24/10/2016 Inside Out East


24/10/2016

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Is the diabetes epidemic too big for the NHS?

:00:00.:00:07.

Inside Out investigates how serious the epidemic of type two di`betes

:00:08.:00:14.

And in Cambridge, scientists study our relationships with food.

:00:15.:00:24.

You eat a chocolate bar, you drink too many fizzy drhnks and,

:00:25.:00:26.

before you know it, you are a ticking time bomb.

:00:27.:00:30.

And how one of the world's lost famous sporting upsets

:00:31.:00:32.

prompted a jockey to become a bestselling author.

:00:33.:00:37.

Revealing the stories that matter closer to home,

:00:38.:00:40.

Around 4.5 million people in the UK now have diabetes

:00:41.:00:59.

Most have type two, which is usually linked to lifestyle.

:01:00.:01:04.

And diabetic care is alreadx costing the NHS ?10 billion a year.

:01:05.:01:10.

Well, new figures seen by the BBC show those costs are

:01:11.:01:16.

likely to get even higher if obesity continues to risd.

:01:17.:01:20.

Well, here's BBC health correspondent Dominic Hughes.

:01:21.:01:22.

And a warning, you may find some pictures in this film disturbing.

:01:23.:01:32.

Today, I'd like to invite you to a shoe shop with a difference.

:01:33.:01:44.

So what we've got here are 040 shoes and they represent 140 amputations

:01:45.:01:48.

that take place in England dvery week due to diabetes.

:01:49.:01:57.

We set up this shoe shop to show just how serious type

:01:58.:02:12.

Where you come from and your family history can increase your rhsk.

:02:13.:02:33.

But doctors say most of it is down to obesity.

:02:34.:02:36.

Now new data given exclusivdly to the BBC by Public Health England

:02:37.:02:41.

estimates there'll be an extra 250,000 people with type two

:02:42.:02:45.

diabetes by 2035 if we conthnue to get fatter.

:02:46.:02:51.

Diabetics are at greater risk of kidney failure, blindness

:02:52.:02:56.

The NHS is spending ?10 billion a year on diabetic care.

:02:57.:03:03.

As things stand, we are certainly looking at a crisis in diabdtes

:03:04.:03:11.

which threatens to bankrupt the NHS if we continue

:03:12.:03:13.

One of our shoes belongs to Steven Woodman.

:03:14.:03:24.

We caught up with him as he arrived at the Royal Shrewsbury Hospital for

:03:25.:03:27.

Like 90% of diabetics, Steven has the type two version

:03:28.:03:36.

which is linked to lifestyld and so largely preventable.

:03:37.:03:40.

But diagnosed as a young man, he ignored his GP's advice.

:03:41.:03:45.

I never took it that seriously so I carried on eating,

:03:46.:03:55.

going to the pub, doing things people of my age did.

:03:56.:04:01.

Like many diabetics, Steven developed an ulcer

:04:02.:04:09.

The ulcer wouldn't heal and, in the end, he had

:04:10.:04:16.

My surgeon did say to me, when he was taking my third toe off,

:04:17.:04:27.

it's only a matter of time before you lose that one,

:04:28.:04:30.

it's inevitable that will go the same way.

:04:31.:04:34.

I've become an old man very very quickly and,

:04:35.:04:37.

Patients with type two diabdtes aren't just losing their tods.

:04:38.:04:49.

Some have had to have a foot amputated or even a lower ldg.

:04:50.:04:53.

It's life-changing and very expensive.

:04:54.:04:57.

It's approximately ?20,000 for the first six months

:04:58.:05:00.

There's the limb fitting and even a basic prosthesis costs

:05:01.:05:10.

All of those aspects mean its very expensive process for the state

:05:11.:05:22.

Nick Hex is the health economist who worked out the current

:05:23.:05:26.

cost of diabetes care - that ?10 billion figure.

:05:27.:05:30.

Most of that is spent on complications.

:05:31.:05:34.

Foot ulcers and amputations cost nearly ?1 billion a year.

:05:35.:05:39.

Then there's sight loss and nerve damage.

:05:40.:05:46.

But the biggest cost of all is for heart attacks and strokes.

:05:47.:05:50.

With both obesity and type two diabetes affecting more and more

:05:51.:05:54.

of us, costs for diabetic c`re are expected to increase

:05:55.:05:58.

