nine people have now been rescued from an italian hotel which was buried by an avalanche three days ago. a man has appeared in court in sheffield, charged with the murder of 16—year—old leonne weeks. her body was found on a pathway near rotherham on monday. i'm back at the top of the hour. ( now on bbc news — inside out. hello, welcome to a brand new series. in the next half an hour, a close—up look at health care. we're 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 i'm 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 i've had to pay for my treatment, it's 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 hadn't done the cpr my mother wouldn't have survived today. i'm 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 didn't want to be here and i wa nted where i didn't 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. we're 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 i'll retire any way. after losing eight—and—a—half stone, donna needs surgery eight—and—a—half stone, donna needs surgery to eight—and—a—half stone, donna needs surgery to remove 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 don't get your hopes up. it drives me up the wall. i want to do what i'm 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 patients to fit the design of the services. if you bear with me, i'm afraid there will be a bit of a wait for dr scott. i will double check for u -- for you. come in.

there's 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. it's 12. 30pm, mike's now worse than the national average. it'512.30pm, mike's now on home visits. hello. dorothy has a severe muscle wasting disease and has developed suspected chest infection. if the nurse hadn't been in, would you have been thinking about calling us? would you have been worried? no, not at all. let's have a listen. dorothy has had the disease for 15 yea rs. dorothy has had the disease for 15 years. i've had it specially refrigerated to give a thrill. ok. that's looking good. all right, ok? that's looking good. all right, ok? that's fine. often patients have already diagnosed their illness before the doctor arrives. do you wa nt before the doctor arrives. do you want my clothes... don't worry,

we'll preserve your modesty. i'm not bothered. when you get to blooming nearly 83. never say die, don't say that. give us a few deep breaths. yeah, you're sounding like a bag of weesels here. i thought i was. yeah, you're sounding like a bag of weesels here. ithought i was. i think your vest is tucked into your socks here or something. my thermal vest. i agree with your diagnosis. it's more than a cold certainly. you have a flair it's more than a cold certainly. you haveaflairup it's more than a cold certainly. you have a flair up of the bronchitis there. lunch at the surgery. there are five partime gps here, earning less tha n are five partime gps here, earning less than 59,000 a year on average. their time is rationed. ten minutes a patient. if i had 15 their time is rationed. ten minutes a patient. ifi had 15 minutes 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, i'm sure i could improve their quality of life. but you basically have to do what's 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. it's hard if you try to say there's no appointments left. you notice everything. a couple of deep breaths. there's all sorts of squeaks and rattles. you knowl don't like steroids, i don't mind a short period of them. ok, doctor... i'll go on your recommendation. the commissioning group that funds hospital services recently began paying gps to reduce their referrals to specialists. mike thinks it's 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, don't trust your doctor any more. when he tells you, i don't think you need to go to hospital, he could be saying, i honestly don't think you need to go

to hospital or he could be thinking, i need to save up for my foreign holiday and if i don't refer this person to hospital, it will cover some of the cash flow that we missed last year. if i'm honest, i don't think anybody‘s going to be saying, that but it puts you in an in—— inviious. the commissioning group said it was to make best use of resources . said it was to make best use of resources. there are schemes in other areas, after you made the referral, another doctor looks after the referral letter and says no, you can't make that referral. i think that absolutely stinks. somebody who doesn't know me and doesn't know them says no. you know, ijust don't 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 is just a rationing cry tierament that —— criteria. the bar is too high. more telephone consultations. a seriously hill 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 he's capable of working is worth a whole lot more than this other guy, who's dog a tick—box exercise for a private company, contracted to the government. it's 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. ok. what you need from me tonight is pain relief and not vomiting? uh-huh. 0k. pain relief and not vomiting? uh-huh. ok. 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 hadn't 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 couldn't cope with this. i'd crack up, quite frankly. i'm 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 ca re 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 we've grown up with is beginning to fragment it's not a national service. absolutely there isa national service. absolutely there is a postcode lottery. it's 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? we're going to put that to the test. ona bad

