"This is a film about flesh and blood..." "Our flesh and our blood." "NYE BEVAN:" "What I had in mind when we organised the National Health Service..." "Should be made available to people when they needed them irrespective of whether they could afford to pay for them or not." "Because of the NHS, until now, no-one born since the end of the war has had to worry who would pay the bills when they get sick." "But even in the best of times, there were always voices saying that free medicine for all was too good to be true." "The pressure is mounting on a service struggling to meet demand." "We are facing a crisis." "Too many patients..." "How long can this utopian situation go on?" "Too little money..." "The health service has now reached a tipping point." "We've heard it all before." "This is an absolute crisis in the NHS." "It used to be thought the NHS was too big to fail." "Not any more." "Today the NHS is looking down the barrel of a gun." "Everyone knows that it's in trouble." "The question is, does anyone know how to save it?" "Simon Bowers - born in Liverpool, studied medicine in Liverpool and now a Liverpool doctor in the front line of the battle to save the NHS." "This was the finest, most advanced western hospital in the world - all driven by Florence Nightingale." "The compassion, the good care, the cleanliness - this bright, airy design with the big windows." "Long before the NHS, Florence Nightingale's wards in Liverpool's old Infirmary pointed the way towards what a health service for all might look like." "An ideal with hospitals as great citadels at the centre of the system." "When the NHS was born, the goal was to take people who were sick and try and make them better." "The pattern of disease was very different." "Now, such are the demands on the service, such has been the change in the way health care needs to operate to reflect the changing population." "The focus of the National Health Service has to change and if the English National Health Service continues to deliver the way it delivers now... it will die." "The NHS is a colossus." "You take all the police, all the teachers, all the sailors, soldiers and airmen of the country and you still have only half of those who work for the NHS." "Every day an army ten times the size of D-Day is set to the task of keeping Britain healthy." "But even this turns out not to be enough." "How many?" "30 at worst but I haven't smoked this week." "Why did you do that?" " Did you mean to do yourself any harm?" " Yeah." " Do you still feel like that?" " Yeah." "An ageing population, a rising tide of long-term conditions - diabetes, cancer, dementia, heart disease, breathing problems and depression." "So, A  E..." " Full." " Beds?" " Seven hours..." "Day and night, the struggle to find beds for patients arriving at A  E." "Critical care, two." "Into hospital, zero." "Zero capacity in AMU at the moment." "Our longest wait is eight hours." "Over 70% of the NHS budget is devoured by people with long-term conditions." "The pressure is felt throughout the system." "Good morning, come in, take a seat." " How are you?" " It's that pain." "Thanks very much." "Come in and take a seat." " Your elbow's stiff?" " Yeah." "I can't go to sleep." "Everything keeps going round and round in my head." "How's it going?" "MOUTHS RESPONSE" "Every day, 2.5 million prescriptions." "Every day, 30,000 operations." "Every day, three quarters of a million patients." "Every day, another £400 million spent." "And behind everything, the most alarming statistic of all..." "EMERGENCY SIRENS" "Without radical change in five years' time, the NHS in England will be overspending to the tune of £30 billion a year." "The deficit alone is enough to pay for the Army and Navy put together." "At the top of the NHS, they know that no-one is going to find that kind of money." "Something's got to give." "It's that perfect storm - an ageing population that are getting sicker..." "..in a time when we're in the grip of a financial recession." "There isn't an answer that doesn't involve a complete and total revolution in the way we do business." "In Liverpool, the revolution has already begun." "For nearly 200 years, this city has been one of the unhealthiest places in the country." "NHS professionals, social workers, local officials, representatives from the voluntary sector, public health, the entire spectrum of the health establishment, have joined forces to launch Healthy Liverpool to solve the problems of an unhealthy city..." "..and a sick NHS." "Doctors like Simon Bowers," "Samih Kalakeche, heading up the social workers." "Joe Anderson, the Mayor." "Locally he's got the reputation of being something of a bruiser but he is recognised as a driving force behind the change." "We've got an ageing population that has increased need and we've got this issue around health and inequalities." "This is our once-in-a-generation opportunity to finally do something." "Let's take our central patient." "Our Terry, the Scouser that lives somewhere in the north in Liverpool and who has a number of long-term conditions and is potentially in and out of hospital because of lack of support." "Through Healthy Liverpool, we are keeping people healthy before they get ill." "If we then have to react to