1 00:00:03,520 --> 00:00:06,735 The NHS is under intense pressure. 2 00:00:06,760 --> 00:00:09,535 Emergency departments are packed. 3 00:00:09,560 --> 00:00:12,295 It's the most pressure I've felt as a clinician 4 00:00:12,320 --> 00:00:14,295 in my time since I've qualified. 5 00:00:14,320 --> 00:00:15,735 CHANTING: We want fair pay. 6 00:00:15,760 --> 00:00:18,735 Staff say they are at breaking point. 7 00:00:18,760 --> 00:00:20,895 Your NHS, our NHS. 8 00:00:20,920 --> 00:00:22,735 Ambulances are queueing for hours, 9 00:00:22,760 --> 00:00:26,055 it can be desperate for patients. 10 00:00:26,080 --> 00:00:30,895 We sat there and A&E was just absolutely crammed full. 11 00:00:30,920 --> 00:00:35,615 So, what needs to change? I've been meeting doctors and nurses 12 00:00:35,640 --> 00:00:39,615 rethinking health care, picking problems up early... 13 00:00:39,640 --> 00:00:43,455 We've essentially clone 20 consultations in one here. 14 00:00:43,480 --> 00:00:49,495 The more people get a chance to come here, the better. 15 00:00:49,520 --> 00:00:54,335 ...and using new technology to take the hospital into the home. 16 00:00:54,360 --> 00:00:57,655 So, can the NHS be fixed? 17 00:00:57,680 --> 00:00:59,175 We're not replacing the hospital, 18 00:00:59,200 --> 00:01:01,655 this isn't about the death of a hospital, if anything it's 19 00:01:01,680 --> 00:01:03,655 the rebirth of the hospital. 20 00:01:09,600 --> 00:01:12,855 Hello, Mrs East. 21 00:01:12,880 --> 00:01:15,735 93-year-old Elizabeth East is being assessed 22 00:01:15,760 --> 00:01:18,455 at the john Radcliffe in Oxford. 23 00:01:18,480 --> 00:01:21,055 How are you doing? 24 00:01:21,080 --> 00:01:24,775 Like many hospitals across the country, 25 00:01:24,800 --> 00:01:26,815 it is being pushed to its limit. 26 00:01:29,360 --> 00:01:30,935 Good morning. 27 00:01:30,960 --> 00:01:33,895 How are you feeling today? 28 00:01:33,920 --> 00:01:37,975 Elizabeth fell at her care home and has a broken arm. 29 00:01:38,000 --> 00:01:42,095 She's already spent nearly five hours in the emergency department. 30 00:01:42,120 --> 00:01:47,015 Now she's being assessed on a special unit run by Dr Jordan Bowen. 31 00:01:48,320 --> 00:01:50,975 You've had a long night, you must be very sleepy. 32 00:01:52,840 --> 00:01:54,575 When admitted to a hospital ward, 33 00:01:54,600 --> 00:01:59,455 frail older patients stay for an average of ten days. 34 00:02:01,120 --> 00:02:04,455 You're feeling cold, are you? Yes, I am. All right. 35 00:02:04,480 --> 00:02:07,975 And this is not a good place for someone like Elizabeth 36 00:02:08,000 --> 00:02:10,815 who is also living with dementia. 37 00:02:10,840 --> 00:02:13,935 One of the treatments already for the way her brain's working 38 00:02:13,960 --> 00:02:16,095 is by trying to normalise her environment, 39 00:02:16,120 --> 00:02:18,215 but we simply can't do in hospital. 40 00:02:18,240 --> 00:02:21,295 Which is why already my intent is to do as much as I can 41 00:02:21,320 --> 00:02:24,455 within her own familiar environment in her own care home. 42 00:02:25,920 --> 00:02:30,375 This assessment unit aims to get people who arrive as emergencies 43 00:02:30,400 --> 00:02:33,135 home the same day. 44 00:02:33,160 --> 00:02:36,455 So, what we try to do is intercept patients who would otherwise 45 00:02:36,480 --> 00:02:38,655 be arriving in the emergency department 46 00:02:38,680 --> 00:02:40,695 or being admitted into the hospital, 47 00:02:40,720 --> 00:02:43,615 and instead be offering them all an alternative to that, 48 00:02:43,640 --> 00:02:46,215 where still they get the same quality of treatment 49 00:02:46,240 --> 00:02:47,655 and yet go home. 50 00:02:49,160 --> 00:02:51,055 Here, they've been very successful, 51 00:02:51,080 --> 00:02:54,375 seeing an average of 7O patients a day. 52 00:02:54,400 --> 00:02:58,895 95% are treated without needing an overnight stay. 53 00:02:58,920 --> 00:03:01,015 Have you been able to get some bloods off her? 54 00:03:01,040 --> 00:03:03,855 They're geared up to get test results back quickly. 55 00:03:03,880 --> 00:03:04,935 Is that all OK? 56 00:03:04,960 --> 00:03:07,895 Elizabeth has problems with her kidneys, 57 00:03:07,920 --> 00:03:10,295 so Dr Bowen adjusts her medication. 58 00:03:11,880 --> 00:03:15,415 Once her arm is treated, she can go back to her care home. 59 00:03:15,440 --> 00:03:17,415 Staff there will monitor her. 60 00:03:19,080 --> 00:03:23,975 Biggest thing is trying to explain to someone who is feeling unwell 61 00:03:24,000 --> 00:03:27,775 why it's OK for them to be at home feeling unwell. 62 00:03:27,800 --> 00:03:32,055 By keeping people recovering safely in their own home, 63 00:03:32,080 --> 00:03:34,895 we think that people get better quicker and return back 64 00:03:34,920 --> 00:03:37,975 to the things that they value sooner than being in hospital. 65 00:03:38,000 --> 00:03:40,175 It's a massive change in thinking. 