There is a fixed amount of money for the NHS so,

:05:59.:06:08.

clearly, if one disease are` like diabetes is taking up ` more

:06:09.:06:11.

considerable amount of that cost, then there's less money

:06:12.:06:13.

So it's really important policy-makers think about w`ys costs

:06:14.:06:23.

can be mitigated over the ndxt few years because there won't bd enough

:06:24.:06:26.

Back at the Royal Shrewsburx Hospital, Steven is getting

:06:27.:06:37.

Losing three toes means he has to have specially made shoes.

:06:38.:06:43.

Just out of interest, how much do they cost?

:06:44.:06:52.

We're facing a diabetic epidemic and need to find ways of prdventing

:06:53.:07:03.

those patients from reaching surgeons because the cost to the

:07:04.:07:07.

A new problem is expected to put even more financial

:07:08.:07:20.

16-year-old Aisha is one of a small but growing number of children

:07:21.:07:28.

I developed type two diabetds by having a sweet tooth, mostly

:07:29.:07:37.

I used to try out every new sweet in the store and I used to drink

:07:38.:07:42.

When I was taken to the hospital, it hit me then because I st`rted

:07:43.:07:50.

Aisha now has to rely on medicine to control her condition.

:07:51.:08:01.

But she's managed to lose a stone in weight and those fizzy drinks

:08:02.:08:04.

It's been really hard at tiles but you can only have health once

:08:05.:08:12.

You have to keep changing your diet plan to keep fit and healthx.

:08:13.:08:23.

New research shows the numbdr of children like Aisha with type two

:08:24.:08:27.

diabetes has nearly doubled in the last ten years.

:08:28.:08:31.

And they're likely to develop complications much earlier.

:08:32.:08:37.

People who are getting type two diabetes when they're 15 or 16

:08:38.:08:41.

are likely to have signific`nt problems maybe at the age of 35

:08:42.:08:45.

36, and that's really much younger than you'd expect.

:08:46.:08:51.

These are things like renal failure and heart attacks and strokds

:08:52.:08:54.

and it's going to have a huge impact for them.

:08:55.:08:58.

Ultimately, tackling the rise in type two diabetes will ddpend

:08:59.:09:01.

I believe we're facing a crhsis and we really need concerted action

:09:02.:09:09.

right across society for us to fund more research, provide the best

:09:10.:09:13.

possible care and, cruciallx, prevent so many cases of type two

:09:14.:09:18.

We need to stem the tide otherwise we could see a crisis

:09:19.:09:28.

and there are issues of sustainability for the NHS

:09:29.:09:31.

Steven's diabetes has stabilised but it's too late to save hhs job.

:09:32.:09:46.

The toe amputations have left him unsteady on his feet and he's been

:09:47.:09:50.

told by his employer he's no longer fit for work.

:09:51.:09:52.

Given everything you've been through, Steve,

:09:53.:09:53.

what would your advice be to people being diagnosed now

:09:54.:09:57.

It's the biggest regret I'vd ever made in my entire life.

:09:58.:10:10.

Well, if there's something xou think we should be looking

:10:11.:10:22.

into on the programme, get in touch with me on Twitter

:10:23.:10:26.

This is Inside Out for the Dast of England here on BBC One.

:10:27.:10:34.

Later on, we are in Newmarkdt to find out why the town inspires

:10:35.:10:37.

so many of the world's popular thrillers.

:10:38.:10:46.

So, we now know what the problems are facing the NHS but,

:10:47.:10:49.

to help solve the problem wd need to know what to do to reducd

:10:50.:10:52.

the risks of developing typd two diabetes in the first place.

:10:53.:10:56.

One area is our relationships with food.

:10:57.:10:59.

It turns out our brains react differently to different foods.

:11:00.:11:09.

Mark Holland is 42 and lives just outside Ipswich in Kesgrave.

:11:10.:11:12.

He likes to run here in his local park.

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He wants to make sure he keeps his weight down.

:11:17.:11:20.

He used to be 16 stone but now he's just under 1two.

:11:21.:11:24.

But being overweight led hil to being diagnosed

:11:25.:11:27.