when they become unwell, we will react close to them, close to home to keep them where they are, where they want to be." "If we don't do that, he'll go into hospital four times and this system is unsustainable because the number of our Terrys is growing." "It is ambitious." "It is not going to be easy." "It's cultural change." "The separation between social services and the NHS needs to disappear." "We need to be seeing one care system, one entry into services and one way of delivering the services." "Unless we work very differently, we will not be able to care for people in the future the way we do now." "It is a visionary plan - an all-out attack on unhealthy lifestyles, combined with a massive shift of care from hospitals into the community." "What I will say to you, what I will make absolutely no apologies for saying to you is that I want action on everything and I want speedy action." "I'll be looking for serious progress." "This is a complete and utter change of the way that care will be delivered to the people who live in this city." "This is Vauxhall in Liverpool, heartland of the old docks, historically one of the unhealthiest places in one of the unhealthiest cities in Britain." "In Liverpool's Vauxhall, people don't live as long as in Vauxhall in London." "They live ten years less than people in the posher parts of Liverpool." "It's a tough area." "A lot of unemployment, not much money." "A lot of health problems." "As a GP, Vauxhall has been Phil Cumberlidge's patch for the past ten years." "And if the NHS is facing the perfect storm, the surgery at Vauxhall is ground zero." "MAN GROANS" "So, how are you doing?" "The doctor has sent me a letter." " He wants me to go in hospital." " Which doctor?" "The mentally ill doctor." " Now, though, this week." " OK." " For eight weeks." "Because he said something about the front part of me brain" " is not working." " OK." "Taken as a whole," "Phil's patients get ill more often, more seriously and younger than patients elsewhere." "The diseases of smoking, drinking, poor diet type conditions are going to be more prevalent here." "But this isn't just what is going on in an area like this, this is going on everywhere." "So maybe not to the degree of here, but it's going on everywhere." "Ian Ross is 59, he's got heart trouble and without a major bypass operation, he's in serious risk of having a heart attack." " Come in, take a seat." " Ta." "Where are you up to with the heart?" "The heart is scheduled for March 4th." "It's five vessels, is that right?" "It's four definitely, but I think he said he's secretly hoping to go for his record," " which is six." " Right." "And how do you feel about going for this big operation?" "It has to be done, and, you know, everybody tells me that once you've had it done, you'll feel a whole lot better." "Yeah, looking after the op... health-wise...we need to look at a few things, don't we?" "Your lifestyle." "Is there anything that you could be doing?" "I don't own a chip pan or a frying pan." "I don't drink to excess." "Erm..." "I suppose the other thing we need to look at, as well, there's a high risk of you becoming diabetic and the biggest... driver of that is going to be your weight." " Are you calling me fat or what?" " A little bit." "It's not as though I sit around eating junk food all day." " Cos I don't, you know?" " But we could look at this." "It's just thinking for the future." "OK." "Let's just see how much you weigh." "OK, 18 and a half." "I have no idea how that compares to anybody." "OK, so that puts your BMI at 30.6, which is the... ..obese category." "Well, yeah, I mean, I've always been technically obese, cos I'm six foot five." "On that curvy graph..." " It is weight by height." " I don't feel obese." "I..." "Yeah, but it's just..." "At that number, it does put you at a higher risk of having things happen, so we'll look at that again, but... that's something I want to work on, as well as getting your heart sorted out." "Don't panic." "I never panic, as you well know." " Only when Everton are losing." " Which is a lot." " Which is quite a lot at the moment." " I must say, I'm not disappointed." "You wouldn't be, would you?" "You wouldn't be." " Right, OK, then." " So I'll see you next week." " OK." "There's a good chance that over the next five years, he'll become diabetic, and then he's got that as well as clearly heart disease, as well." "There's a huge risk of ongoing health problems there - that combination is not a good one." "High cholesterol, high blood pressure, heart disease..." "Most of those are something you can do something about." "And that is lifestyle." "I think he is typical in that way." "He's got a big year coming up, you know, this is huge, major surgery." "There's always a small chance that something could happen that you don't want to happen." "So I can't even take Hook to the hospital?" " No." " He might like to go to the hospital." "No, I don't like going to hospital." "No, I don't, either." " Be that Peter Pan." "Be Peter Pan." " OK." " So you're not going to come and see - me, then?" "Yeah." " You are?" "This has got water in it." "'It's not as though I can blame myself for what's happening, 'cos I don't, I think it's just bad luck.'" "I used to be super fit." "I