10/08/2016 Newsnight

Imagine accident emergency closed at night?

Well, soon it might be a reality as hospitals struggle

with lack of staff, money shortages, and increasing

Lord Robert Winston and junior doctor Rachel Clark -

We have an exclusive interview with the Syrian rebels holding

the remains of the Russian helicopter crew shot

The woman who brought the story of Adnan Syed to Serial,

And this was the moment Michael Phelps won his 21st Olympic Gold.

Our own Olympic great Duncan Goodhew is here to analyse the phenomenal

The pressure on the NHS in England has never been greater,

and perhaps the most acute pressure is on accident emergency.

As an indicator of the myriad problems at A, a hospital

in Lincolnshire warned today it may have to close at night, saying it

Add to that the volume of traffic at A as patients substitute it

for their GP surgery, and the rising demands

Can the NHS in England survive without radical surgery?

The financial crisis is such that the government says NHS England

must save ?22 billion a year for the next five years.

The English NHS is a huge old machine, which has

Short, medium and long-term forces are all running against it.

An A might be cut in Lincolnshire because of recruiting trouble,

and a stark warning today came from a Royal College.

We are seeing deteriorating waiting times.

My own hospital is actually doing reasonably well,

but many trusts in the country are noticing that there

are deteriorating waiting times both for elective surgery,

getting treatment within the appropriate time.

And we are seeing increasing pressure upon A

If you only looked at one graph to understand the NHS in England,

This first line here shows you the change in the amount

of money that we have paid to hospitals per procedure

Something for which we would have paid hospitals ?100 back in 2009-10,

The idea of that squeeze was that it would force hospitals to become

So what happens to the costs faced by hospitals per procedure?

Well, you can see from this line, first of all,

But since 2011-12, hospitals simply haven't kept pace

The gap between those two lines, that's the NHS's financial problem.

It means that hospitals are spending more per operation

So to solve the NHS's financial crisis, we have

Either cut hospitals' costs, and that means lowering

the top line even further, or putting more money in,

The short-term response to that medium-term problem is to encourage

hospitals to squeeze pay bills in particular.

But that means the financial squeeze is exacerbating some long-standing

We've had a history of some small, particularly rural hospitals,

having trouble getting doctors to come and work there.

And that seems to be a problem across the public sector in other

The second issue is that some specialities are not

It's partly a combination of the very high pressure of the job

and the fact that we have, frankly, not trained enough and people do not

want to go into those training posts in the numbers that we need.

You can see why NHS managers have been so worried that the Brexit vote

might make it harder for them to recruit abroad.

Remember, the fall in sterling will be felt most keenly by people

who plan their lives in other currencies.

These are times historians will pore over,

Let's get two medical perspectives on this now.

