24/02/2014 Inside Out West


24/02/2014

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Hello from Bristol where we're investigating concerns about heart

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surgery at Bristol Children's Hospital.

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Tonight, we speak to the parents of two children who died here. We have

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a child who has gone from a good heart function to a pure heart

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function. Is not that he had bad care, he had no care at all.

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Also tonight: what happened to all the flax? I meet a man trying to

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bring it back. You grasp the handful and then lay

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it out, but one end, seeds the other end.

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I'm Alastair McKee, and this is Inside Out West.

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We all want our local NHS to be a service we can trust ` especially

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when it's our children at stake And the care of children's hearts in

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Bristol has had a traumatic history. Two decades ago at least 35 babies

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died unnecessarily following sub`standard surgery. The scandal

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led to multiple inquiries and with a new surgeon the unit rebooted itself

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to become one of the best in the country. But now new concerns are

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emerging. A coroner has ruled that Bristol Children's Hospital lost

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opportunities in treating a 4`year`old boy who died following

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heart surgery. The last three months have seen

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national headlines accompanying the inquests into the deaths of two

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children at the Bristol Children's Hospital in 2012. A report by the

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hospital linked the deaths, as well as several near misses to poor

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staffing. The coroner found there was no gross negligence, but in the

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case of 4`year`old Sean Turner said there were lost opportunities.

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All very concerning according to Steve Bolsin, the Bristol doctor who

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blew the whistle to me 19 years ago, and who was forced to leave and work

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in Australia. There were warning signs, there were

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people raising flags and as there was 20 years previously, as you

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know, and still children are being allowed to die.

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Following these two deaths, a report by the health watchdog, the Care

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Quality Commission, demanded more money to be spent on staff and

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resources. And the hospital said that's exactly

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what they did ` investing more than ?1 million to employ more nurses.

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But new questions are now being asked about care here in Bristol,

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and the wider services for children heart surgery here in the West.

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Paul Starr and Catherine Holley live in Great Elm near Frome. In June

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2009 they had a little boy, called Samuel.

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He was a beautiful boy, he was smart, clever, he had a good

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vocabulary, he had lots of friends, he went to nursery, he had a nice

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life. He had plenty of time with his family and friends, he was full of

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fun, he was well loved. Samuel was born with a heart condition and

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after initial surgery at nine months, he thrived. But at age

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three, his parents were told that Samuel's condition had deteriorated.

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We sat down at the cardiologist s desk and he said he didn't want to

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shock us but that Samuel needed surgery that summer. And we were

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shocked, it wasn't at all in our understanding that this was going to

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have to happen. And it was later we found that it was quite severe,

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really. Samuel's operation in August 20 2

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took longer than expected and there were complications that required

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additional surgery. As we were coming back to the ward,

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the matron was there and he wanted to confirm that we were Samuel's

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parents and we said yes, and he said at that point that he thinks that

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Samuel had a stroke, so that was obviously devastating news for us.

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After weeks in the Paediatric Intensive Care Unit ` known as PICU

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` Samuel had a cardiac arrest. We came back to the hospital as

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quick as we possibly could to be told that a second cardiac arrest

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looked imminent and would we consider withdrawing treatment and

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we had to agree, at that point it didn't looked recoverable, so we

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went back into PICU, they removed his lines and we spoke to Samuel and

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read him stories and he passed away in our arms.

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Heart surgery on children is complex and carries risks. And, as a result

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of the Bristol heart scandal, deaths amongst children who've had surgery

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are monitored and compared to other hospitals. League tables are now

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published. But care at Bristol has slipped, and although its results

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are classified as safe, it's ranking measured over the last three years

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has dropped from third to seventh out of ten.

