MUSIC: 'Jerusalem'
# And did those feet In ancient time
# Walk upon England's mountains green?
# And was the Holy Lamb Of God
# On England's Pleasant pastures seen? #
It happens late at night.
After ten and before four.
It's called patient dumping.
Wait, so you are just gonna leave
this lady out here with no clothes on?
That is not OK.
Due to the circumstances and what it was.
So y'all need to call the police.
So y'all are just gonna leave this lady out here like this?
Argh! Are you in pain?
Argh!
Argh! Argh!
Argh!
For any society
just to drop somebody off in the middle of the night
and expressly with a disability,
and expect them to fend for themselves, is really barbaric.
'And if a hospital wants to make the most profit,
'they want to get the most number of people in the beds,
'so to get somebody out and get the next person in
'find a place, dump them off.'
Because if your heart really is to help those in need,
on the one hand,
but on the other hand, if somebody else's heart is profit,
how can you reconcile those two?
We've had people who have arrived literally in scrubs
and open-toed sandals
from mental health units.
Where there's been a sort of discharge meeting
at sort of ten o'clock in the morning.
Five o'clock in the afternoon, they are put in a taxi
and sent down to us.
Last year, we had a man who had been...
discharged from the local hospital
nine days after having open-heart surgery.
Hi, I'm Emily, a talent community manager
at UnitedHealth Group.
Here at UnitedHealth Group we are providing healthcare
to over 90 million people worldwide.
Hi, I'm Alison.
And I just became eligible for Medicare
so I signed up for a Humana Medicare Advantage
and Prescription Drug plan. I'm excited.
The NHS has been repurposed from a public service
to something for profit extraction.
And all the changes we have seen
have just been about
liberating up these potential assets
for the corporate raiders to take them over.
Healthcare is...
A multi-trillion-dollar opportunity
if you listen to any of the lobbyists.
It is. I mean, globally, if you look at it...
..it is a huge, huge market.
Potential market.
And the NHS stands out
as a 120-odd-billion-pound opportunity.
Lobbyists normally lobby for one of two reasons.
A threat or an opportunity. And the NHS is a nice, juicy opportunity.
We share in the risk of ill health together.
It's a joint project. We fund it together.
We share that cost fairly.
That's the essence of the NHS.
What's truly worrying
about the way in which the NHS is moving
is that that whole essence is being fractured
and undermined
by the involvement of the private sector.
And by the underfunding process.
If things continue unchecked,
and this really is a juggernaut which is accelerating
and seems to be in its final stages,
then we will end up, I think, and we already are,
in a situation where there is a two-tier system.
You will never abolish the NHS.
The NHS simply becomes eventually,
ultimately, a third-class
basic service.
The biggest open secret in Britain
is that the National Health Service,
the NHS,
is under attack.
This war on a unique institution
is not new,
but has entered a dangerous new stage.
In 2019,
more of the NHS
was sold to private firms than ever before.
The term "privatisation"
is seldom used,
it's reality concealed in corporate spin,
in deceitful words like "reform" and "partnership".
Of course, the NHS may look and feel the same,
and it works often brilliantly,
but it's changing fast.
With hospitals forced to compete,
and profit-making companies cutting back on vital services,
especially to the vulnerable,
this film is a tribute
to an institution
that gave freedom from fear to millions.
The first of its kind in the world.
A last bastion
of true public service.
It's also a film about democracy.
Above all, it's a warning.
This is Michael and Matthew Moncrieff,
who lost their father, Trevor,
to a heart attack.
Aged 66, Trevor Moncrieff
lived in Melton Mowbray in Leicestershire.
He died after an ambulance from a private company, Amvale,
answered a 999 call to his home.
The ambulance pulls up and they've gone into the house
and seen Matthew performing some rudimentary first aid
on my father.
At which point, they've taken out their machine,
taken out their defibrillator.
Charged it up.
Things looked like they are going OK.
And at the point at which they tried to administer a shock,
the defibrillator fails.
Causing great consternation
amongst the staff.
They need a new defibrillator on site as soon as possible.
But they are unable to get hold of the people who can dispatch that.
A text is sent to the call centre.
They left messages with the call centre?
In texts, in the middle of an emergency?
Absolutely. So no-one directly spoke to someone
who would actually be able to dispatch
a new ambulance with a working defibrillator.
The ambulance staff recommend that my brother calls the fire service
to get a defibrillator on hand,
because they are known to keep them on their trucks.
And the fire service had dispatched to my father's address
and they arrived and they do have a defibrillator.
But obviously this is all contributing
to a general scene of chaos.
This is all valuable time that's been lost
in an extremely critical period of a heart attack.
And we've still yet to hear back
from the call centre at this point.
So the situation has kind of descended into
a harrowing farce.
There followed confusion
about which hospital to take Mr Moncrieff.
He was taken first to Grantham and stabilised.
Then to Lincoln, a heart specialist centre,
a journey of 45 minutes.
Every subsequent action kind of went wrong.
It feels as if there was nothing in place
to account for this eventuality.
And that from that point onwards,
we just entered this Kafkaesque nightmare
of poor decision after poor decision after poor decision.
Which we are certain led to his untimely passing.
A report by a leading cardiologist
found that Trevor Moncrieff
most likely would have lived
had he received the proper emergency care.
And what we have here is defibrillators
that have been bought second-hand,
that haven't been tested effectively or properly
for many a month, because they haven't purchased the devices
with the manufacturer's guidelines.
Which smacks of cutting corners.
It smacks of people trying to...
to cut costs,
to make profit.
And not to provide the best care for people
who desperately need it.
In 2018,
the NHS in England
spent more than £92 million
on private ambulances and taxis for patients.
Many carry the NHS logo.
But look closely.
Often unknown to the public,
private ambulances are frequently sent to emergencies.
In 2019,
the Care Quality Commission
warned that patients were put at risk
by private ambulances.
East Midlands Ambulance Service,
which employed Amvale,
apologised to the family.
They declined to give an interview.
A "freedom of information" search
has since revealed
that Amvale was still in service in the East Midlands
in 2017,
three years after the death of Trevor Moncrieff.
Keith Salt waited almost a year
for a gallbladder operation.
He was in constant pain.
In 2013,
he was offered the procedure in a private hospital,
Spire Parkway in Solihull.
The NHS would pay for it.
A feature of privatisation
is that thousands of NHS operations
are outsourced to private hospitals,
many of which do not have the same facilities as the NHS,
the same expertise,
and the same responsibility
if something goes wrong.
Unlike the NHS,
private hospitals like Spire Parkway
have slick, corporate advertising.
When did you find out that something was wrong?
When I actually came round in intensive care
and...
the consultant was standing over us
saying that they'd experienced problems
and that was the reason for why I was where I was.
What was the result of this mistake?
He'd nipped the bile duct,
it was a 75% cut in it.
And I had one of the worst injuries of a bile duct that you could have,
without, I suppose,
dying.
When I did delve into what
these kind of injuries do,
a lot of people a few years back
was quite bad and a lot didn't survive...
beyond 12 months
with this kind of injury.
I'll just get this right. Dr Mercer, the specialist,
who rescued the situation,
I suppose,
he came from the NHS hospital?
The QE, yes. The QE.
Queen Elizabeth.
It isn't until later
that you suddenly realise,
that unlike an NHS hospital,
when there is a problem, they haven't got the back-up
to call on at that particular time
as you do in an NHS hospital,
where they've got probably several in the same field
that they can call on at that time.
Had you known this before, would you have gone over to them?
I was desperate at that time to just get it done.
I was in that much pain.
Do you think the NHS should send
patients like yourself
to private hospitals?
Well, I thought...
I thought it was good at the time.
I mean, I must say,
I was quite impressed in the fact
that going into a private hospital
as opposed to when you saw the surroundings.
Why were you impressed?
Just simply because the difference in
what you were getting, even the rooms.
The reception areas.
The facilities.
