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tv   How to Heal the NHS  BBC News  February 4, 2023 11:30pm-12:00am GMT

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this is bbc news, the headlines... a suspected chinese spy balloon is shot down off the coast of south carolina — on the orders of president biden. three airports were shut and airspace closed, so it could be targeted over the atlantic ocean. i ordered the pentagon to shoot it down on wednesday they successfully took it down and i want to compliment our aviators who did it.
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detectives searching for nicola bulley, who disappeared during a dog walk in lancashire more than a week ago, say they want to speak to a woman who was seen pushing a pram. the forced installation of pre—payment metres — the bbc learns that magistrates in england and wales were given advice suggesting permission could be waved through. a peace mission to south sudan — the pope makes an unprecedented visit, alongside the leaders of the church of england and church of scotland. you are watching bbc news. now, jim reed examines the underlying causes of the nhs crisis, with the help of medical experts and analysts, and looks at ways to make it better in how to heal the nhs. we've been almost 12 hours in an ambulance. there were people sitting on the floor, people on trolleys everywhere. it was just horrendous. record waist in a&e, trolleys stacked up along busy corridors, ambulance crews forced to queue outside for hours with their patients.
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it does get tricky when you see a timer come on the call. it's hours ago and you are thinking, oh, gosh, what are you going to turn up to? and they are in a bad state. the health service in every corner of the uk has been battling through its worst winter in a generation. we are running two and three times above our capacity continually, and often more than that. we've had crises in the nhs before, but doctors say nothing like this. this is undoubtedly a crisis, and it's undoubtedly a national scandal. we simply haven't seen the action that was necessary to improve things along the way. it's been too little and too late. i'mjim reed, the bbc�*s health reporter. i spend most of my time covering the impact of all this on doctors and nurses and their patients. the idea in this
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programme is different. here i want to explore the underlying causes of some of these problems, and ask what could and should be done to get the nhs back to health. we will take you through the hospital, splitting it into parts, and showing how problems in one area of the building can cause huge disruption in others. from the main building, where most patients are treated in general wards, intensive care and on special wards like cardiology, to the front door in a&e, accident and emergency. most urgent cases walk into the department. the most serious are brought in by ambulance after what could be a stroke, heart attack or bad accident. and it is here we will start. over the past year, we've seen pictures like this all over tv and social media, lines of ambulances forced to queue up, sometimes for hours with their patients because there's simply not enough room inside to treat them.
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we come in on a morning at nine o'clock and we were queueing then and there were no bed spaces at nine in the morning. that is the start of a normal weekday. and you will hear calls coming out for assistance for other groups and you can't get to them. it is delays like this that stop paramedics getting back on their own quickly to the next person who needs help. now, we've pulled together some of the key data, figures that help explain how the nhs is performing and what that means for patients, starting with those ambulances. anyone who calls 999 for an emergency like a stroke or heart attack should get an ambulance in 18 minutes, that's the target. in december, that soared to 93 minute in england, easily the highest on record. there are 90 patients waiting to be seen at the moment, that is 90, who are still waiting to be seen. our current waiting profile is seven and a half hours. by the time i get home
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in the morning at eight o'clock, some of you will still be here waiting for a doctor. when patients reach a&e itself, there is often another long wait. the number turning up has risen sharply since the pandemic when restrictions, lockdowns stopped some from getting the care they need. out of that, high rates of covid flu and other bugs over the winter. in a&e, the target is for doctors to see and treat patients in four hours. in england, only half, 50%, of patients were dealt with in that time in december, again the worst on record. things are not much better in wales and scotland, and even worse in northern ireland, with just 45% of patients who are dealt with in four hours. in england, the government says it has added extra space in hospitals this winter, with more money for new control