66 00:03:42,440 --> 00:03:45,455 With the health service under such pressure, 67 00:03:45,480 --> 00:03:47,335 most hospitals are doing this. 68 00:03:49,600 --> 00:03:51,975 But in Oxford, they've gone further 69 00:03:52,000 --> 00:03:56,015 by also providing high level hospital treatment 70 00:03:56,040 --> 00:03:57,695 in people's homes. 71 00:03:57,720 --> 00:04:01,695 The hospital is full at the moment, 110% filled. 72 00:04:01,720 --> 00:04:03,535 There are people in there for 22 hours, 73 00:04:03,560 --> 00:04:05,095 eight hours waiting to be seen. 74 00:04:05,120 --> 00:04:06,375 The clay is very young. 75 00:04:06,400 --> 00:04:09,255 Could we actually get you and the hospital home team to go out? 76 00:04:09,280 --> 00:04:10,615 Yeah, very much so. 77 00:04:10,640 --> 00:04:15,175 Professor Dan Lasserson was one of the first doctors in the country 78 00:04:15,200 --> 00:04:18,575 to provide this kind of home-based medical care. 79 00:04:20,000 --> 00:04:22,655 We can assess you, we can diagnose you, 80 00:04:22,680 --> 00:04:24,695 and with the right support, 81 00:04:24,720 --> 00:04:27,055 we can treat you at home if that's your choice. 82 00:04:27,080 --> 00:04:28,615 We're not replacing the hospital. 83 00:04:28,640 --> 00:04:30,575 This isn't about the death of the hospital, 84 00:04:30,600 --> 00:04:32,855 if anything it's about the rebirth of the hospital. 85 00:04:34,920 --> 00:04:39,255 New technology means he's now able to look after much sicker people 86 00:04:39,280 --> 00:04:40,935 in their own homes. 87 00:04:43,480 --> 00:04:47,495 Professor Lasserson is here to see 91-year-old Ted. 88 00:04:47,520 --> 00:04:52,215 He has heart failure and has been referred to Dan by a specialist. 89 00:04:52,240 --> 00:04:55,215 Hello, my name's Dan. I'm one of the doctors from the hospital. 90 00:04:55,240 --> 00:04:56,735 How are you? 91 00:04:58,200 --> 00:04:59,815 I feel really rotten. 92 00:04:59,840 --> 00:05:01,615 You feel rotten? 93 00:05:01,640 --> 00:05:05,375 Are you getting any pain in your chest? 94 00:05:05,400 --> 00:05:06,415 No. 95 00:05:06,440 --> 00:05:08,855 No, OK, or your tummy? 96 00:05:08,880 --> 00:05:13,615 Last week, Ted fell and paramedics wanted to take him to hospital. 97 00:05:13,640 --> 00:05:19,575 But Ted, supported by his wife and daughter, didn't want to go. 98 00:05:19,600 --> 00:05:22,535 He was always able to do his own medication 99 00:05:22,560 --> 00:05:25,495 up until about three weeks ago. 100 00:05:25,520 --> 00:05:28,695 Hospital at home has given them choice. 101 00:05:28,720 --> 00:05:32,895 It means a doctor, nurse, or paramedic will visit him every day. 102 00:05:34,280 --> 00:05:37,455 Can I undo this? Because I'm going to need to listen to your heart 103 00:05:37,480 --> 00:05:39,935 and your lungs and have a scan of you. Yeah, yeah. 104 00:05:39,960 --> 00:05:43,775 Usually, blood tests, heart monitoring, and an ultrasound scan 105 00:05:43,800 --> 00:05:47,575 would involve separate hospital or GP appointments. 106 00:05:47,600 --> 00:05:50,695 But Professor Lasserson and his team carry all this equipment 107 00:05:50,720 --> 00:05:52,495 in their bags. 108 00:05:52,520 --> 00:05:56,855 The ultrasound scanner even connects to his mobile phone. 109 00:05:56,880 --> 00:05:58,775 That black area is fluid 110 00:05:58,800 --> 00:06:02,815 that's outside the lung and in the chest cavity. 111 00:06:02,840 --> 00:06:04,775 Ancl that bright thing there is the... 112 00:06:04,800 --> 00:06:09,895 Within moments, they can see the cause of Ted's breathlessness. 113 00:06:09,920 --> 00:06:12,415 His heart isn't pumping properly. 114 00:06:12,440 --> 00:06:13,855 ...right ventricle, 115 00:06:13,880 --> 00:06:16,935 and this isn't squeezing very well at all, this left ventricle. 116 00:06:16,960 --> 00:06:18,935 Ancl that's the problem. 117 00:06:18,960 --> 00:06:22,375 By quickly uploading the images to the hospital system, 118 00:06:22,400 --> 00:06:25,015 Professor Lasserson can discuss the results 119 00:06:25,040 --> 00:06:27,135 with the heart specialist. 120 00:06:27,160 --> 00:06:29,215 Sean, have you had a chance to look at the images? 121 00:06:29,240 --> 00:06:31,175 Yeah, I've looked at the images. 122 00:06:31,200 --> 00:06:33,015 What do you think? 123 00:06:33,040 --> 00:06:36,335 His LV... His LV isn't bad. 124 00:06:36,360 --> 00:06:39,415 They will keep monitoring Ted and give him a dose 125 00:06:39,440 --> 00:06:41,215 of intravenous drugs. 126 00:06:41,240 --> 00:06:44,895 Professor Lasserson also fits a catheter to help his body 127 00:06:44,920 --> 00:06:47,695 get rid of the excess fluid. 128 00:06:47,720 --> 00:06:51,295 Our key is to get the fluid out of the body, the extra fluid out. 129 00:06:51,320 --> 00:06:53,815 Ted can do very little for himself. 130 00:06:56,680 --> 00:06:59,335 So, with him at home rather than in hospital, 131 00:06:59,360 --> 00:07:01,895 most of his care is down to his family. 