both qatar and morocco deny claims they bribed officials to win influence in parliament. good morning dew. it is 3.30. now on bbc news, here's panorama. the nhs is under intense pressure. emergency departments are packed. it is pressure. emergency departments are acked. , pressure. emergency departments are packed-— are packed. it is the most pressure _ are packed. it is the most pressure i _ are packed. it is the most pressure i have _ are packed. it is the most pressure i have felt - are packed. it is the most pressure i have felt as - are packed. it is the most pressure i have felt as a l pressure i have felt as a clinician in my time since i qualified. clinician in my time since i qualified-— clinician in my time since i qualified. staff say they are at breaking _ qualified. staff say they are at breaking point. - qualified. staff say they are at breaking point. during i qualified. staff say they are at breaking point. during a| at breaking point. during a “azz, at breaking point. during a jazz. our— at breaking point. during a jazz, our nhs. _ at breaking point. during a| jazz, our nhs. ambulances at breaking point. during a - jazz, our nhs. ambulances are crueuein jazz, our nhs. ambulances are queueing for — jazz, our nhs. ambulances are queueing for hours. _ jazz, our nhs. ambulances are queueing for hours. it - jazz, our nhs. ambulances are queueing for hours. it can - jazz, our nhs. ambulances are queueing for hours. it can be l queueing for hours. it can be desperate for patients. everyone was absolutely crammed full. 50 everyone was absolutely crammed full. ,, ., ., , everyone was absolutely crammed full. ., , ., full. so what needs to change? i have been _ full. so what needs to change? i have been meeting _ full. so what needs to change? i have been meeting doctors i

full. so what needs to change? i i have been meeting doctors and nurses rethinking healthcare, picking problems up early. we have picking problems up early. - have essentially done 20 consultations in one here. the more peeple _ consultations in one here. the more people they _ consultations in one here. the more people they get a chance to come — more people they get a chance to come here, the better. and usin: to come here, the better. and using new _ to come here, the better. fific using new technology to come here, the better. fific using new technology to to come here, the better. e"ic using new technology to take the hospital into the home. so can the nhs be fixed? mat can the nhs be fixed? not replacing _ can the nhs be fixed? not replacing the _ can the nhs be fixed? iirrt replacing the hospital, it isn't about the death of a hospital. isn't about the death of a hospital-— isn't about the death of a hospital. hello mrs east? 93-year-old _ hospital. hello mrs east? 93-year-old elizabeth - hospital. hello mrs east? | 93-year-old elizabeth east hospital. hello mrs east? - 93-year-old elizabeth east is 93—year—old elizabeth east is being assessed at the john radcliffe in oxford.- being assessed at the john radcliffe in oxford. how are ou radcliffe in oxford. how are you doing? _ radcliffe in oxford. how are you doing? like _ radcliffe in oxford. how are you doing? like many- radcliffe in oxford. how are i you doing? like many hospitals across the _ you doing? like many hospitals across the country, _ you doing? like many hospitals across the country, it _ you doing? like many hospitals across the country, it has - you doing? like many hospitals across the country, it has been | across the country, it has been pushed to its limits.— pushed to its limits. good morning- _ pushed to its limits. good morning. how _ pushed to its limits. good morning. how are - pushed to its limits. good morning. how are you - pushed to its limits. good - morning. how are you feeling today? — morning. how are you feeling toda ? ., today? elizabeth phil at her care home _ today? elizabeth phil at her

care home and _ today? elizabeth phil at her care home and has - today? elizabeth phil at her care home and has a - today? elizabeth phil at her| care home and has a broken today? elizabeth phil at her - care home and has a broken arm. she has already spent nearly five hours in the emergency department. now she is being assessed on a special unit run by doctorjordan bowen. you had a lona by doctorjordan bowen. you had a long night- _ by doctorjordan bowen. you had a long night. you _ by doctorjordan bowen. you had a long night. you must _ by doctorjordan bowen. you had a long night. you must be - by doctorjordan bowen. you had a long night. you must be very i a long night. you must be very sleepy~ — a long night. you must be very slee . ~ . a long night. you must be very slee . . ., ., a long night. you must be very slee . ~ . ., ., sleepy. when admitted to a hosital sleepy. when admitted to a hospital ward, _ sleepy. when admitted to a hospital ward, frail, - sleepy. when admitted to a hospital ward, frail, older l hospital ward, frail, older patients stay for an average of ten days. patients stay for an average of ten da s. �* , ., patients stay for an average of tenda s. �* ten days. are you feeling cold, are you? _ ten days. are you feeling cold, are you? yes- _ ten days. are you feeling cold, are you? yes. alright. - ten days. are you feeling cold, are you? yes. alright. and - ten days. are you feeling cold, are you? yes. alright. and it l are you? yes. alright. and it isn't a good _ are you? yes. alright. and it isn't a good place _ are you? yes. alright. and it isn't a good place for - are you? yes. alright. and it isn't a good place for a - are you? i'ezs alright. and it isn't a good place for a person like elizabeth who is also living with dementia. it is living with dementia. it is t in: living with dementia. it is trying to _ living with dementia. it is trying to normalise - living with dementia. it is trying to normalise her i trying to normalise her environment. which we simply can't _ environment. which we simply can't do — environment. which we simply can't do in _ environment. which we simply can't do in a hospital. i intend _ can't do in a hospital. i intend to do as much as they can within _ intend to do as much as they can within her home, familiar environment, in her care home. this— environment, in her care home. this assessment unit aims to get people who arrive as emergencies home the same day. it is important, and what we try to — it is important, and what we try to do _ it is important, and what we try to do is intercept patients