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As far as I can see, it's not definitive data that proves that

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Bristol was statistically significantly worse, but it is data

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which is indicative of a need to change your approach to these

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particular types of operations. What's crucial to a hospital's

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league table position is how many children die within 30 days of their

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operation. Following Samuel Starr's death, a

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medical professional raised concerns that the hospital might have been

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keeping him alive for longer than was necessary to ensure that he

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passed that 30`day point. Nurse s notes submitted for a review into

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Samuel Starr's death said: "I was concerned that stalling for a couple

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of days would not only be cruel to the family and unethical, but would

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possibly mean that survival from cardiac surgery for 30 days would be

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achieved for statistics." Not surprisingly, the Starrs were

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shocked by this suggestion. We had some information from a nurse

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involved in Samuel's care that she had questioned whether Samuel's

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passing had been manipulated for the sake of statistical records, that

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really stopped us in our tracks And in hindsight do you wish that

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you had allowed him to die earlier? I think we should have been given

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the option and we should have known. They knew.

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We put this allegation to the medical director of the Bristol

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Children's Hospital. Our clinicians utterly refuse that

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allegation. It is very difficult to believe that an allegation can be

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meant to be quite that blunt. I don't believe there is any evidence

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to support that allegation and the attempting to prolong survival so

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that a certain statistic is achieved is utterly unbelievable and I can't

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believe it would cross a clinician's mind that would be a factor making

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any clinical decisions at all. Clinical decisions are made

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consistently in the best interests of the patient irrespective of what

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data might be collected. Despite the many questions the

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Starrs have about Samuel's operation and subsequent care, their biggest

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concern is whether Samuel's death might have been prevented if there

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weren't huge delays to his regular check`ups while he was alive.

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Samuel's local hospital was the RUH in Bath where Bristol consultants

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held outpatient clinics. Sam's condition meant that he was

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supposed to have regular scans to make sure his condition didn't

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suddenly worsen. Following successful surgery in 2010, his

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heart was scanned. But that turned out to be the last scan he had for

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some 20 months. So now we have got a child who in 21

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months has gone from a good heart function to a poor heart function.

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Now, that has happened in that time, not because he had had bad care

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within that time, but no care at all.

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So how can a child with a serious heart condition essentially drop off

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the system? There was some human error. The Starrs asked a community

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nurse to ring for an appointment on their behalf. She rang five times

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over as many months but failed to get an appointment. And Inside Out

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has discovered that another key factor in these delays was a new

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American IT system that was being installed to deal with appointments

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at the RUH. Richard Bacon, MP, who's been asking questions about NHS IT

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systems for years, says that its faults were well known.

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There were problems with bookings being missed, because the data would

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just drop off the system. When you have got things like waiting lists

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which you have in the NHS ` which are largely unknown in the United

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States ` making a system deal with waiting lists when it is not

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designed to deal with waiting lists causes its own big set of problems.

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And minutes of board meetings at the RUH a year before Sam's death show

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the hospital was fully aware of the problems with their new computer

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system. "There were significant issues

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with?data that had not been migrated. This affected?long term

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follow up appointments." What do you think now you know that this was a

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recognized problem a year before Samuel's death?

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I am absolutely disgusted that it was recognized but no or limited

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action was taken on it. What should they have done?

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Reverted back to the old system while they got the new system up and

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running so that these problems didn't occur. How can you rely on a

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new system if it doesn't work? In a review of Samuel's death,

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Bristol Children's Hospital concluded that these delays might

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have played a part. But were other patients affected by these delays

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too? We asked the RUH in Bath how many appointments were overdue or

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delayed because of the computer system and they told us there were

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63 overdue appointments, with some delays are up to two years before

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they were discovered. It's very, very serious and the

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nature of this is that you are dealing with people's lives and it

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is absolutely essential that if you are going to be using computer

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systems that you have computer systems that work.

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The RUH declined to answer any specific questions about their

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computer system, saying in a statement: "The Coroner's inquest

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will be held very soon and we hope that this will provide both Samuel's

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family and everyone involved in his care, with a clearer indication of

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the circumstances surrounding his death." What the inquest won't be

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getting to the bottom of is whether any of the other delays involving

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children with cardiac problems at the RUH might also have affected

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their care. Despite not knowing all the

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circumstances behind their son's death, the Starrs have at least some

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of their questions answered. But other families have been less

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fortunate. In April 2012 Daniel and Debbie

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Janew from Gloucester were the proud parents of a baby girl called

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Isabella. She was also born with a heart defect that needed corrective

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surgery to give her a better life. We took her down the theatre.