It was just so impressive
for somebody who only ever went to
an NHS hospital
as to what suddenly you were being given.
So it looked good? It looked good. Yeah.
It didn't end up being good, but it looked good.
In 2015,
following Keith Salt's operation,
the Care Quality Commission
published this report
on Spire Parkway.
Four years later,
Spire Parkway's safety and surgery
were rated good.
But the hospital still requires improvement.
Did Spire Parkway Hospital ever apologise to you.
No.
Did the surgeon who did it, did he ever apologise to you?
No.
I'm proud about the National Health Service.
It's a piece of real socialism.
And there's nowhere in any nation in the world...
..Communist or capitalist,
any health service to compare with.
The National Health Service
was not a gift from above.
It was conceived
in the blood, sweat and tears of ordinary people,
who had built the imperial might and wealth of Britain...
..and yet often lived in abject poverty.
In the 1920s and '30s,
modern healthcare was a luxury.
Children died from Dickensian diseases.
Women still died in childbirth.
Infection ravaged slums without running water
and sanitation.
Britain's deadly disease was class.
The Second World War was a political awakening
for millions of ordinary men and women.
In 1942,
a committee chaired by the economist William Beveridge
warned that the war was a revolutionary moment.
CHEERING
The elite were worried.
What would happen when the soldiers came home?
For many Britons,
the war had been fought not only against Fascism,
but for a new Jerusalem of decent homes
and jobs
and healthy lives.
The Beveridge Report
proposed a welfare state
and the world's first national health service.
Winston Churchill and the Conservatives opposed it.
In the 1945 general election campaign,
the war hero, Churchill,
was not always welcomed in the industrial heartland.
Can you hear me?
CHEERING AND JEERING
When we are asked...
what is our policy,
I can only tell you,
that an enormous mass of work... JEERING
CHANTING
..a substantial advantage in the human heart
and the human head will have to be made
before we can
adopt a full, glorious utopia,
which the socialist wool-gatherers
place before us.
The utopian wool-gatherers
would soon have their say at the ballot box,
representing the majority of Britons.
The soldiers' paper, the Daily Mirror,
called for a vote for them.
Meaning the men and women
who had won the war
and the right to a new freedom, said the mirror,
of equal opportunities and robust health.
Labour's landslide victory was a shock.
And the tremors didn't stop there
and became open rebellion.
In the Far East,
50,000 airmen went on strike
in more than 60 Royal Air Force bases.
The greatest mass mutiny in British history.
The issue was democracy
and the right to be demobilised
and not to be part of an imperial presence east of Suez.
Arrested and court-martialled,
the strike leaders were set free
after a public outcry
that symbolised a Britain
that was now changing fast.
On July 5th, 1948,
the most momentous social change of all
was announced by this leaflet delivered to every household.
This leaflet is coming through your letterbox
one day soon.
Or maybe you have already had your copy.
Read it carefully.
It tells you what the new National Health Service is
and how you can use what it offers.
Study the leaflet, then keep it by you.
You'll need it for reference.
The NHS was founded in 1948
to give people freedom from fear.
Freedom from fear of healthcare bills
at a time of great need and distress.
And that fundamental principle of freedom from fear
on the basis of a national health service
providing healthcare for all throughout the UK
on the basis of need,
not ability to pay, and free at the point of delivery,
that's been an enormous, an immense
and an important achievement.
My father was a general practitioner
in the '30s.
He became absolutely convinced
that that system, which was effectively a market in health,
people had to pay, he hated asking for payment
from people he knew couldn't do it.
He looked on 1948 as a day of freedom,
when he no longer had to ask people to pay.
We had something...
..principled and almost lovely.
There was a relationship between the doctor and the patient,
the one-on-one, all-important relationship,
nurse and patient,
which is really the essence of healthcare,
was one that there was no market interference, no market exchange.
Creating an ethos that you are part of something greater than yourself
it is actually a collective act of genius
from 1948 to '58 to '68.
I was born in '68.
And I was born in a country with
almost the best infant mortality rate in the world.
The best place to be born.
I was born in a city which had the first baby incubators,
you know, there.
We were at the very forefront of health.
But in the 1970s,
a secret plan to sell off nationalised industry
was drawn up as Margaret Thatcher prepared to take power.
Nicholas Ridley, a close ally
of Thatcher on the far right, advised...
In the same year,
the American management consultants
McKinsey & Company
proposed that NHS hospitals
should be like hotels
and charge patients a daily rate.
What is the history of this revision, revisionism,
of the NHS?
The real attack, the real decimation
started in the late '80s under Margaret Thatcher
and her two advisers, Oliver Letwin and John Redwood.
How did they express that?
They produced a document called
Britain's Biggest Enterprise.
And this set out
how to get from a public service to an insurance-based system.
They knew that whatever they did to the NHS,
if they took it away from a public service,
there would be a huge backlash.
So key to the plan
was to do it very surreptitiously and covertly
and over a long period of time.
But it was the New Labour government of Tony Blair
that accelerated the sell-off.
Blair used an accountancy trick
called Private Finance Initiative
or PFI.
New hospitals were effectively owned
by the companies that built them
under disastrous pay-later terms.
The effect of PFI has been to deliberately burden hospitals
with huge debts.
And these debts were structured in such a way
that they would become more onerous over time.
What that does, it removes money away from the delivery of care,
because PFI repayments are ring-fenced.
So money has to go to pay the PFI
above any other call on that money.
So you end up having
the servicing of the debt
in preference to the providing of care for patients.
And we've seen hospitals closed down.
Neighbouring hospitals, which don't have a PFI debt,
have been sacrificed
to bail out hospitals with PFI debts.
So if you look at the total PFI debt within the NHS,
we've borrowed about £11 billion
and we're going to be paying back in excess of £80 billion
over 30 to 40 years.
Hmm.
And much of this was secret, wasn't it?
The way PFI was introduced,
it was never explained
in a way the public could understand what a con, what a fraud this was.
At one point though,
the Labour government at one point was looking at actually...
I think it was about a third of the NHS assets
were going to be effectively privatised in this way
and handed over to PFI.
And were these deals accountable?
Publicly accountable? They were profoundly secretive.
You couldn't get any access to what was going on at all.
They were all behind closed doors.
It's an enormous, appalling public scandal.
124 hospitals and more
are now built, designed, built and operated
using private finance.
And remember it was accompanied by one of the biggest
hospital closure programmes and land disposal programmes.
PILGER: In the late 1990s,
Labour's health secretary, Alan Milburn,
declared his undying love
for the NHS.
This is a once-in-a-lifetime opportunity for the NHS
to redesign its services around its patients.
We've got more money going in and that will allow us now
to get the basics right. to get more nurses, more doctors.
More beds in the system.
But if we're gonna get the best from the money,
and we're gonna get the best for the patient,
then there has to be some big changes.
What the changes concealed was the beginning of a sell-off.
The Blair government pushed through Parliament
a series of bills
that opened the door to private business
and PFI.
Having overseen the changes to the NHS,
Alan Milburn left the government
and later joined the board of Bridgepoint Capital,
a private equity company.
WOMAN: 'Welcome to Care UK.'
In 2010,
Bridgepoint bought Care UK,
one of the biggest healthcare companies
contracted to the NHS.
'Which balances making a profit
'and delivering quality NHS services.'
This is Simon Stevens, Tony Blair's health adviser.
In 2004,
Stevens stepped into the revolving door
and was hired by the American health industry giant
UnitedHealth.
UnitedHealth Group believes that businesses and consumers
will want to do business with us,
because we hold integrity at such a high level.
Integrity isn't hard.
It's living our beliefs us being ethical, us being honest.
Honesty, integrity,
maybe.
But UnitedHealth has another reputation.
Its former chief executive,
William McGuire, known as "Dollar Bill",
was forced to give back $620 million
in the biggest share scandal in corporate history.
APPLAUSE
After ten years with UnitedHealth,
Simon Stevens was brought back by the coalition government
as head of the National Health Service in England.
