Hello, welcome to a brand new series. In the next half an hour, a close up look at health care. Were on the rounds with a local gp, Fighting Financial Pressure as well as infection. It drives me up the wall. I want to do what im trained for, not to be some sort of clinical accountant. We ask do we still have a National Health service . Or does where you live increasingly affect your care . The fact that ive had to pay for my treatment, its criminal. It is absolutely criminal. Sorry. And learning to help ourselves, should a lesson in life saving be compulsory . She was lying there on the sofa, totally unconscious, with eyes wide open. If i hadnt done the cpr my mother wouldnt have survived today. Im chris jackson. This is inside out. Tonight, in a special programme, we look at the increasing pressures on the nhs. As budgets tighten and the number of patients arriving in a doctors surgery rockets, gps are under increasing pressure to cut the cost of care. We followed one tyneside doctor to get a first hand account of how he and his patients are coping. Mike scott has been a gp in newcastle for more than 35 years. Good morning. Thanks, julie. Life saver. Cheers. The nhs is under huge financial pressure. Gps like mike are at the sharp end, making decisions about where the money is spent. Good morning, surgery, julie speaking. The surgery has more than 5,500 patients. Donna has back problems and suffers from depression. It got to the stage where i didnt want to be here and i wanted to be rid of myself. When they said that was useless, i thought, what is the point . The first tough call of the day. The drug that works for donna being rationed because its price has rocketed. Were being strongly encouraged by the people who run the Health Service not to prescribe this. The plan then for the next four weeks is i keep supplying you with it, if i get struck off, it will take them a few years and ill retire any way. After losing eight and a half stone, donna needs surgery to remove the loose skin. That counts as cosmetic. I will put in an application, because you just told me you felt suicidal. I will have to full in an ifr, an independent Funding Request and look, just dont get your hopes up. It drives me up the wall. I want to do what im trained for, not to be some sort of clinical accountant. We need to configure the Health Service to fit the needs of patients, not the patients to fit the design of the services. If you bear with me, im afraid there will be a bit of a wait for dr scott. I will double check for you. Come in. Theres a patient who has had three seizures in the last 15 minutes. Would you mind looking at that as soon as possible, please. Deprivation, unemployment and poverty here are all significantly worse than the national average. Its12. 30pm, mikes now on home visits. Hello. Dorothy has a severe Muscle Wasting Disease and has developed suspected chest infection. If the nurse hadnt been in, would you have been thinking about calling us . Would you have been worried . No, not at all. Lets have a listen. Dorothy has had the disease for 15 years. Ive had it specially refrigerated to give a thrill. 0k. Thats looking good. All right, ok . Thats fine. Often patients have already diagnosed their illness before the doctor arrives. Do you want my clothes. Dont worry, well preserve your modesty. Im not bothered. When you get to blooming nearly 83. Never say die, dont say that. Give us a few deep breaths. Yeah, youre sounding like a bag of weasels here. I thought i was. I think your vest is tucked into your socks here or something. My thermal vest. I agree with your diagnosis. Its more than a cold certainly. You have a flair up of the bronchitis there. Lunch at the surgery. There are five part time gps here, earning less than 59,000 a year on average. Their time is rationed. Ten minutes a patient. If i had 15 minutes to see all my complex patients with half a dozen different medical problems, im sure i could improve their quality of life. But you basically have to do whats feasible. The average waiting time in england for a routine appointment is now almost two weeks. It can be stressful at times. I can understand when people are poorly, they want to be seen. Its hard if you try to say theres no appointments left. You notice everything. A couple of deep breaths. Theres all sorts of squeaks and rattles. You know i dont like steroids, i dont mind a short period of them. 0k, doctor. Ill go on your recommendation. The Commissioning Group that funds Hospital Services recently began paying gps to reduce their referrals to specialists. Mike thinks its wrong. Inevitably, some people who should have been referred will not be referred. I think more pernicious is the message if your practice is signed up for that, dont trust your doctor any more. When he tells you, i dont think you need to go to hospital, he could be saying, i honestly dont think you need to go to hospital or he could be thinking, i need to save up for my foreign holiday and if i dont refer this person to hospital, it will cover some of the cash flow that we missed last year. If im honest, i dont think anybodys going to be saying that, but it puts you in an invidious. The Commissioning Group said it was to make best use of resources. Said it was to make there are schemes in other areas, after you made the referral, another doctor looks after the Referral Letter and says no, you cant make that referral. I think that absolutely stinks. Somebody who doesnt know me and doesnt know them says no. You know, i just dont accept that. I would do