HOSPITAL - BBC documentary

BBC Two: HOSPITAL

Imperial College Healthcare NHS Trust features in a new documentary, following staff and patients at its hospitals, to be broadcast on BBC Two from Wednesday 11 January

We have given BBC Two unprecedented access to our five hospitals and the key decision makers within them, as they make life changing decisions and work to transform and improve services for the future.

Hospital, a six part series, is a ground-breaking documentary that goes behind the scenes of one of the largest and busiest NHS trusts in the UK.

Two patients await life-saving surgery at St Mary's in Paddington, the biggest of five hospitals in the Trust. They both need a bed on the intensive care ward. But the hospital is full to capacity and there is only one bed left.

67-year-old Simon needs an operation to remove a cancerous tumour from his oesophagus. As he is being prepped for surgery, St Mary's takes a call from an ambulance speeding to London. In the back is 78-year-old Janice. She is being 'blue lighted' to St Mary's with a ruptured aneurysm in her aorta and is less than six hours from death. If she arrives alive, and survives the surgery, she will also need a bed in intensive care.

Surgeons Professor George Hanna and Richard Gibbs, who are slated to carry out the operations, are at the centre of this film. They attempt to do the right thing for both patients in a complex life-and-death situation where two into one just won't go. In a world where beds are at a premium, operating can seem like the easy part. Simon has had his cancer operation cancelled once already and, having completed extensive radiotherapy and chemotherapy, needs his surgery to be completed soon. The consultant in charge of the Intensive Care Unit is also feeling the pressure. It is down to him to make the difficult decision about who to admit for surgery.

In this episode, with nearly all of St Mary's 297 beds occupied, the hospital must discharge patients before any new ones can be admitted. While the hospital tries to discharge patients, new ones continue to arrive. Peter Lai, a 60-year-old retired software engineer, arrives at the hospital for a lifesaving operation on an aortic aneurysm in his chest. St Mary's is a centre of excellence for vascular surgery and this is one of the biggest operations they carry out. It has taken two months to co-ordinate the diaries of the expert team, led by consultant Colin Bicknell. But unless the hospital staff can clear a bed for him, Peter's operation won't go ahead.

Discharge nurse Sister Alice Markey is trying to discharge a homeless Polish man, but until she can find a translator to explain what will happen to him when he leaves St Mary's, the man will remain in a hospital bed. Alice says: 'The pressure that's on the NHS, you worry about it because the walls are not elastic and the demand is high... But you have to look after the patients, whether they come from Buckingham Palace or the park bench.'

Another patient the hospital needs to discharge is 91-year-old Dolly. After breaking her ankle, Dolly has been in hospital for three weeks while she waits for a place in a rehabilitation centre. Dolly laments: 'They're so short of beds... but then I have to have somewhere to go where I'm going to be safe. I feel guilty because I've got nowhere else to go.'.

After collapsing at work, 48-year-old crane driver Phil is becoming increasingly paralysed with each passing day. Kevin O'Neill, one of the country's leading brain surgeons, diagnoses him with a fast-growing brain tumour and decides to perform a potentially life-threatening operation to remove it. But as the clock ticks, securing theatre time for Phil is not straightforward in a hospital approaching full capacity.

O'Neill and his colleagues deal with some of the country's most complex and challenging neurological cases. Their work is so in demand, the department has one of the longest waiting lists in the country. But the hospital is determined to clear the backlog of patients - some have been waiting for their operations for over a year. The pressure is on for O'Neill and his team to get through a packed list.

At the same time, the Trust is pioneering a form of non-invasive brain surgery that replaces knives and drills with MRI-focused ultrasound waves. Consultant neurologist Dr Peter Bain says: "The first time I saw an operation like this was on Star Trek". One of his first patients is Selwyn, a 52-year-old painter and decorator with an uncontrollable tremor. If successful, Selwyn's operation could pave the way for significant reductions in brain surgery recovery times and potentially reduce patient waiting times for some brain surgeries.