mean, I played football, like we all did, I was super fit, but, I mean, as you get into a work environment..." "I'm a journalist." "You know, there are temptations when you're a journalist - there's always good company, there's good wine, there's good beer, there's cigarettes, there's whatever you want, really, and you work hard and you play hard, and I've always done that." "So I don't actually have any regrets at all about the way that I've run my life." "You know, I've got my age and this is the first major, major problem" "I've ever had." "You will never be able to catch me, because I'll be up in the sky." " Peter Pan?" "!" " Yes?" " Come down here." " You can't fly, can you, Hook?" "'I've got two kids, you know, and two grandkids.'" "I know how worried they are." "And that concerns me more than myself." "'It has brought home to us all how important he is to us." "'When I was very little... 'that's how I always see him, 'is this very big, strong, solid person.'" "As long as he's there, we sort of feel reassured." "'It's difficult.'" "Give it to Mummy." "It's a very difficult time for me." "But it's probably more difficult for my family than it is for me." "'They are the nucleus of my entire life.'" "What's that?" "Is that Tinker Bell?" "For Ian, what's happening is bad luck." "For his doctor, lifestyle is in there somewhere." "But these days, when it comes to lifestyle," "Healthy Liverpool has got a story to tell." " RADIO:" "Call Roger." " 0151 709 9333." "BBC Radio Merseyside." "Yes, that's the number to ring." "And in the studio with me is Dr Simon Bowers, GP, vice-chair of Liverpool Clinical Commissioning Group, who's here to take your calls about how you can help the NHS." " Thank you for coming in, Simon." " It's my pleasure, Roger." "How can we help the NHS?" "Taking care of ourselves?" "The new message is that doing little bits of what keeps you well prevents immeasurable harm." "People will be surprised to hear that 30 minutes walking five times a week reduces risk of heart attack or stroke more than any pill I can prescribe." "And over the next, kind of, six to 12 months," "Healthy Liverpool are going to be going out in a big, big way and engaging people in this city around living well and staying well." "Our next caller is Pat from Eastham." "Hello, Pat." "Oh, hello, Roger, I'd like a lot more joined-up thinking..." "'The only way to make this system sustainable 'is to have a completely different conversation 'with the public about health." "'We've got a National Health Service 'that at the moment patches people up when they're sick." "'And that's what the vast majority of people out there believe 'the NHS is there for." "'Now we can't carry on doing that, 'because if we don't start to involve ourselves more 'in keeping people well, 'then the National Health Service 'as a reactive patching-up illness service can't survive.'" " RADIO:" " Simon, thank you very much indeed for coming in." "Very good to speak to you." "Been a pleasure, Roger, cheers." "The crisis in the NHS is a crisis of numbers." "Over half the Liverpool budget is spent on hospitals, and there the numbers are telling their own story." "Two thirds of arrivals in A  E are over 65." "..said you've had a bit of a fall?" "Or you slipped off the bed?" "'That's fairly typical of a lot of the older patients we see.'" "I've been practising for 20-odd years now and I'm seeing more older, frailer people." "A quarter of people in hospital beds are suffering from dementia." "As people get older and frailer, they will utilise... health care." "It was like pressure, just up from there to there." "Any history of angina at all?" "No, nothing." "The average age of a patient in a hospital bed is over 80." " Coughing blood." " Coughing blood?" "OK." "What the numbers are saying is that overwhelmingly the NHS crisis is a crisis of ageing." "Once the patient's dealt with, they need to leave the hospital, go to..." "Again, it has to be a place of safety, where there's a social care package sorted." "And if they're struggling to get patients out, you're struggling get them in." "You can't stop people getting old, but if you can't treat them in hospital, then you must find ways of looking after them outside the hospital." "And, for Phil, this means anticipating what might go wrong before his older patients turn up at A  E." "John has been living alone since his wife died." "He's just really declined." "He had a fall just two or three weeks ago." "It could also be a sign that he's starting to just generally become more frail." "He could end up being taken into hospital, which is the worst place that he could be, really." "And that's why we're seeing him a lot more at the moment." "John is 91." "A frail heart, a history of prostate cancer and a recent fall all indicators that are making Phil more watchful." " How are you?" " Nice to see you." "You too." "Doing well with that." " It is handy." " Yeah, you look a bit more steady on your feet." "How are you?" " Puffed." " Yeah?" "Erm..." "I haven't been out." "I just don't like the idea of..." "I just couldn't do it." "You know, to go out, say, into town..." "You were very active, weren't you, not so long ago?" " So it's a big change, isn't it?" " Oh!" "It was, I must admit." "I