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. i'm about to lose myjob. i haven't been at work since april. i've been off sick. i could possibly lose the flat over my head. there are new drugs that could potentially cure ben's hepatitis. they're expensive and rationed. ben has been denied them. all i got was wait, basically, because my liver wasn't 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 wouldn't do, that but i wouldn't be surprised if anyone else wouldn't. the money is there for just over 10,000 treatments. each area has a target to meet. it's claimed that means there are no queuesin 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, they'll 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, i'm sorry, you're going to have to wait. this is just inherently unfair. you're going to have to wait. this isjust 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. it's the fact that it's 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 don't really

have that. the fact that i've had to pay for my treatment is criminal. it is absolutely criminal. sorry. i'm tired of being tired basically. ben is hoping the generic drugs will cure him in a matter of weeks and he's not alone. the hepatitis c trust estimates around a thousand people in britain may have bought the drugs abroad. if you go outside, it's halos around the lights, like some shadows. it's often hard to see things, they're a bit distorted. gloria has cataracts in both eyes.|j can't take stairs, go up or down stairs with any kind of confidence. ca ta ra cts stairs with any kind of confidence. cataracts a re 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 she's been waiting seven. it's too long because there is such potential for accidents. there's such a change in the person's 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. it's not about clinical need. it's about some places in england having poor systems, having budgetary pressures and deprioritising cataract surgery. that doesn't feel national to me. gloria expects her operation later this month. it really makes me angry because i think that it's almost like the survival of the fittest. clinical commissioning groups or ckgs control health budgets. it's 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 short—term. whilst the ccg says it can be clinicallyjustified the royal college of surgeons say it can't. there's very good evidence that people are now got getting locate tiff operations which they —— elective operations, which they desperately require simply because of financial restriction. it is up to the chin linicians to decide who -- clinicians to the chin linicians to decide who —— clinicians to decide who should have what treatments. a bureaucratic syste m have what treatments. a bureaucratic system which produces a blanket ban, we think it's morally wrong. it's 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 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. we've 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. they're putting up barriers. they're using delaying tactics. it's 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 yea rs. risen by about 30% in the last two years. you can risen by about 30% in the last two years. you can see 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 doesn't 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, it's not a national service. it's now a local health service. it matters because it means it leads to inequality in health care. that's the problem. some people will get health care for free and others won't. in the statement the department of health told us: far from rationing, more people than ever are getting prompt treatment.

3,261 more cancer patients are being seen every 3,261 more cancer patients are being seen every day. and standards of ca re are seen every day. and standards of care are improving. 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. it's 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. it's really important that we commission and respond to the needs of that population on a local basis. it's about making sure the pathway is correct. we don't want to squander any money. we have limited resources . squander any money. we have limited resources. it's 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. we've met a newcastle teenager, who understands that only too well. i'm 15. understands that only too well. i'm15. 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 14 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

ha rd broken hearted. as a mother, it was hard watching her go through it. i couldn't 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, and defibrillator training. after what happened to herfriend, she wa nts what happened to herfriend, 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 don't act fast and do cpr, you have so don't act fast and do cpr, you have so much less chance of surviving. i think it's something that when you get to a certain age, you should be trained, in because anything could happen. but if bobby 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 yea rs. curriculum here for the last ten years. ina 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 bea campaign 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 it's a good thing to help. it's always interesting to see the children's 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 hadn't done the cpr my mother wouldn't have survived today. it is

a very, very, very good thing to know. you never know when it's 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 didn't know how to respond to that, but well, i guess i did. now nearly 70% of people in denmark know cpr. that's compared to just people in denmark know cpr. that's compared tojust10% people in denmark know cpr. that's compared to just 10% in the people in denmark know cpr. that's compared tojust10% 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 ta ke 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 mejust 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. it's just one hour, school. i cannot find that reason. it'sjust one hour, it's school. i cannot find that reason. it's just one hour, it's cost effective and it doesn't 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? you're 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. that's what one paramedic wa nts to smaller. that's 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. i've been shocked at how much they cannot only take on board and retain. then deliver. they're really interested.

