29/02/2012 Newsnight

It affects all of us, and we will all have to live with the

consequences of the most contentious piece of legislation of

the entire Cameron Government. Tonight, the plan to reform the

National Health Service. The legislation is far bigger than

the law which created an institution all parties profess to

love and protect. Does the system have to stay the same forever and

ever? The Health Secretary tells us,

there is nothing wrong with the reforms, it is all about

perceptions. You could say blame me as a communicator, but if people

are literally distorting and misrepresenting what the bill does,

I just literally have to fight back against that.

These people have to make the health service work, they will be

putting their anxieties and hopes directly to the Health Minister,

who thinks the whole reform is solely about making the system work

better for patients. And one sunrises as another departs.

How long before News Corporation gets out of British newspapers for

good, as James Murdoch quits. Another day, another pile of

argument about the Government's attempts to reform the healthcare

system, Labour claim tonight that the Government was trying to rush

its now very knocked about bill through parliament, by the time of

the budget next month. Rubbish said the Government. The plan described

by a senior NHS boss, as so big you can see it from space, has had a

very checkered history. Promoted by the Liberal Democrats, and amended

by them. Introduced into parliament in January last year, then

suspended for a while, now approaching final votes. It is not

what the Government had hoped for. Away from Whitehall and Westminster,

to Worthing. A beach on the south coast. The Government's health

reforms look set to make it on to dry land, what exactly do they

change, how and when? What we have here is a charity that

is part of, in effect, the NHS. asked the Health Secretary to take

us to somewhere that exsemplified the reforms they are trying to get

going, he has brought us to Action For Deafness. This charity is being

billed as the best provider of help for those who are hard of hearing.

It isn't strictly the NHS, as it stands it is asked by the health

service to cater for patients' needs. Lansley's bill is supposed

to give help to give suppliers like this, who want the best for their

patients, the work. In 60 seconds, Josie clearly isn't fully aware of

what is going on, explain it? we are setting out to do, it comes

down to, firstly, making sure that you as a patient, everything that

happens to you, you should get really good information, and

wherever possible you should have some choice about the service that

is provided to you, including where it is provided from. Secondly, you

are registered with a GPs' surgery, your GP locally, and doctors and

nurses around locally in Worthing, they should be in a position where

they are able to design the services that you need locally, and

use the NHS resources to make sure those services are here for you.

Days ago Nick Clegg urged his party to take pride in the fact that they

had saved the NHS from privatisation. It strikes a bit of

fear with privatisation. Because, just explain to me what is it? From

my point of view, we are not going to do privatisation, explain to me

what it is you think privatisation means as a problem? It will just go

out to various people, are those people going to care like the

National Health Service cares now. I have had a lot of dealings with

the National Health Service regarding my father, he died a

couple of years ago, to try to bring all those bits and pieces

together was one long fight, but we got there in the end. Because we

all worked together. If it is going to be put out to privatisation, is

it all going to work. The sort of thing I have been saying, actually

it is going to be NHS care, like this is NHS. It doesn't have a big

sign saying it, but this is NHS care. The political peril of this

bill is clear, while the Health Secretary is down south, at Prime

Minister's Questions, Labour's leader goes on the attack for yet

another week. Let me refresh his memory as to who opposes his bill.

There is no good the Deputy Prime Minister smirking, I don't know

whether he opposes or supports the bill, which day of the week. Oh he

supports it, oh, he supports it, Mr Speaker. What you are saying is the

critics don't really understand the bill? I have to say, there are a

lot of things that I have seen said about the bill that appear to

suggest they haven't even bothered to read it. That includes coalition

partners, doesn't it? No. Of course it does? To be fair, Shirley

Williams, actually, that is the point. We have spent some

considerable time working with Shirley and others in the Lords, to

get to a point where, yes, we are going to make some amendments, but

they are amendments that give us, and them, a sense of actually,

finally putting precise reassurance in. Health Minister Mr Bef van cuts

the turf. Lansley's predecessors include the founding fathers of the

NHS. Is it up there with Beveridge these reforms? I wouldn't say.