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Isabella sat her on Debbie's lap, the gas was applied and she fell

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asleep. We went back up to ward 32 and we waited and we were expecting

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to be told soon that we were to have her back and take her home after a

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few hours, maybe. Shortly after thinking that, nurses ran into the

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room and told us that they'd started the procedure, it hadn't been

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completed fully because during some parts of the procedure, Isabella's

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heart went into arrest. Later that day Isabella sadly died.

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But what caused her to suddenly crash during surgery? The reality is

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that the Janews simply don't know because they say Bristol Children's

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Hospital didn't talk to them for five months or offer to let them see

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an investigation into their daughter's death.

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I was asked if I could comment on the child death review when it was

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in draft stage, just to verify any of the facts as we understood them,

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I was told that this was not possible. I was asked if I could

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have a copy of the child death review for our own daughter and was

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told I would not be allowed to get this.

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Last November, following the scandal of hundreds of unnecessary deaths at

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Mid Staffordshire Hospital, the Health Secretary, Jeremy Hunt, said

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that the public will see a new culture of openness in the NHS.

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"From 2014, every organisation registered with the CQC will have a

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statutory duty of candour. Patients must be told promptly about any

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avoidable harm but there will be a statutory requirement for the

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hospital to notify when there has been an avoidable death or serious

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injury." But what do the Janews think of this promise?

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We showed them the speech. What do you think of it of that? So, our

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experiences in the four months after Isabella died doesn't really follow

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an openness policy by the hospital. We have sent many emails to the

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hospital and we've had no reply And it seems as if, following the four

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months after Isabella's death, we have had nothing but obstacles and

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hurdles that the Trust has put in our way to obtaining the truth.

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Well, it's part of this culture of honesty and openness which has

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failed to pervade the NHS. We have people at the top telling us very

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clearly that the NHS has changed, the culture is now one of

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transparency and openness. This is not what we are seeing in Bristol `

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perhaps the message has not got to Bristol. Perhaps someone needs to

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come down and explain to them what openness and transparency are.

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We also showed Jeremy Hunt's speech to Bristol's medical director. From

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2014 every organisation registered with the CQC will have a statutory

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duty of candour." Is that something you think you have been doing?

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Yes. We want to be even better at it. We know now we've made changes

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to some of our policies and procedures to make sure that it s

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built into what we do. But parents like the Janews say that

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the trust has just, in the last few weeks, started to have a fuller

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dialogue with them, with what happened there. This is several

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months after their bereavement. Well, I know that we did make

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contact with those parents immediately after their bereavement,

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we have made several contacts. But they said they were told that

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you were not prepared to let them see their child death review, they

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could only see a summary of it. I don't know about that, I am not

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aware of that. Can you understand why families like

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the Janews feel that when they are being told that they can't see the

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full child death review, they automatically feel there is some

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kind of cover`up going on? If that is what they were told, then

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I can understand why they must feel that. As I have said, one thing we

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want to learn from the review is how we improve the ways in which we

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communicate with patients so they understand what is going on. We

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know, we get a lot of feedback from parents, and we know that 98% of

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parents measured over an entire year have said to us that their care is

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excellent, very good or good. Can you just sum up your thoughts

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where we are now as a unit in term of safety and care for patients

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I think primarily, fundamentally, it is important to recognise that

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Bristol is a safe unit. Since I started investigating this

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story, parents, including the Starrs and the Janews, met the NHS's

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medical director Sir Bruce Keogh to talk about their concerns.

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Immediately after the meeting, he announced an independent review

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We've heard some very harrowing stories in a very dignified way

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What I'm really after is getting to the bottom of these problems,

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finding a solution and getting the Bristol unit to be the best in the

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country as quickly as possible. Next week the inquest into the death

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of Samuel Starr begins ` it will try to get to the bottom of what

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happened. It will again bring care at Bristol and the RUH into the

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Spotlight. The government is now deciding which

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heart surgery units in England should close, and with Bristol in

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the firing line, many patients here in the West are still waiting to be

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convinced that this region's service is as good as it can be and

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hospitals are being open about problems they face.