I was out and about with my job in the car all day, I'd stop

:11:28.:11:34.

to fill up, eat a pie, eat a chocolate bar,

:11:35.:11:39.

have a few fizzy drinks, before you knew it, you're

:11:40.:11:42.

I think before I was diagnosed I realised, I knew I was getting

:11:43.:11:56.

bigger, I was buying bigger trousers and shirts,

:11:57.:11:58.

which is quite an obvious shgn I was doing something wrong.

:11:59.:12:00.

I was very lethargic, I would often have to stop

:12:01.:12:03.

in the afternoon and kick b`ck in a layby, I wasn't sleeping very

:12:04.:12:06.

well, I was starting to get a lot of symptoms of diabetes,

:12:07.:12:09.

which I didn't realise were symptoms until I started googling it.

:12:10.:12:11.

And I think that's when I rdalised that I really had to do

:12:12.:12:15.

The first thing I did was cut down on high sugary

:12:16.:12:20.

foods so fizzy drinks, chocolate bars and high-fat foods.

:12:21.:12:22.

You've really had to change your lifestyle, haven't you?

:12:23.:12:26.

I started off baby steps, rdally, doing a mile or two.

:12:27.:12:31.

It was really good cos I got a lot of support from the family `s well,

:12:32.:12:35.

had a couple of friends comd running with me too,

:12:36.:12:37.

then started building it up and building it up and realhsed

:12:38.:12:40.

Type two diabetes is seen as a bit of a soft disease versus type one.

:12:41.:12:48.

They are different but it does have some massive consequences

:12:49.:12:50.

if you don't control it in the right way.

:12:51.:12:58.

Snacks and alcohol top the list of the things we most

:12:59.:13:01.

Of course, these things in moderation are fine.

:13:02.:13:05.

But too much and not enough exercise is leading to a rise in the number

:13:06.:13:08.

of people being told they'vd got type two diabetes.

:13:09.:13:12.

And the age of people being diagnosed with it is getting lower.

:13:13.:13:16.

More younger people have type two than ever before.

:13:17.:13:20.

But let's face it - we know that is going to be better

:13:21.:13:23.

And apparently, our brains literally light up when we see this khnd

:13:24.:13:30.

of food and dims again when we see this kind of thing.

:13:31.:13:41.

This is the Institute of Metabolic Science in Cambridge.

:13:42.:13:46.

The scientists working here are looking at our relationships

:13:47.:13:48.

with food and how our brains react when we see and eat certain things.

:13:49.:13:54.

Here, experts look at everything that leads to people

:13:55.:13:56.

Almost a quarter of all adults and one in five children in the UK

:13:57.:14:03.

are considered obese and obdsity significantly increases the risk

:14:04.:14:07.

of developing life-threatenhng conditions such

:14:08.:14:10.

Professor Sadaf Farooqi is conducting extensive resdarch

:14:11.:14:15.

at the institute and has made a startling discovery.

:14:16.:14:19.

Here at the institute, we try to understand why

:14:20.:14:22.

people gain weight and, when they do gain weight,

:14:23.:14:24.

why do some people but not all people develop diabetes.

:14:25.:14:27.

Weight problems are a clear driver of type two diabetes but not

:14:28.:14:30.

everybody who gains weight gets diabetes and not everyone who has

:14:31.:14:34.

So there's quite a lot more that we need to understand

:14:35.:14:39.

about what causes both condhtions and why they're linked.

:14:40.:14:42.

What kind of work do you and your team do here?

:14:43.:14:45.

My team is really interested to see why people gain weight and one

:14:46.:14:48.

of the particular things we're focussing on is could it be down

:14:49.:14:51.

Now we know sometimes that weight problems can run in families

:14:52.:14:57.

and we've been focussing on children who really gain a lot

:14:58.:14:59.

of weight at a young age and, using that approach,

:15:00.:15:02.

we've found quite a few gends that, if they're defective,

:15:03.:15:05.

So you've managed to pinpoint, identify defective genes th`t

:15:06.:15:10.

actually trigger something in the human body that

:15:11.:15:14.

That's right, and those gends are part of a clear pathway

:15:15.:15:19.

in the brain that seems to be present in all of us

:15:20.:15:22.

and controls our weight, but means we generally we kdep

:15:23.:15:25.

a fairly stable weight despite the fact some days we eat

:15:26.:15:27.

more than other days and we do less activity.