everything to circumvent that. They made 2,500 referrals to specialist last year. For operations like removing tonsils many hurdles have been overcome. Seven or more well documented clinically significant sore throats in the previous year. That to me isjust a rationing criteria. The bar is too high. A seriously ill patient is deemed ready for work by the department more telephone consultations. A seriously ill patient is deemed ready for work by the department of work and pensions. I find it mindboggling that someone who has never met you in your life before overrules my opinion. He has very severe arthritis and a very severe depression. I think my opinion as to whether hes capable of working is worth a whole lot more than this other guy, whos Dog A Tick Box Exercise for a private company, contracted to the government. Its now approaching 7pm. Mike has seen 26 patients, but there are still three home visits to do. Do you still feel sickly now . A bit. 0k. What you need from me tonight is pain relief and not vomiting . Uhhuh. 0k. Home visits are costly in time terms. But they can also save the nhs money. That lady there, i think, as a result of visiting her this evening, we can keep her out of hospital. If we hadnt seen her tonight, she could have been in hospital by midnight. I give myself a day off each week, as well as the weekend, otherwise i couldnt cope with this. Id crack up, quite frankly. Im going to go home and i may pour myself a nice, cold beer and watch something that involves no mental effort at all on the telly. While dr mike is facing the squeeze on the frontline, others are looking at the Bigger Picture and asking is the nhs still a National Service . Or does where you live now matter more than ever when it comes to the care on offer . The nhs is facing the most significant financial challenge in its history. There are fears the service weve grown up with is beginning to fragment. Its not a National Service. Absolutely there is a Postcode Lottery. Its criminal. It is absolutely criminal. This is the start. This is going to get worse. So, is the nhs in danger of ceasing to be a National Service, where everyone is entitled to the same care . It is treating more patients but is it becoming a Postcode Lottery where access can depend on where you live . Were going to put that to the test. On a bad day it ruins your life. Muscle pains, it feels like my bones are actually screaming at me, at times. 33 year old ben franklin has hepatitis c, the virus can cause life threatening liver damage. Im about to lose myjob. I havent been at work since april. Ive been off sick. I could possibly lose the flat over my head. There are new drugs that could potentially cure bens hepatitis. Theyre expensive and rationed. Ben has been denied them. All i got was wait, basically, because my liver wasnt bad enough. And that made me want to go out and just get absolutely wasted and ruin my liver. Just so that they would treat me. I wouldnt do, that but i wouldnt be surprised if anyone else wouldnt. The money is there forjust over 10,000 treatments. Each area has a target to meet. Its claimed that means there are no queues in parts of the north and long waits in places like london. Two people with exactly the same state of liver damage could present themselves in different parts of the country and in one, theyll be able to walk in, get hepatitis c treatment immediately, get cured. In another part of the country, they may go there and be told, im sorry, youre going to have to wait. This is just inherently unfair. Nhs england told us it was regularly re allocating unused Hepatitis C Treatments to places with waiting lists. The number of patients treated will increase by 25 next year. Its the fact that its down to money that upsets me the most. Just money. So ben is taking the risk of treating himself with cheaper copies of the new drugs. How much have you spent on that box . £1300. £1300, yeah, i dont really have that. The fact that ive had to pay for my treatment is criminal. It is absolutely criminal. Sorry. Im tired of being tired basically. Ben is hoping the generic drugs will cure him in a matter of weeks and hes not alone. The Hepatitis C Trust estimates around a thousand people in britain may have bought the drugs abroad. If you go outside, its halos around the lights, like some shadows. Its often hard to see things, theyre a bit distorted. Gloria has cataracts in both eyes. I cant take stairs, go up or down stairs with any kind of confidence. Cataracts are supposed to be treated within four and a half months of referral. Gloria, who lives in the north east, says shes been waiting seven. Its too long because there is such potential for accidents. Theres such a change in the persons mood. If gloria had lived in luton, her wait could have been as little as 15 days. A Postcode Lottery . Absolutely, there is a Postcode Lottery. Its not about clinical need. Its about some places in england having poor systems, having budgetary pressures and deprioritising Cataract Surgery. That doesnt feel national to me. Gloria expects her operation later this month. It really makes me angry because i think that its almost like the survival of the fittest. Clinical Commissioning Groups or ckgs control health budgets. Its claimed some are delaying treatments like Cataract Surgery by slowing down referrals. Others are requiring patients to lose wait before getting operations, like hip replacements. Postponing an operation in these circumstances can save money in the short term. Whilst the ccg says it can be clinically