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In our final film tonight we're looking back at a once vital ` but

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now largely forgotten ` arable crop. Flax went into decline 400 years

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ago. But in World War One it became essential for the production of

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aircraft wings. I've been to meet a farmer in Gloucestershire who's

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trying to bring it back again. This is not your ordinary boat. It

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is made entirely out of this, flax. I will take to the water to find out

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if it can float. But first, a bit more about the strange crop it is

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made from. Simon, Hello ` so this is your crop of flax? Yes, over this

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half an acre. Simon, what made you decide to start farming flax?

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Curiosity ` we thought we'd find out why, or why not. It has been grown

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for thousands of years but not in the last few hundred. Simon is

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particularly keen to find new uses for flax fibres ` but he's learning

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by farming it the traditional way ` and that means doing things by hand.

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What you do is grasp the handfuls... Pull it and give it a shake to get

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rid of the soil. When you have a handful, let it out.

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Once pulled, the crop is laid out in the field to allow moisture from the

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ground to dissolve the tough outer stalks so we can get to the

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all`important fibres within. You've got to get it just rotten enough but

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not too rotten otherwise it spoils. Fields of flax are a very rare sight

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in Britain today but for many years it was an important crop. The

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ancient Egyptians farmed it to make their famous linen. In fact there is

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evidence that it was grown in the country of Georgia as early as

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30,000 BC. In Britain it was a popular crop for clothes and other

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products until relatively recently. To learn about its decline I'm

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joined by an agricultural historian. John, I know that for centuries even

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millennia, fields of flax were a very common sight in this country `

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what happened ` why did it disappear?" In a word, cotton. With

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the expansion of cotton production in America, it undermines flax as a

:21:57.:22:03.

viable source of fibre. So it was cheaper to bring cotton in from

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America than grow flax in this country? Considerably cheaper.

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And I guess the use of slave labour in places we bought cotton from

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played a part in keeping it cheaper to use cotton.

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Despite a long`term decline, the outbreak of World War One saw demand

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And with their men away on the front line, the country turned to its land

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girls to do the hard work, as one landgirl Winifried Sandford later

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explained. We were taken to and from the fields

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in lorries, a jolly ride bumping over the country roads, standing up

:22:39.:22:42.

and holding on. Flax must be pulled by hand, not by machines, we were

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told. We were a welcome amusement for the folk who lived around and in

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Yeovil. They came in hundreds to see girls in breeches, living in tents,

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girls who were helping to make those aeroplanes that zoomed low over the

:22:54.:23:02.

fields of Somerset. Back on the farm I'm finding out

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what's happening next to the flax we've harvested, with Simon's wife

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Ann. This has been dried out for several months and stored away until

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we're ready to use it. We will break it. Right, let's do it.

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To break the stalks we're using a homemade hand`roller based on

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designs from the late`1700s. Next comes a process called

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scutching. This is the process. As you can see it flies everywhere and

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you get lots of small piece of small fibre coming off. Once upon a time

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every worker in the village would have had their own personalised

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scutching knife. People spend a lot of time on their names. They would

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decorate and paint them and give them to their loved ones.

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So you knew you were really loved if you go a scutching knife for

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Christmas. Exactly. This is your own design?

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Obviously I'm not loved. To scrape away the last dusty shives

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of stalk the fibres are pulled through a set of hackling combs `

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ready for spinning into yarn. You are going onto the next ones, that

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looking good. All the time you are getting rid of the fibres, you're

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separating the fibres. I can feel it getting softer. I started with

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rather more... I'm not sure I've been very efficient here. It is

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lovely. It is very fine. You are just being nice.

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Fibres vary in length. They are drawn by hand over to a series of

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metal spikes... With World War Two looming the

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country again found itself in need of flax. By now the crop was being

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imported, but the threat of war cut off supply.