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rooms and ambulance staff to try ease the intense pressure on the nhs. we are going to bring you the thought of three experts with long experience in the health service to help us understand what's going on. first, dr ian higginson works on the front line as a senior doctor in a&e in the south—west, and he is vice president of the royal college of emergency medicine. so, dr higginson, can you give us an idea of what it's been like this winter? it's been incredibly difficult for all staff working in the accident and emergency care sector, but particularly for paramedics and for staff working in emergency departments. we've never experienced conditions like this, but most of us can remember... i've been working in the business a long time, so i can remember times of maybe 20 years ago when it was terrible, but certainly most of the staff have never experienced anything like this. so when you go into work, can you paint a picture
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of what the situation is like for a doctor at the moment like you? are there patients in trolleys that really shouldn't be there? why and how are things difficult for people on the front line? what i'd like to do when i go into work is walk into an environment that under control, where we are able to see the sickest patients first and see all the other patients in a timely manner, where we have time to do ourjobs properly and we can do that in an appropriate space. what we actually experience is that most of us will go to work expecting to find the department that is full to bursting, with patients not only in our resuscitation rooms and ordinary trolley spaces, but in our corridors, maybe in waiting areas that aren't supposed to hold patients at all, and some places where there are cupboards. we might see our ambulance car parks absolutely full of ambulances with patients in those. you and then we might hear about ambulances not being able to get to patients. so we are aware of this
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overwhelming sense of crowding and of patients everywhere, and the knock—on effect is we can't do, can't treat patients as we'd like. so, when you have queues of ambulances waiting outside hospitals with their patients in, can you explain how those patients are looked after? doctors actually having to go out to those ambulances and actually care for them in those vehicles? this is something that is relatively new for us in emergency medicine, so we are learning to adapt to it. we started in many departments by sending our nursing staff or our health care assistants out to ambulances to try and help us prioritise which of those ambulances we should off—load this, which patients we needed to bring in first. we've now moved on to the awful situation of having to send our doctors out into ambulances to treat patients because we know we won't bring those poor patients into our department in time. so we are moving everything forward into the ambulance car park. we've got these bizarre setups now where we send catering trolleys round the ambulances to make sure patients are fed.
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most departments have set up systems that patients can be brought in to go to the toilet. and we are even doing things like bring in patients of the ambulances in for things like x—rays and ct scans, and then taking them back out to the ambulances to wait to be seen by doctors. but of course, it is utterly wrong to be doing that. those ambulances are needed to be out on the road so the paramedics can do theirjob in patients' home. the pressure on a&e and ambulance services this winter has been intense, with long waits, both to see patients and crucially, to move the most sick into another part of the hospital for further treatment. to find out what's really going on, we need to go back to our example hospital, to really understand the problems that are surfacing in a&e, we need to look deeper into the hospital, into the wards where
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thousands of patients stay overnight to be treated. in england at any one time, the number of hospital beds available to the nhs is about 100,000 in total. doctors say a safe limit for bed occupancy, the numberfour of patients, is 85%, or around 85,000 beds. but this winter, it's been a much, much higher, around 94,000 beds have been used up on any average day. one reason for that is because patients are often stuck in hospital, even though they are well enough to leave. over the winter, roughly 14,000 people were in that situation everyday in england. that is one in every seven beds taken up by someone who doesn't really need to be there. these are often elderly people who could leave hospital if care was available for them at home or in a care home.