expert and Labour peer, the reproductive health

and from Rachel Clarke - a junior doctor who has worked in A

Lord Winston first, the financial gap is a given. Does it have to be

some radical change? I think one of the first things the government has

to think about is, how is it to manage to dis- incentivise one of

the most altruistic, most well-qualified, one of the most

intelligent workforces in the country? From the age of 16 these

people have wanted to go to the health service and now they want to

leave it early. They have been trained at a very high level at a

great cost. Now one of the key issues with A, general

practitioners are wanting to leave because they are so dis-

incentivised because of the way they restructured the health service with

the disastrous 2012 act. Rachel, as somebody who worked in A a year

ago, tell me the good things and bad things. Before you start your first

A job, people say to you, it's a battle ground, and it is. There is

blood and gore and drunks and abuse. But none of that actually makes it

bad, necessarily. It makes it an environment where you can strive to

be the best doctor you can, you can save lives everyday. It could be

everything you want as a medical career. But, the brutal truth of the

matter is, in every A wrote there are among junior doctors. But there

are no restrictions on the number of patients coming in so the doctors

left are having to do the jobs of two or more doctors. And that is

unbearable. You literally might have somebody in the first bed who has

just had a life threatening heart attack and the second bed might have

somebody with a stroke. Both lives are in your hands and how do you

look after them both? The Lincolnshire hospital is thinking of

closing night, isn't that unthinkable? It's absolutely

catastrophic. It means millions of people in that environment will

suddenly be denied emergency care and they will go to other A,

swamping those who probably also have gaps in their rotors. The idea

this is happening up and down the country, and the Health Secretary is

turning a blind eye to it, he's not being upfront about it. What do you

think might be done to alleviate the situation? One of the things we

should not do is to have a ridiculous idea meant with junior

hospital doctors over working at weekends when we are closing

hospitals at night-time. That shows the kind of thinking from the

Secretary of State. First of all, we should tell the truth about what

happens at the weekends and wider deaths he records isn't related to

staffing. It's very important for the health service not to be a

political football. We are in a situation where the Tory party is

unopposed by a weak opposition and that doesn't help. Looking at you

with your medical hat on, what do you think can be done, particularly

in A? For example, and this might be unpopular, our patients part of

the problem? You have to go to primary care and see how it has been

delivered. At the moment most general practitioners are totally

dissatisfied because they are running the health service as

commissioners instead of looking after the health service. What would

you do in A, bring in privatisation? You could bring in

private practice, and I speak as a member of the Labour Party, we could

have private practice but make sure it's inside the health service or

the profit goes to the health service and not to private providers

who could tender outside. You might have in A, and you would go there,

but if you can afford to pay you would go faster? It wouldn't help

A As somebody who works in A still, I can offer two other

suggestions. The first is that you have to be honest and candid about

the lack of doctors and you have to recruit more. Jeremy Hunt and his

government don't want to do that because it costs money. But if we

don't do that we deny the population a safe standard of care. Secondly,

and your film doesn't make clear, what the statistics don't point out,

year-on-year since 2010, the share of GDP this government spends on

health has gone down. It's now at 6.7%, almost the lowest in Europe.

Let's have practical solutions. How do you educate patients about going

to A and is not going to it in the first instance? You have to provide

primary care with the general practitioners, and if the GPs are

not there, they have to go to A That's what happens at the moment. I

routinely see patients who are life threatening me sick, at death's

door, and then people who have had a tummy ache for 30 years. Of course

that end of the extreme shouldn't be there, but if you are a worried

mother told by a GP receptionist that it will be three weeks before

you get your child to a GP, what will you do? The crisis isn't just

in A, it's in general practitioners as well. In some GP

training rotors there are 50% gaps. There are nowhere for patients to

go. If the government will not be honest, will not fulfil their duty

of candour with the electorate to come clean about that, then they are

being dangerous and threatening and endangering patients. Once before,

Gordon Brown put a penny on national insurance, and said it could be for

the NHS. Is it time to hypothesise taxes for the NHS? I don't think

that's the right way to do it at all. Very few people who work in

health service believe that's the answer. We have done is create a

very unwieldy structure. Your film focuses on so many different

problems. Let me put it to you, the NHS is not fit for purpose and that

isn't just do with money, it's the way we deliver it. And it's also

with how we encourage staff to come into it. We make it difficult to

recruit staff, we don't even provide work experience. They're all sorts

of things at every level that haven't been thought through. Why is

it impossible to have this kind of debate? Because we have made the

health service into a political football. As Rachel says, we are not

having an honest debate and until we do it will be a major problem. I

would say one of the problems is, Sir Robert Francis, who investigated

the horrors of mid Staffordshire said that junior doctors were the

eyes and ears of the health service, and we are, we see things crumbling

around us at the moment and we are packed with solutions, we know how

to do things differently. The government could listen to us, but

instead they impose policies from on high, such as the notorious

seven-day NHS, and that is a disastrous way to do things.

When the Syrian opposition shot down a Russian military helicopter over

Idlib province ten days ago, killing five people, it was the largest

single loss of Russian life since their involvement in support

The rebels are now trying to barter the bodies and the remains,

in exchange for opposition prisoners.

Our Diplomatic Editor Mark Urban has spoken exclusively to the rebels

who have the bodies, and reports on how negotiations are impacting

on the Erdogan-Putin summit in St Petersburg.

On the last day of July a Russian helicopter returning from a mission

into Aleppo was shot down by Syrian rebels.

As jubilant locals picked over the wreckage,

the bodies of two crew members were defiled.

And the stage was set for a secret negotiation that shows how

the warring parties would use anything or anyone in their cars.

the warring parties would use anything or anyone in their cause.

This afternoon, we contacted the prisoners committee

of the Syrian resistance that says it is now holding the dead crew

and wants concessions before returning the remains.

TRANSLATION: Any further details can be negotiated directly

Hence we cannot discuss the details now.

The committee sent us these images as proof that it holds

Three crewmen have been identified by Russian

journalists as Oleg Shelamov, Roman Pavlov and Pavlo Shirahov.

Who the other two were and whether one of them is the woman

The Syrians told us three bodies were burned beyond recognition.

But in a conflict where so many have died without trace,

and the Russians have been accused of merciless bombing,

is getting the bodies back even a priority?

It is very important to get these bodies back because we

And this is message for all the people around the world.

As Syrians, we're looking to respect others.

The issue of the pilots has been raised on the margins of this week's

The initial rebel demand that the Syrian government release

all 140,000 prisoners it holds is now giving way to a more

realistic discussion about possible humanitarian access.