never..." "Well, I never, ever thought I'd be housebound, if you like." "But..." "Perhaps the odd thought that I did have, and I used to think," ""Oh, no..." But it doesn't bother me now." "That's what I was going to say, does it not bother you?" "Not really, to be honest." "I'm just trying to think, we seem to have got..." "We've got the nurses looking after your legs, you've had the heart failure team coming in about your heart." "So I think we're just about on top of things, aren't we?" " Aye, hopefully." " You can't have any more things wrong with you." "You're not allowed, OK?" "JOHN LAUGHS" " No." " Would you mind if I checked your blood pressure?" " Are you breathing OK?" " It's..." "It's..." "It's just the same, to be quite honest." " As long as I don't, sort of, rush, if you like." " Yeah." "Blood pressure's fine." " OK." "Bye-bye." " Cheerio." "I think I'll stay here as long as possible." "And especially when I think back, er... ..and see some old photographs." "I was lucky at meeting Joan." "And, well... one thing led to another and two years later we married and we had a very, very good life together." "John's gone from being active, independent to now being very much housebound, and the change in that has been dramatic, and what you are concerned about is not that six months that has happened, but what's going to happen in the next six months." "And the worry is that when somebody like John gets that ill that quick, then it's a start of very quick downwards trend." "There's a letter there from the, er..." "Queen when we were 60 years married." "And that picture there on your left, that's the last one of us." "But, erm..." "I'm just thankful for all... the years." "Yeah." "What to do about John and all the other Johns?" "Keep John away from hospitals, says Healthy Liverpool, unless absolutely necessary." "Not only is hospital expensive but hospital is bad for him." "Two thirds of all hospital admissions occur in people over 65 and that will get worse if we don't do anything about it." "Furthermore, they stay in longer." "If you're over 75 and you're in hospital for seven days or more, you lose 14% of your muscle mass which is the equivalent of ten years of ageing." "Mid-November." "The Liverpool Clinical Commissioning Group." "Three years ago, local GPs took over control of NHS finances." "The outcome here has been the Healthy Liverpool programme." "Simon Bowers is the group's vice chair." "'The entire opportunity hangs on me 'and my gang being responsible for the money." "'The budget of Liverpool CCG is £750 million 'and that is where the ability to influence sits." "'The power exists with the money.'" "One of our key transformation programmes needed to be a focus on the elderly." "What can we do to prevent them, ideally, going into hospital?" "But when they do go into hospital, what can we do to do something different?" "And that's where this comes in." "This is the new plan to get older people out of hospital quicker." "And this is Hilda." "She's had a fall at home and has just arrived at A  E." " I had the Zimmer and that came on top of me, banged my head here." " OK." " I keep getting the pain there." " Uh-huh." " It's on my temple." "And then I crawled on my bottom right to the kitchen and I sat there until the care workers came." "In the past, it could take days for doctors, therapists and social workers to work out whether Hilda could go home." "Now they'll be assessed in a different way." "I'm from the frailty service." "It's to try and get you home more quickly" " and hopefully within 72 hours." " That's great, love." "The idea is we take them home to do their assessments and the community frailty team will take these people home and support them." "Now with doctors and care workers for the first time working in a single team," "Hilda is in and out of hospital in just a couple of days." "I really welcome this initiative." "This is the right way to do it." "We don't want people to stay in hospital because when you think about it, one night of hospital stay costs something like £500 a night whereas somebody going into reablement costs £700 a week." "We're nearly at your house." "So it's a no-brainer how we need to shift resources, we really do." "And it'll look after them, it will assess them." "We just need to be sure that you're going to manage when we leave." " Oh, I can manage." "I managed before I went to the Royal." " OK." "The team have decided it is safe to leave Hilda at home." "Better for Hilda, she wants to be at home." "Better for the NHS, she's not occupying a hospital bed." "56% of the Liverpool CCG budget is spent in hospitals where care is at its most expensive." "The new model is funded by moving money around the system, so that inevitably means taking money out of hospitals to spend it in the community." "We do not need hospitals." "We need less hospitals and more care in the community." "The more hospitals you have, the more people end up in hospitals." "So, therefore, why can't we shift the balance away from hospital setting to a community setting?" "Shifting the balance is code for shifting the money." "For the system to work," "Liverpool's £750 million NHS pie has got to be divvied up differently." "We will have less hospitals in Liverpool at the end