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In 1938 flax imports from Russia virtually ceased ` governments

:25:23.:25:24.

increased production with increased in acreage. Farmers were encouraged

:25:25.:25:38.

to plant it. Labour is released to enable activities like weeding and

:25:39.:25:44.

harvesting in the autumn to be successfully undertaken. First boy

:25:45.:25:53.

takes pieces from the bundle and passes them the machine. You can see

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this steady rise and fall of the flyers as they went the yarn onto

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the bobbins. Back with Ann and we're spinning our

:26:03.:26:06.

flax fibres into yarn the old fashioned way.

:26:07.:26:11.

And then finally the yarn is woven into cloth.

:26:12.:26:23.

So that's it. I've been through every step to get from this to this

:26:24.:26:30.

and it's only taken ` well, all day. Despite being part of life in

:26:31.:26:33.

Britain for thousands of years, the farming, processing and weaving of

:26:34.:26:39.

flax has all but vanished. So is there any chance of a revival?

:26:40.:26:45.

Is there any future for flax in this country? The future is quite bright

:26:46.:26:53.

if we successfully mechanise the task of harvesting and if we develop

:26:54.:26:56.

machines to harvest mechanically. That is intentional for further

:26:57.:27:07.

expansion. Simon also thinks flax has a future: as an alternative to

:27:08.:27:09.

man`made fibres. New uses are in composites. It has

:27:10.:27:18.

natural variability in it and it has flexibility. There is a great deal

:27:19.:27:26.

of research in this country as well into plant fibes.

:27:27.:27:30.

To prove his point Simon has developed a canoe made out of woven

:27:31.:27:33.

flax fabric, waterproofed with flax resin. So, you reckon it floats

:27:34.:27:39.

Yes. Well the only way to find out is to put it in the water.

:27:40.:27:48.

From linen bed`sheets to aircraft wings and Canadian canoes, there's

:27:49.:27:54.

no doubt Flax has its uses. And who knows, the idea of a locally`grown

:27:55.:28:09.

boat might actually catch on. And BBC local radio will be

:28:10.:28:12.

unearthing many of the forgotten stories of WW1 and its impact here

:28:13.:28:18.

at home. You can catch these at 8.15 every morning this week.

:28:19.:28:25.

Well that's just about it for this week but if you'd like to keep in

:28:26.:28:29.

touch with what we're up to then you can find us on Twitter. Or you can

:28:30.:28:32.

email us: [email protected] But from all of us here in Bristol

:28:33.:28:42.

thanks for watching and goodnight. Next week ` we're in Romania on the

:28:43.:28:55.

trail of the fake bomb detectors. You are crazy people. What is this

:28:56.:28:56.

BBC? Hello, I'm Ellie Crisell with your

:28:57.:29:10.

90 second update. Two women and four dogs have been found shot dead at a

:29:11.:29:14.

house in Farnham. An 82-year-old dog breeder has been arrested on

:29:15.:29:17.

suspicion of murder. He's been named locally as John Lowe.

:29:18.:29:21.

Dave Lee Travis is to face a re-trial over two charges of

:29:22.:29:24.

indecent assault and sexual assault. The former Radio One DJ was cleared

:29:25.:29:27.

of 12 other offences earlier this month. He said his "nightmare goes

:29:28.:29:31.

on". They call it a living hell. These

:29:32.:29:35.

are the faces of men, women and children desperate for food. More

:29:36.:29:38.

than 20,000 are trapped in a bombed-out area in Syria. Just 0

:29:39.:29:41.

packets of food made it in today. We've a special report at Ten.

:29:42.:29:46.

Just where is Ukraine's former President? He's on the run after the

:29:47.:29:49.

crisis there. An arrest warrant s out for Viktor Yanukovych. He's

:29:50.:29:54.

wanted for mass murder. Was he just too British for American

:29:55.:29:57.

tastes? CNN is axing Piers Morgan's primetime chat show. The programme

:29:58.:30:01.

Hello, I'm Sabet Choudhury. Teacher Jake Thompson died of head injuries

:30:02.:30:05.

after being hit by a 13.5 tonne truck. Lorry driver Paul Vowles is

:30:06.:30:08.

alleged to have driven through changing traffic lights. He denies

:30:09.:30:11.

causing death by careless driving.

:30:12.:30:12.

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