The idea being that Russia might deliver the Assad government

TRANSLATION: We welcome any international mediation,

especially from the Turkish government, because they have stood

We are very flexible, open to other possibilities,

and we shall use all available methods to release the prisoners

It is in trying to help broker a deal that Anasol Shami has

gone to St Petersburg this week, and believes it could happen.

Like the prisoners, which are not killers, you understand me?

Some prisoners, they are political prisoners.

With heavy fighting going on around Aleppo, neither side

But the talks over the pilots' remains reveal how channels

between Syrians remain open when it is in their mutual interest.

And now to Newsnight's much-laurelled Olympics coverage,

brought to you from a storied sofa not a million miles from here.

In a case of life imitating art, the diving pool

Stephen Smith's bathtub has been that colour for days.

Throne of Games, analysis as clear as a Russian

When you're preparing for an event of this size,

it all comes down to two words - professionalism.

The top athletes will tell you, if you can drag yourself out

of bed even when it's the last thing you want to do,

You know, it came as a horrifying surprise to me that it wasn't

Are they allowed to punch each other?

I think that is frowned on technically.

The number of women's teams, British women's teams that

are incomparably better, internationally speaking,

Women are just better at stuff.

And everybody goes, do women even box?

Well, surely our friend Nicola Adams has changed perceptions there.

She's one of the faces of Team GB, isn't she?

Do you know what, judo, it looks like two kids fighting

It looks like one of them has some Opal Fruits

and the other one's like, gimme an Opal Fruit!

I think that would give it some extra zing.

We need to talk about the colour of the pool because...

Did the guy forget to go out with the chlorine,

is that what it is, the pool boy didn't show up?

I would like to know when they have to start synchronising.

Is it when they come out of the loo, when they open the door?

I guess their outfits have to be the same.

I mean, do they synchronise from the morning just

What do you think would be the easiest

Yeah, because the difference, the tolerances between competent

The number 16 seed causing a major potential shock.

Hang on a sec, I thought the other one just stabbed her.

It will be interesting to see where she is...

You've been watching Throne of Games.

Trust me, no-one's getting paid more than the Prime Minister for this.

Now - we thought we'd take a moment to talk about possibly the greatest

Olympian of all time: the American swimmer Michael Phelps.

More than one hundred countries have won fewer gold medals

Sixteen years after becoming an Olympian -

and ten years older than the age at which most swimmers peak,

he took gold again last night for the 200m butterfly.

Duncan Goodhew knows what it feels like to win gold -

he triumphed in the 100 metres breaststroke in the

Have you been glued to the set? I have, and I only won one gold medal,

and when you look at what Michael Phelps is done, it is extraordinary.

His achievements are almost superhuman. I grew up with Mark

Spitz and we thought, how can anybody win more than nine gold

medals, seven in one games? And now enter Michael Phelps. He seems to

have broken through on so many different levels. And if you just

play your mind back, you have one gold medal, the heats, the

semifinals and finals. But if you want to get two, then they are going

on in sequence, so you were going back to back. So how do you keep

emotionally up, and not tire of it? When you are looking at him,

ordinary think about him? It is just extraordinary. I interviewed him for

the Financial Times when he was just breaking through, when he was 17

years old. Both him and his coach were convinced that one gold medal

would satisfy. One gold metal would satisfy most people! -- gold medal.

For him, he knew he was talented and it was reflected in everybody around

him. And he had that enormous support. Physically, he has changed

massively in that time. It has been a real journey. He has changed his

shape. Some archaeologists have found that gladiators grew longer

arms. I think with Michael Phelps, he has grown more like a fish by the

moment. He is extraordinary in the water. And he is not exactly Mr

super healthy. He used to eat 10,000 calories a day. You have to swim

that much. When you talk to Olympic athletes, they all accept that

swimming is the most demanding of all sports. I think it is because

you are lying down, you can wrap up the engine and keep going for

longer. If you are running, your body is pounded, and you have to get

the blood up through your legs. But he has obviously calibrated what he

is doing as he is getting older. At 31, he is way beyond the age that

most athletes and swimmers peak. How is he changing it? What is the game

plan? For him he was obviously really upset to lose in the 200

metre butterfly in London and that really rankles. Now he has got a

young child and he has settled down a bit. From what I understand of his

attitude, it has changed things massively over the last couple of

years. And we are seeing the results of that. But also what he is doing,

he is going for 100 metres and 200 metres, so it is, dare I say it, a

quick blast without having to deal with the stamina. I am very much for

the taps. Seriously, I think you have to look at him as the man. Can

anybody beat this? It is going to be tough. But they did beat Mark Spitz.

