Summary

Media caption,

Watch: BBC goes inside Royal Free Hospital at full capacity

  1. A hospital on high alert, days-long A&E waits and praise for hardworking staff - our day inside the NHSpublished at 17:59 Greenwich Mean Time 13 February

    Sam Hancock
    Live page editor

    Doctor helps hospital patient walk by supporting her backImage source, PA Media

    As the latest NHS England figures were released today, a team of BBC health reporters headed to the Royal Free Hospital in north London to see what happens in an NHS hospital on a day-to-day basis.

    We spoke to Margaret, a pancreatic cancer patient, who said she was trying to "be positive" ahead of having surgery to remove a tumour. We spoke to a senior matron as the hospital began operating at its highest level of alert, treating patients in corridors. And we heard from a ward manager who explained the process of patients moving from A&E to wards, and the delays that occur due to a lack of beds.

    Meanwhile, you - our readers - have been sharing your experiences with the NHS throughout the day and before we head off, we wanted to bring you a snapshot of what we've heard:

    As our health editor Hugh Pym writes, research shows people are proud of the NHS - they just want it to do better.

    We're going to bring our NHS live coverage to a close, but thank you for following along - and for contributing if you shared your stories with us. We're proud to have been able to tell them. For more updates on the BBC's day at the Royal Free, though, read our news story.

  2. Royal Free able to reduce alert level - but patients still being treated in corridorspublished at 17:30 Greenwich Mean Time 13 February

    Nick Triggle
    Health correspondent, reporting from the Royal Free Hospital

    Patients are still being treated in corridors, but the Royal Free Hospital - which earlier declared its highest level of alert (a four) due to a lack of space - has been able to move down to a level to three in the past few hours.

    Peter Hollely, the senior matron in A&E, says a key factor is that the hospital has been able to start freeing up beds on wards, which has eased the pressure in his department.

    "At one point we had 20 patients here waiting for a bed," he says. "It’s now down to 12. It’s still busy, but we’ve coped OK".

    "One local hospital is diverting ambulances to us and the evening tends to be the busiest period. If we have a surge in walk-ins and ambulances arriving things could change quickly."

  3. Pancreatic cancer patient 'positive' as she heads into surgerypublished at 17:10 Greenwich Mean Time 13 February

    Hugh Pym & Chloe Hayward
    Reporting from the Royal Free hospital

    Margaret, who has pancreatic cancer, wears a hospital gown and smiles

    We've been speaking to Margaret, who has pancreatic cancer.

    "I've got to be positive and keep going," she tells us before heading into surgery.

    The operation to remove a tumour can take six to 10 hours and lead to complications, her surgeon David says.

    And the five year survival rate for pancreatic cancer is low, so early detection is crucial, he explains.

    Since the operation, David updates us to say Margaret's doing well but is in need of some oxygen so hasn’t managed to leave the ICU yet.

    The team at the Royal Free during an operation to remove a tumour from a patient with pancreatic cancer
  4. Inside the Royal Free: 'I've got a second chance'published at 16:54 Greenwich Mean Time 13 February

    Emily sits on the left wearing a white jumper, she has short blonde hair and black glasses. On her left is the doctor, wearing blue scrubs. He has facial hair and sits at a desk with two monitors on it. A press microphone is being held to him as he speaks

    Someone our health reporters have been chatting to today is Dr Anant Patel - as well as his patient Emily Reynolds - who was being treated for pneumonia at the Royal Free Hospital.

    He says when she came into the hospital, it wasn't clear if there was underlying lung cancer, which happens often in patients who have history of smoking - like Emily.

    After treating her pneumonia and running tests, it became clear Emily didn't have cancer, and the doctors helped her to quit smoking.

    After seeing pictures of the inside of her lungs, she says "just knowing that there was something in me that could kill me... I was really upset". Now, she adds, "I've got a second chance".

  5. What's going to happen with NHS spending?published at 16:27 Greenwich Mean Time 13 February

    Last year, the Office for Budget Responsibility (OBR), the government's official forecaster, said , externalthere was every likelihood there would be continued upward pressure on UK public health spending - citing an ageing population, rising ill health and more demand for new medicines and treatments.

    The amount of health spending on an individual rises dramatically as they grow older. Average annual spending per person on those aged 45 is around £2,000. For those aged 85 it is £13,000 a year.

    As people's incomes grow, research suggests they are typically willing to spend more of those incomes on healthcare, which in the UK is done mainly through the taxpayer-funded NHS.

