:00:00. > :00:09.Shia Muslims are not Muslims is pretty radical by most people's
:00:10. > :00:12.beliefs. Thank you. Tonight on Newsnight Scotland: is
:00:13. > :00:16.there a chronic problem with acute care in our hospitals? Three
:00:17. > :00:20.Lanarkshire hospitals seem to show abnromally bad death rates. Is that
:00:21. > :00:25.bad statistics, bad medicine, bad management, or something which could
:00:26. > :00:29.happen anywhere? Also tonight, the view of the police
:00:30. > :00:33.officer at the very heart of the Lockerbie investigation.
:00:34. > :00:38.Good evening. Three Scottish hospitals, all
:00:39. > :00:43.practices of the Lanarkshire hospital and put patients at risk,
:00:44. > :00:47.according to a report today. Faults were found at Wishaw and elsewhere,
:00:48. > :00:49.but it is of the situation at Monklands that is causing most
:00:50. > :00:52.concern. The government told us programme tonight it had already
:00:53. > :00:57.checked to make sure some of the problems found there were not
:00:58. > :00:58.present in other acute hospitals across the country. But can patients
:00:59. > :01:07.be reassured? It is frightening to realise that a
:01:08. > :01:14.nurse or doctor doesn't realise what is happening to you and what has
:01:15. > :01:18.been planned. We were repeatedly asked questions
:01:19. > :01:26.also constantly correcting errors and misconceptions.
:01:27. > :01:28.These are real statements from patients who have been in hospital
:01:29. > :01:37.in NHS Lanarkshire. In August this year, concerns were expressed about
:01:38. > :01:41.Monklands, and Wishaw. I have an average death rates prompted an
:01:42. > :01:46.investigation, the first in this country, by Health Improvement
:01:47. > :01:51.Scotland. There were problems with understanding, patient care and
:01:52. > :01:55.record-keeping. This review is mixed. First of all, it is a review
:01:56. > :01:59.the Scottish Government commissioned, because we saw the NHS
:02:00. > :02:04.Lanarkshire hospital standardised mortality ratio is not improving at
:02:05. > :02:11.the same rate as the rest of the country. When we looked at this
:02:12. > :02:14.review, including a large group of clinicians and some patients
:02:15. > :02:16.involved, it would appear that particularly at Monklands, that
:02:17. > :02:18.ratio isn't improving at quite the same rate of the rest of the
:02:19. > :02:24.country. In Parliament this afternoon, the
:02:25. > :02:28.government 's plans to turn failing hospitals around were outlined. To
:02:29. > :02:33.help NHS Lanarkshire deliberately is important recommendations, I am
:02:34. > :02:36.putting in place a covenants and improvement support team to help NHS
:02:37. > :02:39.Lanarkshire make the changes necessary to improve their
:02:40. > :02:45.performance for the people and patients of Lanarkshire.
:02:46. > :02:51.Lieber said it was a damning report. People have died unnecessarily and
:02:52. > :02:55.Lanarkshire due to failings in the NHS. I have no doubt senior
:02:56. > :02:57.management will seek to pass the buck onto those hard-pressed staff
:02:58. > :03:01.who are trying to provide care despite the failings of management.
:03:02. > :03:07.The makes 21 recommendations. Amongst them, safe nurse staffing
:03:08. > :03:11.levels, improved patient support, and improved emergency patient
:03:12. > :03:14.admission. The government are sending a hit
:03:15. > :03:18.squad in to sort out the problem is urgently. There is no doubt there
:03:19. > :03:25.are huge problems, but hospital standardised mortality ratio is not
:03:26. > :03:28.supposed to be definitive. Inspectors advise it should be used
:03:29. > :03:33.as a smoke alarm rather than a smoking gun. The Health Secretary
:03:34. > :03:38.takes issue with not enough resources. He has batted that back
:03:39. > :03:41.to NHS Lanarkshire to manage their staff better. This is about the
:03:42. > :03:46.management of those resources. It is not about when the resulting. We
:03:47. > :03:52.have given NHS Lanarkshire the resources they need. NHS Lanarkshire
:03:53. > :03:55.have accepted these recommendations. First of all, I would like to say,
:03:56. > :04:01.we welcome the report. This is about improving patient quality and
:04:02. > :04:04.patient care. We will take those recommendations and implement them,
:04:05. > :04:08.and in fact, we have started lamenting many of them already. We
:04:09. > :04:16.are starting to see changes insignificant, -- and significant,
:04:17. > :04:20.positive improvements. Patients' Association spear these problems
:04:21. > :04:24.could happen other boards. not just Lanarkshire, it could be other areas
:04:25. > :04:27.in Scotland. Sometimes we think, and so do the patient, that the health
:04:28. > :04:33.boards are not fit for purpose any more. Alex Neill expects these
:04:34. > :04:36.changes to be made as soon as possible. He has asked for big
:04:37. > :04:42.improvements by next year, with another report due out in March.