The relays make the difference for him. As an American, he has nine

gold medals on the relay. Unless it is another very strong country, to

win those kind of numbers again will be difficult. But never say

impossible because another Michael Phelps will probably come along.

Thank you very much indeed. Serial is the most popular

and downloaded podcast of all time. It reinvented story telling

for a new generation. The true story of the US murder

conviction of seventeen year old Adnan Syed reached more

than 500 million international Now lawyer and family

friend Rabia Chaudry, who brought the story to Serial,

and has worked to overturn his conviction, has written

about the phenomenon. In case you didn't tune in,

journalist Sarah Koenig explored the case of Adnan Syed,

a 17-year-old American high school student of Pakistani

origin who was convicted of murdering his ex-girlfriend,

Hai Min Lee, in 1999. This is a global cell link,

prepaid calls from... ..an inmate at Maryland Correctional

Facility. He was sentenced to

life plus 30 years. The case rested on a 21 minute

window, the time frame in which the prosecution alleges

Adnan left school and But the podcast raised a number

of questions about whether it was In particular, a key witness

who could have served as an alibi And crucial cell phone evidence

that was used to locate Adnan Syed at the scene of the murder

was unreliable and not cross In June this year,

a judge ordered a retrial. The world now waits

for the next chapter of this I feel like I want to shoot myself

if I hear someone else say, I don't think you did it

because you're a nice guy. But I have heard people say that

to me over the years, I would love them to say,

I don't think you did it because I looked at the case and it

looks kind of flimsy. Earlier, I spoke to lawyer

Rabia Chaudry, a family friend and campaigner for the innocence

of Adnan Syed, about her new book on the case which comes

out in the UK tomorrow. I began by asking her

about the impact Serial Cereal had a tremendous impact. We

never would have gotten this far without the work they did, the

storytelling they did. Without it, we would still be at a dead-end in

the case. And what was the contribution made by the listeners,

as they became more engrossed in the podcast? So many of the listeners

did not just look at this as entertainment, they came out and

supported us. We have raised hundreds of thousands of dollars

because of listener donations. They have written thousands of letters to

Adnan Syed and they followed the story after Serial. They wanted to

know what else there was. They listened to other podcasts and

continued to follow the case. And criminal investigators listened to

the podcast as well. Yes, a lot of experts have come forward and

offered their services. Obviously, my colleagues at Undisclosed our two

lawyers who began investigating on their own. Unlike them, many other

volunteers came forward and helped us continue the investigation. So

the journalists working on Serial did not take a stand. They did not

say innocent or guilty. What do you make of that? I cannot compel

anybody to come to some kind of conclusion. Obviously my hope was

that this would be somebody who would become an advocate for Adnan

Syed, who would feel convinced and follow the story to that end, and

look for the evidence to help exonerate him, feeling that he was

innocent. When that did not happen, it is what it is. You do the best

you can. And I think we have. The fact that Sarah Kane was not able to

reach a conclusion is fine because many other people have taken up the

case. -- Sira Koenig. In a sense, isn't it better that Serial did not

take a stand because it allowed the audience to becoming grassed and

engaged, and the position of the journalist was not clear. Is that

not a better position to be an? Does that not hold more listeners? I

think part of the draw of Serial was the sustained ambiguity. The mystery

is what kept people there. But that does not necessarily mean...

Undisclosed, the podcast we followed up with, it has more than 90 million

listeneds. We have a clear stands. -- listens. I am not a journalist

and I do not know what it means to have journalistic standards. Does it

mean you have to always be neutral? I thought investigative journalism

meant that sometimes you take a stand. I do not think the story

would have been hurt if at the end they decided they would take a stand

knowing what they know now. Very clearly in the book you made it

clear that you have a low opinion of the state often and how they handle

trials and there are many thousands of miscarriages of justice. Is there

a danger that by focusing on this one, not for yourself personally but

programmes focusing on one, it allows people to not think about the

bigger picture? Actually, I think that is a great lesson from Serial,

that people become interested in issues when there is a human story.

When you talk about people and you say that there is systematic racism,

they will say, OK, fine, too bad. But when you sell them -- tell them

about a person, they are able to understand the issue and how it

affects somebody. What has happened, hundreds of people have reached out

to say that because of Adnan Syed's story, we were able to understand

things we did not understand, how the criminal justice system works.

We understand how bad lawyering can ruin a person's life. We understand

bigotry. They are able to understand issues that otherwise might become

intangible. I know you spoke with him recently. How is he now? He is

doing well. We spoke about a week ago and ever since the new ruling in

which his conviction was vacated, he has been positive. We expected the

state to appeal it but he is patient and he has been patient for a long

time. Thank you very much indeed.