of the Healthy Liverpool programme." "This is one of those moments where we knew at some stage we'd have to step off a cliff in Liverpool and do something a bit different that would be intuitive and we'd have to accept the level of risk." "I think we are going to have to go jumping off cliffs, we are going to have to develop our appetite for risk and that's something very hard to do in the NHS." "But Hilda is only one, not of thousands but of millions of old people in need of care in and out of hospital." "And with Britain at the centre of a dementia epidemic, within the next few years the number with dementia alone will exceed one million." "Look over that way, Peter, look." "Can you see something out there?" "Can you see it?" "There." "This is Peter and his wife, Pat." "Seven years ago, Peter was diagnosed with Alzheimer's disease." "Could be anywhere in the world, anywhere." "Where would you like to be most?" "We've been all over the world." "Done marathons - 25 marathons, you know." "So we've always been active." "There's your medals." "That one's the Paris." "We put all your bits and bobs in here." "All your medals and..." "That's for Rotterdam." "That was like a pancake, that one, wasn't it?" "PAT LAUGHS" "This box has been a life-saver and all Peter's memories of all his bits and bobs go into it." "This is your Everton season ticket." "PAT GASPS" "Over 65." "What am I...?" "How old do you think you are now?" "Eh?" "Have you got much older than that?" " A lot more." " A lot more." "You're 73." "Peter." "There's a lot of years in that box, isn't there, eh?" " Peter." " Yeah." " Yeah." "All in one box, your life." "It's been a good life." "The big day." "Where are you on that?" "Where are you?" "There you are." "Where am I?" "About two years ago, Peter took the wedding ring off and just gave it to me." "He could never, ever get it off so... 48 years of marriage and then..." "That was hard but..." "There's lots of good times, isn't there?" "They become... ..your child." "Eh?" "There is a world of health and a world of sickness." "Sooner or later, almost everyone will find themselves crossing over from one world to the other." "At one point you are independent, next your life is in the hands of strangers." "In this country we call the strangers the NHS but now they're saying if you don't try harder to look after yourselves, we're not sure how much longer we can go on looking after you." "Four, three, two, one." "Cue titles." "Ian's presenting his show, Football Friday, on local TV but he's been having chest pains and his major heart bypass operation has been brought forward." "OK, Ian." "Hi." "Welcome back to the final part of Football Friday." "As ever, I'm joined by two witty and erudite individuals who barely need an introduction." "We'll start with Liverpool." "The studio's chat is on Saturday's game." "Ian's big fixture begins on Monday." "His surgeon already knows what to expect." "The manager's thinking..." "'Mr Ross.'" "He's an ex-smoker, he's got high cholesterol." "He's got high blood pressure." "He claims to be pre-diabetic but the pre-op bloods we did, you know, as far as I'm concerned he's diabetic." "He's a bit younger than the average, the average is a bit older than him having surgery, but no less worthwhile to have his operation done." "IAN: 'It's a bit scarier than it was 24 hours ago, I suppose." "'The anaesthetist said he's done it hundreds and hundreds of times 'and so has the surgeon." "'It's very unlikely they're going to open somebody up 'and find something they haven't confronted before, so...'" "I mean, the reason I brought him forwards was because he was having pain at rest." "You know, the next step beyond that is to have a heart attack and so he was brought forward." "But, go on." "I think, again as you said, they need to start..." "Six, Five, four..." "OK, thank you very much for watching." "Time's beaten us again." "I'm away for a few weeks" " I'm entrusting my health and wellbeing to the cultured hands of people in Broadgreen Hospital, so I'll be back in a few weeks." "Enjoy your weekend, enjoy your football and I'll see you soon." "Thank you very much for watching." "Dr John Duncan." "In Liverpool, they've commemorated" "Britain's first public Officer of Health by naming a pub after him." "Do you know what?" "Somebody told me once, I couldn't believe this, there was a patient who was about 52 and he had a few illnesses and I was saying to him," ""If you don't look after yourself better, do more exercise," ""lose weight and things like that, you're not going to live long."" "Do you know what his answer was?" " "I've had a good innings." - 52?" "!" "And you're like, "Crikey, 52?" "!" ""You think you've had a good innings?" "!"" "I mean, that's the scale of the problem, isn't it?" "There are going to be people who, for lots of reasons, don't want to do stuff and what's the answer for them?" "There's got to be some kind of..." "If enough of them don't do the right thing, if we've not turned back that tsunami, then what the city loses by collectively not changing enough is services." "They will lose massive chunks of the services that they currently rely on." "I wouldn't be doing this job if I didn't completely believe that." "He said he wasn't nervous at