:15:28.:15:32.

For most people, weight stays relatively stable,

:15:33.:15:34.

but some people put on weight very easily and that can be

:15:35.:15:37.

They are also conducting unhque research at the institute which may

:15:38.:15:44.

go further in understanding why people eat the way they do.

:15:45.:15:51.

Here, what we're doing is using functional MRI,

:15:52.:15:53.

so this is like a regular MRI scanner where you get the anatomy

:15:54.:15:56.

of the brain but, in addition, when people are lying

:15:57.:15:58.

in the scanner, we can show them pictures of food and we see parts

:15:59.:16:01.

of their brain light up when they see certain

:16:02.:16:04.

Yeah, and it depends on what type of food you like,

:16:05.:16:09.

so if you really like a burger or really like broccoli,

:16:10.:16:12.

it'll be those foods that lhght up this key part of the brain.

:16:13.:16:16.

If, say, someone was more attracted to say a fatty burger

:16:17.:16:19.

or a large slice of cake, is there something that

:16:20.:16:22.

you could switch off that would change that perception

:16:23.:16:24.

So, we haven't got something like that yet, but that's the kind

:16:25.:16:30.

of thing we're working on wd need to understand why this happdns

:16:31.:16:33.

because the key thing we've now learned is that certain beh`viours,

:16:34.:16:35.

the things we thought were purely under voluntary control,

:16:36.:16:38.

And their research has also found that certain people are acttally

:16:39.:16:44.

attracted to more fatty foods than others.

:16:45.:16:48.

Even when the food looks and tastes the same, subconsciously,

:16:49.:16:51.

they are more likely to eat the fattier dish.

:16:52.:16:55.

What we have found very recdntly is that there appears to be

:16:56.:16:58.

a pathway in the brain that regulates how much we like fat.

:16:59.:17:02.

So, to do this study, what we actually did was we chose

:17:03.:17:05.

chicken korma and rice, which we can hide quite a lot

:17:06.:17:07.

of fat in chicken korma, you can make a low-fat,

:17:08.:17:10.

a medium-fat and a high-fat version, and we did that and we found people

:17:11.:17:14.

with a particular genetic problem at 95% more of the high fat food

:17:15.:17:18.

Even though it tastes exactly the same, they still ate

:17:19.:17:23.

Meanwhile, back at Mark's house, it's dinner time.

:17:24.:17:30.

And this is where the whole family has been helping Dad.

:17:31.:17:36.

Everything is now geared to being that bit more healthy.

:17:37.:17:40.

You're his wife, you must've been shocked?

:17:41.:17:46.

I was because to me he wasn't hugely overweight, he was a bit podgy,

:17:47.:17:51.

I mean, this looks like a pretty healthy meal you're doing now,

:17:52.:17:57.

has it changed your lifestyle as a family?

:17:58.:17:59.

Definitely, yeah, cos we trx and look at what we're eating

:18:00.:18:02.

and what we're feeding the children, try and make sure we're not eating

:18:03.:18:05.

The kids have their treats and sweets like any other

:18:06.:18:09.

We're certainly not going to deny them all that stuff.

:18:10.:18:13.

But they know now as well it's a little bit about moderation

:18:14.:18:16.

but we're not kind of taking their chocolate away

:18:17.:18:18.

and confiscating stuff but we try to make sure

:18:19.:18:20.

everything's in moderation, they go off and help themselves

:18:21.:18:22.

I think it's sunk in and it's really good as well,

:18:23.:18:26.

so we go round the supermarket, they're looking actively

:18:27.:18:28.

at what we're buying and I think they make some of the purch`sing

:18:29.:18:31.

decisions for my wife as well on the way round,

:18:32.:18:34.

so I think everyone's really embraced it.

:18:35.:18:35.

It was quite tough to start with so, obviously, I had to change ly diet

:18:36.:18:39.

quite significantly, it was a really noticeable change

:18:40.:18:41.

Mark will always be type two diabetic but, at the moment,

:18:42.:18:45.

he manages to control the sxmptoms with his diet and exercise.

:18:46.:18:48.

And if you or someone you know is affected by diabetes,

:18:49.:18:50.

details of organisations offering information and support are

:18:51.:18:53.

60 years ago, one of the most famous sporting upsets prompted a jockey

:18:54.:19:06.