    In its central forecast, the OBR projected UK public healthcare spending will rise by around 3% every year, after adjusting for inflation. This would be broadly in line with average growth over recent decades, although the rate has fluctuated under different governments.

    The OBR estimates this trend would add up to roughly an extra 1% of GDP going on public health spending every decade going forward.

    The OBR assumes public health spending will grow roughly twice as fast as the overall economy.

    A line graph with the years going up in 10 from 2000 to 2070 along the bottom. Up the side are the numbers going from 0-15 going up in fives. The line is slowly increasing from left to right, except from one large up and down at the 2020 time. It shows the projected spend on GDP
  6. Analysis

    People are proud of the NHS - they just want it to do betterpublished at 16:21 Greenwich Mean Time 13 February

    Hugh Pym
    Health editor, reporting from the Royal Free Hospital

    Since the birth of the NHS in 1948, the institution has always been seen as a source of pride.

    Polling by the Health Foundation think-tank, for the service's 75th anniversary in 2023, suggested that the health service made people more proud to be British than national history, culture, the system of democracy or the Royal family.

    The most quoted reason by those polled was that it was free at the point of use.

    And yet the 2023 British Social Attitudes survey, in association with the King’s Fund and Nuffield think-tanks, recorded the lowest levels of satisfaction with the NHS since it began in 1983.

    It seems both can be true. People are proud of the NHS and most, according to polling, support the taxpayer funded model. They say just want it to do better.

  7. 'The older I get the more neglected I feel by the NHS'published at 16:18 Greenwich Mean Time 13 February

    Your Voice, Your BBC News
    Emily Doughty

    Trevor Hartnup, in Suffolk, spent five days in hospital over Christmas, which he says was "the worst experience in my 25 years as a patient".

    He recalls being unable to use washing facilities, instead being given a pot and a towel.

    The experience was so bad, he tells us, that he didn't go back to hospital when he later experienced a bout of tachycardia - where the heart beats faster than normal - against his doctor’s advice.

    "I don’t think I could have mentally coped with going back," the 75 year old says, adding that he believes the NHS is declining.

    "I am nearly as old as the NHS. They have kept me alive this long, but the older I get the more neglected I feel."

    Trevor, wearing a grey suit jacket, stand beside his wife, who wears a white top. They're in a brightly-lit room and there's flowery wallpaper in the background.Image source, Handout
  8. Analysis

    Even at one of the biggest NHS trusts, thousands of specialist referrals a year can impact wait timespublished at 15:44 Greenwich Mean Time 13 February

    Nick Triggle
    Health correspondent, reporting from the Royal Free Hospital

    The Royal Free London NHS Trust is one of the biggest in the NHS, serving a population of 1.7 million.

    When it comes to waiting times, performance in the A&E here and for routine hospital care is broadly in line with national averages.

    But that is not the case across every measure. The trust is a specialist centre for a range of conditions, including heart attacks, transplants and certain types of cancers.

    This creates a range of challenges.

    Take cancer for example. The trust, which includes four hospitals, gets more than 65,000 referrals a year where cancer is suspected. That is the second most in the NHS.

    It partly explains why waiting times for cancer at the trust are below the national average - 59% vs 71% for 62-day waits for treatment to start.

    Lead cancer nurse Jemma O’Reilly says: “We encourage GPs to refer in and we identify a lot of suspected cancers via screening. We want to catch cancer early, but it means we have a lot of cases to check.”

  9. 'Lack of joined-up care made parts of my mum's treatment difficult'published at 15:31 Greenwich Mean Time 13 February

    Your Voice, Your BBC News
    Emily Doughty

    We've been hearing from Jane, who says her mum's experience in hospital was a "serious eye opener".

    "The facilities were awful," she says. "The shower would flood water into the ward - the nursing staff were just expected to deal with that."

    Recalling conversations she overheard, Jane also says her family heard "quite confidential information being given to other patients" - leading her to wonder whether it was better to take her mum elsewhere.

    But, she tells us, the lack of communication between hospital trusts made this difficult.

    "There is a lack of joined-up care, between social care, between counties. I told the doctors I was only taking my mum to Cornwall - not the moon."

  10. We still want to hear your stories - get in touchpublished at 14:47 Greenwich Mean Time 13 February

    Your Voice Your BBC News logo

    If you've got a story to tell about the NHS, we'd still very much like to hear it.

    Your Voice, Your BBC News was launched to give our audience - you - more of a say in what we cover and to be part of the news.