all." "There was lots of bravado and I think it was just covering up." " Done?" " Yeah, done." "9:29." "The point is, though, we've got to get people thinking." "You could have a really good quality of life but to do that, you've got to be losing weight, doing your exercise, you know, and how do we get to people to do that?" "That's the tricky part, it's the people, isn't it?" "He's a big man so he's got a, sort of, adequately-sized heart for him." "It looks to be functioning relatively well." "Very few people who need coronaries done are non-smokers." "People smoke and things go wrong and certainly of the coronary arteries ones, it's probably 80% or more." "People like me are employed because of other people's bad habits, basically." "My dad was a smoker for the vast majority of his adult life and the smoking caught up with him because he got bowel cancer and died." "I see those people, I see my dad and my mum and Jim's mum in those people every single day." "Thank you." "Forceps, please." "There can't be a plan B." "Plan B is the NHS continues as it is and it's not financially viable." "And then you've got people in Whitehall, people in private organisations making decisions based on financial need rather than patient need." "And as a National Health doctor, to me, that's the situation where... the last person who leaves the room turns out the light." "Initially, Ian's operation was a complete success." "No-one predicted the complications that were to follow, after doctors discovered an infection in his lungs." "I think he was unlucky." "Made a good initial recovery in the first day, was taken off the ventilator as planned." "So was making pretty good progress." "When we looked down into his lungs with a camera, he had a lot of secretions which he hadn't been able to cough up himself." "Took some more samples from down within his lungs and, unfortunately, he's grown some MRSA." "He wasn't getting enough oxygen and they said it was putting so much stress on his other organs and that included his kidneys." "And they said that his kidneys were failing and the next 48 hours were crucial for them to start working again cos if they don't..." "Give Jennifer a kiss." "'He's the one that we all go to." "'The only way that we really are reassured 'is that he's getting the care here." "'Here is the best place for him." "'These people and this state-of-the-art technology...' is..." "TEARFULLY: ..is keeping him with us." "Because if they weren't here, he wouldn't be." "There comes a time when almost everyone says thank you to the NHS." "It's regularly called the best gift the British people ever gave themselves." "The envy of the world, an irreplaceable component of the national soul, rich and poor, old and young, the same heart bypass in Kensington in London, as in Kensington in Liverpool." "But even the soul of the nation has a price." "And at some point, there'll come a limit to what we can afford to pay." "So I took the last of the steroids this morning." "Come and take a seat." "This is bigger than this practice." "This is bigger than the NHS." "It's beyond that." "This is life." "That, kind of, non-specific but, kind of, everything's not great at home, shit life syndrome." "Somebody who's not clinically depressed, who's not on medication, necessarily, or they may end up, you know, being diagnosed as being depressed, but their life is just shit." "And you're powerless to change that." "I can't think of a single thing that I can do." "I need them, erm..." " Well, the injection things." " Yeah." " Because I've got none left." " OK." " For me head." " Mm." "I don't move." "I don't do nothing at all." "I just cannot be bothered." "I just keep taking tablets." "That's me life, just tablets all the time." "I've been staying on the couch for the last four-and-a-half years, five years." "So you need to get out and about." "Get some, you know, a bit of exercise, a bit of fresh air, don't you?" " I have exercise." " Yeah?" "That woman in the neuro said that to me." "She said, "Walk for 20 minutes a day."" "And I said, "Look, I'm telling you now, I'll collapse halfway down..."" "What about go for a swim?" "Or join the gym?" "Go for a swim?" "Think about it." " I can't be bothered." " I know." " I can't be." " But you might." " I know." " You don't realise how I feel." " No, I do." "I can't be bothered doing nothing at all." "But that's why I'm trying to say, if you try and do something, even if you don't want to, you might feel better for it." "It's getting from there to the baths." " You made it here, though." " I got a lift here." "Get a lift to the baths." "Think about it." "Next time I see you, when I see your feet, we'll think about doing something else like that." "So..." "I'll leave you alone now." "Social and health are so interlinked, especially in areas like this." "The demand has gone up in my own life." "But that's everywhere." "If you look at any statistic, the consultation rate has shot up." "This is why I don't think it can be just NHS." "You know, because this is more than the NHS." "It's got to be more than health service." "No health service can cope, whether it be the National Health Service or anything that's gone on anywhere else." "No health service will cope with the way things