i think the characters really help. always wanting to get involved in the characters and activities that we run. no, it's not compulsory, i think it should be because personally i think it's 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: it's not good enough at all. we're way behind the curve here. we're failing our population because people are dying prematurely unnecessarily. push really hard. it makes me really sad. it's such a simple thing to introduce. it doesn't cost much. the benefits

would be so huge. good job! in newcastle, it's a special day for 15—year—old bobby. she's up for an award. this awards are to recognise unsung heroes and champions in the local community. overall i've raised about £10,000, i've bought ten defibery lators. we have been —— defibrillators in the areas where me and michael were. the award goes to bobby... cheer cheer —— cheering. it's about getting the word out. everyone will know that michael had a cardiac arrest. he would be over the moon. he really would be over the moon. he really would be. congratulations to bobby on that fantastic award. that's it for now. there'll be more from the bbc‘s

inside out teams on the bbc news channel next weekend. hello there. it's a cold start to our weekend. high pressure dominating the scene for the weekend and into next week too. so weather patterns will continue to be similar to how they've been for a few days. lots of sunshine around. can you see where most of it has been. there's been areas of cloud, low cloud, mist and murk that's developing across central and northern parts of wales. meanwhile across scotland, glorious sunshine, widespread sunshine compared to what we saw yesterday. glorious picture here of the western highlands there. temperatures plummet under clear skies. where we have the cloud this evening it's not as cold. with one or two showers around in the south—west of the england, cloud developing across southern counties of england. the blue hue there, south wales, into the south—east. north of here, we have an area of cloud. this is thick number to produce further outbreaks

of light and patchy rain. winteriness over higher ground as well. northern ireland looks like the cloud will roll into most of northern ireland through the evening period. for scotland, it's going to bea period. for scotland, it's going to be a fine end to the day. then overnight, we'll see variable cloud. clear spells too. where we have clear skies, mist and fog will form. with the cloud, outbreaks of rain. rain in the south—west, but across northern england, towards scotland, there'll be winteriness. don't be surprised with a dusting of snow. watch out for ice on untreated surfaces in northern and western areas where we have these showers. againa areas where we have these showers. again a cold, frosty start with the clear skies. mist and fog around through sunday morning. that said, that will clear and we should see sunshine around, maybe not as much sunshine around, maybe not as much sunshine as today across northern and western areas. the best of it central, southern, south—eastern parts of the it will be another cold day with temperatures of four to seven celsius. a cold weekend all in all. but a lot of dry weather around

for many of us. sunday evening, temperatures fall away, widespread frost develops. dense fog patches across england and wales. that's the theme as we head into monday and tuesday. we're starting to pick up mild airoff the tuesday. we're starting to pick up mild air off the near atlantic, cold air trapped mild air off the near atlantic, cold airtrapped in mild air off the near atlantic, cold air trapped in this area of high pressure means some of the fog could be particularly dense in places on monday and tuesday morning. could be long lived as well lasting into the afternoon in some areas. and it could cause travel disruption as well. keep tuned to the weather forecasts and bbc local radio. this is bbc news. the headlines at three. president trump begins his first full day as america's new leader, and starts to follow through on his campaign pledges. inauguration day ended with a series of balls, with the president promising to fight for the american people. we're gonna do a really good job, and i will be fighting every single day for you. meanwhile, women's groups are holding protest marches across the uk,

and around the world, against trump's presidency. nine people have now been rescued from an italian hotel which was buried by an avalanche three days ago. 23 people are still missing. british tennis number one johanna konta storms into the last 16 of the australian open. in halfan in half an hour, stephen sackur