:04:43. > :04:45.A short while ago, I was joined by Doctor Bryan Robson, the clinical
:04:46. > :04:50.director of Healthcare Improvement Scotland. I put it to him that his
:04:51. > :04:54.report mentioned practices which may affect safe patient care. I asked
:04:55. > :04:58.what they were. Let me tell you briefly what we did
:04:59. > :05:01.and what we found. What we did was, for the first time, carried out a
:05:02. > :05:07.detailed review of the quality and safety of care in NHS Lanarkshire.
:05:08. > :05:11.We interviewed or heard from more than 300 patients and relatives. We
:05:12. > :05:16.heard their experiences of care. We met with more than 200 members of
:05:17. > :05:26.staff, and we reviewed 150 or more clinical records. What we found what
:05:27. > :05:32.a range of issues that NHS Lanarkshire... I understand that. I
:05:33. > :05:35.will come back to this point. You say practices which represent an
:05:36. > :05:39.unacceptable risk. What are these practices? We have looked at a whole
:05:40. > :05:45.range of activities in NHS Lanarkshire, and in particular, the
:05:46. > :05:50.three key areas we are interested in our the area of leadership in
:05:51. > :05:55.management. We found confused structures and arrangements for
:05:56. > :05:58.leadership and management across NHS Lanarkshire. We also looked in
:05:59. > :06:04.detail at patient care, and we were concerned to find that patients who
:06:05. > :06:11.were sick and deteriorating on wards were not being attended to in a way
:06:12. > :06:17.we expect. Thirdly, we found that staffing was inappropriate at
:06:18. > :06:21.inappropriate times. However, I must say that we also found in this
:06:22. > :06:26.detailed review, many areas of good practice. The bottom line is, I
:06:27. > :06:28.suppose, if you are a patient, particularly at Monklands, or if you
:06:29. > :06:36.are due to be admitted to that hospital, can you trust that
:06:37. > :06:41.hospital to treat you safely if what you say in your report is true?
:06:42. > :06:45.Well, yes. We found many areas of good practice at Monklands. I'm sure
:06:46. > :06:48.there are many areas of good practice. However, if there are
:06:49. > :06:51.practices which represent unacceptable risk to sell patient
:06:52. > :06:55.care, and I was due to go into that hospital, I don't think I would feel
:06:56. > :06:58.very safe will start that was the reason we were asked by the Cabinet
:06:59. > :07:01.Secretary to carry out this detailed review. The point is, these
:07:02. > :07:05.practices have not yet been corrected or addressed. Throughout
:07:06. > :07:08.the process of the review, we've worked with NHS Lanarkshire, who
:07:09. > :07:11.have indeed been putting in improved care throughout the process of the
:07:12. > :07:18.review, and are committed, as you heard, to follow through on all 21
:07:19. > :07:23.of our recommendations. I'm sure they are, but one of the points you
:07:24. > :07:27.also making the report is that some of these problems in these hospitals
:07:28. > :07:33.were identified some time ago, and that measures were taken to address
:07:34. > :07:36.them, and you say, and I kind of quote the document, the inescapable
:07:37. > :07:40.conclusion is that the actions taken today are adequate. We have
:07:41. > :07:45.certainly found areas for improvement, and with set them out
:07:46. > :07:49.very clearly in our report. But the point is, if I have already taken
:07:50. > :07:53.steps to improve, and they haven't worked, and you are now saying, we
:07:54. > :07:57.will take more steps, as a patient, not being a medical expert, and if I
:07:58. > :08:01.was due to go in there, I would be thinking, sorry, I might see if I
:08:02. > :08:04.can go to another hospital. This is the first time we carried out this
:08:05. > :08:08.sort of review, and it's the most detailed review ever carried out
:08:09. > :08:11.quality and safety and care in the health board in Scotland. We have
:08:12. > :08:15.found areas of good practice, but also other areas for improvement.