who— try to do is intercept patients who would otherwise be arriving in the _ who would otherwise be arriving in the emergency department or being _ in the emergency department or being admitted into the hospital and instead offering an alternative to that, when they— an alternative to that, when they still— an alternative to that, when they still get the same quality of treatment and yet go home. here _ of treatment and yet go home. here they— of treatment and yet go home. here they have been very successful, seeing an average of 70 patients a day. 95% are treated without needing an overnight stay. they are geared up overnight stay. they are geared up to get test results back quickly. up to get test results back ruickl . �* , ., up to get test results back ruickl . �* ,. up to get test results back - quickly._ elizabeth quickly. are you ok? elizabeth has problems _ quickly. are you ok? elizabeth has problems with _ quickly. are you ok? elizabeth has problems with her - quickly. are you ok? elizabeth has problems with her kidneys| has problems with her kidneys so doctor bowen adjusts her medication. 0nce her arm is treated, she can go back to her care home. staff there will monitor her.— care home. staff there will monitor her. , , monitor her. the biggest thing is t in: monitor her. the biggest thing is trying to _ monitor her. the biggest thing is trying to explain _ monitor her. the biggest thing is trying to explain to - monitor her. the biggest thing | is trying to explain to someone who is— is trying to explain to someone who is feeling unwell why it is a for— who is feeling unwell why it is a for them to be at home, feeling _ a for them to be at home, feeling unwell. by keeping people recovering safely in their— people recovering safely in their own home, we think that people — their own home, we think that people get better quicker, and return— people get better quicker, and return back to the things that

they— return back to the things that they value sooner than being in hospilah — they value sooner than being in hospital. it is a massive change _ hospital. it is a massive change in thinking. with the health service _ change in thinking. with the health service under - change in thinking. with the health service under such i health service under such pressure, most hospitals are doing this. but in oxford they have gone further, by also providing high level hospital treatment in people's homes. the hospital is full at the moment. 110% filled. people are in there — moment. 110% filled. people are in there for 22 hours, eight hours — in there for 22 hours, eight hours waiting. could we get you to hours waiting. could we get you lo go— hours waiting. could we get you to go out? — hours waiting. could we get you to go out?— to go out? professor dan matheson _ to go out? professor dan matheson was _ to go out? professor dan matheson was one - to go out? professor dan matheson was one of- to go out? professor dan matheson was one of the to go out? professor dan - matheson was one of the first doctors in the country to provide this kind of home—based medical care. we provide this kind of home-based medical care-— medical care. we can assess ou, medical care. we can assess you. diagnose _ medical care. we can assess you, diagnose you, - medical care. we can assess you, diagnose you, and - medical care. we can assess| you, diagnose you, and treat you, diagnose you, and treat you at home, if that is your choice. we are replacing the hospital, it isn't about the death of a hospital but the rebirth of a hospital. mega rebirth of a hospital. new technology _ rebirth of a hospital. new technology means - rebirth of a hospital. new technology means he - rebirth of a hospital. new

technology means he is l rebirth of a hospital. new technology means he is able to look after much sicker people in their own homes. professor lasserson is here to see 91—year—old ted, who has heart failure, and has been referred to dan by a specialist. mr; failure, and has been referred to dan by a specialist. my name is dan and _ to dan by a specialist. my name is dan and l _ to dan by a specialist. my name is dan and i am _ to dan by a specialist. my name is dan and i am a _ to dan by a specialist. my name is dan and i am a doctor- to dan by a specialist. my name is dan and i am a doctor from i is dan and i am a doctorfrom the hospital. hello. i is dan and i am a doctor from the hospital. hello.— the hospital. hello. ifeel rotten- — the hospital. hello. ifeel rotten. you _ the hospital. hello. ifeel rotten. you feel- the hospital. hello. ifeel rotten. you feel rotten? l the hospital. hello. ifeel. rotten. you feel rotten? are ou rotten. you feel rotten? are you getting _ rotten. you feel rotten? are you getting any _ rotten. you feel rotten? are you getting any pain - rotten. you feel rotten? are you getting any pain in - rotten. you feel rotten? are you getting any pain in your| you getting any pain in your chest? ., you getting any pain in your chest?- all— you getting any pain in your chest? me. all yourtummy? last chest? no. all your tummy? last week, ted _ chest? no. all your tummy? last week, ted fell— chest? no. all yourtummy? last week, ted fell and paramedics wanted to taken to hospital, but ted by his wife and daughter, didn't want to go. he was daughter, didn't want to go. he: was always able to manage his own medication up until about two weeks ago. own medication up until about two weeks ago-— own medication up until about two weeks ago. hospital at home has liven two weeks ago. hospital at home has given them _ two weeks ago. hospital at home has given them choice. _ two weeks ago. hospital at home has given them choice. it - two weeks ago. hospital at home has given them choice. it means| has given them choice. it means a doctor, nurse, or paramedic, will visit him every day. can a doctor, nurse, or paramedic, will visit him every day.- will visit him every day. can i undo this? — will visit him every day. can i undo this? because - will visit him every day. can i undo this? because i - will visit him every day. can i undo this? because i want i will visit him every day. can i undo this? because i want to i undo this? because i want to

