Hospital Season 8 is yet to be announced by BBC Two

As Covid-19 levels rise again, the Royal Free London prepares to roll out a mass vaccination programme, but it faces a staffing crisis that in turn threatens vital cancer operations.

Covid-19 patients are again being transferred to intensive care, but clinicians now have a wider array of treatments used to fight the virus, including experimental drugs and convalescent plasma.

This episode focuses on the perpetual challenges of trying to discharge older patients as the hospital experiences a bed shortage, alongside the added complexities of Covid-19 infection risks. 

As autumn begins, the hospital's Emergency Department is seeing a resurgence of patients after a summer of low attendances. More people are arriving in A&E than almost any other day since last winter, and they are admitting more patients than they are discharging. Every patient being admitted must be tested for Covid-19, but the results can take up to 48 hours to come back. Staff must deal with the conundrum of where to place patients, as they must isolate symptomatic patients and manage the constant risk that those without symptoms later test positive. If a patient that was deemed low risk, and therefore placed on a ward, is then found to be Covid-19 positive, all patients that were in proximity to them must isolate, and therefore occupy one of the hospital's precious single rooms. 

This issue, combined with the recurring challenge of older patients staying as in-patients for long periods, means that Barnet's bed shortage, which was an issue even prior to the pandemic, has suddenly multiplied. As the hospital hits capacity, the brand new Rainbow Ward, specifically built with a £4 million investment during the pandemic to ease the pressure created by Covid-19, stands empty. Building problems have delayed its opening, so the pressure to discharge patients is higher than ever.

This episode explores the impact of Covid-19 on the Royal Free Hospital's transplant services, which treat some of the hospital's most vulnerable patients.

The Royal Free London faces the long-lasting effects of Covid on their patients, staff and services, amidst the looming threat of a second wave.

The UK lockdown is over, but London's Royal Free Hospital is counting the cost of having to prioritise Covid-19 above almost everything else as they battle to treat the patients left behind.

The second of two programmes following hospital staff treating Covid-19 cases features patients who are on dialysis or who have recently had a transplant, and as such are among the most vulnerable to the virus. Royal Free London faces a near catastrophic breakdown of oxygen supply, while an infectious diseases consultant starts a trial of an anti-viral drug used in the treatment of Ebola.

The documentary returns to follow the day-to-day realities the NHS faces in tackling the coronavirus pandemic, following staff and patients at London's Royal Free Trust from the first day of the lockdown. The Royal Free Hospital's emergency department is inundated with patients displaying symptoms, among them 88-year-old Peter, who is struggling for breath. He is quickly put on oxygen and moved to what was the coronary care unit, but has now become a ward for covid-positive patients.

Eighty-one-year-old Joe has been left with a hole in his heart after suffering a heart attack, and face a complex procedure that carries a high-mortality rate. Ellie, 28, is one of the growing population of adults with congenital heart disease, who had devices fitted into their hearts as children, and need further procedures as they get older. Already cancelled twice before, she hopes that this time her operation to replace her pulmonary valve with keyhole surgery will go ahead, so she can begin to plan her wedding to Jade.

At Aintree Hospital's major trauma centre, a 15-strong team try to save the life of a young man who has arrived by emergency helicopter. He has been stabbed in the chest - one of three stabbings to arrive during the day. Across the city at the Royal Liverpool University Hospital, staff deal with a homeless man who has been returning for at least 18 years. He is always treated with patience and dignity and given somewhere to sleep his alcohol or substance misuse. However, his increasingly aggressive behaviour leads to him being issued with an ultimatum.

The city's new state-of-the-art hospital remains unfinished, three years after it was due to open, so two of the biggest hospital trusts are planning an ambitious merger. But this means that hundreds of patients and staff have to be transported across the city, while all the operating theatres bar one are closed.

A teenager self-funds cutting-edge surgery for his cerebral palsy. Surgeons go to appeal to fund an 81-year-old's surgery and use new DNA tumour profiling to try to save a baby.

Three transplants are due at the Royal Liverpool University Hospital. At the Women's Hospital, a pregnant mum faces a heart-wrenching decision

Alder Hey closes its critical care unit to new admissions. A five-year-old returns three times for her cancelled heart operation.

A consultant recruitment crisis threatens care at Liverpool Women's Hospital. Doctors care for a pregnant mother with cancer.

This episode follows a patient who has been in intensive care for 12 months, and another ready for rehab for the past two.

Floods and an electrical fault disrupt A&E and operating theatres in the crumbling Royal.