:08:16. > :08:20.You have said that. One of the things you point out is, you say in
:08:21. > :08:23.your report that water flag this up was this Hospital Standardised
:08:24. > :08:26.Mortality Ratio, these figures which are death rates in hospitals. You
:08:27. > :08:30.say your conclusions and recommendations are independent of
:08:31. > :08:35.that. It flag it up, you done the report. Now, it is still possible,
:08:36. > :08:39.is not, that the fact it was flagged up could some statistical anomaly.
:08:40. > :08:43.If we assume that that is the case, is it not possible that you could
:08:44. > :08:47.take any three hospitals in Scotland and do the kind of rapport you have
:08:48. > :08:50.just done? And you would find exactly the same problems? Well,
:08:51. > :08:54.what we have done is take that indicator, that smoke signal if you
:08:55. > :09:00.like, and we have looked in more detail to see what areas could
:09:01. > :09:04.contribute more to this higher mortality ratio, and this means the
:09:05. > :09:11.areas we are set out clearly in our report today. My point remains, if
:09:12. > :09:14.you examine... It may well be all you done is scratched the surface of
:09:15. > :09:19.a problem that is going on in hospitals right across Scotland. We
:09:20. > :09:24.have found many areas of good practice in NHS Lanarkshire. We have
:09:25. > :09:26.set out 21 key recommendations. We expect all boards in NHS Scotland
:09:27. > :09:35.will be interested in those recommendations will . But because
:09:36. > :09:39.of the way the report is written, and with lots of very detailed stuff
:09:40. > :09:44.in it, it is not clear to me that you actually identify anything which
:09:45. > :09:48.you could sit there and say, this explains why Monklands Hospital is
:09:49. > :09:52.experiencing abnormally high death rates. Well, Healthcare Improvement
:09:53. > :09:55.Scotland have carried out a detailed review of quality and safety, and we
:09:56. > :09:59.have set out throughout the report the areas that need to be improved.
:10:00. > :10:02.As I said, there are three key areas around leadership and management,
:10:03. > :10:06.making those structures more understandable and less confusing,
:10:07. > :10:10.around patients deteriorating on the wards and recognising those
:10:11. > :10:14.patients, and acting on those patients, and also, finally,
:10:15. > :10:16.insuring that the appropriate staff are dealing with patients at the
:10:17. > :10:19.appropriate times. Thank you very much.
:10:20. > :10:23.Now, the Scottish Government's Health Secretary is Alex Neil. When
:10:24. > :10:32.he came into our Edinburgh studio, I asked him: if the problem was to do
:10:33. > :10:37.with the management either of the health boards or the hospitals
:10:38. > :10:40.themselves. The report itself makes it absolutely clear that the issue
:10:41. > :10:45.is largely about governance and leadership, and management will stop
:10:46. > :10:48.and making sure that every level of management takes better decisions
:10:49. > :10:53.and resources are allocated more correctly. Yes, but if it is about
:10:54. > :10:55.bad management, why not remove the management? If you remove the
:10:56. > :11:01.management over night, that will destabilise the situation that we
:11:02. > :11:06.already have, so what I have said to the Chief Executive when I spoke to
:11:07. > :11:10.him this morning is that I expect them now to turn around this
:11:11. > :11:13.situation, along with the support team who are in from the Scottish
:11:14. > :11:26.Government, and I expect significant progress by the end of March. If
:11:27. > :11:29.there is not significant progress by then, I may have to take a different
:11:30. > :11:32.set of decisions. Which could be to remove a manager? Well, obviously if
:11:33. > :11:35.we had not made progress, we need to look at why we have not, and base
:11:36. > :11:39.any decisions on that. So if in effect, they are on probation. I
:11:40. > :11:42.would not like to say that. What I am saying is, if the situation does
:11:43. > :11:45.not improve significant by the end of March, I will take whatever
:11:46. > :11:51.decision needs to be taken to get this organisation back on course.