listen to your heart and lungs and have a scan of you. usually blood tests. — and have a scan of you. usually blood tests, heart _ and have a scan of you. usually blood tests, heart monitoring, | blood tests, heart monitoring, and an ultrasound scan would involve separate hospital gp visits. but dan and his team carry this equipment in his bag. carry this equipment in his baa. . carry this equipment in his ba., ., , ., . ~' carry this equipment in his bag. that black area is fluid. that is outside _ bag. that black area is fluid. that is outside the _ bag. that black area is fluid. that is outside the lung - bag. that black area is fluid. that is outside the lung and | bag. that black area is fluid. i that is outside the lung and in the chest cavity. that bright thing is the... the chest cavity. that bright thing is the. . ._ the chest cavity. that bright thing is the... within moments the can thing is the... within moments they can see — thing is the... within moments they can see because - thing is the... within moments they can see because of - thing is the... within moments they can see because of the i they can see because of the breathlessness. his heart pumping properly. bud breathlessness. his heart pumping properly. and this isn't squeezing _ pumping properly. and this isn't squeezing very - pumping properly. and this isn't squeezing very well. pumping properly. and this isn't squeezing very well at| isn't squeezing very well at all. and that is the problem. by all. and that is the problem. by quickly uploading the images to the hospital system, professor lasserson can discuss the results would be hard specialist.— the results would be hard specialist. have you had a chance to _ specialist. have you had a chance to look _ specialist. have you had a chance to look at - specialist. have you had a chance to look at the - specialist. have you had a - chance to look at the images? yes, i'm looking at the images. what _ yes, i'm looking at the images. what do — yes, i'm looking at the images. what do you think? his yes, i'm looking at the images. what do you think?—

what do you think? his lp isn't there. what do you think? his lp isn't there- they _ what do you think? his lp isn't there. they will _ what do you think? his lp isn't there. they will keep _ there. they will keep monitoring _ there. they will keep monitoring ted - there. they will keep monitoring ted and l there. they will keep i monitoring ted and give there. they will keep - monitoring ted and give them there. they will keep _ monitoring ted and give them a dose of intravenous drugs. professor lasserson also fits a catheter to help get rid of excess fluid.— catheter to help get rid of excess fluid. ~ , , ., excess fluid. our key is to get the extra _ excess fluid. our key is to get the extra fluid _ excess fluid. our key is to get the extra fluid out _ excess fluid. our key is to get the extra fluid out of- excess fluid. our key is to get the extra fluid out of the - the extra fluid out of the body. the extra fluid out of the bod . .., the extra fluid out of the bod . .. ., , body. ted can do very little for himself. _ body. ted can do very little for himself. so _ body. ted can do very little for himself. so with - body. ted can do very little for himself. so with him i body. ted can do very little for himself. so with him at| for himself. so with him at home rather than in hospital, most of his care is down to his family. his daughter, jill, returned from her home in france to help, two months ago. her mum, grace, was already struggling. i her mum, grace, was already struggling-— struggling. i am trying to rotect struggling. i am trying to protect him _ struggling. i am trying to protect him from - struggling. i am trying to protect him from going l struggling. i am trying to i protect him from going into hospital. i'm trying my best to do that. but it is a strain. mum has mobility problems and balance — mum has mobility problems and balance issues. so often all the toileting and washing she can't — the toileting and washing she can't do _ the toileting and washing she can't do. ted needs two or

three _ can't do. ted needs two or three care _ can't do. ted needs two or three care visits a day. they on waiting _ three care visits a day. they on waiting list _ three care visits a day. they on waiting list for _ three care visits a day. they on waiting list for council i on waiting list for council support butjill needs to return home next week. and with no help, she is worried about how her mother will cope. mum needs support- _ how her mother will cope. mum needs support. she _ how her mother will cope. mum needs support. she can't - how her mother will cope. mum needs support. she can't carry l needs support. she can't carry on what she has been doing. i’m on what she has been doing. i'm frightened _ on what she has been doing. i'm frightened because if he fell, and he — frightened because if he fell, and he heard himself badly, i don't — and he heard himself badly, i don't think i was down for anybody. don't think i was down for anybody-— don't think i was down for an bod. ., ., , anybody. how important is it that they _ anybody. how important is it that they get _ anybody. how important is it that they get some - anybody. how important is it that they get some help - anybody. how important is it l that they get some help soon? is probably the most important thing in a case like this. i think the — de — our attempt to get rid of the fluid may not work. but what will make more difference to him is support coming into the home very quickly, and that will help them, as a couple, just focused on being with each other. the hosital on being with each other. the hospital team _ on being with each other. the hospital team helped ted remain

at home for as long as possible. he got some social care, but his family says it wasn't enough. he died a few weeks later, in a hospice. the hospital at home to work more widely, families will need support. about half a million people are waiting for local authority care services in england. authority care services in england-— england. our busy as it? phenomenally _ england. our busy as it? phenomenally busy. - england. our busy as it? - phenomenally busy. stephen chandler runs 0xford to chancey council. —— 0xford shed council. -- oxford shed council-— council. -- oxford shed council. ~ ., ., council. we are looking at new and innovative _ council. we are looking at new and innovative arrangements l council. we are looking at new| and innovative arrangements to help people. so we have been doing everything we possibly can and yet i would say to you thatis can and yet i would say to you that is still not enough. in that is still not enough. in england this winter, a total of