Cancer operations at Nottingham University Hospitals are under threat of being cancelled as the Trust has run out of beds. As people lie on trollies waiting to be admitted into A&E, hundreds of mostly-elderly patients are stuck in hospital. They are well enough to leave, but must wait either for a place in a residential home or for the appropriate care packages to be set up to support them in their own homes. 93-year-old Ray has dementia and will need a package of care to help him once he is back at home. After ten weeks, social services organise a care package but doubts arise about his ability to cope at home on his own. 89-year-old Jean has been waiting for the package of care that will allow her to go home. Her flat will need to be decluttered before it is deemed safe enough, but Jean's keys are missing, so she is offered a temporary place in a residential home until they are found. However her social worker is concerned that a residential home is not right for her.

On most days in winter, the Paediatric Intensive Care Unit at Queen's Medical Centre is full. Intensive care is often the last resort for very sick children, a place that can keep them alive while doctors work on making them better. It's also where children undergoing the most serious surgery come to recuperate. It's the job of lead consultant paediatrician Patrick Davies to balance the ever increasing demands that are made on the over-flowing unit every day. Lack of children's intensive care beds is a nationwide problem. Four-year-old Esme is rushed to Queens Medical Centre from Hull, 90 miles away, when her closest intensive care units in Leeds and Sheffield are both completely full. She is suffering from septic shock, an extreme form of sepsis, a life threatening condition that occurs when the body reacts to an infection by damaging its own organs. Patrick and the team must stabilise her so that her life is out of danger.

The advice from the NHS to cancel all non-urgent surgery is taking a heavy toll at Nottingham University Hospitals. Cameras follow Val, a 55-year-old mouth cancer patient, and Dilip Srinivasan, the surgeon fighting to see her operation goes ahead despite the new NHS ruling. Also featured is orthopaedic consultant surgeon Tony Westbrook, who has had most of his routine surgical list cancelled.

Head and neck surgeon David Grant returns from annual leave to find his surgical list has snowballed. He's one of only two consultant surgeons at Nottingham University Hospitals' busy cancer head and neck service.

A huge influx of patients into the emergency department at Queen's Medical Centre, Nottingham, results in dozens of people lying on trollies waiting to be admitted. With A&E departments across the country bursting at the seams, NHS bosses make an unprecedented move - they advise every hospital in England to cancel all operations that are not clinically urgent or for cancer. The hope is that this will release beds for the patients queuing to get into A&E.

How staff at Imperial College Healthcare NHS Trust are pushing the boundaries of what is possible technologically, at a time when savings need to be made across the board.

This episode explores the daily reality and complexity of dealing with the many patients who find their way to one of Imperial College Healthcare's hospitals hoping that the NHS can pick up the pieces. Until their care package or offsite psychiatric unit placement can be arranged, for their own safety and that of others, they can't be discharged.

Nicky has ovarian cancer and is attempting to crowdfund £60,000 to buy herself a promising drug course not yet available to her on the NHS.

The opening episode of the second series of Hospital follows events as St Mary's Hospital in Paddington receives victims from the Westminster terror attack.

Surgeons are forced to use unconventional methods to get their operations completed against the odds, in the final episode of the series.

This episode looks at pioneering treatments for some of the oldest and youngest patients in the hospital.

A woman from Nigeria recovers in the hospital after going into premature labour with quadruplets, having fallen ill on a flight. Only three of her babies survived the dangerously premature births and they are now being cared for in Neonatal Intensive Care.

She receives a visit from the hospital's overseas officer Terry, whose job it is to prepare her for a huge bill. Because she is not a British resident, she must pay for the care that she and her babies are receiving. The cost of such specialist care quickly tops £100,000 and looks likely to rise to half a million pounds during their stay.

Terry explains that, despite her distressing predicament, it is a legal requirement for the hospital to collect the money the NHS is owed.

"We have to start raising invoices on a weekly basis. She has three babies in ICU. So that's £20,000 a week for each baby, plus her own charges as well. You have to distance yourself emotionally, otherwise you wouldn't get the job done."

The woman is just one of a number of overseas patients who are receiving life-saving care and from whom the hospital must now try to recoup money. Although emergency treatment given in A&E is free, non-UK residents who are admitted to a ward have to be billed.

Terry also needs to charge Sonia, a 56 year-old woman from the Philippines who suffered heart problems while visiting her sister, a UK resident. Cardio-Thoracic surgeon Rex Stanbridge saves her life, but she suffers complications and needs a bed in Intensive Care - costing thousands of pounds per day.