justified the Royal College of surgeons say it cant. Theres very good evidence that people are now got getting elective operations, which they desperately require simply because of financial restriction. It is up to the clinicians to decide who should have what treatments. A bureaucratic system which produces a blanket ban, we think its morally wrong. Its claimed new systems for Vetting Appointments with specialists are another form of rationing. Why are they treating their patients with such contempt . Last month mps complained about a private company being paid £10 for every gp referral they stopped. This is rationing by the back door and has the potential to compromise patient safety. The same private company oversees referrals in North Tyneside. Weve spoken to doctors who say the system is putting patients at risk. Gps, who fear speaking out, have told us that Cancer Diagnoses are being held up. I tried to get a patient referred to a dermatologist. The Referral Management Service said it was a skin lesion. That was a disaster. It was a nasty, invasive skin cancer. The system is dangerous. Theyre putting up barriers. Theyre using delaying tactics. Its getting between the doctor and the specialist. In a statement, North Tyneside ccg said there was no evidence the system caused additional risk or delay. Cancer referrals do not go through the system and are made directly to hospital. The number of referrals knocked back to gps in england has risen by about 30 in the last two years. You can see the details of our research online. Shortage and regional difference have always been part of the nhs. Today the differences could get much worse. The nhs is under an unprecedented level of pressure. If it doesnt get more funding, Waiting Times will get longer and the quality of patient care is going to suffer. So we will see different decisions taken in different parts of the country and Different Services being available to patients. So, is the nhs still a National Service . One of our most prominent medics is clear. No, its not a National Service. Its now a local Health Service. It matters because it means it leads to inequality in health care. Thats the problem. Some people will get health care for free and others wont. In the statement the Department Of Health told us far we asked the Health Secretary and nhs england for an interview, both declined. The people actually paying for nhs services, the clinical commissioners, did agree to speak. Its a National Service with local variation based on the need of the population. Demographically populations vary quite significantly from town to rural, from county to county. Its really important that we commission and respond to the needs of that population on a local basis. Its about making sure the pathway is correct. We dont want to squander any money. We have limited resources. Its really important that we spend most effectively and get the best value for our population. For those forced to take their own action, rationing appears all too real. Would you know how to save a life . Well, this year, around 30,000 people will have a Cardiac Arrest and need urgent help until a medic arrives. Campaigners say that means that resuscitation should be taught even at a very young age. Weve met a newcastle teenager, who understands that only too well. Im 15. I raise money for a charity that Defibery Lators in primary schools and Public Places and raises money for cpr training. I started fundraising when i lost my best friend michael. Michael was just 1a when he had a Cardiac Arrest. It was triggered by an asthma attack. She was absolutely devastated, totally broken hearted. As a mother, it was hard watching her go through it. I couldnt do anything to make it better for her. Bobby has now raised over £10,000 and funded her own cpr and defibrillator training. After what happened to her friend, she wants everyone to knowjust how important it is to know life saving skills. Cpr is what keeps the organs going, what keeps you alive. If you dont act fast and do cpr, you have so much less chance of surviving. I think its something that when you get to a certain age, you should be trained, in because anything could happen. But if bobbi lived in denmark, she and her peers would already have learned it. Resuscitation skills, cpr, has been a compulsory part of the School Curriculum here for the last ten years. In a copenhagen classroom, 11 and 12 year olds are being challenged to make their own films about resuscitation. This class will produce five films. Each film will be a Campaign Film telling me or you how to act if you see a person dropping down on the streets. The aim is that the children have fun and creative day and by making films about it, they will obtain the knowledge and they will obtain the idea that its a good thing to help. Its always interesting to see the childrens perspective on these quite difficult issues about life and death. 