they are going to last for a long time? The character is very

different. If you go back to 1950, Bevan said there is the tension

between the centralised funding system and decentralised

administration. And actually, over the years, the fact that the centre

has provided all the money, has meant the centre has had all the

control. Andrew Lansley was so trusted by the Prime Minister, that

years out of forming Government, he was the only one of David Cameron's

team to be promised he would make the grade, and go from Shadow

Health Secretary to the Government job. The idea was no major reform

change, reorganisation, steady as she goes, the public was to trust

the Conservatives on the NHS. But now, because of these reforms, it

is almost certain the NHS will be a battleground at the next legs, that

was never part of their plan. -- next election, that was never

part of their plan. It is one thing to get a bill through parliament

against opposition, many have done it. But verdicts on policy come

later, in the real world of people's experience. The challenge

for this Government is, while they may will it to work, it is probably,

very soon, out of their hands. As you heard there, the Health

Secretary was at a centre for the hard of hearing in Worthing earlier

today, by happy chance, it is also the town where Oscar Wilde wrote

the Importance of Being Ernest. Did you anticipate the sort of trouble

that you have run into on this bill? Yes, I always knew there

would be, there is always noise, the NHS matters, so people make a

lot of passionate remarks about it. You could go back, 2003, do you

remember, it is only less than a decade ago, Alan Milburn put

forward foundation Trusts, over 100 members of his own parliament

rebelled against him, The Royal College of Nursing came out against

it, others said it would be the end of the NHS. You are the person who

said in 2006 you would build consensus on the need for change?

You failed? On the need for change, absolutely we have, and on the

principles of the bill. If you look at it, not only amongst

organisations, but last year, when the Future Forum went to thousands

of NHS staff, at hundreds of meetings across the country, they

established there was a consensus on the principles. Would the bill

have been any different if you had not been in coalition? If it had

just been a Conservative Government, we would have started now the a

different place. The bill is better as a result of the coalition coming

together to shape it. Actually, I think, the central point, from the

Liberal Democrats' point of view, has been democratic, local,

democratic accountability. Local Government, in the new health and

well being boards, bringing together health, social care,

public health, into a combined forum, where local voices, and

local views can be added to professional views from the health

service. Actually it is stronger, as a consequence of being a

coalition bill. If you can't take cabinet colleagues with you, on a

profoundly important piece? We have taken cabinet colleagues with us.

They sign off on one thing and then they try to amend it? I'm sorry, we,

as a Government, as a coalition Government together, designed the

legislation. As a coalition together, Nick Clegg, David Cameron

and I, we want to improve the bill, we want to respond to people's

concerns, we did that last year. I think we did that very successfully.

Are you also going to maintain that this rigmarole we have been through,

the legislation being introduce, paused for consultation, and

amendments introduced many of which you accept, that was all

anticipated too was it? No, I thought when we published the White

Paper, which we did in 2010, and we had 6,000 consultation responses,

that actually most of the concerns would be there. It turned out it

didn't happen that way. That, it wasn't until the bill was in the

Commons, that many people said, we're worried about this and that.

Actually it was important to pause the bill, to listen, and to respond.

We did that. I think, actually, what that demonstrated was the

support, in principle, for the bill, across the service. It gave us a

lot of recommendations, and we were able to accept them. Which is why,

actually, I think, across the NHS, there is an understanding among

many staff that this is actually, in a sense, the bill they helped

shape. Doesn't it also demonstrate that however well you may be on top

of your brief, you are a hopeless communicator? No, I don't think

that at all. You didn't take people with you? Then that didn't happen

to any a second on health legislation at any time in the past.

Patricia Hewitt stood up in front of the Royal College of Nursing and

they booed her. Ken Clark, a fabulous communicator, he tried

reform in the early 1990s, and the BMA said it was the end of the

world as we know it, they put up posters with a picture of Ken Clark

asking what do you call a man who doesn't take medical advice. There

is no way of undertaking major reform, important reform, and

imagining that you are going not to be misrepresented, distorted or the

subject of argument, not going to be the subject of genuine concerns,

and genuine issues, that you have to genuinely respond to. I think we

have pretty much reached the stage where quite a lot of the

disinformation out there is a problem too. People are saying

things that are literally not true. The list of organisations,

organisations that ought to know about the NHS, as well as you know

about the NHS, the Faculty of Public Health, BMA, nurse, midwives

and all the rest of it? The Family Doctor Association, and the

representatives of Trusts and Hospitals. Are you saying they are

ignorant, have they fallen for propaganda? They are engaged in

various campaigns for various purposes. When you actually get to

it, take The Royal College of Nursing, for example. When do you

think they opposed the bill? January, up until that point they

had been literally with us. They said they supported the bill. What

changed? They fell victim to some piece of propaganda or something?

You tell me. Maybe they read the bill? I tried to find out what

change caused them to change their minds. What is your theory? I think

they were angry with the Government because there was a continuation of

pay restraint and the pensions issues, frankly, I find it...These

Organisations if they are against the bill, they have a right to be?