:11:52. > :11:54.But as you know, some patients' rights campaigners are calling for
:11:55. > :11:58.the removal of management. People will say that, given that one of the
:11:59. > :12:00.things this report says is that these problems were identified
:12:01. > :12:05.before in this hospital and measures were taken and they did not work,
:12:06. > :12:09.this is not exactly the first time. This will be a second chance. Is
:12:10. > :12:15.there a third chance? Well, it is true to say that none of the
:12:16. > :12:21.measures worked. -- not true. There was some progress. What is important
:12:22. > :12:25.to remember is that the Hospital Standardised Mortality Ratio in
:12:26. > :12:29.Lanarkshire has improved by 4.3%. It is below the Scottish average, which
:12:30. > :12:32.is 12.4%, and that is what triggered this investigation. It is not right
:12:33. > :12:45.to say no progress has been made. There has been progress, but very
:12:46. > :12:53.insufficient progress. Monklands, you cancelled the closure, today's
:12:54. > :12:58.report said the challenge of providing services on three sites
:12:59. > :13:01.was a recurrent theme so perhaps consolidating accident and emergency
:13:02. > :13:08.in that area would have been a good idea. They mention services, such as
:13:09. > :13:13.orthopaedics, where having three sites requires a review and we
:13:14. > :13:16.agreed. It does not say there is a need to review three accident and
:13:17. > :13:27.emergency departments or three hospitals. I should point out that
:13:28. > :13:33.already in Lanarkshire there is a degree of specialisation between the
:13:34. > :13:41.hospitals, four example maternity is centred in Wishaw and children's,
:13:42. > :13:46.and Monklands leads on cancer and how Myers on coronary. There is a
:13:47. > :13:54.degree of specialisation -- how Myers hospital. Given the report
:13:55. > :13:59.says there are practices at these hospitals that will put patients at
:14:00. > :14:04.risk, if people in those hospitals, or about to be admitted, why should
:14:05. > :14:09.they believe they are safe, especially given that not only are
:14:10. > :14:14.the practices going on, but nothing is being done to remove present
:14:15. > :14:21.management. During the review, changes have taken place. There have
:14:22. > :14:27.been major intensification of the early warning system. That part of
:14:28. > :14:34.the recommendation is under way and some others have already started to
:14:35. > :14:41.be implemented. We have to see significant turnaround by the end of
:14:42. > :14:45.March. If patients say, I am sorry, I do not understand, I am not a
:14:46. > :14:48.medical person, I am due to go in for treatment and given this report
:14:49. > :14:53.and nothing much appears to have been done, can I transfer to another
:14:54. > :15:00.hospital, will you make sure that will happen? It is the choice of the
:15:01. > :15:06.patient. The border between Lanarkshire and West Lothian is
:15:07. > :15:11.around Harthill and many patients for convenience go to St John's
:15:12. > :15:14.Hospital. All patients can choose if they are due to go to one of these
:15:15. > :15:21.hospitals to go to Livingston instead? Within reason. Some of the
:15:22. > :15:27.services they might require may not be available in Livingston or if it
:15:28. > :15:36.is elective surgery they my -- Bay may require longer. This is about
:15:37. > :15:42.the degree of improvement. It is perfectly safe to go into these
:15:43. > :15:45.hospitals in Lanarkshire. Thanks. It is almost 25 years to the day since
:15:46. > :15:49.the quiet town of Lockerbie became one of those international bywords
:15:50. > :15:52.for atrocity. One of the key figures on that night was Detective Chief
:15:53. > :15:57.Superintendent John Orr, later to become Chief Constable of
:15:58. > :16:00.Strathclyde. Glenn Campbell has been speaking to the man who found
:16:01. > :16:17.himself leading one of the world's largest criminal investigations. 25
:16:18. > :16:21.years ago, this building became the headquarters of the biggest murder
:16:22. > :16:34.enquiry the UK has ever known. The detective in charge of it was Sir
:16:35. > :16:38.John Hall. -- John Orr. We had officials from the FBI, the German
:16:39. > :16:44.police, in here. Somebody described it as a nerve centre of the enquiry.