In 2015/16 the Trust's overseas patient charges were £4 million, with Terry's team managing to collect £1.6 million. Despite carrying a credit card machine to take on-the-spot payments, Terry finds it hard to get many patients to pay up.

After collapsing at work, crane driver Phil is becoming increasingly paralysed with each passing day. Kevin O'Neill, one of the country's leading brain surgeons, diagnoses him with a fast-growing brain tumour and decides to perform a potentially life-threatening operation to remove it. But as the clock ticks, securing theatre time for Phil is not straightforward in a hospital approaching full capacity.

O'Neill and his colleagues deal with some of the country's most complex and challenging neurological cases. Their work is so in demand, the department has one of the longest waiting lists in the country.

But the hospital is determined to clear the backlog of patients, some have been waiting for their operations for over a year. The pressure is on for O'Neill and his team to get through a packed list.

At the same time the Trust is pioneering a form of non-invasive brain surgery that replaces knives and drills with MRI focussed ultrasound waves. Consultant neurologist Dr Peter Bain says: "The first time I saw an operation like this was on Star Trek". One of his first patients is Selwyn, a 52-year-old painter and decorator with an uncontrollable tremor. If successful, Selwyn's operation could pave the way for significant reductions in brain surgery recovery times and, potentially reduce patient waiting times for some brain surgeries .

In this episode, with nearly all of St Mary's 297 beds occupied, the hospital must discharge patients before any new ones can be admitted.

While the hospital tries to discharge patients, new ones continue to arrive. Peter Lai, a 60-year-old retired software engineer arrives at the hospital for a lifesaving operation on an aortic aneurysm in his chest. St Mary's is a centre of excellence for vascular surgery and this is one of the biggest operations they carry out. It's taken two months to co-ordinate the diaries of the expert team, led by consultant Colin Bicknell.

But unless the hospital staff can clear a bed for him, Peter's operation won't go ahead.

Discharge Nurse Sister Alice Markay, is trying to discharge a homeless Polish man, but until she can find a translator to explain what will happen to him when he leaves St Mary's, the man will remain in a hospital bed. Alice says: "The pressure that's on the NHS, you worry about it because the walls are not elastic and the demand is high… But you have to look after the patients, whether they come from Buckingham Palace or the park bench."

Another patient the hospital needs to discharge is 91-year-old Dolly. After breaking her ankle, Dolly has been in hospital for three weeks while she waits for a place in a rehabilitation centre. Dolly laments: "They're so short of beds… but then I have to have somewhere to go where I'm going to be safe. I feel guilty because I've got nowhere else to go".

Late October 2016… Two patients await life-saving surgery at St Mary's in Paddington, the biggest of the five hospitals in the Trust. They will both need a bed on the intensive care ward. But the hospital is full to capacity - on red alert - and there is only one bed left.

Sixty seven year-old Simon needs an operation to remove a cancerous tumour from his oesophagus. As he is being prepped for surgery, St Mary's takes a call from an ambulance speeding to London en route from Norwich. In the back is 78 year-old Janice. She is being ‘blue lighted' to St Mary's with a ruptured aneurysm in her aorta and is less than six hours from death. If she arrives alive, and survives the surgery, she - like Simon - will also need a bed in intensive care.

The surgeons - Professor George Hanna and Richard Gibbs who are slated to carry out the operations are at the centre of this film. We follow their attempts to do the right thing for both patients in a complex life-and-death situation where two into one just won't go.

"To cure Simon, he needs to have the operation", says Professor Hanna. But, in a world where beds are at a premium, operating can seem like the easy part. As surgeon Gibbs remarks: "I sometimes feel that I spend as much energy on trying to organise and manage beds… to allow us to just get on with [the operation]".

Simon has had his cancer operation cancelled once already and having completed extensive chemotherapy needs his surgery to be completed soon. Simon explains, "You just rely on them to do the operation. You just want it done; you reach a point when you just can't keep putting it off forever."

Consultant in charge of the Intensive Care Unit, Simon Ashworth, is also feeling the pressure. It's down to him to make the difficult decision about who to admit for surgery: "It does feel to me like the elastic is a bit nearer to breaking now than it perhaps ever was. Everyone thinks what they're doing is important and guess what everybody's right".

Two floors down from ICU, 18-year old Deborah is anxiously awaiting a life-saving bone marrow transplant to cure her of chronic sickle cell disease. St Mary's is the only specialist centre in the UK that has pioneered a treatment for sickle cell disease with bone marrow transplants that aren't the normal 100 per cent donor match. Deborah's brother Sam is a 50 percent match and the family's hopes rest on him being able to provide her with the bone marrow she needs to save her life.