NHS crisis: The medics trying to fix the health service

The wellness work is successful urgent request of assistance with doctors informing that unprecedented pressures could outgo lives. Ambulances are queuing extracurricular hospitals, exigency departments are packed and exhausted healthcare unit person much strikes planned. So bash we request to bash things otherwise to hole the NHS?

The authorities says the NHS has grounds numbers of unit and that it is tackling the pressures - including providing further funding. But currently, galore different records are being breached successful England's wellness and attraction strategy for the incorrect reasons. The latest NHS Digital figures show:

Even astatine a clip of crisis, determination are doctors and nurses rethinking healthcare.

BBC Panorama has been to Hull and Oxford wherever they are identifying problems early, and taking infirmary attraction straight into people's homes.

"We've fundamentally done 20 consultations successful 1 here," says Dr Anna Folwell, arsenic she finishes a aesculapian consultation with 83-year-old Mary.

Rather than the rushed 10 minutes that's much accustomed successful the NHS, Dr Folwell has spent much than an hr with Mary - who is having a full-body and beingness MOT astatine the Jean Bishop Integrated Care Centre successful Hull.

During her day-long visit, Mary besides sees a nurse, pharmacist, physiotherapist, occupational therapist and societal worker.

The NHS-funded centre is simply a one-of-a-kind hub that tries to expect and forestall problems among radical who are frail - astir of them are elderly.

In the UK, determination are astir 3 cardinal radical who tin beryllium described arsenic frail - that's astir 4% of the colonisation - and research suggests they necessitate astir 40% of each infirmary beds and GP resources.

Doctors, paramedics, and immoderate wellness oregon attraction work successful the country tin notation idiosyncratic here. Mary was sent by her GP aft her 3rd autumn successful the past year.

"I've ne'er seen her look truthful frail. She'd been laid connected the level for a while," says Mary's daughter, Jackie, who has accompanied her.

"Frail? I looked frightful. Blooming 'eck!" adds Mary.

Usually, doctors lone person a partial presumption of someone's aesculapian history, but Dr Folwell has entree to each Mary's GP, infirmary and societal attraction records.

She concludes that Mary's humor unit pills whitethorn beryllium expanding her hazard of falling. She adjusts the dose and removes different medicine altogether.

The centre says these reviews consistently prevention much than £100 per diligent per twelvemonth - removing medications wherever the risks of continuing them outweigh the benefits for the patient.

It believes if that was replicated for each frail radical crossed the UK, it could prevention astir £270m annually - wealth which could beryllium reinvested successful services.

The centre's societal idiosyncratic sees Mary to measure if she needs much assistance astatine home. She besides provides accusation astir clubs and time centres, arsenic loneliness tin summation the hazard of dementia and mediocre health.

Dr Folwell and Dr Dan Harman acceptable up the Jean Bishop centre. Both are advisor assemblage geriatricians - they specialise successful the attraction of older people.

Twelve 1000 patients person travel done the centre's doors successful the 4 years since it opened. They person needed less GP and infirmary visits, but the biggest interaction has been among immoderate of the frailest patients.

"For those patients deemed to beryllium predominant flyers - 3 oregon much exigency section attendances successful the past six months - we trim those attendances by implicit 50%," says Dr Harman.

The NHS is successful a captious condition. The BBC's societal affairs editor, Alison Holt, assesses the innovation and caller ways of moving that mightiness connection the NHS the lifeline it needs.

"The biggest happening is trying to explicate to idiosyncratic who is feeling unwell, wherefore it is OK for them to beryllium astatine location feeling unwell," says Dr Jordan Bowen.

"It's a monolithic alteration successful thinking."

Dr Bowen says galore patients, peculiarly those who are older, volition get amended quicker successful an situation they know.

He runs a portion astatine the John Radcliffe Hospital successful Oxford that tries to get people, who get arsenic emergencies, location the aforesaid time safely.

They spot astir 70 radical a time - 95% volition spell home.

Many hospitals person akin units - but here, they are going a measurement further.

They privation to trim the fig of radical who request to spell to infirmary successful the archetypal place, by providing high-level attraction astatine home.

"The infirmary is afloat astatine the moment, 110% full," Dr Bowen says, studying a surface that shows the patients waiting successful A&E.

He turns to Prof Dan Lasserson, who is lasting beside him. "Could we get you and the hospital-at-home squad to spell out?" helium asks.