20 year old rasmus knows more than mostjust how important it is to help. Two years ago, he was at home ah, loan with his mum, when she had a Cardiac Arrest. She was lying there on the sofa, totally unconscious. Indeed it was very scary. The only thing that kept me going was really that i could hear her breathe slightly sometimes. If i hadnt done the cpr my mother wouldnt have survived today. It is a very, very, very good thing to know. You never know when its going to happen. It could come all of a sudden. Like for me, my mum, of course, she is very grateful. The first thing she told me when she could speak again, was, you saved my life. I really didnt know how to respond to that, but well, i guess i did. Now nearly 70 of people in denmark know cpr. Thats compared to just 10 in the uk. And the Survival Rate from Cardiac Arrest has trebled. This is the Emergency Dispatch Centre in copenhagen. It is about changing the attitude that you can do something and you cannot do anything wrong and to take a social responsibility. It has an impact on survival. It has an impact on the new future generation of life savers. Give me just one reason not to teach children cpr in school. I cannot find that reason. Itsjust one hour, its Cost Effective and it doesnt cost very much. Everybody should be able to do cpr. Back in the classroom, the sixth grade students are finishing off their films about resuscitation. Anybody wants to help . Youre ok. Thank you, thank you. You can save lives. Everybody can save lives. But the more you hesitate, the chances of surviving gets smaller and smaller. Thats what one paramedic wants to teach children here in the north east. This class is for five and six year olds in south shields. Come up here and sit in the middle. Little ones are like sponges. Ive been shocked at how much they cannot only take on board and retain. Then deliver. Theyre really interested. I think the characters really help. Always wanting to get involved in the characters and activities that we run. No, its not compulsory, i think it should be because personally i think its probably one of the most important life skills that you can ever have. Are we any closer to making this the norm in uk classrooms . And following the lead of denmark . The Department Of Education told us its not good enough at all. Were way behind the curve here. Were failing our population because people are dying prematurely unnecessarily. Push really hard. It makes me really sad. Its such a simple thing to introduce. It doesnt cost much. The benefits would be so huge. Good job in newcastle, its a special day for 15 year old bobby. Shes up for an award. This awards are to recognise Unsung Heroes and champions in the local community. Overall ive raised about £10,000, ive bought ten defibrillators in the areas where me and michael were. The award goes to bobby. Cheering. Its about getting the word out. Everyone will know that michael had a Cardiac Arrest. He would be over the moon. He really would be. Congratulations to bobbi on that fantastic award. Thats it for now. Therell be more from the bbcs inside out teams on the bbc news channel next weekend. Good morning. It is a very wintry Sunday Morning across many parts of the uk. Even with the frost with temperatures as low as minus eight celsius. Freezing fog patches in kent and some of us has seen snow. A dusting of that in parts of wales, the West Midlands and a few spots in north west england. In scotland as well some flurries giving a light dusting in places. High pressure in control of our weather, but there is this weather disturbance moving through western and northern parts of the uk. A few potential showers in the south west and in west wales, mostly falling as rain. The odd flurry is still possible into parts of northern england. Northern ireland will see some sunshine, but across scotland there will be further flurries of sleet and snow. A cold field. In the south west compared with recent days, plenty of sunshine. Hard Frost Setting in for some of us tonight, but also some mist and four patches developing. They are possible just about anywhere, but there is a risk in england and wales of seeing dense Freezing Fog Patches that could cause problems during the monday morning rush hour. It will be slow to clear, so if you are heading out tomorrow morning, check the traffic and travel situation. Not everyone will see it, but problematic possibly. Not just will see it, but problematic possibly. Notjust monday morning its Tuesday Morning as well. The fog will clear, but for some it will linger perhaps all through the day. The risk of that is highest towards the south east. Temperatures will stay around freezing. Out of the fog, a day of variable cloud with some sunny fog, a day of variable cloud with some sunny spells. A dry day, but another cold feeling day. Into monday evening and again, the fog will develop. Once more it is england and wales most at risk. The air isnt moving very far of fast because of the centre of high pressure. Tuesday morning, problematic fog, but scotland and Northern Ireland will get closer to low pressure. The isobars are closer together and the winds are picking up, so your weather will change, gradually turning more unsettled. More as ever available online. This is bbc news. Im gavin esler. The headlines at 11. Theresa may will be the first world leader to meet President Trump when she travels to washington on friday. The Prime Minister says she wont be afraid to tell the president what she thinks. Whenever there is something ifind unacceptable and will not be afraid to say it. After millions took to the streets in protest against the new president , the white house accuses the media of dishonestly reporting the size of the crowd at his inauguration. The Ministry Of Defence says it has absolute confidence in the uks Nuclear Defence system after reports that a Trident Missile test went wrong. The gambias defeated leader yahya jammeh flies into exile, 22 years after taking control of the west african state in a coup. World number one andy murray crashes out of the Australian Open after a shock defeat in the fourth round
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