How can it be we introduce the bill in January 2011, for a year The

Royal College of Nursing work with us, say they support the bill. The

general secretary sits in my office on more than one occasion, saying

they support the bill. We make the amendments they looked for in the

course of the discussions we had with them last year, and suddenly

they say they are against it, well, because actually, other things were

going on. Can you guarantee, finally, that if this bill goes

through, and it is now much improved, you claim, that it will

be the last reform of the NHS, that you can foresee for the next ten

years? Yeah. I think it is a major piece of legislation. Why? Because

we are dealing with issues that haven't been dealt with in the past.

The reason we need the legislation is to effect a transfer of

responsibility and power, to local authorities and local health

organisations. It doesn't deal with the fundamental problem, that the

NHS, for not much longer, can be afforded? It does very much help

with that. What it does is it puts the decision making responsibility,

increasingly, in the hands of people who can use resources better.

Rationing is inconceivable, in your view? Proirt setting is necessary,

and should be done by -- priority setting is necessary and should be

done by the doctors and nurses with the care of the patients. That is

rationing? It is not, that is depriving people access to services,

getting people the right care, at the right time, in the right place,

is what it's about. Thank you. With us is the Shadow Health Secretary,

Andy Burnham. Apart from taking �20 billion out, what is your policy on

the NHS? We had a successful NHS when this Government came in,

judged by the Commonwealth fund to be one of, if not the best

healthcare system in the world. What they have done in the 18

months in power, is take the self- confident NHS, destablise it, and

demoralise it, and turn it into an organisation fearful for the if you

are tue. We will be the judge of what -- Future. We will be the

judge of what they turned it into, what is your policy? We have a

planned National Health Service that for 60 years delivered care.

You haven't a policy other than what exists? I have a policy, a

National Health Service that is planned and provides care to a

whole population, not legislation for a market in healthcare, that

basically, breaks all of that apart. No change? No, and one of the

arguments I would make, one of the problems with this bill, it is a

distraction from the real reform the NHS needs. It needs service

reform, not back office structural reform. It needs reform? It needs

more care in the patients' homes in the community, changes to service

on the ground. The whole debate about the structures of the NHS s a

massive distraction to the change of services we need on the ground.

In policy terms, what are you advocating? I have just explained,

we need service change. You have asserted people need more care in

their homes? In the ageing society, we need to bring together health

and social care. It was an argument I made as Health Secretary.

would you do that? We needed to reform the social care system to

provide more prevention in people's homes, better integration with the

health service. This bill is a recipe for fragmentation, and a

move away from the integrated care we need to see. I'm interested in

what you want to do. Is it just coincidence, that when you are in

Government, Tony Blair boasts about the scars on his back, that come,

he said, from taking on vests interests in the public sector, and

that when you are in opposition, you basic clo dance to the vested

interests -- basically dance to the vests interests tune? I don't agree

with that. The it is not opportunism, what they did was make

a catastrophic mistake, by combining the biggest-ever

financial challenge in the NHS, with the biggest-ever top-down

reorganisation. They would do well now, at this late stage, to give

the NHS the stability it needs to face the financial challenge. That

is what I will be doing now. I will be giving the NHS the ability to

focus on changing services, make them more sustainable so, they can

face the future. Will there be any detail in what you will do, should

you be elected? I was part of Government that took the NHS, that

was on its knees in 1997, and turned it into one of the best

healthcare systems in the world. needs changing? It needs service

change. I have always argued for that. We made some difficult change

to skefrss in Government. We made changes to stroke services in

London, maternity services in Greater Manchester. These are the

difficult changes the NHS needs. That is the nettle all politicians

need to grasp. If we are in the position where we are always using

the NHS as a political football we will never get there. That is what

the bill should focus on, this bill is a massive distraction from it.

With us now is the Minister of State for Health Simon Burns, and

an ensemble of healthcare professionals, between them they

represent thousands of nurses, doctors and patients across England,

and listen to those who have been patients of the NHS. Some agree

with Government reforms, others are sceptical. Let's start with this

accusation about The Royal College of Nursing. Did you sit in Andrew

Lansley's office and tell him you believed in the bill? Sat in Andrew

Lansley's office many times, telling him we had severe anxieties

and concerns about this bill, but we were committed to try to work

with it, and we worked with it for a year, and we didn't get anywhere,

we made the decision that we would now withdraw our support, because

while there was a lot of listening, there wasn't much action. So you

did tell him you supported the bill in one sense, but when it came to

it you decided you couldn't? thought it was the responsible

thing to do, with the elected Government of the day, to try to

work with this, to see if we could change it, and we didn't succeed.