Under the coalition government,
the budget of the NHS
was cut from an average annual increase of four percent
to one percent.
Thousands of doctors and nurses
have left the NHS,
which now has one of the lowest bed capacities in Europe.
In the NHS today,
one American company stands out.
McKinsey, the management consultants,
with a worldwide reputation
for helping governments reform public services.
If you look at the documents that I've got,
from around 2010, 2011.
So this is when they really ramp up the privatisation,
the reforms of the NHS.
And you look at McKinsey's involvement there,
they are attending meetings of the management board.
The steering group that sets up these new structures within the NHS.
This is a McKinsey document.
It's about designing the new system
and they have set the agenda here.
This is a great document.
This is them discussing the new organisational designs.
So you have an American healthcare model.
They are looking at Kaiser Permanente.
Lots of glossy pictures of Kaiser Permanente,
smiling patients and doctors.
I think the management of the NHS
have become dependent on the management consultants.
It seems to be no longer there is a management
ever sit down and actually draw up its own plans.
They actually bring in somebody else.
And at the end of the day, all you're getting
is the management consultancy kind of approach.
In which you come along,
you ask a management consultant the time,
he borrows your watch, tells you the time and charges you £1,000.
And we've got that right across the NHS.
This is the centre of Britain's democracy, Westminster.
Unknown to many of us,
a network of pressure groups, lobbyists
and right-wing propagandists
have their offices in the streets that border Parliament.
Their target is the National Health Service.
Tamasin Cave and I are taking a tour.
OK, and this humble abode just round from Parliament
is the Institute Of Economic Affairs.
Tell me about them.
The IEA is an incredibly effective propaganda machine.
You look at the size of it,
it's not a big, massive advertising company
or lobbying agency.
It's a small organisation.
But the relationship it has with the media
is incredibly tight.
So, it manages to get its messages into the tabloid press,
it's all over the internet.
But particularly the BBC.
We do know from other sources
that it has taken money from the tobacco companies.
So, for somebody like Philip Morris, a huge tobacco giant,
they describe the IEA as particularly useful
in getting its messages out into the public domain.
The NHS represents everything that the IEA stands against.
So, it is a public institution.
But right now, it has some friends in very high places.
OK, we're now in Tufton Street.
It's worth noting that Tufton Street is this epicentre
for these kind of think-tanks.
Yeah.
You've got the... you know, low tax advocates over there,
you've got your climate change deniers over there,
you've got your privatisers over there,
your deregulators, they're all here. It's brilliant.
And in the middle of it,
you've got the Centre For Policy Studies,
which... this was Margaret Thatcher's think-tank.
So, these are the offices of another free market think-tank.
Mm-hm. Business lobby group.
It's called Reform.
And this is one of the... a younger version of the CPS, basically.
And it was set up specifically
to lobby for privatisation of public services.
So, not just the NHS, but education and justice and the like.
Mm.
The brilliant thing about Reform, very clever, this,
they set up a front group, so it wasn't enough
that they were then saying the corporate messages in the press,
they set up another group,
they set up a thing called Doctors For Reform,
which brilliantly was led by a GP.
One who specialised in Botox.
A distinguished specialist (!) Exactly.
And he can reach parts of the media that a think-tank can't.
They're all round the honeypot, aren't they?
They're all close to power.
Because just down the road there is the Department Of Health.
Yeah, I mean, we are...
Imagine the corporate interest lined up there... Yeah.
..literally behind the Department Of Health.
It's very, very handy.
OK, here we are in Bressenden Place, just off Victoria Street.
Portland House, what's in there?
This is the office of the trade body
for all the companies, all the other companies
that are looking to get their hands on NHS money,
so all the big outsourcers.
You've got in there, Care UK,
the biggest NHS contractor there is at the moment.
You've got Virgin, they've picked up £2 billion worth of NHS contracts
in the last five years,
you got BUPA in there, hundreds of million pounds of NHS work.
And there's the arm of, er, the biggest US health insurer,
which is called UnitedHealth.
Their tech arm, Optum, is a member of this organisation as well.
It's called the NHS Partners Network.
And it paints itself as, kind of, part of the NHS family.
They are investing in influencing the government.
It's an investment they make.
A tactical investment, because it delivers a return.
I spoke to a leading lobbyist, Andrew Haldenby.
The health service is a public service.
Why should it be privatised?
I think the health service is a lot more of a public-private mix
than people may sometimes think.
And actually was right back at the beginning.
So, your GPs, erm, a very crucial part of the health service,
have always been independent contractors in effect.
They have their contracts with the NHS,
in many ways the main thing I have to say is that
the health service is this mix.
It's this mix of public financing and a lot of private delivery,
one way or other.
That has built the health service we have today,
with its strengths and weaknesses.
And I think, I really strongly think,
that it should continue to be that mix going forward.
But Reform has advocated, for example,
the introduction of payment in the health service.
I think you called it a Membership Charge.
And that people staying overnight in NHS hospitals
should pay a hotel charge.
The idea of membership fee was put forward by Norman Warner,
who is a Labour peer.
He was trying to answer the question in a pamphlet for us.
How do we get citizens of this country
to take their health more seriously?
So, he suggested, just as an idea,
a £10 a month, if you like, membership fee,
which is, you know, not a huge amount.
But it would be enough to give people, if you like,
a personal stake thinking about their own health care.
Certainly if we think of something like technology,
which will be absolutely core, it's already core, it has been core,
but going forward it's very exciting to think what new technology can do
to the delivery of health care.
That, at present, can only really be done
in partnership with the private sector.
The new IT system in the health service
was installed by private companies and was a total catastrophe.
Well, er, yes...
I think there may be one minor thing that came out of it,
so we can say nearly a total catastrophe.
All this wheeling and dealing behind closed doors
fed into the 2012 Health And Social Care Act.
Which promoted privatisation, and changed the NHS as never before.
It's a very large act, it's over 450 pages long.
And it's really the act that enables
both the dismantling of the old system
that was in place from 1948, and a switch to a newer system
which is much more modelled on the US health care system,
systems of the US.
People watching this will be shocked
to hear that their health service has been, and is being, dismantled.
One of the founding duties on the Secretary Of State in 1948
was the duty to secure and provide health services throughout England
for everybody.
And that's the duty that has been abolished.
That duty to provide has gone.
The Secretary Of State has a much weaker duty,
to promote a comprehensive health care,
but the duty to provide services in accordance with the act
has gone.
And as well as that, there is now a requirement,
erm, to contract a duty to arrange services instead.
Which is really legalese for contracting.
And the way
in which our government and NHS England is choosing to interpret it,
as commercial contracting.
This, er, external market
created by the Conservative and Liberals
in the Health And Social Care Act
was a monstrous piece of legislation.
It was also a grotesque, a grotesque lie on the British public,
both the Conservative Party and the Liberal Party
went out of their way in the election
to say that they were not going to have
another top-down health service,
and they produced the biggest and most revolutionary change
in the National Health Service throughout its history
in the 2012 act.
Cameron went on to say it's the biggest mistake he made.
And here it is, six years later,
still creating serious damage to the health service.
The biggest lie is that somehow markets and competition
will improve health care.
We know from all the evidence that's available,
that the more you privatise the system,
the more you introduce waste and you introduce conflicts of interest.
That is a big lie.
The NHS prior to the Thatcher reforms,
the administrative costs were estimated to be less than 5%.
But we know now,
best estimates are that the cost of the market bureaucracy
is running in the order of 20%.
So, that is 15% diverted away from the delivery of care.
The beauty of the NHS came from its simplicity.
And you had money coming from the Treasury to health authorities,
and this was divided out between the hospitals and the GPs.
There was no need for this army of intermediaries we now have.
The NHS crisis, which is no longer a winter crisis,
it's an all-year-round crisis.
And that's how privatisation has manifested.
But it's very convenient,
because it looks like it's the NHS that doesn't work,
it looks like it's the principle
of publicly funded, provided and owned health care
which doesn't work.
