Hospital - Episode 1 (Documentary) | Our Stories

foreign [Applause] [Music] this winter one of Britain's busiest NHS trusts opened its doors we have to look after the patients whether they come from book Palace or the park bench to show us what's really happening inside our hospitals we've got lots of patients now competing for an unknown number of events every week more than 20 000 people are treated here what is it completely gone and the numbers as well as our expectations are rising we just had our worst 10 days on record there's nowhere in the hospital to move anybody I mean at some point somebody will be telling us whether we're allowed to do any work this is a place with some of the best specialists in the world Tim was our job done where lives are transformed this is saving his life it has to work but they are operating at a time when the NHS has never been under more pressure it does feel to me like the elastics a bit nearer to Breaking now than it ever was its very future under scrutiny all right and I think we will go out on red because we're under real pressure in the emergency department we're aware of the problems anybody got a solution following the patients from the moment they are admitted anything I've done up to this point means nothing compared to when you can literally give a bit of yourself to save someone else to the moment they leave it's all good news the cancer is gone you don't need any more treatment fantastic thank you bye week we reveal the complex decisions the staff must make about who to care for next that patient is coming to me to be operated on and if I don't do it then there's only one inevitable outcome they're going to die [Music] [Music] right good morning everybody Shall We Begin I've seen the gang at Charing Cross good morning Sharon cross morning good morning okay do you want to just talk us through your screen this morning Leslie pearls is the site director at St Mary's the biggest of the five hospitals in London's Imperial College Healthcare NHS Trust every morning she leads a conference call with the other hospitals to plan the day focus is always the same how many empty beds have they got there's currently no cubicles anywhere in a e to see any new patients okay so not a great start to a Monday morning for you guys then the first call of the day is to kind of take the temperature of what's gone on overnight and what our beds look like going forward for the next couple of hours let's go to St Mary's so as you can see we're in a very similar position to Charing Cross this morning very full and busy ED screen let's just have a look at the beds it's probably easy for me to say what we've got which is absolutely nothing at the moment so really priorities for us this morning are to sort out the rest of the unplaced patients in the emergency department before we do anything else we'll pick up surgical electives in about 10 minutes all right and I think we will go out on red this morning then okay thank you very much everybody will speak again at lunch time Saint Mary's uses a color coding system to indicate its bed status Amber means that the hospital is almost at full capacity with only a handful of its 301 adult beds available for new admissions code red is even more serious it means that throughout the hospital from the a e Department to the Intensive Care Unit from the high dependency unit to the General Nursing Wards there are not enough beds available for the number of patients that need them the hospital is full Saint Mary's must now put scheduled operations on hold the pressure on beds can only be relieved by existing patients leaving the hospital it's one in one out the last three weeks we've rather almost completely 100 capacity we're probably on Code Red every three or four days I'm hoping that within the next couple of hours we get enough beds that we can at least do a couple of our elective patients [Music] that's the trauma patience which it means that we are very likely shortly to need another trauma bed so today we are in trouble [Music] so at the moment Hospital there's a lot of emergencies who will need operating off when Saint Mary's is on Code Red surgical staff must wait while site operations look for patients to discharge today there are no beds in the trust at all right let's go and postpone things it's the job of the on-call anesthetist to stop planned operations getting underway until the hospital gets off code red there won't be enough beds for all the patients to recover from their surgery what tends to happen is if people can be a bit naughty and suddenly they just start their patient I mean after knives to skin there's absolutely nothing you can do about it there is no bed 100 percent there's loads of patients in a e there are no beds whatsoever in the trust Rex you know that it's only day cases or impatients they've said not to go ahead and they want to go ahead I'll go ahead if we haven't got a bed and they can't stand them if we do any patients with me but they have to stay in recovery that's not acceptable no no they can't go because we haven't got the recoveries but do not listen because I said I have to send recovery doesn't mean that the patient can go to recovery it means that it's not acceptable but nobody's listening this is really annoying isn't it because so many hours are wasted waiting for things