£700 million extra is been put into tackling hospital pressures by the government. it includes moving some patients into care homes. for councils, it is a short—term fix that doesn't tackle the deeper problems, including 165,000 unfilled carejobs. brute problems, including 165,000 unfilled care jobs.— problems, including 165,000 unfilled care jobs. unfilled care “obs. we have to do firstl unfilled care jobs. we have to do firstly address _ unfilled care jobs. we have to do firstly address the - do firstly address the workforce. so that comes from, the very positioning social care in their workforce capacity as being equal to the nhs. so social care workers being valued and rewarded equally in that context. iflare equally in that context. care worker rachel _ equally in that context. care worker rachel further - equally in that context. care worker rachel further is - worker rachel further is starting an evening shift in east yorkshire. each day there are thousands of patients stuck in hospitals across the uk. even though they are medically fit to leave. many are waiting for the sort of care she

provides. for the sort of care she provides-— for the sort of care she rovides. ~ . , ., . , ., provides. when ambulances are . ueueinu provides. when ambulances are queueing outside _ provides. when ambulances are queueing outside the _ provides. when ambulances are queueing outside the hospital, | queueing outside the hospital, you can actually see the pressures on the health and care system. pressures on the health and care system-— care system. but here on a cold, care system. but here on a cold. dark— care system. but here on a cold, dark night, _ care system. but here on a cold, dark night, and - care system. but here on a i cold, dark night, and villages and towns where people live and need support, those pressures are invisible, but perhaps even more intense. rachel's first visit is to see shirley. share visit is to see shirley. are ou visit is to see shirley. are you ready _ visit is to see shirley. are you ready for _ visit is to see shirley. are you ready for putting, - visit is to see shirley, e: you ready for putting, shirley? did you enjoy that? was it nice? i like the fact that i can come into people's homes, make them feel safe, and do everything they need. it is make them feel safe, and do everything they need.- everything they need. it is a role that _ everything they need. it is a role that rachel _ everything they need. it is a role that rachel believes i everything they need. it is a role that rachel believes is| role that rachel believes is undervalued. it role that rachel believes is undervalued.— role that rachel believes is undervalued. it isn't cluster skill worker, _ undervalued. it isn't cluster skill worker, which - skill worker, which is unfair. we are really underpaid. can i get you anything else before i lead? . ., ..,

get you anything else before i lead? ., ., . ., ., 4' lead? on average, care worker in england _ lead? on average, care worker in england is— lead? on average, care worker in england is paid _ lead? on average, care worker in england is paid a _ lead? on average, care worker in england is paid a little - in england is paid a little over £10 an hour. just above the minimum wage.- over £10 an hour. just above the minimum wage. people can go to a local supermarket, _ the minimum wage. people can go to a local supermarket, the - to a local supermarket, the work isn't as hard, and they can get the same amount of money what they would get from working a 12 hour shift. iiirui’ith working a 12 hour shift. with an ageing — working a 12 hour shift. with an ageing population, - working a 12 hour shift. with an ageing population, social care can also be vital in identifying problems early. hello. �* ., ., hello. and heading of emergencies. - hello. and heading of emergencies. how. hello. and heading of l emergencies. how have hello. and heading of - emergencies. how have you hello. and heading of _ emergencies. how have you been? are ou emergencies. how have you been? are you alright? — emergencies. how have you been? are you alright? in _ emergencies. how have you been? are you alright? in the _ emergencies. how have you been? are you alright? in the uk, - are you alright? in the uk, about 496 _ are you alright? in the uk, about 496 of _ are you alright? in the uk, about 496 of the _ are you alright? in the uk, about 496 of the population are you alright? in the uk, i about 496 of the population is about 4% of the population is described as frail. that is nearly 3 million people. around 40% of all hospital beds and gp resources are required to treat

them. in hull, this 1—of—a—kind medical centre is trying to anticipate and prevent health problems for frail, often older people. in one day, patients see doctors, physios, occupational therapists, pharmacists, and social workers. thejean bishop centre was the brainchild of two doctors, both specialists in elderly care.— doctors, both specialists in elderl care. ~ .~ . , ., , elderly care. we make decisions as a team _ elderly care. we make decisions as a team so — elderly care. we make decisions as a team so a _ elderly care. we make decisions as a team so a person _ elderly care. we make decisions as a team so a person isn't - as a team so a person isn't having to go to seven or eight different appointments to receive the care they require. 83—year—old mary has come from assessment with her daughter, jackie. she was referred to the centre by her gp after falling at home. how concerned with you about your mom last week? i’ee about your mom last week? i've never seen _ about your mom last week? i've never seen her _ about your mom last week? i've never seen her look _ about your mom last week? la: never seen her look so about your mom last week? lg:

never seen her look so frail. about your mom last week? i've never seen her look so frail. i i never seen her look so frail. i look frightful. this _ never seen her look so frail. i look frightful. this is - never seen her look so frail. i look frightful. this is a - never seen her look so frail. i look frightful. this is a full i look frightful. this is a full body and _ look frightful. this is a full body and life _ look frightful. this is a full body and life mot, - look frightful. this is a full l body and life mot, designed look frightful. this is a full - body and life mot, designed to pick problems up early. what pick problems up early. what we're going _ pick problems up early. what we're going be _ pick problems up early. what we're going be doing - pick problems up early. what we're going be doing in - pick problems up early. what we're going be doing in this l we're going be doing in this bit is an ecg. we're going to check your weight, bit is an ecg. we're going to check yourweight, height, bit is an ecg. we're going to check your weight, height, your blood pressure, and your oxygen and tolls. , , , and tolls. then she sees the pharmacist _ and tolls. then she sees the pharmacist and _ and tolls. then she sees the pharmacist and a _ and tolls. then she sees the| pharmacist and a consultant. usually doctors only have a partial view of someone's medical history. 50 partial view of someone's medical history.— partial view of someone's medical history. so i'm going to concentrate _ medical history. so i'm going to concentrate a _ medical history. so i'm going to concentrate a little - medical history. so i'm going to concentrate a little bit - to concentrate a little bit more on medical aspects. here doctorfor— more on medical aspects. here doctor for well— more on medical aspects. here doctor for well kensi _ more on medical aspects. here doctor for well kensi mary's i doctor for well kensi mary's gp, hospital, and any social care records. with a longer consultation, she gets a much fuller picture. i consultation, she gets a much fuller picture.— fuller picture. i think this is our fuller picture. i think this is your second _ fuller picture. i think this is your second fall, _ fuller picture. i think this is your second fall, wasn't - fuller picture. i think this is your second fall, wasn't it? third this year. she had one in june — third this year. she had one in june. . , ., , ., third this year. she had one in june. . , .,, ., ., june. treating people who have had falls is _ june. treating people who have