What people can't see is everything we've discussed behind the scenes.
That it doesn't work because tens of billions are being siphoned off
to running a market system, to the PFI debt.
To outsourcing profits, to management consultants.
So, 2,500 years ago,
this woman was walking on the streets of Babylon
and she sees a frog, and the frog says,
"Lady, please pick me up and give me a kiss,
"I will turn into the most beautiful,
"handsome prince you've ever seen."
This is Ali Parsa.
A former Goldman Sachs trader and super salesman,
who claims he is starting a world revolution in health care.
We are about to change everything about health care.
It's going to become completely democratised.
Maybe not in the next five years,
but certainly the next ten years it's going to become accessible,
going to be affordable, it's going to be everywhere.
Ali Parsa became a national figure in Britain
when his company Circlehealth
won a contract to run Hinchingbrooke Hospital
in Cambridgeshire, from 2012.
It was an historic moment for the NHS.
The first NHS hospital to be effectively sold off.
We were classed as a failing hospital,
so we were informed that this great businessman was coming in.
Ali Parsa. Yes.
And I must admit, when I first met him I thought,
"What a charismatic, inspiring man we have here."
That's how he came across.
And he said, "So, you have my expertise.
"And I am going to take this hospital to great heights.
"You are going to be the best hospital in the UK.
"Dream the impossible."
That's what he kept saying.
As he kept saying, "Dream the impossible."
Dream the impossible, yes.
OK. Yes.
We had a meeting where Vince Cable,
the then Business Secretary attended,
and he was obviously very, very friendly with Ali Parsa.
They came up together.
And, erm, Mr Cable came and he sat opposite me.
And, erm, he was talking very, very business-like
and he said to me,
"Do not have any doubts about Mr Parsa's ability,
"he will make this hospital fly as a business,
"it will thrive as a business."
It was all, "This business, business."
Mm.
And I look to him and I said, you know,
"I don't mean to be rude or anything,
"but this is a hospital, it's the NHS,
"I don't see it as a business."
And what reaction did you get?
He said, "Yes, it is, my dear. It is a business."
We asked Vince Cable for a response,
he says he has no recollection of the conversation.
The selling of Hinchingbrooke Hospital
is a story of propaganda.
This is how the BBC's Newsnight reported the exciting prospect
of Britain's first privatised NHS hospital.
For the first time in the UK,
a district general hospital was given over
to a private sector organisation to manage.
Six months on from the start of that experiment,
Newsnight has been given exclusive access to Hinchingbrooke,
to find out what's changed.
So, in one of our wards in here,
we're getting 100% satisfaction of our patients.
There is still a way to go.
Nevertheless, at Hinchingbrooke
they are celebrating the six-month milestone with cupcakes.
In my job, we are feeling that now
we are satisfied with looking after every single one of our patients.
These partner meetings are a big part of the turnaround strategy.
They are called partner meetings
because the staff now own 49% of the company.
That's part of the plan,
reigniting and then harnessing their creative enthusiasm.
Our response to that was that every person that worked at that hospital
and the local community
already had a stake in that hospital.
They didn't need to become shareholders in some fantasy scheme.
And to be honest, I didn't want to be a part of that,
that didn't sit right with me. And I actually said that.
I said, "I don't want to have shares."
I said, "This is the NHS. I just want to do my job."
It was a ten-year contract.
They promised absolutely astonishing levels of savings.
It was absolutely incredible,
yes, it was something in the region of 300 million over ten years.
They sold this idea
they were going to get all the staff working in the new corporate way.
And, so, they gave them all new uniforms,
so they no longer had NHS uniforms,
they were Circle Hinchingbrooke uniforms.
They decided that as lead nurses we would then, on top of our jobs,
we would meet daily, and go round all of the wards,
our own wards, and look very carefully, you know,
it would take an hour or so of our working life,
to look into the patients to see if we could actually get them out...
Mm. ..quicker.
And we used to have to do that,
erm, and have our results back for Circle by one o'clock every day,
as to how many patients we could move out.
So that we could accommodate the planned admissions,
and the planned admissions are the ones that bring the money in.
And the sad thing was, as lead nurses,
we were all put up against each other.
So, there were six of us,
and we all used to work really well before Circle.
But because of the nature of it, erm, it became very competitive.
In the performance meetings and in the operational meetings
it was a competition.
And we, therefore, that cohesiveness, didn't exist any more.
So, if you still had patients blocking beds, as they say... Yes.
..then you would be failing in this competitive situation?
Well, yes, yes.
And I was always a failure, I was always told that.
So, it gets to you when you are being told that.
But before 2012 was over, Ali Parsa had stepped down.
Taking a contractual payment of more than £500,000.
In 2015, a Care Quality Commission report
revealed the safety of patients at Hinchingbrooke
including children, was at risk.
Circle disputed the report...
..and says it won a national award for patient care.
The Care Quality Commission were brought in
and there was a damning report produced.
So bad, in fact, that they put the hospital,
for the first time that they'd had to do this,
in special measures.
Circle withdrew from the contract.
A dramatic failure in terms of the privatisation project.
In 2015,
Circle abandoned Hinchingbrooke, which returned to NHS control.
Why were these people allowed to run a hospital?
Because what happened when they withdrew,
three years into a ten-year contract,
the NHS was left to pick up not only the financial damage,
but the damage it caused to the local community and to the staff,
who had to work through these three years... of incompetence.
One day, I came in to work as usual
and, erm, my brain had just switched off.
My bleep kept going off,
and I couldn't remember how to recall my bleep.
Oh. It was as if my brain had gone.
I couldn't function.
Oh.
So, yeah...
It's OK.
SHE SNIFFS It's OK.
It's...
..it's very sad.
It's a very painful memory.
SHE SNIFFS
It is. It's a job you loved.
So, it was really sad, because...
I'd worked there so long.
How long?
24 years.
And, erm...
..I'd lost my extended family.
Yeah. ..they'd all tell me.
The patients and the doctors and...
..it was a part of my life and it was just gone.
SHE SNIFFS
Hinchingbrooke and the Circle debacle
should be in stone, given to any Secretary Of State For Health.
In terms of what could go wrong did go wrong. Mm.
Privateers have no place in the NHS.
They are there to make a profit.
And patient care and health is not about making a profit.
Well, during the...
I asked Ali Parsa for an interview, but his spokesman declined.
Here is Ali Parsa again,
promoting what he called his next project.
A company called Babylon Health, and its app, GP At Hand.
This gives you a doctor on your smart phone, or a robot.
Most of our time, as easily as possible.
This is the Conservative Health Secretary Matt Hancock,
who believes technology offers a new utopia for the NHS.
He's one of Babylon's biggest fans.
The Secretary Of State For Health, Matt Hancock, is very keen on this.
Well, I suppose he is, but, I mean,
you know, I don't have much confidence in this guy's ability,
or his judgement.
He also appeared in that crazy advertorial, didn't he?
I mean, that's the other thing.
A big question about what is his links with this company?
He's prepared to appear in the Evening Standard double spread
paid for by GP In Hand.
Paid for by Babylon.
I mean, that is just questionable, I would say,
giving a personal endorsement to one particular piece of software.
I think, if you're looking at the cost of the NHS,
and somebody comes along and says, "I've got a bit of technology here
"that can replace an awful lot of expensive clinicians
"and do their job just as well, better..."
Particularly if you are already biased towards tech,
you might be uncritically enthusiastic,
which I think Matt Hancock has been.
In its long-term plan for the NHS,
the government wants to replace thousands of GPs
with consultations by video and app, and robot.
This young woman, let's call her Ellie, isn't feeling well.
But she doesn't go to the doctor's office,
he comes to her via an app called Babylon Health.
Hello.
'Hello, there, this is Doctor Butt from Babylon.'
Thanks very much for choosing us for your consultation today.
How can I help? The last few days...
Ellie explains that her eyes itch.