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it's what the government describes as the number one problem in the nhs. it says it has made more money available to speed up those discharges out of hospital this winter. sally warren is the director of policy at the independent health think tank the kings fund, and the former head of social care at the department of health. so one in seven beds, 14,000 people every day in england are well enough to leave hospital but can't. i think some people watching this might be thinking, that is surely a huge waste of nhs resources. just explain why this is happening. so, a multidisciplinary team will say we've looked at you and we decided you are medically fit to leave hospital, but that doesn't mean you canjust go home and be by yourself. you might need more support from community health services, so you might need a district nurse to be available to come to your house to help
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clean dressings etc. and much like we've got pressures with not enough staff in hospital, we don't have enough staff in our community health service or our social care services. one thing that always gets brought up is wages for people in the care sector. so in england, generally, a lot of care workers get paid minimum wage, over 23, that's £9 an hour, and a lot of the criticism is, look, these people are doing what is a very difficult and at times demanding job. could just as easily go into retail, could go work for amazon, jobs like that. if we paid people more in those jobs, would that solve the problem? it certainly would help with the problem. the social care workforce reduced for the first time last year. 50,000 people left the sector, so it is 50,000 people smaller than last year, despite an ageing population and more people needing social care. so there is a huge workforce crisis in the social care sector. and pay has to be part of it. it won't be everything about recruitment retention, but if people can leave the social care sector to go work in pretty much any other sector and get paid more, particular the cost of living crisis, it is understandable that
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people want to do that. so, sally, is some of this historical? because we've had the nhs and social care as two very different systems in the uk, from the creation of the health service back in the late �*40s. yes, so we do have two different fundings for the nhs and social care, and it definitely had some complication, it being a means tested system where individuals have to pay for themselves. but i say right now, the issue is whether you can pay for care yourself or not, or whether the government is paying for you. there just isn't the x by the social care you need. i think rishi sunak, the prime minister, described this as the number one problem for the nhs at the moment. and there has been more government funding, £500 million, which sounds like a lot of money, in september and then another 200, 250 million emergency funding just before christmas. is that the best way to be spending that money, or is there a more sustainable, more efficient way to fund social care? £750 million... like normal people, that sounds a huge amount of money, but the social care budget is more than £20 billion a year, so actually it's quite a small portion of the overall budget.
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some of the all—party committee is in the house of commons have looked at, and the house of lords as welcome as looked at what would it take to sustainably improve the social care system. and they've concluded you need around £6—£7 billion more a year to be able to pay staff the right amount to attract and retain them, to meet their need and to meet demographic pressures. so this is not a cheap thing to be able to sustain the social care, but we are seeing the costs of failing to do that everyday now with families not able to access the care they need, people being stuck in hospitals. there is a cost of not acting as well as a cost to acting. asked any emergency doctor and they will tell you a lot of what is needed to sort out the problems inside hospitals is down to part of the health system outside. there is no short—term fixes for this, i'm afraid, because it's a problem that has been allowed to develop over the years and it will take years to sort out. but the basics are
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pretty straightforward. there needs to be an absolute strategic investment in the health and social care sector, and that particularly needs to focus on the social care sector, so making sure there is an adequate provision of social care for those that needed. we need to see an investment in primary care because that is the backbone of the nhs. and that means patients can be treated at home. by that, you mean gps? not only gps, the sort of community care that may be provided by district nurses or other community—based services, and that can help patients be cared for in their own home and can help keep them out of hospital. and then finally, we need to see an investment in the capacity of hospitals, which means the beds and the staff, so that those hospitals on a full up, so that our emergency departments don't get full up, which is what is holding up all the ambulances and stopping them getting out to patients. so the three key things are social care, primary care, and hospital bed capacity. i'm wrapped around all of that is the nhs workforce, because the nhs is all
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about workforce, and without a workforce, we haven't got an nhs. the future of that workforce is one of the major problems keeping health bosses awake at night. the nhs is one of the biggest employers in the world, just behind walmart, macdonald and the chinese military. overall, the number of nurses and hospital doctors in england has been rising since the pandemic. this group here has recently been recruited from india. but the numberjoining up is not enough to meet demand, leaving huge holes in staffing, from radiology to dentistry, to speech therapy. at the moment, around one in ten posts across the nhs cannot be filled. that includes 10,000 vacancies for nurses and more than 9,000 for doctors. and when you compare the uk with other western european countries, our health service does