132 00:07:03,400 --> 00:07:05,975 Do you want this buttoning up, Ted? 133 00:07:06,000 --> 00:07:09,695 His daughter, Jill, returned from her home in France 134 00:07:09,720 --> 00:07:11,495 to help two months ago. 135 00:07:11,520 --> 00:07:15,095 Her mum, Grace, was already struggling. 136 00:07:15,120 --> 00:07:18,895 I'm trying to protect him from going into hospital, 137 00:07:18,920 --> 00:07:22,415 and I'm trying my best to do that. 138 00:07:22,440 --> 00:07:24,255 But it is a strain. 139 00:07:25,360 --> 00:07:29,375 My mum has mobility problems and balance issues, 140 00:07:29,400 --> 00:07:33,255 so, often, all the toileting and washing she can't do. 141 00:07:33,280 --> 00:07:37,615 Ted needs two or three care visits a day. 142 00:07:37,640 --> 00:07:40,815 They're on the waiting list for council support, 143 00:07:40,840 --> 00:07:43,175 butjill has to return home next week, 144 00:07:43,200 --> 00:07:47,935 and with no help, she's worried about how her mother will cope. 145 00:07:47,960 --> 00:07:49,055 Mum needs the support. 146 00:07:49,080 --> 00:07:50,815 She can't carry on doing what she's doing, 147 00:07:50,840 --> 00:07:52,775 what she has been doing. 148 00:07:52,800 --> 00:07:54,815 I'm frightened because... 149 00:07:56,720 --> 00:07:59,255 ...if he fell, 150 00:07:59,280 --> 00:08:01,415 and he'd hurt himself badly... 151 00:08:02,680 --> 00:08:04,855 I think I'd just want to sit and cuddle him. 152 00:08:04,880 --> 00:08:07,055 I don't think I'd want to send for anybody. 153 00:08:11,000 --> 00:08:14,175 How important is it that they get some help soon? 154 00:08:14,200 --> 00:08:16,735 It's probably the most important thing in this case, actually. 155 00:08:16,760 --> 00:08:18,655 I think the... The... 156 00:08:18,680 --> 00:08:21,175 Our attempt to get rid of the fluid may not work. 157 00:08:21,200 --> 00:08:24,255 But what may make more difference to him, I think, 158 00:08:24,280 --> 00:08:26,775 is support coming to the home very quickly, 159 00:08:26,800 --> 00:08:29,015 and that will help them as a couple 160 00:08:29,040 --> 00:08:31,455 just focus on being with each other. 161 00:08:33,440 --> 00:08:37,895 The hospital team helped Ted remain at home for as long as possible. 162 00:08:37,920 --> 00:08:43,215 He got some social care, but his family says it wasn't enough. 163 00:08:43,240 --> 00:08:46,255 He died a few weeks later in a hospice. 164 00:08:55,200 --> 00:08:58,015 For hospital at home to work more widely, 165 00:08:58,040 --> 00:09:00,735 families will need support. 166 00:09:00,760 --> 00:09:03,215 About half a million people are waiting 167 00:09:03,240 --> 00:09:06,135 for local authority care services in England. 168 00:09:07,200 --> 00:09:09,055 So they're busy at the moment? 169 00:09:09,080 --> 00:09:11,295 Phenomenally busy. We've seen... 170 00:09:11,320 --> 00:09:14,855 Stephen Chandler runs Oxfords hire County Council. 171 00:09:14,880 --> 00:09:16,215 Oxfords hire is no different. 172 00:09:16,240 --> 00:09:18,415 We are really struggling with the demand. 173 00:09:18,440 --> 00:09:22,015 We've been doing everything you'd expect a good health and care 174 00:09:22,040 --> 00:09:25,775 system to do, commissioning new and innovative arrangements 175 00:09:25,800 --> 00:09:26,895 to help people. 176 00:09:26,920 --> 00:09:29,535 So, we've been doing everything we possibly can. 177 00:09:29,560 --> 00:09:33,615 Yet I would say to you that's still not enough. 178 00:09:33,640 --> 00:09:38,175 In England this winter, a total of £700 million extra 179 00:09:38,200 --> 00:09:42,655 has been put into tackling hospital pressures by the government. 180 00:09:42,680 --> 00:09:46,615 It includes moving some patients into care homes. 181 00:09:46,640 --> 00:09:50,575 For councils, it's a short-term fix that doesn't tackle 182 00:09:50,600 --> 00:09:53,095 the deeper problems, 183 00:09:53,120 --> 00:09:57,615 including 165,000 unfilled care jobs. 184 00:09:57,640 --> 00:10:00,695 We've got to, firstly, address the workforce. 185 00:10:00,720 --> 00:10:05,695 So, that comes from, at the very beginning, positioning social care 186 00:10:05,720 --> 00:10:10,255 in the workforce capacity as being equal to the NHS. 187 00:10:10,280 --> 00:10:14,655 So, social care workers being valued and rewarded 188 00:10:14,680 --> 00:10:16,415 equally in that context. 189 00:10:18,400 --> 00:10:21,535 Care worker Rachel Feather is starting an evening shift 190 00:10:21,560 --> 00:10:23,735 in East Yorkshire. 191 00:10:23,760 --> 00:10:27,335 Each day, there are thousands of patients stuck in hospitals 192 00:10:27,360 --> 00:10:31,455 across the UK, even though they're medically fit to leave. 193 00:10:33,160 --> 00:10:36,775 Many are waiting for the sort of care she provides. 194 00:10:38,520 --> 00:10:42,575 You know, when ambulances are queuing outside a hospital, 195 00:10:42,600 --> 00:10:46,655 you can actually see the pressures on the health and care system. 