Why do you think so many of your colleagues in the medical profession
have expressed quite serious doubts about Babylon?
So, I think those doubts will be very quickly dispelled
by some of the recent reports that have been published.
So, you may have seen that there was a report published by the regulator,
the Care Quality Commission, who inspected our services
and found them to be good.
Er, there's also been a report published yesterday,
this is an NHS England commissioned report, an independent evaluation,
that has shown overwhelmingly
that patients and GPs are really satisfied with these services.
I mean, there have been quite some claims.
The claim that your chat bot
achieved a higher score in a medical exam than human doctors.
I mean, that wasn't true, was it?
So, it was true for the test that we did.
The test itself was extraordinary,
according to doctors working for you, I think, at the time,
it answered only something like 15 of 50 questions.
And yet Babylon claimed, as a result of that,
that the chat bot had intelligence equivalence with human doctors.
What we found, which was really interesting,
is actually there's a huge amount of variation
in actual human doctor performance when it comes to accuracy.
And that ranged from as low as 64%, right up to 94%.
With an average of 80%.
And then when we did the same testing with our AI products,
erm, we were able to show that the AI performed at about 80%.
You've said that the majority
of the medical profession are, and I think the word you used was askance
at Babylon's virtual doctor.
What's wrong with it?
I think probably the bottom line is it's a completely mistaken idea.
So...
It's based on the idea that you can reduce people's health problems
down to perhaps some very simple yes/no questions,
predictably churn those through a machine
and come up with the right answer every time.
I think there are two big issues with that.
Number one, it doesn't work a lot of the time
for anything that's more than very straightforward.
So when I'm consulting with patients,
erm, they may come with the same kind of symptom
and what I try and do is I try and understand
what it is that's worrying them
and what I need to do to be able to address their particular concern.
So it's less about the symptom and more about the person who's got it.
I mean, the Advertising Standards
has picked you up on a number of things
described as misleading.
One of them was it was 100% safe,
or 100% the best in the world.
So I think sometimes things are taken out of context
and that example that you cite of 100% safe is actually accurate,
but it's 100% safe in the test that we performed.
Now, that doesn't, of course, mean...
Is anything 100% safe? Well, that's a good point.
Erm, but, you know, and that's why it's very important,
that's why I'm saying it's all about the detail.
So, actually, in the particular test,
the results showed it was 100% safe.
But that, of course, doesn't mean it's 100% safe all of the time,
and as you rightfully point out, can anything be 100% safe?
I mean, medicine is a science, but it's an art, it's a humanity,
erm, and machines have no emotional intelligence,
they cannot understand people, they can't understand metaphor.
They can't, erm...
You know, probably the majority of what my patients communicate to me,
they communicate not in words but in what they do with their body,
what they don't say,
how they choose to answer my question.
And I'm constantly understanding them
through communication that's nothing to do with words.
And again, a machine cannot understand human communication
in that way.
What we say in words is actually only a very small part,
a minority of what we're actually trying to say.
I mean, Babylon is a progeny of Circle Health.
Circle Health has a rather notorious reputation.
And I don't need to go over the details,
but it took over Hinchingbrooke Hospital
and you talked about the Care Quality Commission
giving you a good report.
Well, they gave Hinchingbrooke,
after Circle had been there, its worst report.
Of course, I can't really speak on behalf of Circle,
not having had anything to do with that organisation.
What I do know is, you know, our founder, Dr Ali Parsa,
as you mentioned, actually, you know,
did some really amazing transformative things in Circle
and took the hospital you mentioned, Hinchingbrooke,
from being a failing hospital
to actually being a highly performing hospital.
Now... No, that's... Excuse me.
But things change. That's not true.
It didn't become highly performing.
I mean, I can't obviously specifically comment on Circle,
but what I can comment on with great confidence
is, erm, the...
Babylon as an organisation.
And actually, you know, I can't commend Dr Parsa enough
for his leadership.
You know, if you think about the success of Babylon
and everything that we've managed to achieve
to transform patient care here in the UK and beyond.
You have words and you have actions.
Hm.
Erm, and the actions are taking us
further and further towards an American model.
The words keep spouting out the rhetoric,
but the actions are taking us further away from that public good
towards the kind of American model.
So the actions are what tell us what's going on.
RADIO JINGLE
'This is Chicago's all news station.
# WBBM. #
'Newsradio 780 and 105.9 FM
'and CBSChicago.com.'
'WBBM news time, 10:53.
'The news watch continues.'
Chicago is one of America's wealthiest cities.
Article 25 of the Universal Declaration of Human Rights
says that everyone has the right to a standard of living
adequate for the health and well-being of a family,
including food, clothing, housing and medical care.
In the United States, that right has yet to be granted.
Instead, a group of health insurance companies
dominate the health care industry
and often decide who shall live or die.
As many as 87 million Americans cannot afford health insurance
or their insurance is made virtually worthless
by excess charges known as deductibles.
At least 20,000 Americans die every year
because they can't get treatment.
And this is the system that inspires so-called reform of the NHS.
It happens late at night, after ten and before four.
It's called patient dumping.
This woman says it happened to her,
dumped at a homeless shelter by a nursing home, alone.
Had you ever heard of patient dumping before?
She says two men in a white van
drove her here to the Pacific Garden Mission
and dumped her right here at the mission's front gate.
It was the middle of the night, she was in a wheelchair
and she didn't have her medication.
For any society just to drop somebody off,
especially with a disability,
and expect them to fend for themselves is really barbaric.
And when we saw these things happening,
we were appalled at that practice.
In the United States, the dumping of patients is so common
that this hospital patient was caught on CCTV
being dumped at a refuge.
People just want to get rid of the person
and at whatever cost, find some place
where somebody can go to and just dump them
and get out of there, move onto the next person.
And if a hospital wants to make the most profit,
they want to get the most number of people in the beds,
so to get somebody out and get the next person in,
find a place for a person to go to, and if you can't dump them off...
Because they know that an organisation like ours,
we wouldn't leave them out there,
so they're really trusting the goodwill of the organisation.
On the other side of Chicago,
in what is known as Skid Row,
is Franciscan House, a former broom factory
that's another refuge for the unwanted sick
dumped by hospitals.
They do their best here,
but it feels like a warehouse for expendable people.
When this is full, how many does it hold?
This dorm here is 148. Right.
All right.
What happens to people who have no health insurance,
or maybe have health insurance but it's not adequate?
So it's not like the hospital calls us and says,
"This person is coming over." We're gonna dump a patient.
"And these are the issues." All right.
No, the driver's gonna come by the front door
and is ready to just drop them off right there.
Some of them possibly had some surgery,
some of them might be psychiatric patients. Yeah.
Sometimes we have to call an ambulance
to have them readmitted to a hospital
because they're just not well enough to navigate the place on their own.
But sometimes we're nowhere near the door
and the person gets dropped off.
So they can be very quick?
It doesn't take much to open the door and let somebody out.
Wendell Potter was the chief public relations executive
of Cigna, a giant health insurance company.
His job was to spin the company's propaganda
often, as he describes, with deadly effect.
You were the spokesman, the public voice,
for a health insurance industry whose routine practices -
and I quote you - "amount to a death sentence
"for thousands of Americans every year."
Yeah. That's an extraordinary statement.
Could you talk a little about that? It's not extraordinary
when you look at the reality of our health care system.
That happens all the time.
Every day decisions are made by insurance company employees
as to whether or not you will get some life-saving care.
Hm. There was one case in particular,
it involved a 17-year-old girl in Los Angeles
who needed a liver transplant
and her doctors at UCLA Medical Centre
said they felt the chances were significantly good
that she would come through the surgery and live many years.
Just remind me of her name. Her name was Nataline Sarkisyan.
And there was a medical doctor at Cigna,
2,500 miles away in Pittsburgh,
who looked at the request for prior authorisation,
which is again a term that is prevalent in our system.
Doctors have to ask insurance companies in advance
for permission to proceed with a procedure,
or at least to get coverage for it,
or some assurance that it will be paid for.