had falls is estimated _ june. treating people who have had falls is estimated to - june. treating people who have had falls is estimated to cost i had falls is estimated to cost the nhs more than £2 billion a year. doctor fulwell believes the blood pressure pills may be having unintended consequences. what is happening with your blood pressure is it has been really well—controlled. but when you are standing, it is dropping. and they can make you feel a bit woozy and dizzy. we are not the experts are we 'ust we are not the experts are we just take — we are not the experts are we just take what we given. but i haven'l— just take what we given. but i haven't had a change for a long time _ haven't had a change for a long time. ., .. ., ., ., time. you can own it a long time. you can own it a long time- it _ time. you can own it a long time- it is _ time. you can own it a long time. it is nice _ time. you can own it a long time. it is nice to _ time. you can own it a long time. it is nice to have - time. you can own it a long time. it is nice to have the | time. it is nice to have the opportunity _ time. it is nice to have the opportunity to _ time. it is nice to have the opportunity to talk - time. it is nice to have the opportunity to talk about | time. it is nice to have the | opportunity to talk about it because when you go to the gps you just — because when you go to the gps you just don't have time to ask questions _ you just don't have time to ask questions-— questions. time has been key for this. how _ questions. time has been key for this. how often _ questions. time has been key for this. how often in - questions. time has been key for this. how often in a - questions. time has been key| for this. how often in a normal hospital run or in a gp's practice what you have the sort of time to go through things with someone? i of time to go through things with someone?— of time to go through things with someone? i think there would be — with someone? i think there would be really _ with someone? i think there would be really unusual. -

with someone? i think there| would be really unusual. not for want of desire, but we have essentially done 20 consultations on one here. some will say well. _ consultations on one here. some will say well, actually _ consultations on one here. some will say well, actually the - consultations on one here. some will say well, actually the nhs i will say well, actually the nhs can't afford to have someone such as yourself spending so much time on one patient when there are so many people who have needs. i there are so many people who have needs-— have needs. i think we can't afford not — have needs. i think we can't afford not to _ have needs. i think we can't afford not to do _ have needs. i think we can't afford not to do things - afford not to do things slightly differently. we need to be able to do both. we are never going to get on top of the reactive work if we are not doing preventative proactive work as well.— doing preventative proactive work as well. just this one on the door— work as well. just this one on the door is — work as well. just this one on the door is open. _ work as well. just this one on the door is open. dr- work as well. just this one on the door is open. dr fulwell l the door is open. dr fulwell reduces mary's _ the door is open. dr fulwell reduces mary's blood - the door is open. dr fulwell i reduces mary's blood pressure medicine, and stops another medication altogether. it's a small change that helps mary and the nhs. how much money can be saved by looking at medication?— be saved by looking at medication? . , medication? over the last 4.5 ears, medication? over the last 4.5 years. we _ medication? over the last 4.5 years. we have _ medication? over the last 4.5 years, we have consistently i years, we have consistently demonstrated that greater than £100 per patient per year cost saving in terms of the reduction in those medications where the risks outweigh the benefits, which can be then

reinvested into other areas of the health system. the centre believes if— the health system. the centre believes if this _ the health system. the centre believes if this was _ the health system. the centre believes if this was adopted i believes if this was adopted across the health service in the uk, an estimated £270 million could be saved on medication alone. mary also sees the saves —— the centre's social worker who can assess if she needs help at home. it is she needs help at home. it is our role to — she needs help at home. it is our role to find _ she needs help at home. it is our role to find out _ she needs help at home. it 3 our role to find out how you are managing everything at home. i are managing everything at home. ., �* ., , home. i don't do the things i used to do. _ home. i don't do the things i used to do, like _ home. i don't do the things i used to do, like chopping i home. i don't do the things i i used to do, like chopping trees down — used to do, like chopping trees down. �* , down. laughter stones _ down. laughter stones and - down. laughter| stones and things down. laughter - stones and things like down. laughter _ stones and things like that. something like this may be a couple of years ago, if she had access to it then, she wouldn't have gone through what she has gone through the last couple of years. gone through the last couple of ears. �* , gone through the last couple of ears. ~ , ., ., years. and she might not have had the falls. _ years. and she might not have had the falls. she _ years. and she might not have had the falls. she might - years. and she might not have had the falls. she might not i had the falls. she might not have had — had the falls. she might not have had the _ had the falls. she might not have had the falls. - had the falls. she might not have had the falls. what - had the falls. she might not have had the falls. what do | had the falls. she might not i have had the falls. what do we want? when — have had the falls. what do we want? when do _ have had the falls. what do we want? when do we _ have had the falls. what do we want? when do we want - have had the falls. what do we want? when do we want it? i have had the falls. what do we i want? when do we want it? now! as winter deepens, _ want? when do we want it? now! as winter deepens, pressure - want? when do we want it? as winter deepens, pressure on the nhs intensifies. they have