Prof Lasserson was 1 of the archetypal doctors successful the state to commencement delivering this benignant of infirmary attraction successful people's ain homes.

Like Dr Bowen, helium is simply a advisor specialising successful the attraction of older people.

Paramedics, GPs and the John Radcliffe's ain specialists alert the hospital-at-home squad if determination is simply a diligent who needs aesculapian care, but would payment from being astatine home.

Prof Lasserson has besides been asked by a bosom specializer to sojourn the location of 91-year-old Ted - who fell past week. A furniture has been moved into the family's beforehand room, and Ted's woman and girl are looking aft him.

"I consciousness rotten," says Ted, who is uncovering breathing hard - but doesn't privation to spell to hospital.

New exertion means Prof Lasserson tin present dainty overmuch sicker radical successful their ain homes.

He plugs a tiny ultrasound scanner into his mobile telephone - and scans Ted's heart, lungs and kidneys. Black and achromatic images connected the surface amusement a build-up of fluid astir his interior organs.

They besides amusement his bosom is not pumping properly. "This isn't squeezing precise good astatine all, this near ventricle," says Prof Lasserson. "That's the problem."

Rapid humor tests are done and Ted's bosom bushed is besides monitored. All portion helium is sitting successful his armchair.

He is fixed intravenous drugs to assistance get escaped of the excess fluid and a catheter is fitted.

Within a mates of hours, helium has had attraction that would antecedently person taken visits to respective antithetic infirmary departments and astir apt a enactment connected a ward.

Researchers estimation providing a diligent with infirmary attraction astatine location costs astir fractional that of providing the aforesaid attraction and attraction connected a ward.

Nationally, the NHS is rolling retired an inaugural called "virtual wards". Technology is utilized to show patients, who request much regular attraction astatine home. They are visited if needed. The NHS says past period much than 10,000 patients were cared for successful this way, easing unit and reducing request connected hospitals.

In Ted's case, a caregiver oregon paramedic volition sojourn him each time astatine location - but, arsenic helium is not successful hospital, the assistance helium needs with day-to-day tasks falls to his family.

His daughter, Gill, returned from her location successful France 2 months agone to help, but she has to spell backmost successful a week's time.

"My mum has mobility problems and equilibrium issues, truthful often toileting and washing she can't do," says Gill. "She can't transportation connected doing what she's doing."

In the end, his household was lone capable to get a small societal attraction help. They accidental it wasn't enough. Ted was yet moved to hospital, past to a hospice, wherever helium died a fewer weeks later.

If the Oxford "hospital-at-home" inaugural is to beryllium rolled retired much widely, families volition request much enactment successful the community.

The authorities says determination are 35,300 much doctors and 47,100 further nurses moving successful the NHS now, compared to 2010.

But determination remains significant shortages of GPs and district nurses. And the societal attraction system, which supports radical successful their ain homes and successful attraction homes, is besides buckling.

"We're nary antithetic successful Oxfordshire. We are truly struggling with the demand," says Stephen Chandler who runs the region assembly - which cover's Ted's area. He is besides erstwhile president of Adass, the relation which represents the radical moving section authorization societal attraction successful England.

He says councils are doing everything they tin to supply support, but to tackle unit shortages, attraction workers person to beryllium valued and paid more. Most gain conscionable supra the minimum wage.

The Department for Health and Social Care (DHSC) says it is investing £7.5bn into big societal attraction implicit the adjacent 2 years, including improving grooming and recruitment.

In some Oxford and Hull, alteration has been driven by determined doctors and determination was vigor and enthusiasm among staff.

Nurse specializer Yun Ody from the Oxford squad utilized to enactment connected a engaged infirmary ward. She prefers seeing patients successful their homes, due to the fact that she has clip to get to cognize them. "You tin perceive to them and cognize what they need," she says..

Patients we met were fixed invaluable clip that resulted successful problems being picked up early, emergencies being avoided, oregon radical being capable to person their attraction astatine location surrounded by family. It gave them choices.

But astatine a time, erstwhile the NHS and the attraction strategy are facing specified immense demand, galore volition question however realistic oregon imaginable it is to standard up projects similar this.

The doctors successful Hull and Oxford would reason we can't spend not to bash things differently.

Tackling unit shortages volition beryllium key. And if that doesn't hap past the information is the wellness and attraction strategy volition proceed to lurch from situation to crisis.

Photography by Tom Pilston