So that was what happened.
The doctors who attended and were going to be doing the surgery
ask this... ask Cigna
and the medical director said he didn't think
it was medically appropriate for Nataline.
What did that mean, medically appropriate?
Well, even though the policy covered transplants,
in his subjective opinion,
he said he did not think that her doctors were correct.
He had never seen Nataline, he had never examined her.
Keep in mind that a perfect match had been found
and the transplant had been scheduled.
The family came into the hospital
on the morning that the transplant was to have been done
thinking that it would be done.
But instead, one of the doctors took the family aside,
took her parents aside and said,
"We're sorry but we've not gotten clearance from Cigna."
Hm. So the family decided
they would try to make a big media case out of this.
So what happened?
It became very clear to the company
that this was not a media story that was just gonna go away quietly,
as I was often able to make them go away.
They, within an hour or so, convened...
They being the CEO
and the president of our health care division,
the chief medical officer and a few others,
on a conference call,
decided, well, maybe in this case we can make an exception.
She was getting sicker by the day,
her other organs began to shut down.
She died about five hours after Cigna said
it would pay for the transplant.
And I just said, "I am in the wrong line of work,
"I can't keep doing this."
My job was to help perpetuate a very, very unfair,
expensive and dysfunctional system.
What kind of wealth did that company have at its disposal then?
There are a lot of executives close to the CEO level
who make millions of dollars a year.
Billions of dollars flow through these companies,
they make billions of dollars of profits off of that revenue,
partly to reward shareholders, or largely to reward shareholders.
But a lot of money is skimmed off or made available
to conduct PR campaigns and lobbying campaigns.
In 1996, Dr Linda Peeno,
who worked for the insurance giant Humana,
appeared before a congressional committee
with this remarkable confession.
I am here primarily today to make a public confession.
Uh, in the spring of 1987, as a physician,
I denied a man a necessary operation that would have saved his life
and that's caused his death.
No person and no group has held me accountable for this
because in fact, what I did
was I saved a company half a million dollars for this.
And furthermore, this particular act secured my reputation
as a good medical director
and it ensured my continued advancement
in the health care field.
I went from making a few hundred dollars a week as a medical reviewer
to an escalating six-figure income as a physician executive.
In all my work, I had one primary duty,
and that was to use my medical expertise
for the financial benefit of the organisation for which I worked.
This was one of those cases where the request came in...
It was just a little piece of paper in my inbox,
I just happened to pick it up next and it just happened to come to me.
And they had called from a hospital in California,
a patient from Nevada had been on a transplant list.
Heart transplant? Heart transplant.
They had a heart... A heart became available, a match.
Yeah. And the surgeon was ready to operate.
So I called and I thought this was just a formality
because nobody would do a medically unnecessary heart transplant.
You couldn't get through the transplant process.
So I talked to him, he explained the situation,
they had a heart available, they called him,
they got him to this hospital.
So I approved it.
I stamped my little approve on it
and then just everything went to hell.
Because it was a half a million dollar transplant.
So that all these people start rushing in,
"We've got to figure out a way to deny it, we can't pay for it,
"you've got to call the doctor back."
I'm a physician,
I know what the consequences are going to be to this man
who doesn't get his heart.
You know, he's going to continue to deteriorate
and his congestive heart failure could last two days,
two years, but he's...
he's been consigned to cardiac hell.
You know, he's going to slowly deteriorate.
And whether he died two days later or two years later,
you know, I participated in consigning this man to death.
I mean, I signed his death warrant.
I would try to do the best thing I could do as a physician,
but I was always coming up against this huge machine.
It was just grinding away
to keep patients from getting what they needed
because that cost money.
I mean, the whole purpose was to make money.
That's the risk for all these other attempts
at privatising portions of something like the NHS,
is when you...
you begin to hand over the benefits, the funds to these private companies
to manage. I mean, their goal is gonna be to make money,
not to provide better care or more care, appropriate care.
This is the town of Wise, Virginia,
in the mountain country of Appalachia
where some of the poorest Americans live.
The coalmines once gave people here a precarious life.
Today, many are unemployed and unwell.
Every summer, an extraordinary event comes to Wise
offering free health care of a kind unknown in the United States.
This is Remote Area Medical, known as RAM.
It's a wonderful community that comes together,
and actually looks out for each other.
Yeah. They come in, we greet them in the morning,
starting at five, six o'clock in the morning.
They come through and we register
and we don't ask them identifying questions.
Yeah. We don't care if they have insurance,
we don't care about their income, demographics,
but just ask them where does it hurt and how can we help you?
RAM is like a pop-up wartime field hospital
run entirely by volunteers
and set up in an agricultural showground.
It's as if the NHS has come to town.
CHATTER
People wait for days for the clinics to open, sleeping in their cars,
most of them have no other hope of medical care.
You're gonna stay in the car tonight? Yep.
Yeah? So who are you seeing tomorrow?
Dental tomorrow. You've got some urgent problems?
I actually chipped a tooth a week ago and he's got a feeling...
She's just got a cleaning
cos the school does free stuff for the middle schools. Yeah.
Are they sleep in there? He's out.
It's actually peaceful here, so...
at night. It is peaceful, isn't it?
We're supposed to meet up with the plastic surgeon
that did her removal for her little bump on her head last year,
and so he can see a follow-up of what it looks like this year,
so he can see how it turned out, so...
OK, what would that have cost you? To have that done?
Probably several thousand...
Especially if you get somebody like him
because he's actually a really well-known plastic surgeon
from Charlotte. Yeah.
So, to get him would probably be several thousand dollars.
Several thousand dollars? Yes.
Whereas here you get it for free. Mm-hm.
My sister's actually utilising this
because she has no health insurance and...
She's a veteran still fighting to get benefits for that. Oh.
And so we bought her here to get dental work
because she can't afford health insurance.
I can't tell you how happy I am to be here right now
because I have some abscess teeth
that I've been dealing with for the last couple years, and...
So you're gonna have your teeth looked at.
And I have Crohn's disease. And you have Crohn's disease.
I have a lot of medical issues too,
and I've been off my medication because I can't afford it
without health insurance. What does your medication cost?
See, the last time I had it was about six years ago
and just for two bottles they were 490-something dollars apiece. Ooh.
And that would... How long would that last you?
That would last me a month.
And that's only part of my meds. My cholesterol's high.
I'm a million five... about $1,500,000 in debt
for medical bills. You're a million five hundred...
But I've been sued.
My credit is destroyed from medical bills.
Right. And so I can't even buy...
I couldn't even buy one room, my credit is so bad.
And I've been sued and I just don't pay them.
I can't. Yeah.
So...
But this is wonderful
cos Appalachia really needs these kind of clinics,
and I didn't know about them till two years ago.
And tonight we're just gonna sit in the car all night and wait.
So you're sleeping here tonight. Yeah? Yes, sir.
And you've got your ticket for tomorrow. Yep.
Tell me why you're here, then.
Glasses and dental.
Mm-hm. You're getting a full health check-up?
Mm-hm. I usually do. Why do you feel you need that? Yeah?
Well, diabetes runs rampant in my family.
So with this service,
it gives the opportunity to stay one step ahead of it.
Yeah... Yeah.
What are you mostly concerned about?
Neck, back, seventh bulging disc, permanent pinched nerve in my back,
and there's nothing they can do surgical-wise
to make it better. Oh...
So I miss out there helping people, but... So you have a...
You have a lot of pain, then?
Yeah, a lot of pain. Yeah.
And who you will you see tomorrow?
I'll be seeing the neurosurgeons and those people,
and the medical and over to vision
to get my... vision done. Yeah.
Cos I get glaucoma on my left eye.
What would that have cost you to see...
to get that kind of treatment outside?
Outside, you're looking at just for the surgical part
about $1,000 each visit, somewheres around there. Yeah.
So this is like one of the best things here in Wise
that they do every year. Yeah, yeah.