been national strikes, staff want more pay. they say they are struggling with the cost of living, exhausted from the pandemic and the demand on services is unrelenting. cheering across england in december, record numbers of patients arrived in emergency departments. amongst the worst was hull, where nearly two thirds were waiting longer than the four hour target to be seen. when 91—year—old richard was feeling unwell, the overstretched gp practice sent him and his daughter alison straight to the emergency department. i straight to the emergency department.— straight to the emergency deartment. ,': ., , department. i was sat 23 hours on the chair. — department. i was sat 23 hours on the chair, we _ department. i was sat 23 hours on the chair, we sat _ department. i was sat 23 hours on the chair, we sat there - department. i was sat 23 hours on the chair, we sat there and | on the chair, we sat there and a&e wasjust on the chair, we sat there and a&e was just absolutely crammed full. a&e was “ust absolutely crammed full. . but a&e was “ust absolutely crammed full. ., but it a&e was “ust absolutely crammed full.�* but it was _ a&e was “ust absolutely crammed full.�* but it was a _ a&e was “ust absolutely crammed full.�* but it was a simple - full. yeah. but it was a simple blood test _ full. yeah. but it was a simple blood test and _ full. yeah. but it was a simple blood test and antibiotic. - full. yeah. but it was a simple | blood test and antibiotic. now, the gene bishops _ blood test and antibiotic. now, the gene bishops medical - blood test and antibiotic. now, | the gene bishops medical team

is investigating his problems further. ., . ., �* further. hello, richard. i've been asked _ further. hello, richard. i've been asked to _ further. hello, richard. i've been asked to come - further. hello, richard. i've been asked to come out. further. hello, richard. i've| been asked to come out and further. hello, richard. i've- been asked to come out and see you about some tests doctors have requested.— you about some tests doctors - have requested._ blood have requested. comment. blood tests found _ have requested. comment. blood tests found a _ have requested. comment. blood tests found a serious _ have requested. comment. blood tests found a serious problem. i tests found a serious problem. the intervention prevented another trip to the emergency department. richard could have collapsed any time. his department. richard could have collapsed any time.— collapsed any time. his salt levels in — collapsed any time. his salt levels in his _ collapsed any time. his salt levels in his bloodstream i collapsed any time. his salt i levels in his bloodstream had dropped dangerously, it could be fatal if not treated, so we had a planned admissions the next day, straight onto the frailty assessment unit at royal infirmary, which was much better for richard royal infirmary, which was much betterfor richard and royal infirmary, which was much better for richard and for his daughter, alison, but also for the system. daughter, alison, but also for the system-— daughter, alison, but also for the system. two weeks later, i no with the system. two weeks later, i go with dr _ the system. two weeks later, i go with dr harman _ the system. two weeks later, i go with dr harman to - the system. two weeks later, i go with dr harman to see - go with dr harman to see richard. go with dr harman to see richard-— go with dr harman to see richard. �* , ., ., go with dr harman to see richard. , ., ., ., richard. because you have had a tou~h richard. because you have had a tough time _ richard. because you have had a tough time of — richard. because you have had a tough time of it. _ richard. because you have had a tough time of it. a _ richard. because you have had a tough time of it. a worrying - tough time of it. a worrying time, really full stop in my career. it time, really full stop in my career. . , , �* , time, really full stop in my career. , �*, , career. it has been, it's been really difficult. _ career. it has been, it's been really difficult. he _ career. it has been, it's been really difficult. he is - career. it has been, it's been really difficult. he is given i career. it has been, it's been really difficult. he is given a| really difficult. he is given a full checkup, _ really difficult. he is given a full checkup, including - really difficult. he is given a full checkup, including an i full checkup, including an ultrasound scan.- full checkup, including an ultrasound scan. there you go,

ten out of _ ultrasound scan. there you go, ten out of ten. _ ultrasound scan. there you go, ten out of ten. absolutely - ultrasound scan. there you go, ten out of ten. absolutely over| ten out of ten. absolutely over the moon- _ ten out of ten. absolutely over the moon. yeah _ ten out of ten. absolutely over the moon. yeah yeah, - ten out of ten. absolutely over the moon. yeah yeah, great. i | the moon. yeah yeah, great. i mighl— the moon. yeah yeah, great. i might even— the moon. yeah yeah, great. i might even go— the moon. yeah yeah, great. i might even go for— the moon. yeah yeah, great. i might even go for a _ the moon. yeah yeah, great. i might even go for a run- the moon. yeah yeah, great. i might even go for a run now! i might even go fora run now! laughter— laughter since the centre opened four years ago, they've treated more than 12,000 mainly elderly people. researchers found all needed fewer gp and hospital visits, but the biggest impact has been anticipating and preventing problems among the four a—lister patients. for four a-lister patients. for those patients _ four a-lister patients. for those patients that - four a—lister patients. fr?“ those patients that are deemed to be frequent flyers, so three or more emergency department visits in the last six months, we have reduced attendance is by over 50%, and that is not by chance. if we can invest time and energy into trying to prevent that episode of acute care ever being needed, than it pays for itself, both in time but financially as well, but more importantly from the patient�*s perspective. so more importantly from the patient's perspective.- patient's perspective. so if ideas like _ patient's perspective. so if ideas like this _ patient's perspective. so if ideas like this can - patient's perspective. so if ideas like this can ease - patient's perspective. so if. ideas like this can ease nhs pressures and improve patient