196 00:10:46,680 --> 00:10:50,295 But here on a cold, dark night, in villages and towns 197 00:10:50,320 --> 00:10:55,055 where people live and need support, those pressures are invisible, 198 00:10:55,080 --> 00:10:57,975 but perhaps even more intense. 199 00:10:58,000 --> 00:11:00,815 Rachel's first visit is to see Shirley. 200 00:11:00,840 --> 00:11:03,975 Are you ready for pudding, Shirley? Did you enjoy that? 201 00:11:04,000 --> 00:11:05,055 Was it nice? 202 00:11:05,080 --> 00:11:07,855 Don't try and pretend you made it! 203 00:11:07,880 --> 00:11:10,055 Aye, I could! 204 00:11:11,720 --> 00:11:14,495 I like the fact that I can come into people's homes, 205 00:11:14,520 --> 00:11:15,735 make them feel safe 206 00:11:15,760 --> 00:11:17,735 and do everything they need. 207 00:11:19,280 --> 00:11:23,055 It's a role that Rachel believes is undervalued. 208 00:11:23,080 --> 00:11:28,135 Carers are classed as unskilled workers, which is unfair. 209 00:11:28,160 --> 00:11:31,815 You know, we're trained in safeguarding, medication. 210 00:11:31,840 --> 00:11:33,775 And, you know, we're really underpaid. 211 00:11:33,800 --> 00:11:36,495 Can I get you anything else before I leave? 212 00:11:36,520 --> 00:11:41,535 On average, a care worker in England is paid a little over £10 an hour, 213 00:11:41,560 --> 00:11:43,815 just above the minimum wage. 214 00:11:43,840 --> 00:11:45,215 People are leaving, 215 00:11:45,240 --> 00:11:47,655 they can go to a local supermarket, 216 00:11:47,680 --> 00:11:49,295 the work isn't as hard, 217 00:11:49,320 --> 00:11:51,575 and they can get the same amount 218 00:11:51,600 --> 00:11:53,655 of money what they would get 219 00:11:53,680 --> 00:11:55,455 from working a 12-hour shift. 220 00:11:57,240 --> 00:11:59,375 With an ageing population, 221 00:11:59,400 --> 00:12:01,815 social care can also be vital 222 00:12:01,840 --> 00:12:04,735 in identifying problems early... 223 00:12:04,760 --> 00:12:06,095 Hello. Hello. 224 00:12:06,120 --> 00:12:08,415 ...and heading off emergencies. 225 00:12:08,440 --> 00:12:10,655 How've we been? 226 00:12:10,680 --> 00:12:11,895 You're all right? 227 00:12:20,680 --> 00:12:24,095 In the UK, about 4% of the population 228 00:12:24,120 --> 00:12:26,135 is described as frail. 229 00:12:26,160 --> 00:12:28,535 That's nearly three million people. 230 00:12:28,560 --> 00:12:31,055 Around 40% of all hospital beds 231 00:12:31,080 --> 00:12:32,735 and GP resources 232 00:12:32,760 --> 00:12:34,615 are required to treat them. 233 00:12:39,400 --> 00:12:42,375 In Hull, this one-of-a-kind medical centre 234 00:12:42,400 --> 00:12:44,855 is trying to anticipate and prevent 235 00:12:44,880 --> 00:12:46,775 health problems for frail, 236 00:12:46,800 --> 00:12:48,215 often older people. 237 00:12:50,880 --> 00:12:55,215 In one day, patients see doctors, physios, occupational therapists, 238 00:12:55,240 --> 00:12:57,735 pharmacists and social workers. 239 00:12:59,800 --> 00:13:02,615 The jean Bishop Centre was the brainchild 240 00:13:02,640 --> 00:13:05,015 of Drs Anna Folwelland Dan Harman, 241 00:13:05,040 --> 00:13:07,415 both specialists in elderly care. 242 00:13:09,680 --> 00:13:13,095 We make decisions as a team so a person isn't having to go 243 00:13:13,120 --> 00:13:15,575 to seven or eight different appointments to receive the care 244 00:13:15,600 --> 00:13:16,695 that they require. 245 00:13:20,600 --> 00:13:23,415 83-year-old Mary has come for an assessment 246 00:13:23,440 --> 00:13:25,295 with her daughter, Jackie. 247 00:13:25,320 --> 00:13:28,215 She was referred to the centre 248 00:13:28,240 --> 00:13:31,335 by her GP after falling at home. 249 00:13:31,360 --> 00:13:34,495 Jackie, how concerned were you about your mum last week? 250 00:13:34,520 --> 00:13:37,535 Well, I've never seen her look so frail. 251 00:13:37,560 --> 00:13:39,295 She'd been laid on the floor for a while. 252 00:13:39,320 --> 00:13:42,975 Never mind frail, I looked frightful! Blooming heck. 253 00:13:43,000 --> 00:13:45,455 This is a full body and life MOT, 254 00:13:45,480 --> 00:13:48,335 designed to pick problems up early. 255 00:13:50,320 --> 00:13:52,375 So, what I'm going to be doing in this bit, 256 00:13:52,400 --> 00:13:54,775 we're going to do an ECG, so we'll check your heart over, 257 00:13:54,800 --> 00:13:58,575 we're going to check your weight, your height, your blood pressure, 258 00:13:58,600 --> 00:14:00,095 and your oxygen and pulse. 259 00:14:01,760 --> 00:14:05,015 Then she sees the pharmacist and a consultant. 260 00:14:05,040 --> 00:14:09,055 Usually, doctors only have a partial view of someone's medical history. 261 00:14:10,440 --> 00:14:14,535 So, I'm going to concentrate a little bit more on medical aspects. 262 00:14:14,560 --> 00:14:18,775 Here, Dr Folwell can see Mary's GP, hospital, 263 00:14:18,800 --> 00:14:20,815 and any social care records. 264 00:14:22,320 --> 00:14:26,695 With a longer consultation, she gets a much fuller picture. 