this is a bad Monday morning there's been no froths there's been no flu it's not cold you know and the fact that the hospital's already overwhelmed is really quite scary so anyway so I better have my mango Lassie George Reese is one of the surgeons waiting to start work thank you he specializes in Keyhole surgery I.T support as well we have one operation to do today and that's an anterior section um which is an operation for rectal cancer the gentleman's here my team have seen him but um the hospital's on red alerts so we are just going to wait to find out if we've got permission to start operating George Reese can't begin his patient surgery until a bed is available on the high dependency unit for him to recover in morning nurses there are currently trying to discharge patients to make space hello can we do a quick brief please so we don't have permission to start because they don't know if there's a bed or not right so we're not allowed to to do anything the difficulty is that it's three and a half hours of surgery yep and it's cancer and it's cancer so if they don't tell us early we run out of time but they know that Professor George Hannah is also waiting to start a cancer operation his patient will need a minimum of six hours of surgery followed by a bed in the Intensive Care Unit oh hello hello how are you good morning to you hello how are you thank you pretty good thank you very good are we good to go or not we're just speaking we're just still waiting okay still waiting have you doing your exercises to do my exercises very rigorously so once we know about the it I will let you know we'll call you to come in good well I'll see you shortly see you again yes okay thank you the patient has a cancer of the Galaxy the esophagus to cure him he needs to have the operation otherwise really he can't survive I was first diagnosed back in April and then I went onto a chemo and radiotherapy treatment course which was designed to shrink the tumor became quite difficult to eat not now no but I did then oh my God I did then and the thing is you know here's what sort of 13 stone or whatever normally not now well you know but you were I mean big strong a healthy guy you know playing golf three times a week or whatever um and suddenly he's not [Music] so looking at the skin it looks actually he he has a good response to chemotherapy and radiotherapy here the esophagus and this black is the footed Channel inside those office and if we go up you'll find it is wide if you go down you'll find it narrow so the tumor and the thickening makes the inside is small and that's why a patients struggle to eat one of the main aim of the operation is to have a clear margin of normal tissue so we ensure that the tumor is completely removed Simon's surgery has already been canceled once before just like today the Intensive Care Unit was full [Music] we've only got 16 intensive care beds in some areas and those beds are always needed for our sickest patients in the organization so those coming through our emergency department are major trauma patients and our patients who are going to recover from some of the biggest surgery that we do in the organization St Mary's Intensive Care Unit or ICU contains the most sought after bed spaces in the hospital each one provides one-to-one nursing care and the most advanced life support systems there is no capacity to add more beds the team tries to keep at least one of these bed spaces in reserve in case of an emergency admission but with patient numbers Rising this is proving increasingly difficult today all 16 beds are full I need to move patients off intensive care and down to the ward but before we move them I need to go and have a look at them and make sure that they're well enough to move and that they'll be safe on the ward hi there how you getting on how you doing it's good to see you awake I think you're doing really well sir how you going okay good all right I think you're improving all right I think you are Simon Ashworth has identified two patients who could potentially be stepped down from the ICU to other Wards but only if their conditions improve over the next few hours I have to tell you it's nine o'clock what does that mean it means at some point somebody will be telling us whether we're allowed to do any work nervous no I'm not I'm nervous for you you worry too much yogurt heart attack George Reese's cancer patient aladio's operation is already two hours behind schedule I decided not to get frustrated there's nothing I can do to fix this problem so I will trust that the people who are doing it are doing their very best [Music] how are you hello we didn't get to meet last night no no we didn't um I just wanted to set the scene of today a bit at the moment they haven't given us permission to start the operation because there isn't a bed in the hospital but they're working on it and when I know you will know they're lovely is there anything you wanted to ask me well no I'm just like that because I'm parking outside it cost me now is 10 pounds ATP please because if we're gonna be a whole day that's gonna cost me I kind of meant is there anything you wanted to ask me about the operation or about the um the surgery today no I'm okay [Music] an update on the bed situation from the high dependency unit so we've managed to get some discharges which means we