care, why aren't they being rolled out elsewhere? fine care, why aren't they being rolled out elsewhere? one of the things — rolled out elsewhere? one of the things that's _ rolled out elsewhere? one of the things that's really - the things that's really important is it has facilities and heifers to— important is it has facilities and heifers to amanda blore runs the organisation - and heifers to amanda blore runs the organisation that i runs the organisation that funds and delivers health and care in north yorkshire in humber. care in north yorkshire in humber-_ care in north yorkshire in humber. . , ., ., care in north yorkshire in humber. ., ., humber. we really want to make sure we learn _ humber. we really want to make sure we learn all— humber. we really want to make sure we learn all the _ humber. we really want to make sure we learn all the lessons - sure we learn all the lessons we can from thejean bishop centre, and actually the other services that integrate into that. g . services that integrate into that. . . �* , services that integrate into that. . . m that. the jean bishop centre has been — that. the jean bishop centre has been up _ that. the jean bishop centre has been up and _ that. the jean bishop centre has been up and running - that. the jean bishop centre has been up and running for| has been up and running for about four years was that there are huge pressures now, there is urgency, so why aren't we seeing this happening more often? i seeing this happening more often? ., �* ~' .~' often? i don't think taking it and dropping _ often? i don't think taking it and dropping it _ often? i don't think taking it and dropping it elsewhere i often? i don't think taking it and dropping it elsewhere is exactly the right solution, and i think we've got to empower teams of staff in different places to say what's the right solution here for our population?- solution here for our population? solution here for our --oulation? ., , ., , population? hello, my name is claire, i population? hello, my name is claire. i am — population? hello, my name is claire, i am one _ population? hello, my name is claire, i am one of— population? hello, my name is claire, i am one of the - population? hello, my name is claire, i am one of the nurses. claire, i am one of the nurses on the — claire, i am one of the nurses on the ward. claire, i am one of the nurses on the ward-— on the ward. across england, the nhs is — on the ward. across england, the nhs is encouraging - the nhs is encouraging hospitals to free up beds by treating more patients at home.

it says its virtual awards initiative will ease demand and improve care. initiative will ease demand and improve care-— initiative will ease demand and improve care.- good - improve care. hello. good morning- _ improve care. hello. good morning- i— improve care. hello. good morning. i was _ improve care. hello. good morning. i was your- improve care. hello. good| morning. i was your night? doctors _ morning. i was your night? doctors and nurses monitor the patient's �*s health at home. it is focused on more routine patients who will be visited if needed. nhs england says last month, 10,000 people were treated in this way.— month, 10,000 people were treated in this way. hire, dan. how are you? _ treated in this way. hire, dan. how are you? in _ treated in this way. hire, dan. how are you? in hull, - treated in this way. hire, dan. how are you? in hull, the - how are you? in hull, the taruet how are you? in hull, the target is _ how are you? in hull, the target is for _ how are you? in hull, the target is for about - how are you? in hull, the target is for about 300 i target is for about 300 patients to be cared for like this by the end of the year. what are the barriers to this? staffing, training, funding is an issue. we are essentially talking about a small hospital in the community, and i think anyplace would struggle to deliver those numbers under the current operating models that we have. �* v . , current operating models that we have. �* �*, ., , ., we have. and it's a very tough environment _ we have. and it's a very tough environment for _ we have. and it's a very tough environment for people - we have. and it's a very tough environment for people to - environment for people to change the way they are

working. in 0xford, some of the hospital staff alsojoin working. in 0xford, some of the hospital staff also join the national strikes. what is staff morale like, and how does that fit with what you're trying to do? ~ ., ., , ., fit with what you're trying to do? ., ,., ., do? morale is low, you are riaht, do? morale is low, you are right. but _ do? morale is low, you are right. but it _ do? morale is low, you are right, but it is _ do? morale is low, you are right, but it is also - do? morale is low, you are. right, but it is also unevenly distributed. so the morale in our community work is high, because we are involved in changing an approach. there is an energy and excitement about that. members of the team are learning new technologies and ways of different dynamics that they would not do if they stayed in their traditional roles. , , , , roles. here, this nurses being trained to _ roles. here, this nurses being trained to carry _ roles. here, this nurses being trained to carry out _ roles. here, this nurses being trained to carry out some - roles. here, this nurses beingl trained to carry out some tasks usually done by doctors. ii trained to carry out some tasks usually done by doctors.- usually done by doctors. if you see how far — usually done by doctors. if you see how far you _ usually done by doctors. if you see how far you are, _ usually done by doctors. if you see how far you are, the chesti see how far you are, the chest is a barrel... see how far you are, the chest is a barrel. . ._ is a barrel... one of the hospital _ is a barrel... one of the hospital at _ is a barrel... one of the hospital at home - is a barrel... one of the hospital at home team | is a barrel... one of the - hospital at home team and will soon qualify as an advanced

nurse. ., nurse. tell me about the equipment _ nurse. tell me about the equipment you _ nurse. tell me about the equipment you are - nurse. tell me about the equipment you are using i nurse. tell me about the - equipment you are using out in the road. we equipment you are using out in the road. ~ , the road. we either use the la -to- the road. we either use the laptop or — the road. we either use the laptop or ipad _ the road. we either use the laptop or ipad so _ the road. we either use the laptop or ipad so we - the road. we either use the laptop or ipad so we can i laptop or ipad so we can communicate using hospital systems. we have a machine that can deal— systems. we have a machine that can deal with the bloods at home _ can deal with the bloods at home and get results in two minutes— home and get results in two minutes was the— home and get results in two minutes was the that so clever. it is. we love _ minutes was the that so clever. it is. we love gadgets! - it is. we love gadgets! increasing the skills across the health and care workforce is critical for delivering this kind of hospital at home care. used to work on busy general wards. what are the things you find work better this way? i found i have more time to spend with my patient and listen with them and know what they need. what difference does that make? the patients think we listen to them and they are always thinking, oh, you deliver much nicer care to me and that means a lot to them.