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employ far fewer staff. if we look just at doctors, austria and norway top the table with more than five per thousand people. germany and italy have four, the uk sit at the bottom of the table with just over three. for nurses, again, norway and switzerland have more than 18 for everyone thousand people. france and sweden have each about 11, and the uk is again near the bottom with around nine. staff shortages are also one reason why nurses and islands workers have been on strike this winter. they say pay is simply too low to attract and retain enough staff. so i am out here to protest. we need a pay rise. we haven't had a pay rise for ten years in line with inflation, so we deserve better. the government has said pay as appropriate, fair
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and follows recommendations from an independent body. we have an independent process that is a pay review body. that is the right way we should look at the issues, and that is what the government has done, and we have accepted those recommendations in full. it is the trade unions that are not accepting the independent pay review process and not accepting those pay recommendations. we are going to talk now to dame anne marie rafferty, who is a professor of nursing policy at king's college london, and an ex—president of the nurses union, the royal college of nursing. can i begin by asking, why does the uk have fewer doctors, fewer nurses than other european countries? what's the reason behind it? well, it certainly is something that is long—standing, it's not something that has just occurred overnight. we have not been investing enough in doctors and nurses over the last at least 20 years. we did research in the early to thousands, which did direct
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comparisons to 12 european countries, and from that we demonstrated we were bumping along the bottom quartile, notjust in terms of overall numbers, but in terms of the quality of skills and impact on the nurses's psychological welfare, so burn—out rates as well as intention to leave. so these problems have been inferring for a long time. so i think for the public watching, it can be very confusing because you have these two separate arguments. you have the government saying that we are recruiting more, there's another 36,000 nurses, another 5000 doctors. at the same time, we have these huge vacancy rates, we just can't fill these vacancies rates in the health service. so, are both those things true at the same time? can we be recruiting more, but we still have these
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gaps in the service? over the period of the last ten years, we've had boom bust approach to recruitment, turn the tap on, turn the tap off, and although i think politicians claim there is more, they are recruiting more, yes, they are, but more doesn't necessarily mean enough. so there's been no real consistency in planning. and overall, i think without a workforce plan, that actually letters very, very vulnerable. so we do have the two things operating simultaneously, but we have this big leaky bucket, which has also impacted by the conditions under which nurses are actually working. of very challenging work environment and overall staffing levels, which i think is the number one priority that it nurses said either enables or undermines our capacity to deliver care. when we talk about help, we have to talk about money and government funding.
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looking across the whole uk, the amount we spend on the nhs works out at around £3200 per person each year in england, slightly more in northern ireland, wales and scotland, where around £3400 is spent on health each year. hello. how you? the total amount we spend has been rising, and the government says it has put in place of £214 billion of extra funding over the next two years. here is the pm talking to the bbc�*s laura kuenssberg. the nhs is under pressure, but that's why. .. you just think, a few weeks after i became prime minister, we had the autumn statement and an spite of the difficult decisions we had to make in order to stabilise the economy, make sure we get to grips with inflation and reduce debt, we managed to find more money for the nhs and social care. i wanted to make sure everyone, including all the people you talked about, new this was a priority. and that money is
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going into the system. the amount we spend has been rising, but here is the problem. population changes are putting a huge strain on health services around the world. these bars are spaced 25 years apart, butjust look at how the number of people in the uk has jumped between the mid—i9 90s and today. that is a big increase in just 25 years. and crucially, the number of over 65s shown in red has been rising rapidly. and that's the group which needs far, far more from doctors and from the nhs. it's a trend expected to continue in the future, that is projected to put even more pressure the nhs. so, demographic changes is definitely a pressure for nhs and social care systems. it's not necessaryjust being older, it's the fact that as we age, we tend to develop multiple conditions, so we might have
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diabetes and dementia, we might have a mental health condition and a cardiovascular disease. and then the nhs is needing to deal with those multiple problems all at the same time towards the end of people's lives. but a lot of those conditions are caused by a whole host of things about how we've lived our lives, so the food we've eaten, the alcohol we have or haven't drunk, how active we've been. so if we can help the population think about ageing and a healthy way, living in a healthy way, that can reduce future health care demand. fundamentally, though, the big question is, do we spend enough on health care in the uk? £190 billion in the nhs across the whole of the uk each year. people look at that and it's a really big, huge figure. but i guess the question is, compared with other health systems, how do we compare, and is it enough? yes, so the international comparisons are always a little bit tricky because it is on what basis are you comparing on, and changes to gdp, and then also change on what you spend on health.
