Making The Hospital

In The Hospital, a year in the making, we set out to explore what lay behind the headlines declaring today’s teenagers a ‘public health time-bomb’. We asked doctors to talk honestly about patients who should be young, fit and healthy, but are in hospital because of alcohol related problems, obesity or unplanned teenage pregnancies.

Do today’s generation of teenagers drink more than past generations? Dr Naomi Cuthbert, consultant at University Hospital Coventry A&E thinks so. ‘Yes, it has the money to. I think society has completely changed its attitude to alcohol. The shame of being drunk in the street… That was a great restrainer and it’s gone… I think there is now a culture that one has not had a good night unless one has got absolutely hammered.’

The crew endured almost five months of weekend night-shifts in A&E, and came to understand staff frustration. Dr Cuthbert describes a typical case-load for Friday and Saturday night: ‘Predictable, very busy, loaded with an inordinate number of young people, most of whom either shouldn’t be there, or if they’re there their injuries are either self-inflicted or down to alcohol. And it distracts us from managing many other more serious issues’.

Sometimes a Saturday night can lead to tragedy; in The Hospital we see a young man die in intensive care, with staff visibly affected by his death. What must it be like to see such cases day after day? It’s not that doctors and nurses lose their sense of compassion – perhaps more that some come to ration it. Dr Cuthbert tells us: ‘Some visit tragedy upon themselves and some people have it visited upon them. One tries to show concern but undoubtedly some people are more deserving of sympathy than others.’

For the staff of the maternity ward in episode two, their pregnant teenage patients inspire affection and frustration in equal measure. Dr Gabrielle Downey, consultant obstetrician at Birmingham City Hospital, is frank about her concerns; ‘I worry at why they’ve chosen to become a mother… I worry that they really know what they’re letting themselves in for.

The social problems associated with teenage pregnancy have direct health consequences. Teenagers are more likely to smoke during pregnancy, are more likely to have complications during childbirth, and more likely to have a caesarean than a mother who’s a bit older. All teenage pregnancies are classified as ‘high risk’ to make sure that the girls get the level of support they need. Staff like specialist teenage midwife Liz Gibbs could be viewed as spies for Nanny State, but they are there to help the girls make the best of a bad situation. ‘You have to think positive, you have to look at what you can work with. This baby isn’t going to go away…’ With teenage pregnancy figures on the rise again this year, this film explores why it’s so difficult to get teenage girls to wait before becoming mothers, if life seems to offer little else. ‘I wanted a baby since the age of 13… I was having so many problems at home, at school – I thought if I had a baby, my mind would be taken off that’ one 17-year-old told us.

For episode three, we follow Heartland Hospital’s weight management team, whose patients are getting younger and younger. Obesity levels in teenagers are so high that experts are predicting that this could be the first generation to have a lower life expectancy than their parents.

And these teenagers want a quick-fix solution to their weight loss problems. Gastric band surgeon Paul Super’s operation has become something to aspire to for younger patients who’ve read magazine articles on celebrities losing stones in weeks. Young dietician Adrian Brown thinks that this generation’s attitude to the NHS is different: ‘They come as consumers. They do expect certain things to happen. Some of them do expect to be to get surgery straight away.’ And for patients who’ve struggled with diets for years, the idea that an operation can stop them feeling hungry is a revelation.

But the coveted operation won’t be given on the NHS unless a patient can demonstrate they’ve tried everything else first. As we follow young patients attempting to leave their weight behind, it becomes clear that the psychological dimensions of obesity make it one of the most complex conditions for the NHS to treat; patients lie to themselves, to their families and to their doctors about how much they really eat. ‘Patients will tell me they’re only having a salad a day, even if we get them to keep a food diary, they’ll convince me that they’re only eating 1000 calories a day, but the sums just don’t add up. Nobody tells us everything but the scales don’t lie.’ Gastric surgeon Paul Super told us; and we see a young patient visit McDonalds just days before her gastric band operation, despite being told she must stick to a strict pre-op diet.

We love our NHS, but it’s not in its power to solve these problems – it’s picking up the bill for the complex social forces driving teenagers to drink to excess, to have children too young, or seek consolation in food. Could these problems destroy our health system? The real threat to the NHS, doctors told us, is not a generation, but an attitude; the refusal to take responsibility for one’s own health. And that’s not just a teenage thing – we’re all a bit guilty of that…

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