17/12/2013 Newsnight Scotland

Shia Muslims are not Muslims is pretty radical by most people's

beliefs. Thank you. Tonight on Newsnight Scotland: is

there a chronic problem with acute care in our hospitals? Three

Lanarkshire hospitals seem to show abnromally bad death rates. Is that

bad statistics, bad medicine, bad management, or something which could

happen anywhere? Also tonight, the view of the police

officer at the very heart of the Lockerbie investigation.

Good evening. Three Scottish hospitals, all

practices of the Lanarkshire hospital and put patients at risk,

according to a report today. Faults were found at Wishaw and elsewhere,

but it is of the situation at Monklands that is causing most

concern. The government told us programme tonight it had already

checked to make sure some of the problems found there were not

present in other acute hospitals across the country. But can patients

be reassured? It is frightening to realise that a

nurse or doctor doesn't realise what is happening to you and what has

been planned. We were repeatedly asked questions

also constantly correcting errors and misconceptions.

These are real statements from patients who have been in hospital

in NHS Lanarkshire. In August this year, concerns were expressed about

Monklands, and Wishaw. I have an average death rates prompted an

investigation, the first in this country, by Health Improvement

Scotland. There were problems with understanding, patient care and

record-keeping. This review is mixed. First of all, it is a review

the Scottish Government commissioned, because we saw the NHS

Lanarkshire hospital standardised mortality ratio is not improving at

the same rate as the rest of the country. When we looked at this

review, including a large group of clinicians and some patients

involved, it would appear that particularly at Monklands, that

ratio isn't improving at quite the same rate of the rest of the

country. In Parliament this afternoon, the

government 's plans to turn failing hospitals around were outlined. To

help NHS Lanarkshire deliberately is important recommendations, I am

putting in place a covenants and improvement support team to help NHS

Lanarkshire make the changes necessary to improve their

performance for the people and patients of Lanarkshire.

Lieber said it was a damning report. People have died unnecessarily and

Lanarkshire due to failings in the NHS. I have no doubt senior

management will seek to pass the buck onto those hard-pressed staff

who are trying to provide care despite the failings of management.

The makes 21 recommendations. Amongst them, safe nurse staffing

levels, improved patient support, and improved emergency patient

admission. The government are sending a hit

squad in to sort out the problem is urgently. There is no doubt there

are huge problems, but hospital standardised mortality ratio is not

supposed to be definitive. Inspectors advise it should be used

as a smoke alarm rather than a smoking gun. The Health Secretary

takes issue with not enough resources. He has batted that back

to NHS Lanarkshire to manage their staff better. This is about the

management of those resources. It is not about when the resulting. We

have given NHS Lanarkshire the resources they need. NHS Lanarkshire

have accepted these recommendations. First of all, I would like to say,

we welcome the report. This is about improving patient quality and

patient care. We will take those recommendations and implement them,

and in fact, we have started lamenting many of them already. We

are starting to see changes insignificant, -- and significant,

positive improvements. Patients' Association spear these problems

could happen other boards. not just Lanarkshire, it could be other areas

in Scotland. Sometimes we think, and so do the patient, that the health

boards are not fit for purpose any more. Alex Neill expects these

changes to be made as soon as possible. He has asked for big

improvements by next year, with another report due out in March.

A short while ago, I was joined by Doctor Bryan Robson, the clinical

director of Healthcare Improvement Scotland. I put it to him that his

report mentioned practices which may affect safe patient care. I asked

what they were. Let me tell you briefly what we did

and what we found. What we did was, for the first time, carried out a

detailed review of the quality and safety of care in NHS Lanarkshire.

We interviewed or heard from more than 300 patients and relatives. We

heard their experiences of care. We met with more than 200 members of

staff, and we reviewed 150 or more clinical records. What we found what

a range of issues that NHS Lanarkshire... I understand that. I

will come back to this point. You say practices which represent an

unacceptable risk. What are these practices? We have looked at a whole

range of activities in NHS Lanarkshire, and in particular, the

three key areas we are interested in our the area of leadership in

management. We found confused structures and arrangements for

leadership and management across NHS Lanarkshire. We also looked in

detail at patient care, and we were concerned to find that patients who

were sick and deteriorating on wards were not being attended to in a way

we expect. Thirdly, we found that staffing was inappropriate at

inappropriate times. However, I must say that we also found in this

detailed review, many areas of good practice. The bottom line is, I

suppose, if you are a patient, particularly at Monklands, or if you

are due to be admitted to that hospital, can you trust that

hospital to treat you safely if what you say in your report is true?