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generally, it accepted in the uk we spend around a couple of percent less per year on our health care system. if you are doing that for one or two years, it's probably something the health care system can cope with. but if you've been doing it for a decade, that's kind of tens of billions of pounds, which we've not invested in our health care system and other countries have. when you look at polling, which is always tricky, but when you look at polling around the nhs and you see that question, should the government be spending more money, the answer is always, generally tends to be yes. when you asked the question, would you like to see your taxes rise to pay for it, it is a much more mixed answer. we cmc and flows, so a couple of years ago people were saying, yes, i do want to pay more. i think now with the cost of living crisis, some people feeling, i don't like i can afford it. and there's always that personal view that there must be other part of government spending that could be saved, could be more efficient to move money to the nhs.
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so you are absolutely right, politicians need to have an honest conversation with the public about, everyone to the nhs to be what we've come to expect it to be, that go to cost more, that's going to require tax increases. if we don't want those tax increases, we need to equally be able to ask what does that mean for what the nhs can offer? the fact that so many more others are living longer is a success story, of course. huge advances in medicines, along with changes to our behaviour, like cutting smoking, healthier eating, means it's not unusual to reach our 80s, 90s, even beyond that. but the trend is already putting a huge strain on the nhs. it is thought that over the next ten years, we will need to create another1 millionjobs in health and social care. if we don't prepare for these changes now, and it might not be a winter crisis we will be talking about, but the future of the whole nhs that at stake. to see the latest data on hospitals where you live, you can use the bbc�*s winter tracker.
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you just put in your postcode to find the waiting times in a&e or for operations and ambulances. visit... hello. the second half of the weekend is set to be the brighter half of the weekend after a saturday that brought mainly grey skies overhead. sunday promises more in the way of sunshine, but a slightly chillier feel. high pressure building strongly across the uk, keeping the vast majority dry with those lengthy sunny spells. this cold front has been slipping southwards and that's been introducing colder air. so quite a few places starting sunday morning around freezing a little bit milder down
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towards the south of england where we're closest to this area of cloud first thing. but that will be clearing away quickly. and then, as you can see, there will be lengthy spells of sunshine. one thing you can't really see clearly here is some high cloud that's likely to stream in across parts of northern ireland, scotland and northern england. that could turn the sunshine hazy at times, but it shouldn't spoil things too much. temperatures a little down on where they have been, 7 to 10 degrees. but with the brighter skies overhead, i think it will still feel fairly pleasant for the time of year. now through sunday night, this area of high pressure tends to drift. a little further. southeast was under the centre of the high with light winds could see one or two fog patches, but around the edge of the high will be bringing more cloud into northern ireland and scotland. hence it will be a little milder here to start monday morning. the coldest weather down across england and wales with a touch of frost and some fog patches towards the south east corner.
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but any fog should clear pretty quickly. and then plenty of sunshine across england and wales. some bright skies, too, across the east of scotland, the western side of scotland and northern ireland, tending to see a little more in the way of cloud, maybe the odd spot of drizzle, a slightly stronger breeze, temperatures between seven and ten degrees. now, as we get into tuesday, we will see a weak weather front sitting somewhere across the centre of the uk. a little bit of patchy rain with that to the north of it, some sunshine to the south of it could be some quite widespread fog on tuesday morning which will tends to lift and clear to give some spells of sunshine temperatures between six and ten degrees. now, as we head deeper into the week, high pressure holds on close to the south and the east of the uk. but this frontal system pushing in from the northwest may well bring some outbreaks of rain and it will also bring strong winds at times in the north of scotland through the middle part of the week. further south, things stay calm, some spells of sunshine, but with some patchy fog.
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this is bbc news, i'm tanya bekett with the latest headlines for viewers in the uk and around the world. shot out of the sky — the us military gets the chinese balloon that had been floating in american air—space. they successfully took it down, and i want to complement our aviators who did it. three airports were shut and the airspace was closed — it came down off the us east coast. suddenly we saw something take off from the jet, knew it was a missile. and you could see the explosion — didn't hear anything, but saw the explosion of the balloon. the hunt for the british woman who disappeared while walking her dog — detectives want to speak to a key witness seen nearby.
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and a peace mission to south sudan — the pope makes


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