A woman from Nigeria recovers in the hospital after going into premature labour with quadruplets, having fallen ill on a flight. Only three of her babies survived the dangerously premature births and they are now being cared for in Neonatal Intensive Care. She receives a visit from the hospital's overseas officer Terry, whose job it is to prepare her for a huge bill. Because she is not a British resident, she must pay for the care that she and her babies are receiving. The cost of such specialist care quickly tops £100,000 and looks likely to rise to half a million pounds during their stay. Terry explains that, despite her distressing predicament, it is a legal requirement for the hospital to collect the money the NHS is owed.

'We have to start raising invoices on a weekly basis. She has three babies in ICU. So that's £20,000 a week for each baby, plus her own charges as well... You have to distance yourself emotionally. Otherwise you wouldn't get the job done.'

The woman is just one of a number of overseas patients who are receiving lifesaving care and from whom the hospital must now try to recoup money. Although emergency treatment given in A&E is free, non-UK residents who are admitted to a ward have to be billed.

Terry also needs to charge Sonia, a 56-year-old woman from the Philippines who suffers heart problems while visiting her sister, who is a UK resident. Cardiothoracic surgeon Rex Stanbridge saves her life, but she suffers complications and needs a bed in Intensive Care - costing thousands of pounds per day.

In 2015/16, the Trust's overseas patient charges were £4million, with Terry's team managing to collect £1.6million. Despite carrying a credit card machine to take on-the-spot payments, Terry finds it hard to get many patients to pay up.

This episode looks at pioneering treatments for some of the oldest and youngest patients in the hospital.

A 98-year-old man arrives at Hammersmith Hospital for a landmark heart operation. John is the oldest person surgeons have ever carried out the procedure on. The operation known as TAVI (Transcatheter Aortic Valve Implantation) is offered to patients who are deemed not suitable for open heart surgery. An artificial valve is inserted through an artery in the groin, up through the body and into the heart. Without the op, John has been told he has only a 50 per cent chance of surviving the next six months.

The operation gets under way, but things don't go to plan and soon another surgical team from a different hospital within the Trust is drafted in to save John's life.

The clock is also ticking for 18-year-old Debbie at St Mary's Hospital, home to the Trust's specialist paediatric centre. Debbie is about to have a life-saving bone marrow transplant which could cure her of sickle cell disease. She has already had a number of strokes as a result of her condition and without the transplant her outcome looks bleak. Imperial is one of only a few trusts in the country where they transplant with a 50 per cent match, and her brother Sam has agreed to donate his bone marrow to save her life. 'Anything I've done up to this point means nothing compared to when you can give a bit of yourself to save someone else. Now that's responsibility', he says.

Currently, the groundbreaking treatment Debbie will receive is only offered to patients under the age of 19. Leena Karnik, consultant pediatric haematologist, tells us, 'We don't know how things are going to pan out in the future, but it's certainly known that this is Debbie's last chance'.

In this episode, surgeons are forced to use unconventional methods to get their operations completed against the odds.

At Hammersmith Hospital, 31-year-old Jennifer is taking part in a groundbreaking scheme to overcome the five-year wait on the deceased kidney donor list. Jennifer is a live donor and will save her husband Elliot's life by donating her left kidney. Elliot has just five per cent kidney function and is being kept alive by dialysis. Because Jennifer isn't a blood type match for Elliot, she will pool her healthy kidney into a sharing scheme with other donors. After it is harvested, Jennifer's kidney will be couriered to another hospital to be transplanted into a stranger. Elliot will receive a kidney from another anonymous donor elsewhere in the UK.

In St Mary's, 84-year-old Betty arrives to have her bowel cancer removed by colorectal surgeon George Reese. After the operation, she will need a high-dependency bed, but the hospital is on red alert and there is no bed available for her to recover in. George Reese has to decide whether it is safe to go ahead with her operation, knowing that she will have to stay in the operating theatre recovery area after her procedure, rather than on a ward.

After a year and a half on the waiting list, 41-year-old Daniel is booked in for weight-loss surgery with the Trust's leading bariatric surgeon, Mr Ahmed. At a 60 per cent cancellation rate, bariatric patients are the most likely to have their operations delayed due to lack of post-operative beds. To ensure Daniel gets his life-changing surgery, Mr Ahmed has sought approval to use NHS money to buy beds in The Lindo Wing, one of Imperial's private hospitals.