are, you know?" "The NHS, a system buckling wherever you look." "Healthy Liverpool's answer to all this is Care in the Community." "But in the austerity budgets of recent years," "Liverpool City Council, which funds Community Care, has had its budgets cut back by 50%." "In my whole career of 30 years... ..I didn't envisage that I'll be cutting a service by £100 million." "Never ever." "To put it into perspective, what that means... ..we support something like 20,000 people in the community." "If I'm not able to do something different between us and the NHS between now and 2016," "I will no way be able to support the 21,000 people." "If we are able to support..." "We'll be lucky to be able to support approximately 10,000 people." "And you'll come back and say, "Well, what will happen to the others?"" "And my answer to you?" "I wish I could tell you." "Sometimes they're peaceful." "Old people chatting, getting over a bad patch." "Most of them waiting to gather strength to go back to their own homes." "MAN SINGS" "Sometimes, they're a bit more exciting." "MAN CONTINUES SINGING" "What they have in common is that they've all been ill." "And were it not for these intermediate rehabilitation centres, they would all be occupying hospital beds." "Your wish is my command." "These homes are Samih Kalakeche's pride and joy." "Every person here and not in a hospital bed saves the NHS £2,500 a week." " Oh, I like this place so much." " Yeah?" " I feel safe." " That's good." "And the people are lovely." "The hubs save the NHS money, hard cash." "But they need hard cash to carry on." "And faced with massive cuts in his council-funded budget," "Samih's not sure where it's coming from." "This is your home, my love." "I am on a knife edge." "If we are not here in 2016... ..to get you your basic needs..." "..then you stay in hospital." "So it's in nobody's interest to allow that situation to happen." "For the moment, no hint of financial insecurity here... ..as Pat and Pete arrive at one of Samih's beleaguered hubs." "A day centre for dementia patients." "Morning, folks." "Afternoon!" "How are we?" "This is Peter and hopefully he's going to be coming to the day centre." "Yeah?" "And we're doing a quiz." "Are you good?" "Are you good at quizzes?" " Not really." " Not really?" "See you later." "I'll see you later." "Thank you." "Thank you." "I keep getting told that there has to come a time when he'll have to try a day centre, just to give me a break." "And maybe I might try a day centre." "Oh, look at this, Pete." "The fish." "Oh, you like the fish." "Look." "Fish." "Are you all right?" "Is he upset?" "Yeah." "It's up to you." "At the end of the day, it's entirely up to you." "Do you want to leave it for a bit longer?" "What do you think?" "Yeah, I feel like I'm too..." "Listen now." "SHE SINGS SOFTLY" "Shall we give it a couple of weeks, then?" "What do you think?" "I'd love to go into his little world just for five minutes and just for him to say, you know," ""We're all right, Pat."" "He would look after me." "I know he would." "Because I know the love that we've had." "And the love I've still got." "Pat will always want to look after Pete." "The question is, how long will the health service be able to help her?" "What keeps me awake at night is that people may not be receiving the care that they require." "That... ..I'm unable to provide the care." "And that really breaks my heart." "Phil is on his way to see John again." "He thinks the time has come for more home care." "Normal practice..." "A doctor who believes the NHS is on the brink is offering a care package from a council-run service which is running on empty." " Hi, John." "You all right?" " Good to see you again." "You too." "How are you?" "Well..." "I want to avoid you going into hospital." "Yes, well, I want to avoid that myself." "There's so many people that I know are much worse." "Oh, yeah, yeah." "You know, some of them, it's..." "They're ten or 15 years younger than me." "It doesn't mean it's a failing if you don't ask," " you know, if you don't get help now." " No, but it's making me worse because I can't do it myself." "You mean..." "I know, but..." "I know it sounds silly." "You want to stay as independent as you can for as long as you can." "Exactly." "But that's the, erm..." "But if you're struggling..." "Say it wipes you out all day doing some housework." " That's no..." "That's not great, either, is it?" " No." "And maybe if somebody could take that job away from you..." " Yes, I can see that." " And it's not a failing if you get help." "It may have to come one day, but..." "If you're managing, then nobody's going to make you do anything you don't want to do, you know?" "But that's, you know, it's up to you how you cope." "But what I'm saying is there are things that people can do that can help." "Thank you very much for the advice." "Dr Phil, I couldn't possibly fault." "They're doing something for me." "Hopefully, then, it'll be for the best." "Yes, so... ..I can just hope, that's all." "From the very beginning, the NHS has been surviving on a wing and a prayer." "Forever waiting for something to turn up." "Hospitals have always been catching up with rising demand." "And now Healthy Liverpool claims to have found an answer." "According