:16:45. > :16:49.This was the local school at that time. Sir John spent a year of his
:16:50. > :16:56.life in Lockerbie investigating the bombing. He has never told his
:16:57. > :16:59.story, until now. My wife and I were watching the programme this is your
:17:00. > :17:15.life on television and there was a newsflash. A Pan American Boeing 747
:17:16. > :17:25.airline crash to night. As the story unfolded on television, he was sent
:17:26. > :17:29.to the scene. When we got closer there was an omnipresent smell, I
:17:30. > :17:37.will never forget it, of aviation fuel, and smoke. To be brutally
:17:38. > :17:40.frank there was a bit of chaos. Everyone was trying their best to
:17:41. > :17:48.come to terms with what had been presented. We were hearing about
:17:49. > :17:53.human remains, parts of human veins. That was in Lockerbie town itself,
:17:54. > :17:58.particularly in the area of Sherwood Crescent and Rosebank. It created
:17:59. > :18:08.straightaway the urgent need to get a grip of this. In daylight, the
:18:09. > :18:13.extent of the devastation became clearer. 270 people died when the
:18:14. > :18:21.flight was blown up over Lockerbie, including in 11 residents on
:18:22. > :18:27.Sherwood Crescent. The thing that still amazes me every time I come
:18:28. > :18:38.here, these are newly built, was the proximity between here. The crater
:18:39. > :18:46.that was here, the fuse a large -- fuselage. The field, it was like a
:18:47. > :18:53.giant incinerator. He also spent time in Lockerbie town Hall, where
:18:54. > :18:57.officers, including this one, had turned into a makeshift mortuary.
:18:58. > :19:05.What a change. It brings it all back. The team task involved in
:19:06. > :19:08.negotiating with each other, with these wartime stretchers in some
:19:09. > :19:16.cases, it was harrowing and difficult. When you think about this
:19:17. > :19:23.happened four days before Christmas. Clearly, trying to get all the
:19:24. > :19:28.bodies retrieved before Christmas Day, and that effectively was done.
:19:29. > :19:33.In 1988, he was an experienced detective. He faced a task on a
:19:34. > :19:42.scale that is hard to imagine. Literally, from the Northumbrian
:19:43. > :19:48.coast, to the Solway coast, that is your crime scene. He split the
:19:49. > :19:52.massive area interceptors and but senior officers in charge of each
:19:53. > :19:57.one and adapted the police computer system to log luggage and debris
:19:58. > :20:06.found. Where you making it up as you went along? -- were you? Some of it,
:20:07. > :20:13.we did. Scottish police worked with investigators from the US, Germany
:20:14. > :20:17.and other countries. Did you ever feel there was interference from
:20:18. > :20:23.other agencies? I would not allow it. If you are a senior
:20:24. > :20:30.investigating officer, your reputation, and your pride and
:20:31. > :20:36.integrity, they demand that you do it right. Volunteers worked
:20:37. > :20:45.alongside the emergency services. He is proud of what was achieved. In a
:20:46. > :20:49.quiet, modest way, I would say we did all that was asked of us. Is
:20:50. > :20:57.there anything you would have done differently? Not really. Now a quick
:20:58. > :21:05.look at the front pages. differently? Not really. Now a quick
:21:06. > :21:07.look at the That includes the story of the failings at three hospitals.
:21:08. > :21:15.look at the That includes the story of the The Daily Telegraph. That is
:21:16. > :21:28.all we have time for. Good night. After a quiet day today, it will be
:21:29. > :21:33.turning wet and windy with strengthening southerly winds.
:21:34. > :21:39.Sporadic rain will march eastwards. It will take all day to reach the
:21:40. > :21:42.south-east and East Anglia. Wet and windy weather arriving by the
:21:43. > :21:46.evening, pushing towards Northern Ireland. Windy in the West of
:21:47. > :21:53.Scotland. Gales for most of the day. Patchy rain continues through
:21:54. > :21:58.the day and also across northern England, most of it to the
:21:59. > :22:02.north-west. Maybe sunshine in the morning in East Anglia and the South
:22:03. > :22:07.will stop we will not see much rain in the daylight hours, it will
:22:08. > :22:13.probably be further west. It will move to the Midlands and central and
:22:14. > :22:17.southern England. The wind strengthening in the south-west.
:22:18. > :22:21.That is in advance of particularly wet weather after dark, when we will
:22:22. > :22:26.see very wet weather sweeping eastwards. The winds. The even more.
:22:27. > :22:27.As that clears, we get the