can start to operate on patients who can go into high dependency but not patients yet who need intensive care yeah so marvelous and then start the um Rhys patient needing hdu Miriam don't feel any pressure I'm coming to find out if I'm allowed to start because if I can't start now we have to send him home so the cancer patient so we can go ahead thank you thank you so we need to go and tell them we're coming down we're allowed to do the case okay they found a bed Hello site office Leslie speaking Leslie must now deal with a new emergency a patient is on her way from Norfolk with a ruptured aorta [Music] the aorta is the main artery in the body it bursts on root the patient will die in the ambulance Saint Mary's lead vascular surgeon Richard Gibbs will perform the life-saving operation very sensitive because we're a specialist center for aortic surgery we feel a real moral responsibility for accepting patients like this without any Shadow of Doubt they will need an intensive care bed but to a certain extent we just have to get onto the operation so we'll have to worry about the rtu bed at the later stage of the day thank you that patient is coming to me to be operated on if I don't do it then there's only one inevitable outcome which they're going to die itu are uncertain now as to so this morning they were declaring two steps two patients to step down they're now not sure that they have two to step down they think they might just have one bed if they have one bed that bed will have to be held for the ruptured patient coming from Norwich Richard Gibbs goes to discuss the impact of his incoming emergency on George Hannah's patient George as things stand and you need lie to you bad we need an idea bed because we've got this woman who's in an ambulance on the way from Norfolk with a rough aneurysm so she needs an open operation so if she arrives alive which we think and hope she will she's gonna we're gonna do anything and not worry about it for now we've got to get on with that and sort it out fine so what are we waiting for now this one or maybe two pages tonight that can step down so we're just waiting for confirmation from then that one or both will go we only need one bed which will free up the rgu bed for you [Music] Simon and Patricia his wife of 36 years have been waiting for three hours to find out if his operation can go ahead you don't quite know whether not hearing something is a good sign or a bad sign do you get when we were first embarked on this process we were told that there is a window of I don't know how many weeks five to eight weeks after the chemo and radio stops when it is the best time to do the operation I haven't asked the question so if you can't do it today do I then have to start doing chemo and radio again or something or what what actually happens because you don't like to ask those questions you don't don't really want to be answering because you just relying them to do the operation if you reach a point but you just say I want it done you know you just can't keep putting it off forever [Music] it's not just for you it's even impact on family oh yes and me can you tell me your name great and your date of birth January 22 1949. that's a great birthday it's my birthday as well yeah yeah all right stupid and closed that hand a couple of times so it's exactly four weeks after Christmas isn't it it's your birthday yeah from the Philippines yes yeah surgeon George Reese begins his patient eladio's operation we're going to do a keyhole operation for him where we remove the part of the bowel with the cancer and it's adjacent blood supply so that we can take any lymph glands that may or may not be affected by the cancer and then we're going to join it all back together again [Music] four hours later later the tumor is out and the operation is over why should I feel Victorious that I'm actually just allowed to do what I should have started doing at eight o'clock this morning it's because the beds are so bad at the moment that it seems rare to be allowed to actually go ahead and do an operation very bizarre the emergency patient from Norfolk is an hour away the team doesn't know if she will survive the journey the risk we run here is we're holding a bed for a patient who hasn't even made it into the organization yet and not going ahead with patients who are already here [Music] do you have to do this for people every day struggling with stocks ah hi George hi thank you the two people I'm kicking out from ICU I one of them I'm not really that comfortable with so I don't have a guaranteed bed for anybody at the moment right so I might get one or both of them out but you know your patients leave do you think you'll have this fish if this patient is does he survive from from norfolks and you know well what we can't predicate so she'll always have it's a bit more the only thing you can do is wage but I don't think the odds are very good we don't have enough slack in our capacity to to be able to let um Prof Hannah go ahead and do do the esophagectomy um I mean what's hard about this is that you know we're also talking about um well we can go ahead and do it um if the patient from Norwich doesn't survive the journey and that's a very hardened callous sounding thing to be talking about but that's the Practical reality they had this patient coming in who might require