265 00:14:26,720 --> 00:14:29,535 I think this was your second fall, wasn't it? 266 00:14:29,560 --> 00:14:32,215 Third this year. Oh, third this year. She had one in June outside. 267 00:14:32,240 --> 00:14:33,775 Yeah, so for... 268 00:14:33,800 --> 00:14:37,775 Treating people who've had falls is estimated to cost the NHS 269 00:14:37,800 --> 00:14:40,455 more than £2 billion a year. 270 00:14:41,520 --> 00:14:44,695 Dr Folwell believes Mary's blood pressure pills 271 00:14:44,720 --> 00:14:47,375 may be having unintended consequences. 272 00:14:48,480 --> 00:14:50,895 Because what's happening with your blood pressure, I think, 273 00:14:50,920 --> 00:14:54,415 is it's been really well controlled. 274 00:14:54,440 --> 00:14:57,335 But when you're standing, it is dropping, 275 00:14:57,360 --> 00:15:01,175 and that can make you feel a bit woozy or dizzy. 276 00:15:01,200 --> 00:15:03,455 We worry about that because then that makes you 277 00:15:03,480 --> 00:15:05,255 more at risk of falling. 278 00:15:05,280 --> 00:15:08,255 We're not the experts, so we just take what we're given 279 00:15:08,280 --> 00:15:10,975 and then... Cos I haven't had them changed for ages. 280 00:15:11,000 --> 00:15:13,655 No, you've been on it a long time. 281 00:15:13,680 --> 00:15:16,495 It's nice to have the opportunity, really, to talk about it. 282 00:15:16,520 --> 00:15:18,375 Because when you go to the GP's, 283 00:15:18,400 --> 00:15:22,095 you just don't have time to ask questions. 284 00:15:22,120 --> 00:15:25,175 Time has been key for this. Hmm. 285 00:15:25,200 --> 00:15:30,015 How often in a normal hospital run or in a GP's practice 286 00:15:30,040 --> 00:15:33,415 would you have this sort of time to go through things with someone? 287 00:15:33,440 --> 00:15:37,575 I think that would be really unusual, not for want of desire. 288 00:15:37,600 --> 00:15:42,015 I mean, we've essentially clone, like, 20 consultations in one here. 289 00:15:42,040 --> 00:15:47,055 Some will say, well, actually the NHS can't afford to have someone 290 00:15:47,080 --> 00:15:50,415 such as yourself spending so much time on one patient 291 00:15:50,440 --> 00:15:53,415 when there are so many people who have needs. 292 00:15:54,480 --> 00:15:57,615 I think we can't afford not to do things slightly differently. 293 00:15:57,640 --> 00:15:59,815 We need to be able to do both. 294 00:15:59,840 --> 00:16:02,535 We're never going to get on top of the reactive work 295 00:16:02,560 --> 00:16:06,095 if we're not doing preventative, proactive work, as well. 296 00:16:06,120 --> 00:16:08,495 Just this one up, and the door's open. 297 00:16:08,520 --> 00:16:12,375 Dr Folwell reduces Mary's blood pressure medicine 298 00:16:12,400 --> 00:16:15,695 and stops another medication altogether. 299 00:16:15,720 --> 00:16:19,135 It's a small change that helps Mary and the NHS. 300 00:16:21,280 --> 00:16:24,335 How much money can be saved by looking at medication? 301 00:16:24,360 --> 00:16:27,735 Over the last four and a half years, we've consistently demonstrated 302 00:16:27,760 --> 00:16:30,935 a greater than £100 per patient per year cost saving 303 00:16:30,960 --> 00:16:33,815 in terms of the reduction in those medications, where the risks 304 00:16:33,840 --> 00:16:37,335 outweigh the benefits, which can then be reinvested into other areas 305 00:16:37,360 --> 00:16:39,015 of the health system. 306 00:16:39,040 --> 00:16:43,055 The centre believes if this was adopted across the health service 307 00:16:43,080 --> 00:16:49,535 in the UK, an estimated £270 million could be saved on medication alone. 308 00:16:51,280 --> 00:16:54,055 Mary also sees the centre's social worker 309 00:16:54,080 --> 00:16:57,895 who can assess if she needs more help at home. 310 00:16:57,920 --> 00:17:00,215 It's our role, Mary, to just find out 311 00:17:00,240 --> 00:17:02,815 how you're managing with everything at home. 312 00:17:02,840 --> 00:17:05,535 Don't do the things I used to do, 313 00:17:05,560 --> 00:17:09,575 like chopping trees down, lifting up stones and things like that. 314 00:17:12,480 --> 00:17:15,695 Something like this, maybe a couple of years ago, 315 00:17:15,720 --> 00:17:18,215 if she'd have accessed it then she wouldn't have gone through 316 00:17:18,240 --> 00:17:20,975 what she's gone through the last couple of years. 317 00:17:21,000 --> 00:17:23,375 And she might not have had the falls. 318 00:17:23,400 --> 00:17:25,175 She might not have had the falls. 319 00:17:25,200 --> 00:17:26,695 What do we want? 320 00:17:26,720 --> 00:17:28,095 Fair pay! 321 00:17:28,120 --> 00:17:29,815 When do we want it? Now! 322 00:17:29,840 --> 00:17:33,695 As winter deepens, pressure on the NHS intensifies. 323 00:17:33,720 --> 00:17:36,175 HORNS HONK 324 00:17:36,200 --> 00:17:38,415 There have been national strikes. 