Dick Francis set his novels in the world of horse racing

:19:07.:19:12.

Well, sadly, Dick Francis has since died but,

:19:13.:19:16.

every year, his son, Felix, publishes a new book.

:19:17.:19:20.

Well, we've been to Newmarkdt to meet Felix to talk about why

:19:21.:19:23.

the town inspired some of the world's popular books.

:19:24.:19:31.

Early morning in Newmarket and long lines of horses

:19:32.:19:34.

You really don't think of murder when you're here.

:19:35.:19:40.

But this is the backdrop usdd in many of Dick Francis'

:19:41.:19:43.

His descriptions of the place are spot on.

:19:44.:19:50.

No other town in England provided a special series of roads

:19:51.:19:53.

upon which the only traffic allowed was horses, but one could go

:19:54.:19:57.

from one end of Newmarket to the other, only yards

:19:58.:20:01.

behind its bustling high street, and spend only

:20:02.:20:03.

a fraction of the journey on the public highway.

:20:04.:20:07.

Dick Francis died in 2010 but his son, Felix, keeps the family

:20:08.:20:10.

business going and there's still a new Francis book

:20:11.:20:13.

Like his father, Felix has ` great love of Newmarket.

:20:14.:20:20.

It's the centre of horse racing, its headquarters.

:20:21.:20:23.

Racing itself is such a wonderful background to write

:20:24.:20:26.

It takes all economic and socio economic groups, from royalty to the

:20:27.:20:45.

man in the street, and of course where there is money, and lots of

:20:46.:20:51.

cash, there are always people trying to make a killing.

:20:52.:20:54.

Former champion jockey Dick Francis was an internationally bestselling

:20:55.:20:56.

He sold more than 60 million copies of his books in 35 languages.

:20:57.:21:00.

But Dick Francis is also relembered for an incredible sporting tpset

:21:01.:21:04.

What took place at the 1956 Grand National shocked all those

:21:05.:21:18.

Dick Francis was riding the Queen Mother's horse,

:21:19.:21:22.

He was favourite to win and it looked like he had the race

:21:23.:21:26.

It was a heart-breaking moment for Dick Francis.

:21:27.:21:45.

Dick Francis would never win the Grand National.

:21:46.:21:48.

A year later, he suffered a serious fall and retired from

:21:49.:21:51.

He then embarked on a very different career.

:21:52.:21:57.

Because of the Devon Loch incident. He was invited to write somd

:21:58.:22:12.

articles for a Sunday newsp`per and he went on to be Earth newspaperman

:22:13.:22:16.

for 16 years. He always said what taught him to write because they

:22:17.:22:22.

editor would scrub out anything that was unnecessary because thex did not

:22:23.:22:28.

have space because of the adverts. So, instead of being one of us, he

:22:29.:22:36.

became one of them. Nowadays, every sport as exports and as journalists,

:22:37.:22:39.

but in those days, it was vdry fresh. He was the first one to move

:22:40.:22:44.

from the jockey's changing room to the press room.

:22:45.:22:46.

It wasn't long before Dick turned his hand to crime fiction.

:22:47.:22:48.

It was a good move as he wotld go on to become one the world's

:22:49.:22:52.

Many of his stories featured the Cambridge town of Newmarket

:22:53.:22:55.

Over the years, the two namds have become intrinsically linked.

:22:56.:22:58.

It is the rolling hills, lovely green grass.

:22:59.:23:01.

It is perfect for training race horses and writing murder mxsteries.

:23:02.:23:10.

Racing is such a wonderful background.

:23:11.:23:13.

Just behind the gallops is ` special place which overlooks

:23:14.:23:15.

The cars and lorries that thunder by are unaware they're passhng just

:23:16.:23:20.

The real-life location feattres in Dick Francis's book Bonecrack.

:23:21.:23:30.

So this is the location my father used in his book.

:23:31.:23:41.

It's quite emotional to comd and see it. I have never been here before.

:23:42.:23:45.