    Health and the NHS are consistently among the topics you want to talk about, making up around one in 10 of the responses we get.

    Among them, hospital services - from waiting times for referrals to the care patients receive - regularly come up as a concern.

    We want you to tell us your experiences of hospitals, good as well as bad, whether you're a patient or an NHS staff member.

    To do so, you can email bbcyourvoice@bbc.co.uk, WhatsApp +44 7980 682727 or click here.

  11. 'We've all had bad experiences, but we forget how marvellous NHS staff are'published at 14:27 Greenwich Mean Time 13 February

    Your Voice, Your BBC News
    Thomas Copeland

    Woman in a floral top eating some cake next to a man in a blue jumper holding a small Union Jack flag.Image source, Jane Paterson

    Jane Paterson says that her 80-year-old brother John received excellent care at Bristol Royal Infirmary in the days before his death.

    John had dementia and was admitted last Christmas with a collapsed lung.

    "It was an enormous relief that they understood the dementia was clouding what my brother was really like," Jane says.

    "He was treated with kindness and respect even though at times he behaved badly and resisted help."

    "The hospital was desperately busy with very ill people, but it was spotlessly clean and everyone was cheerful," she says.

    "We've all had bad experiences but we forget to remember how bloody marvellous they are!"

  12. How does our NHS spending compare to other countries?published at 14:14 Greenwich Mean Time 13 February

    Despite a surge in health spending in recent decades, the UK is by no means an outlier among rich countries.

    In 2022, using comparable data on public health spending, the UK was spending around 9.3% of GDP.

    That was higher than Canada (7.9%) and Italy (6.8%) as well as the EU average, but less than Germany (10.9%) and France (10.2%).

    The US was the real outlier, spending 14.1% of GDP on health, largely because America has a private insurance system with few of the cost controls of other nations.

    And those countries have, like the UK, seen health spending rise considerably in recent decades, driven up by growing demand for new medical treatments and ageing populations.

    Bar graph with countries on the left: US, Germany, France, Japan, UK, Canada and Italy. Along the bottom are the numbers from 0-16 going up in two's. The bars go from longest first to shortest at the bottom
  13. Inside the Royal Free: Luna the therapy dog is backpublished at 13:57 Greenwich Mean Time 13 February

    A woman standing up wearing a long purple coat, with a grey dog sat at her feet. A woman wearing black crouches down next to the dog, you can only see her from behind.

    Earlier, our BBC News team was interrupted by a furry friend, Luna the therapy dog.

    She came back for an interview with her handler Brooke Reeve, who explains a bit about how the therapy dog programme works.

    "She's mainly for staff," Reeve explains, giving "respite and welfare and wellbeing for everybody here".

    Luna is very popular with everyone, and she makes people feel "so supported". Luna even has her own staff card.

    She's already made us feel better, whilst we type away in the BBC newsroom.

    A close up of Luna, a grey short haired dog, wearing a staff badge from a blue harness
  14. Inside the Royal Free: After eight blood transfusions, an incredible recoverypublished at 13:45 Greenwich Mean Time 13 February

    Chloe Hayward
    BBC News, reporting from the Royal Free Hospital

    Angela in hospital bed

    We have just caught up with Zoe Billingham and her 83-year old mother Angela, who had an internal bleed and needed eight blood transfusions. She has been in the Royal Free for nearly three weeks and almost died twice.

    "I was really poorly but they have dealt with it," Angela says.

    Full of praise for the nurses and doctors, she says "its been an eye opener" to see how hard the staff work.

    Zoe, who works for the NHS as chair of a mental health trust elsewhere, says the care for her mum has been "amazing."

    "Mum has made an incredible recovery," she says.

    "The nurses have been incredible. Nothing is ever too much trouble and the doctors have been really thoughtful in how they talk to us - I am full of praise for the Royal Free."

    Zoe says her mum's ill health has been the "hardest of times", but there's hope ahead - "we said goodbye to her twice, we are now looking to bring her home in the next few days."

    Zoe Billingham whose mother is in Royal Free hospital
  15. 'I spent four days in A&E - I still have nothing but praise for the NHS'published at 13:34 Greenwich Mean Time 13 February

    Your Voice, Your BBC News
    Jade Thompson

    A man in glasses wearing a black turtleneckImage source, Alan Cowling

    Alan Cowling in London tells Your Voice, Your BBC News that he "can't thank the hospital enough" for the care he received at the Royal Free Hospital, after he was admitted with respiratory syncytial virus due to his immune suppressed condition.