the eye I should care a bit they might die if if they die then the bed is available for me then we can do the operation but if not they've got the bed that's that's the seriousness they've got the best how does that make you feel guilty actually yeah no way yeah I'm the person that when someone's really irate and they say who made the decision that we're not going to do blah my team or various other general managers will say oh Leslie did that and here's her number usually so that's who I am so you're the one that stops things happening sometimes sometimes I stop things happening yeah what's that like horrible it's a horrible feeling because when you stop something happening you know I'm a nurse I I've spent my whole working career doing the bit that is about making things right not always making things better but doing the right thing by people all the time and I do the right thing all the time in this job but it's not always the right thing for one person I do the right thing for the hospital and that's really difficult because that does mean that there will be people who today we haven't done the right thing for [Music] hello hi hello hello hi Simon it's all right I thought I'd pop up and see what we can do to help I have very few options yeah um and what worries me is we've got no slack for the for for the unexpected that is the norm here what I don't want to do Simon is put you guys under loads of pressure I think we're we're asking for trouble if we try and do yeah but we are trying to work out George if you can operate if you could do it tomorrow I think the chances are better yeah but I think I mean we can certainly what you can whatever you step down from itu we will create beds to allow that but the same one now is try to keep an empty bed so just as a slack for something to happen how long do you think you're going to be with us I'll be very late I will I will take six hours of operating if we go ahead now we'll finish by midnight I think the safest thing to do is to defer it but I you know I understand the logistics of that or uh it's not just the logistics it is a clinical issues here because there's a second cancellation with a dedicated time chem radiotherapy and we are not doing him to keep a slack in a system who doesn't have a slack all I'm saying is I've got Mobility to manage any other problems if you didn't have a bed I would have no problems I can understand it but if we are not doing him to keep a slack and while we can use a recovery as an alternative this is the difficulty I have well we're very close to the Limit we are close we're very close to a minute I think operating absolutely on the limit is is unwise the question really if we wait another week or another time this will not be uh I'm not sure how this will get better canceling your cancer patients three times and is is a serious instance so this is something you need to to need to to work on it it's your call Simon what would you want us to do I you know we don't have the slack at the moment I don't think to do this safely we are stuck at that point okay that's fine so just just so so from my point of view if the Rapture one gets here we'll do it anyway and to get on with her we know where we are I will and I'll work on the basis that they will be able to give me a bet foreign scans from the hospital in Norfolk have been received by Richard Gibbs they reveal a huge aneurysm in the main artery from the patient's heart okay so should we just it's just so the team brief here so this lady has a ruptured aneurysm her aorta is four times the normal diameter so it's very dilated and that's like a balloon it's just stretched and stretched to stretch so now it's finally given so blood's starting to come out of it where it's got a small tear in it the surgical plan is to do a left thoracolumne and not disturb the abdomen until we got control of the low thoracic aorta and then we'll obviously open up all right see you in a few minutes there are frustrations so the whole team gets assembled and we make a plan and it takes quite a lot of effort and concentration to get everyone pulling together to do it and so if that plan is preceded by three hours of negotiations about can we slot someone into hdu we think it's the hammersmiths or the itu patient can drop down you know what I thought I sometimes feel that I spend as much energy on trying to organize and manage beds and the movements the flow of patients within the hospital in order to allow us to do what we actually want to just do and get on with which is to to operate Professor Hannah has now been waiting to be given the go-ahead for his operation for five hours hey Leslie it's George hi Leslie the aneurysm will come in one hour time I thought so yeah so now we need to make a decision really [Music] okay just one second Leslie there is a trauma came intubated now just now somebody is hanging so there is an extra kiss into the equation if this patient go to itu then then potentially will be no beds huh definitely now head of intensive care Simon Ashworth must now go to a e to decide if the hanging patient will need an intensive care bed he didn't have a cardiac arrest [Music] the patient will need life support which only ICU can provide we'll need to find a bed for him I think it'll be possible providing that nobody else here needs to come up but it certainly