In some ways, it is quite poignant. Legend has it the boy who's buried

:23:46.:23:49.

here was a shepherd who comlitted suicide after his sheep werd killed

:23:50.:23:52.

by a wolf. Every year, flowers are left

:23:53.:23:55.

anonymously on the grave. Dick Francis tells

:23:56.:23:57.

the story in his book. The grave is always looked

:23:58.:23:59.

after in a haphazard sort of way. It is never overgrown and fresh

:24:00.:24:02.

flowers are often put here. No-one knows exactly who puts them

:24:03.:24:07.

here but it is supposed And there is also a legend that

:24:08.:24:10.

in May, the flowers on the grave are in the colours that

:24:11.:24:18.

will win the derby. Felix says his father, Dick,

:24:19.:24:23.

drew from real-life experiences as a jockey to create a realistic

:24:24.:24:26.

background for his books. Racing stables are wonderful places

:24:27.:24:32.

to come to and to get ideas, You are dealing with living,

:24:33.:24:58.

breathing beings. They all have the personality. And they do give you

:24:59.:25:03.

inspiration. As with all horses you cannot repeat stories because your

:25:04.:25:08.

readers will complain, quitd rightly. By I have an added problem

:25:09.:25:15.

and that I am following on the franchise from my father. Hd wrote

:25:16.:25:21.

39 books I cannot use any of those stories either. We now have 50

:25:22.:25:31.

books, racing thrillers, and I have got the write the 51st, and I will

:25:32.:25:33.

think of the story not any other 50. It is always exciting being on a

:25:34.:25:51.

racecourse. Horses on the w`y to the start. The excitement level rises.

:25:52.:25:59.

Everyone has money on. Too dxciting for words!

:26:00.:26:01.

But what about the people working in the racing industry?

:26:02.:26:03.

Are they happy that the sport features in so many crime stories

:26:04.:26:06.

and perhaps doesn't show thdm in the best of lights?

:26:07.:26:08.

In fact, the racing industrx love the books, according to 1980

:26:09.:26:11.

The good entertainment. It gives you an insight into racing. It was a bit

:26:12.:26:28.

like that sometimes. But thdy are exciting books and there is always a

:26:29.:26:33.

story. It makes you wait until the end. The scams they used to have an

:26:34.:26:39.

old these touches. There is always a grain of truth in there somdwhere.

:26:40.:26:43.

They are all based on something that may have happened. I was asked

:26:44.:26:49.

earlier on today, what is the great untold story in racing? If they are

:26:50.:26:54.

untold, you do not know thel. That is true. But there is always a grain

:26:55.:26:59.

of truth in them. Do you relember the story of Tenby racecourse and

:27:00.:27:03.

how it closed down because someone cut the telegraph wires on the top

:27:04.:27:08.

of the Brecon Beacon and thdy could not get one back to the court? I

:27:09.:27:12.

wrote a story based around that I wrote a story based around that I

:27:13.:27:17.

think those sorts of things are good for racing. People love stories like

:27:18.:27:19.

that they love intrigue. 50 books and counting

:27:20.:27:21.

for the Francis family and Felix has The world of horse racing

:27:22.:27:24.

and Newmarket itself will continue to feature in some of the world s

:27:25.:27:28.

bestselling crime stories. Which did not do racing good. Even

:27:29.:27:43.

though I talk about things which break the rules, making a lddge here

:27:44.:27:53.

and there, trying to get extra money here and there, I've peeled for

:27:54.:27:56.

overall, racing is very happy with them. They certainly seem to be

:27:57.:27:59.

People have talked to me about them and they are very happy with the

:28:00.:28:03.

books. And the fact that it gives exposure. And there you are.

:28:04.:28:09.

Well, that's it from Cambridge, but don't forget

:28:10.:28:11.

It's the last programme and our current series.

:28:12.:28:14.

And it's Halloween on that Londay, so we've got a pumpkin

:28:15.:28:17.

on the programme, but not any old pumpkin.

:28:18.:28:19.

I find out what it takes to grow the biggest pumpkin in Britain. But in

:28:20.:28:28.

the meantime, get in touch with me on Twitter or e-mail. I will see you

:28:29.:28:39.

next week. Goodbye. Also next week, we find out what is being done about

:28:40.:28:44.

Traveller sites in Bedfordshire What Mark is trying to do hd is

:28:45.:28:49.

trying to do for other people what he did for me, and I thank him from

:28:50.:28:54.

the bottom of my heart. That is Inside Out, the last of the series,

:28:55.:28:58.

next Monday, 7:30pm, here on BBC One.

:28:59.:29:03.

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