325 00:17:38,440 --> 00:17:40,175 Staff want more pay. 326 00:17:40,200 --> 00:17:42,975 They say they're struggling with the cost of living, 327 00:17:43,000 --> 00:17:44,695 exhausted from the pandemic 328 00:17:44,720 --> 00:17:48,255 and the demand on services is unrelenting. 329 00:17:48,280 --> 00:17:50,615 Safe staffing! Saves lives! 330 00:17:53,680 --> 00:17:57,815 Across England in December, record numbers of patients arrived 331 00:17:57,840 --> 00:17:59,815 in emergency departments. 332 00:17:59,840 --> 00:18:03,135 Amongst the worst was Hull, where nearly two thirds 333 00:18:03,160 --> 00:18:06,735 were waiting longer than the four-hour target to be seen. 334 00:18:08,360 --> 00:18:11,335 When 91-year-old Richard was feeling unwell, 335 00:18:11,360 --> 00:18:15,455 the overstretched GP practice sent him and his daughter Alison 336 00:18:15,480 --> 00:18:18,095 straight to the emergency department. 337 00:18:18,120 --> 00:18:21,015 Our clad was sat 23 hours on the chair 338 00:18:21,040 --> 00:18:25,775 and we sat there and A&E was just absolutely crammed full. 339 00:18:25,800 --> 00:18:30,175 But it was... Tt was a simple blood test and antibiotic. 340 00:18:33,480 --> 00:18:38,575 Now, the jean Bishop medical team is investigating his problems further. 341 00:18:40,920 --> 00:18:42,335 Hello, Richard. Hello, dear. 342 00:18:42,360 --> 00:18:45,415 I've been asked to come out and see you about some tests the doctors 343 00:18:45,440 --> 00:18:47,495 have requested. Right, come in. 344 00:18:47,520 --> 00:18:50,055 Blood tests found a serious problem. 345 00:18:50,080 --> 00:18:54,575 Their intervention prevented another trip to the emergency department. 346 00:18:54,600 --> 00:18:57,095 Richard could have collapsed at any time. 347 00:18:58,920 --> 00:19:02,095 His salt levels in his bloodstream had dropped dangerously 348 00:19:02,120 --> 00:19:04,255 and could be fatal if not treated. 349 00:19:04,280 --> 00:19:07,895 So we had a planned admission the next clay, 350 00:19:07,920 --> 00:19:10,135 straight on to the Frailty Assessment Unit 351 00:19:10,160 --> 00:19:13,375 at Hull Royal Infirmary, which was much better for Richard 352 00:19:13,400 --> 00:19:16,935 and for his daughter, for Alison, but also for the system. 353 00:19:18,040 --> 00:19:21,935 Two weeks later, I go with Dr Harman to see Richard. 354 00:19:21,960 --> 00:19:24,375 Because you've had a tough time of it. 355 00:19:25,560 --> 00:19:27,495 A worrying time, really. Yeah. 356 00:19:27,520 --> 00:19:30,215 Yeah, it's been really difficult. 357 00:19:30,240 --> 00:19:34,335 He's given a full check-up, including an ultrasound scan. 358 00:19:34,360 --> 00:19:36,455 So, there you go. Ten out of ten. 359 00:19:36,480 --> 00:19:38,455 Absolutely over the moon. 360 00:19:38,480 --> 00:19:41,175 Yeah, yeah. I feel great. 361 00:19:41,200 --> 00:19:43,295 Might even go for a run now! 362 00:19:43,320 --> 00:19:44,495 LAUGHTER 363 00:19:46,480 --> 00:19:48,735 Since the centre opened four years ago, 364 00:19:48,760 --> 00:19:53,375 they've treated more than 12,000 mainly elderly people. 365 00:19:53,400 --> 00:19:57,495 Researchers found all needed fewer GP and hospital visits, 366 00:19:57,520 --> 00:20:01,255 but the biggest impact has been anticipating and preventing 367 00:20:01,280 --> 00:20:03,895 problems among the frailest patients. 368 00:20:05,240 --> 00:20:08,095 Those patients that are deemed to be frequent flyers, so three or more 369 00:20:08,120 --> 00:20:11,135 emergency department attends in the last six months, 370 00:20:11,160 --> 00:20:13,695 we've reduced those attendances by over 50%. 371 00:20:13,720 --> 00:20:15,655 And, you know, that's not by chance. 372 00:20:15,680 --> 00:20:18,895 We can invest time and energy into trying to prevent that episode 373 00:20:18,920 --> 00:20:21,455 of acute care ever being needed. 374 00:20:21,480 --> 00:20:23,695 Then... Then it pays for itself, 375 00:20:23,720 --> 00:20:26,295 both in time, but financially as well, 376 00:20:26,320 --> 00:20:29,815 but more importantly from the patient's perspective. 377 00:20:29,840 --> 00:20:36,135 So if ideas like this can ease NHS pressures and improve patient care, 378 00:20:36,160 --> 00:20:38,975 why aren't they being rolled out elsewhere? 379 00:20:39,000 --> 00:20:41,455 One of the things that's really important 380 00:20:41,480 --> 00:20:43,415 is it's got facilities in here... 381 00:20:43,440 --> 00:20:47,135 Amanda Bloor runs the organisation that plans and delivers 382 00:20:47,160 --> 00:20:50,015 health and care in Humber and North Yorkshire. 383 00:20:51,520 --> 00:20:53,775 I really want to make sure we learn all the lessons 384 00:20:53,800 --> 00:20:57,575 we can from the jean Bishop Centre, and actually the other services 385 00:20:57,600 --> 00:20:59,055 that integrate to that. 386 00:20:59,080 --> 00:21:02,015 The jean Bishop Centre has been up and running for about four years. 387 00:21:02,040 --> 00:21:05,215 There are huge pressures now, there is urgency, 388 00:21:05,240 --> 00:21:08,575 so why aren't we seeing this happening more often? 