It's only this free health care here
that offers you some kind of solution. Yes. Yeah.
It does, it helps a lot.
Not just me, my wife,
everyone else that's here that's camping out tonight.
I wish you well for tomorrow. Thank you.
I hope everything goes... Y'all too.
..really to plan for you and your wife.
Thank you.
It's 6:00 AM, and the sun is just coming up.
Everyone has a number.
Anybody with a number and admission ticket below 40?
41! 42!
43! 44! 45!
We're offering mammograms, pap smears.
We're taking chest x-rays.
We're doing EKGs inside.
'Can I ask you why you're here?'
I work at a gas station
and for me to get insurance for me and my husband is over $200,
that's just for vision and dental.
I can't afford that making eight dollars an hour.
You just can't.
Would you like to see a free public health service
right throughout the United States? I really would.
I thought Trump was gonna get it done,
but I guess that flopped a little.
To have to go out of another state to get health care
and health services is crazy. Did you sleep in the car last night?
No, honey, I actually... We got here about, what?
Three, four in the morning. 3:30.
It took a couple hour's drive, so... Oh, wow.
And I worked till 1:30 this morning.
Oh... Yeah.
I don't know where I'm going.
RAM was founded in 1985 by the late Stan Brock,
a Londoner who believed passionately in the right of people
to health care regardless of their ability to pay.
Stan was the world's expert on free health care.
It had to be free.
It had to be real care, high quality.
He didn't want us to tell somebody to go find a doctor or a dentist.
Stan was the guy who could inspire the workers,
he could inspire the volunteers.
And his words were simple, "We, me, you."
And that is why you folks are gathered here today,
and in Stan's honour, we will never forget the mission.
This is one of the most economically deprived parts of...
America.
The coal industry boomed in years past and has mostly declined.
We have some counties out here that have no dentist and we have...
There are lots of specialties that we don't have at all
that cities take for granted.
That nurse practitioner at the Health Wagon wanted me to come
because I have chest pain sometimes
and my blood pressure is, like, uncontrollable.
OK, can you describe your chest pain?
What kind of a pain is that?
Well, sometimes it hurts like a dull hurt down my arms,
but this morning, it's just been like sharp twinges.
Do you smoke? Yes.
'We're a belt of disease.'
We a belt of lung disease. I'm a pulmonologist.
So we're a belt of asthma, COPD, smoking.
We're a belt of lung cancer.
We're a belt of heart disease and stroke.
We're a belt of obesity,
and we're a belt of opioid use tied into mental health issues.
So when they come to you, what typically do they come with?
They're short of breath, they have a cough.
They have exercise limitation, they're having difficulty working.
And we can do a chest x-ray on the mobile unit.
We can do a breathing test, a pulmonary function.
Are you able to catch disease in time?
We did find three lung cancers in one day here at this event,
and so we do find serious disease with chest x-ray
or other screenings, but the most common thing we find
is, of course, the common diseases.
Discovering high blood pressure, discovering diabetes.
And we discover things that they have no idea about.
A lot of the patients know they don't feel very well,
but they don't know why.
They're trying to cope, trying to exist.
Diabetes is a disease that people tend to deny.
They don't even like the word diabetes.
In the mountains, they'll say, "Got a little sugar."
They won't say the word diabetes.
And they're trying to cope by putting off till tomorrow
what they can't afford today. Yeah.
It's a bit of a life-saver here, isn't it? Yeah.
This is a great programme.
Yeah. Fantastic programme.
What would the people who live around here who...
who don't have the medical facilities...?
They do without. Yeah.
They'd do without. They have no teeth or partial teeth.
They have...
no diabetic treatment, no high blood pressure treatment.
So if they come here, they at least get some medicine.
Typically, what are you dealing with here?
What are you treating?
We've seen several patients this morning
that have received more than ten extractions.
I mean, the reason these people are here
is because they can't afford to go to the dentist.
They can't afford to go to the dentist
or they have insurance that really isn't working for them.
Some of these people who work in these small communities,
their insurance may only be accepted in a regional area.
Go outside that region, the insurance isn't accepted.
It just sounds like...
..chaos. It is.
It's chaos and it's a vicious cycle,
and that's why things like these are so important.
Stan Brock was quoted yesterday about...
His famous quote of,
"All health care should be free." Right.
Yeah. I don't deny that. I don't disagree with that.
And if people are suffering,
it doesn't make much sense to me...
as a human being. Right.
When and how is there gonna be free health care in the United States?
Not in my lifetime.
And our pharmaceuticals are unbelievably expensive.
The highest cost for drugs in the world.
In other countries, I can get medicine,
I can go to India and buy medicine for pennies
and give it out to patients. Yeah.
But here, when I come as a charitable doctor
go to get one as my inhaler for one patient,
that's $400 for one month's supply for an asthma patient
when six percent of our population has asthma.
It's like an incredible rip-off.
And then they were gone,
wrapped up in a few hours.
The lesson for us on the other side of the Atlantic
could not be clearer.
Could the NHS be reduced to charity
that comes and goes like this extraordinary event in Virginia?
This is the City Of London,
home to some of the world's richest money movers, gamblers,
insurance companies, hedge funds and banks.
It was here and in Wall Street that the Great Financial Crash of 2008
was caused by a system of greed, mismanagement and corruption.
Most of it rescued by the government.
And it was here that the imposition
of an extreme ideology called austerity was justified.
Austerity is one of the propaganda triumphs of the age
because there's no need for austerity.
There is a debt owed by banks that were bailed out with our money.
We, the people, don't own a penny, then why are we paying for it?
Why are the poorest picking up the bill
when some of the biggest companies in the world pay little or no tax?
Why has mass poverty returned to Britain?
Why are the very premises of civilised life
of which the National Health Service is a beacon,
being run down or put up for sale?
Why, according to one study,
is there the greatest rise in mortality in 50 years?
The study undertaken by you and your colleagues
gave up some really damning evidence
that thousands of excess deaths in England and Wales
were linked to cuts in the health service.
In the first seven weeks of 2018,
an additional person died every seven minutes.
The only thing that fits is austerity, the cuts,
cuts to the health service, but cuts to social care as well
because as the cuts got deeper and deeper,
people began to die faster.
The frail and the elderly first.
Elderly women who are much more likely
to be living on their own than elderly men.
And we first said this over four years ago.
And the cuts continued and then life expectancy itself began to drop.
You're talking about 120,000 people so far
who have died earlier than they would otherwise.
For child and infant mortality, we're ranked...
with neonatal deaths, we're 19th in Europe.
And that's getting worse.
One thing shocks medics,
our babies used to have a three times better chance of not dying
than babies in Portugal in the '60s and '70s.
Portugal was always put forward as a terrible place to be born.
Now you're much more likely to get to your first birthday
if you're born in Portugal than in the UK.
The changes in the health service
have a great deal to do with privatisation. Yeah.
The change of the character
of the health service has much to do with that. Yeah.
And in making this film,
we found that it's much more prevalent certainly that I realised.
What's the impact of that?
When you think you're part of something,
which is truly precious to people,
that's when you work longer hours that you're not paid for,
that's when you spend another minute with somebody
that you wouldn't otherwise.
Turn it into a business...
where they're customers and not patients,
and, you know, the same way that most people treat their jobs,
it's how you get paid, but it's not a vocation.
And that's very dangerous of health
because you really want the people looking after your health
to actually care about you
not care about when they're gonna be going off shift.
On Clapham Common in London, this glass door -
a voluntary organisation giving refuge and food to homeless people.
For some of the people here,
their predicament bears a striking likeness
to patient dumping in the United States.
We're getting a lot of emergency discharges from local hospitals.
We're getting a lot of people
who have been seen by their local mental health units,
and been told that although they do have a mental health problem,
they don't meet the threshold for care.
We've had people who have arrived literally in scrubs
and open-toed sandals from mental health units
where there's been a discharge meeting
at sort of 10 o'clock in the morning.
