night sitting in the corridor because it was so busy. i was crying because i was in so much pain. this is kirsty. she's also got endometriosis. it's her sixth visit to a&e this year. i saw the first time gyno doctor at whatever time this morning, we both agreed we're going to try and avoid emergency surgery if we can avoid it. kirsty�*s been told she could have up to a 12—month wait for surgery to relieve her pain. after spending almost 2a hours here, she's sent home. they'll reassess clinical urgency depending on how many times you go to a&e... obviously someone that's going more often, they're more urgent. so i'mjust waiting. i don't know what my quality of life looks like in the future. so how are you doing? how have you been doing? not too bad, i'm in a bit of pain today. two months later, things have got worse. but when you say a little bit of pain what does that mean? it's more my right leg, so the impact of my right foot hitting the floor is just so painful in the lower abdomen. so if i use the crutches, itjust takes the impact off. the waiting is having a serious effect on kirsty�*s mental health. there's been times where i've gone to bed not knowing if i'm going to wake up the next day because the pain is that severe. it feels like i'm not going to make it. seriously, it's felt like you are dying? yes, literally. and it's... it's basically ruined my life at the moment. nearly 100,000 patients in england waited more than the government target of four hours in a&e last month — a rise of almost 40,000 compared to before the pandemic. what's the link between patients going to a&e and the length of the waiting list? both affect each other. so the more people that we've got coming forward to a&e and needing to be admitted to hospital and have operations, then we see that the capacity in nhs to do the planned care is reduced. but the longer people are on the waiting list, having problems, getting diagnoses, they're also then appearing in the a&e system so it can become a vicious cycle. you know we're going to turkey on wednesday, hayden? so i'm just getting a few of your stuff ready, you know, after raising £50,000, shauna's preparing to take her son, hayden, to turkey for the operation to straighten his spine. how do you feel about going away? um, good. good, are you getting a wee bit nervous? no. mummy�*s a wee bit nervous. i'm not. we as a family, we wouldn't have had that type of money, and to be put in a position where you're basically begging off people, begging for them to help you get your child's surgery that they should be able to get here, you know, and we shouldn't have to ask people for money to do that. so it is infuriating. what do you think�*s going to happen during surgery? do you know? nope. they might put a mask on your face, you'll go for a wee sleep and when you wake up it'll be all done, won't it? uh-huh. so when is it going to get better? so the most optimistic - assessment i've seen is two years and even that is very, very broadly defining better as the nhs getting back. to the performance levels it was delivering - before the pandemic. my best guess is you're looking at longer than that. _ you're looking at somewhere in the region of, i would say, j broad as it is, five to 10 years. - we're heading into a winter where the waiting list - is in the worst condition i can remember in the last- 10 to 15 years. and you've got a tired — and more than tired — l a knackered workforce, uncertain pressures. i and so i think what it means is more people waiting - and the people who are waiting, unfortunately, being _ asked to wait longer. hayden's had his operation. excellent, hayden, look at you, up on your feet. good boy. he's now looking forward to going home. but for millions of others the delays go on. kirsty is going to counselling to cope with her anxiety while she waits. she still has no idea when her surgery will be. sofia has started repaying her bank loan. she's making a full recovery. brenda has joined a second waiting list, this time for physiotherapy. as for her hip replacement, all she can do is wait. welcome to bbc news. i'm ben boulos. the headlines: the news stranded australians have been waiting for is the prime minister announces international borders will reopen in november after an 18 month closure. the bill is passed. the us congress _ the bill is passed. the us congress votes _ the bill is passed. the us congress votes to - the bill is passed. the us congress votes to avoid i the bill is passed. the us congress votes to avoid a | congress votes to avoid a government shutdown but more tough negotiations lie ahead for president biden. tough questions for british police as the officer who raped and murdered sarah everard last march is jailed for life. nearly 1000 police officers try to restore order inside the high security prison in ecuador where clashes between rival gangs left over 100 people dead. based upon the global head of safety has defended the social media giant against accusations it's photo

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