to the plan, the population will be fitter." "According to the plan, old people will stay independent in their own homes." "The plan says people will live longer and happier lives." "Social services and NHS will bring health into the community." "That's the plan." "But will the plan work?" "A new Royal Hospital is being built in Liverpool." "The new face of the NHS... ..in steel and cement." "£350 million." "Every patient in a single room that comes en suite." "And, critically, fewer beds - 710 in the old Royal," "646 in the new hospital." "A vision of the future." "But with less than two years to go before the new hospital opens, will the NHS in Liverpool be ready for the future?" "On the day that the new hospitals open, the community services have to be right, the preventative services have to be right." "The frailty unit, the re-enablement stuff, all of that has to be in place and working and proven to do what it needs to deliver." "If a single piece of the jigsaw is missing or the wrong shape, we will reach a point where we won't be able to say," ""We can be 100% certain this will work."" "Not everyone would bet on a marriage between a broke NHS and a local council trying to make up a shortfall of £156 million of government cuts." "I don't have the money." "But the money does exist in the system." "It's sitting within the hospitals." "But have the hospitals agreed to give you the money?" "Has the CEOs of the city agreed to that?" "I would say they acknowledged it and they supported it, but whether they would give us the money, that's another question, which we are working on." " And if they don't give you the money, you've already told me what will happen." " Yep." "I mean, if they don't give us the money, then the hospitals will be full." "End of." "And people will be waiting and people will be not discharged." "The new model is funded by moving money around the system." "If the CCG didn't intervene with something of this scale, the first few of our organisations would start to struggle financially by next financial year." "So am I to understand, then, that, erm... ..the cost of implementing the programme is going to be borne largely by money that's been taken out of the hospitals?" "In the longer term... ..yes." "But the NHS does not have the time for a longer term." "Even with the eight billion promised by the new Conservative government, the future depends on the success of schemes like Healthy Liverpool." "But they are untested." "It seems unlikely they will make much impression on the looming shortfall of £30 billion in the next five years." "In the short term, changing the NHS is going to need more money rather than less." "Is everybody terrified of this deficit that we've got?" "There is no excuse for not doing this." "There is no possible argument for not embarking on this journey." "Whether or not this journey, on its own, in isolation, will be enough to protect the publicly-delivered NHS, at this moment in time, is anybody's guess." "My feeling is that it probably won't be and it's going to need more money from central government to continue with the service that the people need." "For as long as anyone can remember, there has been a love affair between the NHS and the British people." "And standing by the banks of the River Mersey, it's not hard to see why." "For well over 100 years, the people of Vauxhall provided the muscle which made Liverpool one of the great cities of the Empire." "They occupy the slums that, until recently, ran down to the river from Everton Brow." "And when in Victorian times they died early in their thousands in the epidemics of typhus and dysentery and cholera, there was no-one there to help them." "This is where John has lived all his life." "And that's me, believe it or not, as a baby." "That's over 90 years old!" "This is where Pat met Peter." "And if Vauxhall is no longer one of the dark places of the earth, then, as much as anything, it is down to the coming of the NHS." "I can't see it any other way than an NHS service." "I would be scared stiff." "But you imagine an area like this, it'd just be..." "It'd be awful." "It scares the life out of me." "NYE BEVAN:" "What I had in mind when we organised the National Health Service in 1946..." "Remember when we did it, you know, you younger ones." "This is immediately after the end of the Second World War." "In the old infirmary, it's tempting to see Healthy Liverpool in a direct line from Nye Bevan, founder of the NHS, to Florence Nightingale." "A reminder that it was a distant dream once, the NHS." "A dream that came true." "Where's Grandad?" "Are you going to wait here?" "When he comes off the ward, Grandad is going to come out, isn't he?" "Can you see him?" "That's it." "Are you going to have a look?" "Keep looking down there, you'll see." "Look." "There he is!" "Who's that?" "Stand back." "Let him open the door." "Here he is!" "That's it." "Be gentle." "That's it." " You don't want to jump up." " Good boy." "You missed me?" "Yeah?" "Here's Grandad!" "Peter Pan." " Say thank you to the nurse." " Bye-bye!" "That's the man that fixed Grandad's heart." " What do you say to Andrew?" " Thank you." " I appreciate it." " Thank you very much, Andrew, for everything." " Look after him." " I will."