means that the chances that we will be able to do the esophage me as zero now it's just a trauma Kim now just literally now yeah do we all have to go home yes okay okay [Music] waste of resources there is an easy distance there is a surgeon is there a theater there's three or four nurses and this is empty it's not used not utilized so it is a waste [Music] [Applause] [Music] after a four-hour Journey from Norfolk the patient with the ruptured aorta retired school teacher Janice arrives at St Mary's a e foreign [Music] what's happened is that the aneurysm was ruptured but luckily the blood is just sitting in the back of the abdomen by the big back muscles so it hasn't just blown that means we've got a chance to fix this we've had a look at it on scans I think it's the safest way to do it it's going to make a cut which is going to run in your chest and then down into your tummy and then we can clamp the aorta and hopefully solve a big graft on and that will be the end of the problem it's obviously a bit risky okay I'm gonna be honest with you and there's a few complications that can happen and I mean you know you're definitely going to lose quite a bit of blood and there's always the risk of things like a heart attack or a stroke or kidney failure um afterwards but I think the thing is we haven't got a lot of choice because if we don't do it then that's kind of the end anyway okay okay this case has trumped the patient with cancer that was going to get done in the other theater because she's got a condition which will kill her um sometime in the next three four five six hours so we don't do it now then there is going to be no five hours time for her multiple cancellations are something we really try to very hard to avoid but actually without slacking the system it's impossible and if you try too hard to avoid them what you end up doing is prioritizing somebody because they've been canceled over somebody who is at immediate risk of dying they're the issues that you're chuckling Jonas's Sons arrive minutes later by which point their mother's operation has already begun [Music] we spoke to her last night literally she'd said that she was in some discomfort got stomach pains but she decided to go to the out of our surgery and took herself off drove herself there but didn't reach he passed out behind the wheel and crashed the car I heard about it from the ambulance driver about Par Four this morning saying that she had this aneurysm [Music] will she survive will she pull through or not there's always significant risks mortality is probably about 50 60 percent [Music] we'd like to try and get the the aorta dissected out in a nice clean way before it flows I mean it's already ruptured but if it starts bleeding freely because we're dissecting around it then then we're going to have to clamp in a real hurry [Music] guys thank you we've got a periodical elevator cover Wiley so the fish slice just needs to go there we can put the lung down if we want but let's try to avoid it because I think she wouldn't like it so that's the heart and this is the thoracic aorta the problem's actually a bit lie down the belly so she's got a huge hematography okay don't touch anything whatever you do so what I mean if it might blow any minute I mean it really might do literally so and that's the blood from the rupt which is tracking around the back and coming towards the front that's the aneurysm press it too hard this is going to go so we need to get a wiggle on yeah she likes to keep herself occupied reception age children choose to teach she does various crafty things she goes bowling she plays darts we we sort of joke that we have to make an appointment to go and see her keep my fingers crossed very nervous [Music] okay the difficult bit's just about to start everyone do it slowly just take the diaphragm away from us so this just get gently let me just get this down here to the last bit and then we're gonna to look relaxed let go let me just do this move that up to there okay [Music] what is it completely gone okay there's a place in our eyes guys give it a minute I can clamp the throttle cables at any time Ross she didn't tolerate there all right it's coming up anyways [Music] hi I'm Richard Gibbs hi I'm just going to tell you this straight the operation was a success but it was quite challenging at times and although she's stable at the moment I won't say anything yet about the prognosis she needs to go to OSU for the next 24 hours and they will stabilize her and support her in any way that's necessary but at her age and having a really big operation like this I don't think we can say she's in the clear yet that we need to give that 72 hours and then she starts to get better and better than um I'll be really hopeful we've been full all day sadly this has meant we had to cancel George Hannah's patient but um you know I'm hopeful that we might be able to to do that tomorrow I think we do need more capacity because we're always under pressure and it does feel to me like the elastics a bit nearer to Breaking now than it ever was is wearing constantly going around taking bad news to people and you know everybody gets a bit irate and it's it's you know it takes it out of you Saint Mary's capacity problems are directly linked to its status as a major trauma center it's a e Department must provide round-the-clock