Five o'clock in the afternoon, they're put in a taxi
and sent down to us.
Last year, we had a man who had been discharged
from the local hospital nine days after having open heart surgery.
We have NHS workers who are homeless.
You know, it's testament to their staggering loyalty
that even though they are sleeping rough,
they'll get up at seven o'clock in the morning,
dust themselves off and go in to work.
They go and work in the NHS? Yes.
Having slept rough? Having slept rough. Yeah.
Well, we have care workers, we have health care assistants,
people who go...
The people who go out and do personal care
for our ageing relatives, our sick individuals,
have often times been sleeping on a church floor the night before.
This is St Stephen's Church in the heart of London,
just behind the Houses Of Parliament.
It's midwinter.
And this is David Coombe,
whose remarkable organisation Street Souls
cares for the victims of austerity.
What can I get you?
We've got tikka masala, bangers and mash.
With hot meals, clothes, glasses that people can no longer afford...
..and above all, a warm place where people can feel human again.
David, just describe Street Souls and how it began.
What I really wanted to do was a compassionate act
involving my two younger children at the time
who I think were six and eight, maybe, at the time.
And, erm...
I said to them... just before Christmas, I said,
"We're not gonna buy Christmas presents this year, boys.
"We're gonna buy sleeping bags for the homeless people,
"and we're gonna take soup and sandwiches out to the homeless."
Which of course didn't go down too well,
as you can imagine, with young lads. No.
We've got a big van full up with sandwiches and soup
and literally drove around London, and we did this several times.
What struck you at first about the people you met?
Erm, that they were just like me. Mm.
One thing that was very apparent was it's not as portrayed as a media.
Yeah. There's not drunk...
Everyone's not drunk, everyone's not a drug addict.
In fact, I'd say that was a minority, you know?
Totally the opposite of what most people will probably believe.
A lot of these people had just had misfortunate events in their lives.
That direct connection between political decisions... Mm-hm.
..and homelessness, that's something you see, isn't it?
Yeah, very much so.
In 2010, Westminster City Council tried to pass a bylaw
within central Westminster to make it illegal
to sleep rough and punishable by, I think,
it's a terrifying fine of £500, you know, which is kind of crazy.
A homeless person's not gonna have £500.
But also illegal to feed homeless people.
What's the direct connection between austerity
and the people that you help here?
The lack of after-care is something that I've noticed.
Some of the guys we have here have had some quite major operations.
They're effectively turfed back out on the street.
What... Give me an example.
Well, I got a fella who has had a couple of knee operations
and what he calls home is a janitor's closet
of seven foot by four foot in a block of flats, you know.
And that's where he goes. That's where he convalesces.
Erm...
Another lovely chap who had... I'm not sure what surgery,
but major surgery so his chest looked rather like a quilt
had to go in a place he was given five stories up with no lift.
Immediately, having this operation
where he had 140 stiches or whatever.
Yeah. It's just so wrong.
Yeah. Yeah. It's in-out, in-out.
It's "free up the beds" and you know...
You know, the life-expectancy on the streets is 47 years old.
47?
47.
It's heart-breaking because the bar is set so high now
on who you can admit to hospital
because there are so few hospital beds, you know, it really is a case
that unless you're threatening to imminently kill yourself
or you're psychotic to the point of just incredibly disturbed
as an individual or a threat to other people then you're sent home.
And unless you... What if home is not a home?
What if it's in the streets? Well, it's just heart-breaking.
I mean, there's been a lot of occasions
when I've had to send someone out onto the streets,
and you just send them out into the night
and you don't know what's going to happen to them.
John Watts works with David Coombe as a volunteer.
We're on his regular run to check on people with nowhere to sleep
in near-freezing temperatures but on the streets.
We've created a have and have-not society.
And we don't like to particularly see the ones who have not.
David was saying that life expectancy
of people on the streets was 47.
Yeah.
How long has he been there, do you think?
Months. Months?
Excuse me are you part of the crew?
I'm part of Street Souls.
Have you got a spare sleeping bag? I need to get one,
I've just come out of jail. I haven't got one.
I need a sleeping bag.
I've got one sleeping bag left, all right.
But I haven't got one. Please.
Please. I'll be back in two weeks, yeah?
One, you can't use a toilet, two, you can't get housing,
three, we're having a nervous breakdown.
And...
it's not good. No, it's wrong.
What happens to their health?
It deteriorates rapidly.
They suffer from all sorts of... things
and their mental health suffers.
They don't sleep enough,
they only get a couple of hours sleep
because they're either moved on or they're nervous about people.
And...
it's just a downwards spiral basically. Yeah.
For those who are not used to being homeless
to sleeping on a cold pavement,
that must be a shock.
I think it would be a shock for anybody. Anybody.
You know, it's bad enough in the summer,
and in this weather and in these temperatures...
I just find it...
unbelievable in the 21st century.
Yeah... Oh.
Erm... MAN: Go back!
Yeah.
Why is this happening in 2019, in the middle of London?
MAN MUTTERING
'We stop filming
'when the frustration of one rough sleeper spills over.'
Fuck off! Shut up!
OK. Fuck off!
Sorry. OK, we'll go.
Fuck off!
For more than six months, we phoned, texted, e-mailed and wrote
to government ministers and officials
who run the National Health Service.
the Secretary Of State Matt Hancock,
the Head Of NHS England Simon Stevens...
..the Chair Of NHS England Lord Pryor...
..the Health Minister Caroline Dinenage,
the former Prime Minister David Cameron,
the former Health Secretary Alan Milburn,
and many other officials and politicians.
No-one responsible for the future of the NHS was available
to be interviewed on the urgent issues raised in this film.
Silence.
If you start out with a core, a principle
of wanting to care for everybody,
you know, you've already started at a foundation of value.
And...
I mean, we've never really had that here.
You know, there's never been...
You know, a healthcare system that started with ethical values
and said, OK, healthcare is a right
or, you know, certain other values.
We've never started there and built on it
so that we have a lens
by which we can measure everything that's happening.
You do. You have that
and if you lose that then you'll never get it back.
We gained the freedom from fear in the past.
There's an enormous sense of relief
from thinking you are no longer gonna be a burden on your family.
You are no longer... Not just having to fear for yourself
and your own pain and suffering
but the idea that your family would either have
to try and look after you or find the money for somebody to treat you.
And it was one of the most remarkable and rapid improvements
in living standards and quality of life.
That fear has come back again.
It was a political decision to give us an NHS
and we got that in 1948 with the 1946 Act.
It was a political decision to take it away in 2012.
It only needs a political decision
and the will of the people and the politicians
because the people have not lost faith with the NHS.
They want an NHS.
I believe there will reach a tipping point of public awareness
at which time our politicians can not get away
with the deception any longer.
If enough of the general public stand up and say no more of this,
if the profession can unite and realise the power they have,
we can stop this very quickly.
The government need to believe in the NHS, not mess about with it.
They need to properly fund it.
Erm...
And they need to trust those that are there to get on with their work,
and let them get on with their work.
People like you. Yes.
To trust us.
MUSIC: 'Jerusalem' by Sir Hubert Parry
# And did those feet In ancient time
# Walk upon England's mountains green?
# And was the Holy Lamb Of God
# On England's Pleasant pastures seen?
# And did the countenance divine
# Shine forth Upon our clouded hills?
# And was Jerusalem builded here
# Among those dark, satanic mills?
# And did those feet In ancient time
# Walk upon England's mountains green?
# And was the Holy Lamb Of God
# On England's Pleasant pastures seen?
# And did the countenance divine
# Shine forth Upon our clouded hills?
# And was Jerusalem builded here
# Among those dark, satanic mills?
# Bring me my bow of burning gold
# Bring me my arrows of desire
# Bring me my spear Oh, clouds unfold
Bring me my chariot of fire
# I will not cease from mental fight
# Nor shall my sword sleep In my hand
# Till we have built Jerusalem
# In England's Green and pleasant land. #
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