Well, yes. We found many areas of good practice at Monklands. I'm sure

there are many areas of good practice. However, if there are

practices which represent unacceptable risk to sell patient

care, and I was due to go into that hospital, I don't think I would feel

very safe will start that was the reason we were asked by the Cabinet

Secretary to carry out this detailed review. The point is, these

practices have not yet been corrected or addressed. Throughout

the process of the review, we've worked with NHS Lanarkshire, who

have indeed been putting in improved care throughout the process of the

review, and are committed, as you heard, to follow through on all 21

of our recommendations. I'm sure they are, but one of the points you

also making the report is that some of these problems in these hospitals

were identified some time ago, and that measures were taken to address

them, and you say, and I kind of quote the document, the inescapable

conclusion is that the actions taken today are adequate. We have

certainly found areas for improvement, and with set them out

very clearly in our report. But the point is, if I have already taken

steps to improve, and they haven't worked, and you are now saying, we

will take more steps, as a patient, not being a medical expert, and if I

was due to go in there, I would be thinking, sorry, I might see if I

can go to another hospital. This is the first time we carried out this

sort of review, and it's the most detailed review ever carried out

quality and safety and care in the health board in Scotland. We have

found areas of good practice, but also other areas for improvement.

You have said that. One of the things you point out is, you say in

your report that water flag this up was this Hospital Standardised

Mortality Ratio, these figures which are death rates in hospitals. You

say your conclusions and recommendations are independent of

that. It flag it up, you done the report. Now, it is still possible,

is not, that the fact it was flagged up could some statistical anomaly.

If we assume that that is the case, is it not possible that you could

take any three hospitals in Scotland and do the kind of rapport you have

just done? And you would find exactly the same problems? Well,

what we have done is take that indicator, that smoke signal if you

like, and we have looked in more detail to see what areas could

contribute more to this higher mortality ratio, and this means the

areas we are set out clearly in our report today. My point remains, if

you examine... It may well be all you done is scratched the surface of

a problem that is going on in hospitals right across Scotland. We

have found many areas of good practice in NHS Lanarkshire. We have

set out 21 key recommendations. We expect all boards in NHS Scotland

will be interested in those recommendations will . But because

of the way the report is written, and with lots of very detailed stuff

in it, it is not clear to me that you actually identify anything which

you could sit there and say, this explains why Monklands Hospital is

experiencing abnormally high death rates. Well, Healthcare Improvement

Scotland have carried out a detailed review of quality and safety, and we

have set out throughout the report the areas that need to be improved.

As I said, there are three key areas around leadership and management,

making those structures more understandable and less confusing,

around patients deteriorating on the wards and recognising those

patients, and acting on those patients, and also, finally,

insuring that the appropriate staff are dealing with patients at the

appropriate times. Thank you very much.

Now, the Scottish Government's Health Secretary is Alex Neil. When

he came into our Edinburgh studio, I asked him: if the problem was to do

with the management either of the health boards or the hospitals

themselves. The report itself makes it absolutely clear that the issue

is largely about governance and leadership, and management will stop

and making sure that every level of management takes better decisions

and resources are allocated more correctly. Yes, but if it is about

bad management, why not remove the management? If you remove the

management over night, that will destabilise the situation that we

already have, so what I have said to the Chief Executive when I spoke to

him this morning is that I expect them now to turn around this

situation, along with the support team who are in from the Scottish

Government, and I expect significant progress by the end of March. If

there is not significant progress by then, I may have to take a different

set of decisions. Which could be to remove a manager? Well, obviously if

we had not made progress, we need to look at why we have not, and base

any decisions on that. So if in effect, they are on probation. I

would not like to say that. What I am saying is, if the situation does

not improve significant by the end of March, I will take whatever

decision needs to be taken to get this organisation back on course.