emergency care a 10 increase in patients in the last 12 months means that it now handles more than 150 new cases every day [Music] a d has full resuscitation base for patients with life-threatening conditions and a further 16 beds for the seriously ill government regulations stipulate the patients either have to be discharged or moved onto another Ward within four hours but when the hospital is at full capacity the department quickly fills up with patients waiting for beds and a four-hour time limit is regularly breached hello I'm Ali I'm one of the doctors can you squeeze my hand yeah Alison Saunders Clinical Director of emergency medicine is the consultant on call in a e what's happened in the last two years is the whole system Countrywide seems to have ground to a halt it just makes us feel as though we are firefighting every single day and we're not unique we're not unique at Imperial we are the same as any other emergency department in the country and any other major Film Center every day we just feel like we are struggling to just keep afloat there's just another trauma coming in now fall from six foot Loc is the shooting coming to us they said two lines of cocaine unknown quantities of vodka and beer 28 year old males have three times seven men with guns it's been given to seven men with guns have gone into a building someone's not moving and what about trauma beds what beds have you got for me please the minute that we have bed problems usually due to patients not being able to leave the hospital at the other end then then we end up we end up in this state um we're gonna meet this man in recess who's gonna need to go to you so what have we got that can come out and where have we got we can put it [Music] it's only so efficient you can be and also I think when everybody is working so hard day in day out then eventually you know they get tired you hope they don't get tired and make mistakes you hope that you've got enough resilience in the system for that but it certainly doesn't make everyone more efficient [Music] [Applause] foreign with winter approaching the pressure is set to intensify within a e and across the hospital [Music] good morning everyone who have we got a Hammersmith this morning sorry and showing cross have we got you guys okay let's look at capacity at St Mary's um we've got a completely full resource very full Majors miners is creeping up so big push on anything we've got dischargeable please St Mary's remains close to capacity however it is no longer on Code Red from a critical care perspective it's not been the best start to the week unfortunately sometimes being a major Trauma Center our demand for very sick patients outstrips what we have in capacity and we can't predict that on the high dependency unit George Reese's patient Eladio is awake and stable following surgery yesterday [Music] so you had a nice sleep yeah yeah I'm waking up he should be well enough to go home by the end of the week in intensive care Janice is yet to wake up following the operation to repair her aorta squeeze my hand Janice Janice trying to squeeze my hand if you can as the nurses reduce her sedation she should begin to regain Consciousness can you open your eyes for me [Laughter] [Music] thank you foreign [Laughter] [Music] forced to postpone Simon's operation yesterday Professor George Hannah is waiting to find out if there is a bed available in intensive care this morning 's Dr Ashworth good morning morning ish we're still trying to get George's case done it's probably contingent on high on moving uh one of our patients they've still got the bed they've still got the bed okay they've still got the best patients stable enough to go are you going to let George out yeah I'll let George out I've already told him that was the contingency yeah he'll be delighted hi George yes you can start I've just spoken to Leslie wonderful good morning I've got good news we have a bed thank you finally after weeks of preparation and two cancellations the operation to remove Simon's tumor can go ahead [Music] um he was okay we had jumbo prawns and noodles and yes I gave him a great big bowl full of as I have been doing with cream latched onto it for him so we ate and watched a bit of TV and chatted and he was fine and I knew he probably wouldn't sleep very much but that was okay the operation will take more than six hours [Music] an esophageal tumor you can't you know you you bombard it with the radiotherapy you bombard it with the chemo which he had and uh and it has shrunk but if we just carried on with our life could just grow again so that's you know there is no there is no choice you just have to have the surgery [Music] so yeah so I do feel relieved because it's now happening and he's there's nothing else anyone can do except teams and waitings waiting is going to be tricky so but it'll be fine foreign will put his life in my hands and I have a duty to do the best of my ability to to give them the best outcome the first stage of the operation is to remove Simon's esophagus and the tumor it contains you open their chest you open the abdomen you dissect along a lot of blood vessels and that's why actually in terms of an impact of the operation is one of the biggest operations the body can take how's the patient is he okay so this is uh Sophia Center tumor we removed now [Music] the