389 00:21:08,600 --> 00:21:11,855 I don't think that taking it and dropping it elsewhere 390 00:21:11,880 --> 00:21:13,615 is exactly the right solution. 391 00:21:13,640 --> 00:21:18,215 Ancl I think we've got to empower teams of staff in different places 392 00:21:18,240 --> 00:21:22,295 to say, what's the right solution here for our population? 393 00:21:24,040 --> 00:21:25,895 Hello, my name's Claire. 394 00:21:25,920 --> 00:21:28,655 I'm one of the nurses on the virtual ward. 395 00:21:28,680 --> 00:21:32,215 Across England, the NHS is encouraging hospitals 396 00:21:32,240 --> 00:21:36,095 to free up beds by treating more patients at home. 397 00:21:36,120 --> 00:21:41,215 It says its virtual wards initiative will ease demand and improve care. 398 00:21:42,440 --> 00:21:44,255 Hello. 399 00:21:44,280 --> 00:21:46,935 Ah! Good morning. How was your night? 400 00:21:46,960 --> 00:21:51,295 Doctors and nurses monitor the patient's health at home. 401 00:21:51,320 --> 00:21:54,215 It's focused on more routine patients 402 00:21:54,240 --> 00:21:56,495 who'll be visited if needed. 403 00:21:56,520 --> 00:22:01,055 NHS England says last month 10,000 people were treated in this way. 404 00:22:03,720 --> 00:22:05,815 Hi, Dan. How are you? 405 00:22:05,840 --> 00:22:10,455 In Hull, the target is for about 300 patients to be cared for like this 406 00:22:10,480 --> 00:22:12,735 by the end of the year. 407 00:22:12,760 --> 00:22:14,935 What are the barriers to this? 408 00:22:14,960 --> 00:22:17,615 Staffing, training, funding is an issue. 409 00:22:17,640 --> 00:22:21,655 You're essentially talking about a small hospital in the community 410 00:22:21,680 --> 00:22:25,695 and I think any place would struggle to deliver those numbers 411 00:22:25,720 --> 00:22:28,815 under the current operating models that we have. 412 00:22:32,840 --> 00:22:36,615 And it's a very tough environment for people to change 413 00:22:36,640 --> 00:22:38,375 the way they're working. 414 00:22:39,880 --> 00:22:42,415 In Oxford, some of the hospital staff 415 00:22:42,440 --> 00:22:44,735 also joined the national strikes. 416 00:22:47,360 --> 00:22:49,575 What is staff morale like 417 00:22:49,600 --> 00:22:53,375 and how does that fit with what you're trying to do? 418 00:22:53,400 --> 00:22:56,055 Morale is low, you're right. 419 00:22:56,080 --> 00:22:58,855 But it's also unevenly distributed. 420 00:22:58,880 --> 00:23:02,255 So, the morale in our particular work is high, 421 00:23:02,280 --> 00:23:06,055 because we are involved in 422 00:23:06,080 --> 00:23:07,495 changing an approach. 423 00:23:07,520 --> 00:23:10,815 There's an energy and excitement around that. 424 00:23:10,840 --> 00:23:14,295 Members of the team are learning new technologies and new ways 425 00:23:14,320 --> 00:23:16,375 of doing things that they wouldn't do 426 00:23:16,400 --> 00:23:18,935 if they'd stayed in their traditional roles. 427 00:23:18,960 --> 00:23:22,015 I came to see your lung on your... 428 00:23:22,040 --> 00:23:25,415 Here, Yun Ody is being trained to carry out some tasks 429 00:23:25,440 --> 00:23:27,255 usually done by doctors. 430 00:23:27,280 --> 00:23:29,655 If you see how far you are from the chest as a barrel, 431 00:23:29,680 --> 00:23:30,815 so it's that way. 432 00:23:30,840 --> 00:23:33,895 She's one of the hospital at home team and will soon qualify 433 00:23:33,920 --> 00:23:35,415 as an advanced nurse. 434 00:23:36,720 --> 00:23:40,175 Tell me about the equipment that you're using out on the road. 435 00:23:40,200 --> 00:23:43,255 We go out, we either bring the laptop or iPad 436 00:23:43,280 --> 00:23:47,615 and iPhone, go out, so we can communicate using hospital systems. 437 00:23:47,640 --> 00:23:50,695 We've got point of care bloods machine, 438 00:23:50,720 --> 00:23:54,135 that can do the bloods at the patient's home 439 00:23:54,160 --> 00:23:56,215 and we've got results in two minutes. 440 00:23:56,240 --> 00:23:58,375 That's so clever. Yeah, it is. 441 00:23:58,400 --> 00:24:00,055 We love gadgets! 442 00:24:01,160 --> 00:24:04,855 And increasing the skills across the health and care workforce 443 00:24:04,880 --> 00:24:09,095 is critical for delivering this kind of hospital at home care. 444 00:24:10,800 --> 00:24:13,215 You used to work on busy general wards. 445 00:24:13,240 --> 00:24:17,415 What are the things you find work better this way? 446 00:24:17,440 --> 00:24:21,735 I find I got more time to spend with my patient and I listen to them 447 00:24:21,760 --> 00:24:23,615 and I know what they need. 448 00:24:23,640 --> 00:24:25,495 And what difference does that make? 449 00:24:25,520 --> 00:24:28,615 I think made the patients think we listen to them 450 00:24:28,640 --> 00:24:31,175 and they're always thinking, 451 00:24:31,200 --> 00:24:34,255 "Oh, you deliver much nicer care to me," 452 00:24:34,280 --> 00:24:36,375 and that means a lot to them. 453 00:24:39,160 --> 00:24:43,015 And the health service of the future will need to work better 454 00:24:43,040 --> 00:24:45,735 for a much wider range of patients. 