But as you know, some patients' rights campaigners are calling for

the removal of management. People will say that, given that one of the

things this report says is that these problems were identified

before in this hospital and measures were taken and they did not work,

this is not exactly the first time. This will be a second chance. Is

there a third chance? Well, it is true to say that none of the

measures worked. -- not true. There was some progress. What is important

to remember is that the Hospital Standardised Mortality Ratio in

Lanarkshire has improved by 4.3%. It is below the Scottish average, which

is 12.4%, and that is what triggered this investigation. It is not right

to say no progress has been made. There has been progress, but very

insufficient progress. Monklands, you cancelled the closure, today's

report said the challenge of providing services on three sites

was a recurrent theme so perhaps consolidating accident and emergency

in that area would have been a good idea. They mention services, such as

orthopaedics, where having three sites requires a review and we

agreed. It does not say there is a need to review three accident and

emergency departments or three hospitals. I should point out that

already in Lanarkshire there is a degree of specialisation between the

hospitals, four example maternity is centred in Wishaw and children's,

and Monklands leads on cancer and how Myers on coronary. There is a

degree of specialisation -- how Myers hospital. Given the report

says there are practices at these hospitals that will put patients at

risk, if people in those hospitals, or about to be admitted, why should

they believe they are safe, especially given that not only are

the practices going on, but nothing is being done to remove present

management. During the review, changes have taken place. There have

been major intensification of the early warning system. That part of

the recommendation is under way and some others have already started to

be implemented. We have to see significant turnaround by the end of

March. If patients say, I am sorry, I do not understand, I am not a

medical person, I am due to go in for treatment and given this report

and nothing much appears to have been done, can I transfer to another

hospital, will you make sure that will happen? It is the choice of the

patient. The border between Lanarkshire and West Lothian is

around Harthill and many patients for convenience go to St John's

Hospital. All patients can choose if they are due to go to one of these

hospitals to go to Livingston instead? Within reason. Some of the

services they might require may not be available in Livingston or if it

is elective surgery they my -- Bay may require longer. This is about

the degree of improvement. It is perfectly safe to go into these

hospitals in Lanarkshire. Thanks. It is almost 25 years to the day since

the quiet town of Lockerbie became one of those international bywords

for atrocity. One of the key figures on that night was Detective Chief

Superintendent John Orr, later to become Chief Constable of

Strathclyde. Glenn Campbell has been speaking to the man who found

himself leading one of the world's largest criminal investigations. 25

years ago, this building became the headquarters of the biggest murder

enquiry the UK has ever known. The detective in charge of it was Sir

John Hall. -- John Orr. We had officials from the FBI, the German

police, in here. Somebody described it as a nerve centre of the enquiry.

This was the local school at that time. Sir John spent a year of his

life in Lockerbie investigating the bombing. He has never told his

story, until now. My wife and I were watching the programme this is your

life on television and there was a newsflash. A Pan American Boeing 747

airline crash to night. As the story unfolded on television, he was sent

to the scene. When we got closer there was an omnipresent smell, I

will never forget it, of aviation fuel, and smoke. To be brutally

frank there was a bit of chaos. Everyone was trying their best to

come to terms with what had been presented. We were hearing about

human remains, parts of human veins. That was in Lockerbie town itself,

particularly in the area of Sherwood Crescent and Rosebank. It created

straightaway the urgent need to get a grip of this. In daylight, the

extent of the devastation became clearer. 270 people died when the

flight was blown up over Lockerbie, including in 11 residents on

Sherwood Crescent. The thing that still amazes me every time I come

here, these are newly built, was the proximity between here. The crater

that was here, the fuse a large -- fuselage. The field, it was like a

giant incinerator. He also spent time in Lockerbie town Hall, where

officers, including this one, had turned into a makeshift mortuary.

What a change. It brings it all back. The team task involved in

negotiating with each other, with these wartime stretchers in some

cases, it was harrowing and difficult. When you think about this

happened four days before Christmas. Clearly, trying to get all the

bodies retrieved before Christmas Day, and that effectively was done.

In 1988, he was an experienced detective. He faced a task on a

scale that is hard to imagine. Literally, from the Northumbrian

coast, to the Solway coast, that is your crime scene. He split the

massive area interceptors and but senior officers in charge of each

one and adapted the police computer system to log luggage and debris

found. Where you making it up as you went along? -- were you? Some of it,

we did. Scottish police worked with investigators from the US, Germany

and other countries. Did you ever feel there was interference from

other agencies? I would not allow it. If you are a senior

investigating officer, your reputation, and your pride and

integrity, they demand that you do it right. Volunteers worked

alongside the emergency services. He is proud of what was achieved. In a

quiet, modest way, I would say we did all that was asked of us. Is

there anything you would have done differently? Not really. Now a quick

look at the front pages. differently? Not really. Now a quick

look at the That includes the story of the failings at three hospitals.

look at the That includes the story of the The Daily Telegraph. That is

all we have time for. Good night. After a quiet day today, it will be

turning wet and windy with strengthening southerly winds.

Sporadic rain will march eastwards. It will take all day to reach the

south-east and East Anglia. Wet and windy weather arriving by the

evening, pushing towards Northern Ireland. Windy in the West of

Scotland. Gales for most of the day. Patchy rain continues through

the day and also across northern England, most of it to the

north-west. Maybe sunshine in the morning in East Anglia and the South

will stop we will not see much rain in the daylight hours, it will

probably be further west. It will move to the Midlands and central and

southern England. The wind strengthening in the south-west.

That is in advance of particularly wet weather after dark, when we will

see very wet weather sweeping eastwards. The winds. The even more.

As that clears, we get the