esophagus is taken to the Pathology Lab to see how far his cancer has spread this is the esophagus here at the top between my fingers this is the stomach here so we expect to find the tumor somewhere at the bottom of the esophagus just where it goes into the stomach I'm trying to put my finger into the esophagus and I can feel it's thickened and narrowed one of the things we want to know is what all the tumor has been removed or not the further the tumor has invaded into the wall the worse the prognosis for the patient and if the tumor has spread to the lymph nodes the worse the prognosis for the patient and the more lymph nodes that are involved the worse the prognosis for the patient [Music] the most challenging part of the operation can now begin Professor Hannah must create a new food pipe in order for Simon to be able to eat we convert the stomach and we need to reconnect the gastrointestinal tract in a way that the patient will be able to eat after that going well really well operation looks looks nice really and if things looks nice usually works very well [Music] Simon will spend the night in intensive care the same unit as Janus [Music] having finished in theater in the early hours Professor Hannah heads to the Intensive Care Unit to check on Simon's progress all the way to us I spoke to your wife yesterday oh sorry thank you she's happy they may send you to go to the high defendants units not today today yeah most likely yeah okay so it's a promotion to go there absolutely yes it happens I wasn't expecting that yeah you obviously need you know you look well you look well you don't need to be here if you don't need to two days after her emergency operation Janice is stable enough to be taken off life support hello [Music] foreign [Music] means so we know there's still a long road to recovery here but um she's been making steady progress all the way through [Music] every week Leslie and her team meet with senior managers to review how they're dealing with the hospital's capacity issues I think things have been getting more and more challenged I mean certainly the pressure feels much more intense and it feels like we are making difficult really difficult decisions much more regularly than we had been doing and then we should be doing sharing today's meeting is Professor Tim Orchard Imperial trust's director of Medicine top of the agenda The Chronic bed shortage if we have a significant flu epidemic we are going to be completely stuffed we have never started winter with so little spare capacity and so I think one of the things that we need to do and we've never had to do it in this trust before but I think we need to think about is what we do when we actually run out of beds what do you do in terms of if we get noro and we lose a ward organizationally we are not going to manage at the moment we've got with nowhere to go to I think that it's felt on many days and so we've had the clip tipping over the edge of the cliff phenomenon where you get to a critical point and you can't function for the admitted or the non-admitted patients because everything is full there is no more capacity on the samari's side we know that it looks like it's going to be impractical to move any surgical Specialties off this side so one possibility is moving the Pediatric outpatient Department which would potentially allow the creation of probably around 15 to 20 beds on the sixth floor but that's obviously going to be quite expensive it might be a really good plan for next year but the reality of getting all of that sorted out by winter feels like we need to do something sensible and practical now one of the big debates people need to have that people are having naturally at the moment is in extremists can adults be nursed alongside to Children what do you do in terms of like we've had on this site where you've had 10 pediatric beds and you've got 10 unplaced adults in ed what decision would you want to make there so the question is where can we board extra patients on Wards how would we nurse that to make sure that patients are safe and that the patients have an appropriate level of privacy and dignity other trusts have used places like gyms endoscopy cath lab recovery so I think we just need to be clear what what the levels of escalation are because what we need to do is to roll out to every single Warden Department in the trust a plan that says you know we've got to aim to do XYZ very good thank you it is tough and I think people are working incredibly hard which we do appreciate the senior managers have agreed a set of new measures called the full capacity protocol I'm still a practicing doctor I still go on the wards regularly so I'm very very well aware very in touch with what's going on I think we know that we need to create more capacity I think we have put in place a number of plans of what to do with our estate to make things better every consultant will go around and make sure that every patient who's in the hospital really needs to be in hospital and obviously we will then make sure that every single bed that can be open safely is opened there are some wards where there is space that is relatively unused and we would be able to fit a bed into that space so it's about using every single square inch of space even if it doesn't normally have a bed in it it will be down to Leslie to implement