455 00:24:45,760 --> 00:24:48,135 As well as people living to an older age, 456 00:24:48,160 --> 00:24:51,775 there are more young people with complex health conditions. 457 00:24:51,800 --> 00:24:53,695 How's him? He's not been too bad. 458 00:24:55,040 --> 00:24:58,295 Yun has come to see Will and his mum, Wendy. 459 00:24:58,320 --> 00:25:01,135 He's the Oxford team's youngest patient. 460 00:25:03,600 --> 00:25:06,255 Did you enjoy your birthday yesterday? 461 00:25:06,280 --> 00:25:08,215 Will's just turned 19. 462 00:25:08,240 --> 00:25:11,215 He has a rare genetic muscle condition. 463 00:25:11,240 --> 00:25:14,655 He's doing computer studies at college and wants to be there, 464 00:25:14,680 --> 00:25:16,455 not in hospital. 465 00:25:16,480 --> 00:25:21,375 The last time that Will had to go into hospital to stay... 466 00:25:21,400 --> 00:25:23,615 How tricky was that? 467 00:25:24,880 --> 00:25:26,575 It was horrible. 468 00:25:31,040 --> 00:25:33,255 And you couldn't sleep. 469 00:25:33,280 --> 00:25:37,895 For someone who is an adult like Will, but is actually 470 00:25:37,920 --> 00:25:42,255 still quite young at heart... And it felt... 471 00:25:42,280 --> 00:25:46,295 It felt inappropriate to his needs. 472 00:25:46,320 --> 00:25:50,375 I think it was noisy, it was scary. 473 00:25:50,400 --> 00:25:54,215 It wasn't as scary as the other one. No, it wasn't scary. 474 00:25:54,240 --> 00:25:56,855 It wasn't scary? Oh, OK. I was for you, but not for me. 475 00:25:56,880 --> 00:26:01,095 It was for me! It might be scary for me. 476 00:26:01,120 --> 00:26:04,135 If potassium levels in Will's blood drop too low, 477 00:26:04,160 --> 00:26:06,495 it affects the rhythm of his heart, 478 00:26:06,520 --> 00:26:09,055 and that's when he ends up in hospital. 479 00:26:09,080 --> 00:26:12,535 Last year, he spent a total of 16 nights there 480 00:26:12,560 --> 00:26:15,975 and had 18 outpatient visits for blood checks. 481 00:26:17,120 --> 00:26:18,935 Now, that happens at home. 482 00:26:20,640 --> 00:26:24,735 Everything falls apart when your potassium's low, doesn't it? 483 00:26:24,760 --> 00:26:26,215 That's right. 484 00:26:28,440 --> 00:26:29,935 The news is good. 485 00:26:29,960 --> 00:26:32,575 Results are fine, great. 486 00:26:32,600 --> 00:26:37,095 Yes. Ancl we can come to check it again, say two weeks? 487 00:26:38,800 --> 00:26:42,775 But Will also needs nursing care night and day. 488 00:26:42,800 --> 00:26:46,015 With one in ten nursing jobs in England unfilled, 489 00:26:46,040 --> 00:26:50,295 finding nurses to visit is really difficult, leaving his family 490 00:26:50,320 --> 00:26:53,215 to provide nearly all of his routine care. 491 00:26:54,520 --> 00:26:59,775 We're only averaging about, I think, one to two days a week at most, 492 00:26:59,800 --> 00:27:03,815 usually one. So, there's a big gap in those services. 493 00:27:03,840 --> 00:27:07,175 It is a big gap and it's... 494 00:27:07,200 --> 00:27:10,735 Month on month, year on year, it is quite exhausting. 495 00:27:17,920 --> 00:27:21,975 The government says there are record numbers of doctors, nurses 496 00:27:22,000 --> 00:27:27,135 and other staff working in the NHS, that it's tackling the pressures 497 00:27:27,160 --> 00:27:32,855 and investing up to £7.5 billion in social care over two years, 498 00:27:32,880 --> 00:27:35,815 as well as improving training and recruitment. 499 00:27:39,760 --> 00:27:44,695 Change can be difficult in an organisation the size of the NHS, 500 00:27:44,720 --> 00:27:47,495 particularly at a time of crisis. 501 00:27:47,520 --> 00:27:51,615 But the doctors and nurses we've met believe building more services 502 00:27:51,640 --> 00:27:54,495 around patients at home is better for them, 503 00:27:54,520 --> 00:27:57,815 better for staff and inevitable. 504 00:27:57,840 --> 00:28:02,015 All change gets resisted and it's... I think it's a complex business 505 00:28:02,040 --> 00:28:04,375 to understand how you can innovate and change 506 00:28:04,400 --> 00:28:05,935 in a stressed environment. 507 00:28:05,960 --> 00:28:09,055 But I think often that's where that innovation is most needed. 508 00:28:11,600 --> 00:28:15,575 How we want our health care service to be is personalised, responsive 509 00:28:15,600 --> 00:28:17,575 and still being able to make a difference, 510 00:28:17,600 --> 00:28:19,735 not just at the health care level, 511 00:28:19,760 --> 00:28:22,895 but also at the thriving and quality of life level. 512 00:28:22,920 --> 00:28:25,255 To achieve that, 513 00:28:25,280 --> 00:28:29,175 solving deep-rooted staffing shortages will be key. 514 00:28:29,200 --> 00:28:33,735 If that doesn't happen, the danger is the health and care system 515 00:28:33,760 --> 00:28:37,735 continues to lurch from crisis to crisis.