    "There was nowhere to put me, so they set me up with a bed in A&E. It was the busiest I had seen the hospital. There were patients in corridors waiting in chairs," he says.

    "The staff coped as well as they could. If it was not for Royal Free, then my life and circumstances would be so different."

  16. Your stories are helping us paint the full picture of the NHS - thank youpublished at 13:26 Greenwich Mean Time 13 February

    Jacqueline Howard
    Live page editor

    When we asked you to share with us your experiences of navigating the NHS, we were anticipating some difficult, personal stories - and we got them.

    We've heard about Jairo’s elderly mother, who spent 30 hours waiting for a bed while suffering pneumonia, and from new mum Lucy, who described her postnatal care as "emotionally traumatic".

    But the majority of stories you’ve sent us actually speak of a deep gratitude for the NHS and its staff doing their utmost to provide excellent care.

    Steven told us the care his 81-year-old mother received was "absolutely outstanding", and John Ruddall, who last week rang the bell to signify the end to his radiotherapy, said he did not see evidence of the many reports suggesting the NHS is broken.

    Thank you for sharing these moments with us. We’re going to continue bringing you stories and updates from inside the Royal Free in London - where our team of health reporters are based today - and around England as we investigate what goes on inside the NHS. Stay with us.

  17. Inside the Royal Free: Hospital now starting corridor carepublished at 13:07 Greenwich Mean Time 13 February
    Breaking

    Nick Triggle
    Health correspondent, reporting from the Royal Free Hospital

    It's lunchtime and I’ve just caught up with Peter Hollely, the senior matron in A&E.

    He’s told me the Royal Free Hospital is now at the highest level of alert, operational pressures escalation level (Opel) four.

    It was a high level three this morning and as recently as Monday was on alert level two.

    He says the hospital is starting to instigate corridor care as there is no space left in the cubicles or bays with 114 patients currently in the department.

    Boarding – whereby patients who need to be admitted are taken to seating areas or on trolleys close to wards – is being maximised to ease pressure in A&E.

    “We are coping just about,” Peter says. “We’re not diverting ambulances elsewhere. But it’s very busy.”

    This winter the Royal Free has been in and out of Opel four regularly – at one point it spent a whole week at that level.

  18. Cancer waiting times longer in the Royal Free than England's averagepublished at 13:00 Greenwich Mean Time 13 February

    The Royal Free London NHS trust is the second biggest provider of cancer services in the UK.

    However, the waiting time target of patients starting treatment within 62 days of an urgent referral is not being met.

    It's also below the average waiting times of England as a whole.

    A line graph with two lines, one blue for England and one red for the Hospital. The hospital line is below England, at 59%, whilst England is on 71%. The target line is 85%
  19. 'Wonderful hospital treatment helped get my cancer under control'published at 12:52 Greenwich Mean Time 13 February

    Your Voice, Your BBC News
    Bobbi Huyton

    Man in red jumper ringing a bell attached to a hospital-ward wall, there are blue cupboards behind himImage source, John Rudall

    John Rudall, 71, in Weston super Mare tells Your Voice, Your BBC News that, after being diagnosed with prostate cancer, care at both Weston General Hospital and Bristol Royal Infirmary has been extraordinary.

    He says, “I was diagnosed a year ago. Within hours of my doctor receiving my test results, he arranged a hospital appointment. The consultant then confirmed the diagnosis of cancer and immediately started a course of treatment.

    “Every event has always been on time and the staff universally have been wonderful.

    “Last Friday, I rang the bell to signal the end of my radiotherapy. I do not recognise these news reports of delays and issues with the NHS. All I do recognise is how lucky I am to have been treated so well.”

  20. Inside the Royal Free: Cancer department 'committed' to providing top carepublished at 12:47 Greenwich Mean Time 13 February

    Standing in a hospital corridor, Gillmore smiles. She has brown hair in a low bun and wears a black top

    Dr Roopinder Gillmore, the cancer lead at the Royal Free London, says the priorities are about the "best patient experience, patient safety, patient outcomes".

    Speaking to the BBC News Channel, she says it is a "challenge, but we're genuinely committed to hitting that challenge" of providing top care to everyone.

    To alleviate some of the pressure on cancer care, she says "very few" patients are admitted as a consequence of chemotherapy and radiotherapy.

    They "do everything possible" to ensure patients live the "lives that they want to outside the hospital".

    They get a lot of support in discharging and supporting their patients outside the hospital, Gillmore says.