nicer care to me and that means a lot to them-— a lot to them. and the health service of— a lot to them. and the health service of the _ a lot to them. and the health service of the future - a lot to them. and the health service of the future will- a lot to them. and the health | service of the future will need to work better for a much wider range of patients, as well as people living to an older age, there are more young people with complex health conditions. how is he? he with complex health conditions. how is he?— how is he? he has not been too bad. how is he? he has not been too bad- she _ how is he? he has not been too bad- she has — how is he? he has not been too bad. she has come _ how is he? he has not been too bad. she has come to _ how is he? he has not been too bad. she has come to see - how is he? he has not been too bad. she has come to see will i bad. she has come to see will and his mum _ bad. she has come to see will and his mum wendy. - bad. she has come to see will and his mum wendy. he - bad. she has come to see will and his mum wendy. he is - bad. she has come to see will| and his mum wendy. he is the oxford team's youngest patient. 0xford team's youngest patient. did you enjoy your birthday yesterday?— did you enjoy your birthday esterda ? ~ ., , , yesterday? will has “ust turned 19 full stop * yesterday? will has “ust turned 19 full stop he _ yesterday? will has “ust turned 19 full stop he has _ yesterday? will has just turned 19 full stop he has a _ yesterday? will has just turned 19 full stop he has a rare - 19 full stop he has a rare genetic muscle condition. he is doing computer studies at couege doing computer studies at college and wants to be there, not in hospital. the college and wants to be there, not in hospital.— not in hospital. the last time that will have _ not in hospital. the last time that will have to _ not in hospital. the last time that will have to go - not in hospital. the last time that will have to go into - that will have to go into hospital to stay, how tricky was that? it hospital to stay, how tricky was that?— and you couldn't sleep. for someone _ and you couldn't sleep. for someone who is an adult —like wheel— someone who is an adult —like

wheel but _ someone who is an adult —like wheel but is actually still quite _ wheel but is actually still quite young at heart, it felt inappropriate to his needs. i think— inappropriate to his needs. i think it _ inappropriate to his needs. i think it was noisy, it was scary, _ think it was noisy, it was scary, it— think it was noisy, it was scary, it wasn't as scary as the _ scary, it wasn't as scary as the other— scary, it wasn't as scary as the other one? rennes no. it wasn't — the other one? rennes no. it wasn't scary. yeah it wasn't scary, — wasn't scary. yeah it wasn't scary, oh. _ wasn't scary. yeah it wasn't scary, oh, 0k. it was for me. if potassium levels in well's if potassium levels in well�*s blood drop too low, it affects the rhythm of his heart and thatis the rhythm of his heart and that is when he ends up in hospital. last year he spent a total of 16 nights there, and had 18 outpatient visits for blood checks. now, that happens at home. , ., , blood checks. now, that happens at home. , . , ., at home. everything falls apart when your— at home. everything falls apart when your potassium level - at home. everything falls apart when your potassium level is l when your potassium level is rare, doesn't it? that's right. the news is good.— rare, doesn't it? that's right. the news is good. great. then we can come _ the news is good. great. then we can come and _ the news is good. great. then we can come and check- the news is good. great. then we can come and check it - the news is good. great. then| we can come and check it again in two — we can come and check it again

in two weeks. but we can come and check it again in two weeks-— in two weeks. but well also needs nursing _ in two weeks. but well also needs nursing care - in two weeks. but well also needs nursing care night i in two weeks. but well also i needs nursing care night and day. with one in ten nursing jobs in england unfilled, finding nurses to visit is really difficult, leaving his family to provide nearly all of his routine care. we family to provide nearly all of his routine care.— his routine care. we are only averaging — his routine care. we are only averaging about _ his routine care. we are only averaging about i _ his routine care. we are only averaging about i think - his routine care. we are only averaging about i think one i his routine care. we are onlyl averaging about i think one to two days a week at most, usually one. 50 two days a week at most, usually one.— two days a week at most, usually one. so there is a big 1 a . usually one. so there is a big aa- in usually one. so there is a big gap in their— usually one. so there is a big gap in their services? - usually one. so there is a big gap in their services? it - usually one. so there is a big gap in their services? it is i usually one. so there is a big gap in their services? it is a i gap in their services? it is a big gap- — gap in their services? it is a big gap- month _ gap in their services? it is a big gap. month on - gap in their services? it is a big gap. month on month, | gap in their services? it is a - big gap. month on month, year on year, it is quite exhausting. the government says there are record numbers of doctors, nurses and other staff working in the nhs, that it is tackling the pressures and investing up to £7.5 billion in social care over two years, as well as improving training and

recruitment. change can be difficult in an organisation the size of the nhs, particularly at a time of crisis, but the doctors and nurses we have met billy building more services around patients at home is better for them, betterforstaff, patients at home is better for them, betterfor staff, and them, better for staff, and inevitable. them, betterfor staff, and inevitable. bill them, better for staff, and inevitable.— inevitable. all change gets resisted and _ inevitable. all change gets resisted and it _ inevitable. all change gets resisted and it is _ inevitable. all change gets resisted and it is a - inevitable. all change gets | resisted and it is a complex business to understand how you can innovate and change in a stressed environment but i think of the matter is where that innovation is most needed. how we want our health care to be, personalised, responsive, and still being able to make a difference, notjust of health care level, but also at a thriving and quality level. to achieve that, solving deep rooted staffing shortages will be key. if that doesn't happen, the danger is the health and care system continues to lurch from crisis to crisis.

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