the hospital's new policy problems definitely aren't easy to solve but we've got something that will see us over the next few months it's much better that we have an ability for the whole hospital to know that we're in trouble rather than just being me and my office I was all sitting here with our head in our hands it's much better to be able to put out an alert that says to the whole of the organization we need some help today right good morning everybody morning well that's better right bed wise so we've got one bed in CDU and two beds on Albert no confirmed discharges and a smattering of queries so we have a really challenging day at St Mary's I think we will go out on red this morning we'll keep this line open because it will require people to dial in to let us know that they're undertaking their new set of actions in the full capacity protocol um okay great we'll speak later thank you there's a lot of both nervousness and excitement about the full capacity protocol what we want to try and do is get to the point where if we are struggling we take an early set of decisions that give departments a bit of breathing space [Music] down from intensive care Simon is making steady progress um he's doing well there is a lot of work he went into him to be at this stage he's a very positive he do ask him to walk a mile he walks three miles I'm looking forward to going home um I've been told to expect to feel very tired but to keep exercising by walking once we get home there'll be some ups and downs inevitably so you cope with them you come out the other end of that there will be dips and they're quite severe and anyone who thinks there won't be is keeping themselves basically [Music] Simon must now wait to find out if his cancer has spread the Pathology lab results are expected in a week [Music] in intensive care Janice is doing well today I want you to lean forward we're just going to help you over here really push with your good leg if her progress continues she will soon be able to leave intensive care and recover on a general award tuck your bottom in well done so push through your arms look up that's it take a big breath in for me secret hello world Janice is out to get you oh dear hello Mrs Medcalf it's great to see you out of bed you get your chest going again and I think that makes the potential for you to be home in a week or two real as opposed to what might be a month or two otherwise so it's really important okay yeah right sorry no it's a pleasure we'll try to just try and get you right as soon as we can all right foreign [Music] is well enough to go home he doesn't need any further treatment the cancer he has was completely removed and there was no sign that it had spread anywhere else around his body which is the best result we could have hoped for some weeks are more emotionally challenging than others and I think this week's been one of those weeks that emotionally we've kind of put ourselves through the ringer the organization chose me to do this role because I'm resilient I mean don't get me wrong it's not like I don't go home some days walk through the front door and start crying because I do I've never done it in the office I'll always work like at home but I mean I do because I've had a day that you know sometimes you think oh God that was just like the day from you know hell I don't know what went so horribly wrong there but it's gone because I've got to make it right the next day the pathology team has concluded its analysis of Simon's tumor they must now disclose the results to Professor Hannah okay let's start first patient Simon a so here is the Lumen here you can see some normal mucosa but in all the blocks we examine there's just a single focus of cancer which is here in the esophagus with all margins are negative so I should have said it was a very good response it would feel like all we do all day is vanish beds actually what we manage here are people who need us to help them that's what we really do the tumors on the on in the inner surface of those surface in the very first layer all the Motions are clear so you continue to be a lucky man thank you so we'll keep an eye on you I'll see you for the next year every three months very nice yes you have lots of food into him thanks very much for all your help well done I mean we can never predict what's going to happen to a patient when they've left us on the next part of their Journey we can't see into the future or all we can do is the Here and Now for people it really is like as if we've been in a thick fog and now we can see the sunshine it's great [Music] we go home knowing that that day we cared and we did everything we could have done for our patients the heart of what hospitals do is have people in them who have a tremendous respect for life but also an understanding that sometimes we can't always save that life foreign [Music] [Music] [Music]

Channel: Our Stories

Views: 306,454

Keywords: Our Stories, Documentary, Observational Documentary, Real Stories, Full Episode, Full Length Episodes, Full Documentary, Fly On The Wall, Yearbook, Real Life, Documentaries, Real Lives, Behind The Scenes, hospital, hospital documentary, bbc hospital, bbc, bbc hospital documentary, medical, medical documentary, nhs, nhs documentary

Id: Rlm021YJ7dc

Length: 57min 20sec (3440 seconds)

Published: Tue Apr 18 2023