This is a very, very significant difference of emphasis, what is

your recollection? I was at some of the meetings, not all, my

recollection is similar to Andrew Lansley's. We did listen, we have

made changes that responded to what The Royal College of Nurse iting

was asking for. For example, they wanted a nurse on all -- The Royal

College of Nursing was asking for. They wanted a nurse on all the

clinical boards, following the Future Forum review, we have sed

that, and that is now happening. We have accepted that and that is

now happening. Is your recollection about the British Medical

Association in any sense similar? With all reforms there will be

people who are for it, within an organisation, and people who aren't.

What we found with the responses to the consultation document, that the

BMA were supportive of some things, but less happy with others. When

the Future Forum reported its recommendations, which we accepted

last June, they warmly welcomed that, because they were taking on

board ideas to improve and strengthen the bill. So Dr Hamish

Meldrum, did you also initially support the bill? No. You have

never supported it? Never supported the bill. When the White Paper came

out, the headlines, which are about better clinical involvement, better

patient engagment quality, of course you support that, when you

read beneath the headlines, no, we didn't support it. We engaged in

the consultation process, three months after the bill came out, we

had a special representative meeting, asking for the bill to be

withdrawn. So to say we have supported the bill, I'm sorry, is a

travesty of the truth. You also opposed the setting up of the NHS?

No we didn't, that is another long and oft repeated myth. The doctors

and the BMA proposed, don't look so surprised. Did he not say, I will

get their agreement, by stuffing their mouths with gold? That is

about the contractual arrangements within the NHS. Exactly? It wasn't

about the NHS itself, doctors didn't want to be state employees

and actually not to...You Don't like change, that is your problem?

That is not true, I have been a GP for over 30 years, I have seen

massive change. It has been evolutionary change not structural.

I have seen nine structural organisations that have made the

NHS worse in many respects, they have been hugely distracting and

costly, and taking the eye off the real things. Do you think those

with a vested interest in the National Health Service are really

adaptable? I would hope they have the best interests of improving the

NHS. I want you to talk about your experience rather than your hopes?

In my experience I have found they have been prepared to engage, but

they have come to conclusions that are not in the interests of moving

the NHS to move forward. What is disappoint beg the BMA is they have

-- disappointing about the BMA, is they have been for the bill, but

they voted for one of the core parts of the bill, clinical

commissioning groups. Dr Alessi you are a GP, you support the bill?

am a GP. You are singing from an entire different hymn sheet from

the BMA? I am looking it on the basis of consultation with patients.

I can think of the way things will change in the future. Things won't

happen quick low, change won't happen rapidly. We will -- quickly,

change won't happen rapidly. We will come to the bit soon where we

will manage the interfaces, and we will have more control over what

happens to patients than we have at the moment, that is what all this

about. You think it gives you freedom? I think the change has

been palpable, the discussions I'm having now with my colleagues in

hospital is completely different to what it used to be before. They

have been liberated as well. They are able to speak to me, before

they just, it just didn't work. doctors' trades unions angry?

fact it is happening before the bill has passed, shows you don't

need a bill to make that happen. That is the whole point. You can't

say it is due to the bill, the bill isn't in law yet, these things are

and were happening. The fact that doctors want to do the best for

their patients, Assam, who sat on a platform with -- as Sam, who sat on

a platform with Andrew Lansley a year ago. He said just because we

want to do the best four patients, doesn't mean we support this bill

and we don't. You are a GP, you also think there

is a lot to be said for the reforms? I do, I think while I have

some mixed views about the bill, there are some parts I'm not

supportive of actually, there is no doubt in my mind, as a GP involved

in commissioning, it has made a huge difference to the influence

that I have been able to exert. the changes have already been

implemented, why do you need another piece of legislation?

have been trying to change things for better for about 15 years. Up

until this legislation, which attracted everybody's attention, I

haven't been able to get the traction I needed to effect change.

You have got the traction, you are making the changes, as Dr Alessi

has been saying? Absolutely, it is because of the bill, the scope,

scale and sheer audacity, has hit the radar of absolutely everybody,

and people have started to behave, I agrie, as if it is in lepblgs --

I agree, as if it is in legislation, but before this happened under the

previous administration it was not possible. The clear indication is

you didn't need to do much of this? We do, that is a false myth, put

around, sadly, mostly by politicians. The reason we have to

have the legislation is because they are moving in pathfinder form

at the moment. But there is nothing in law to make the clinical

commissioning groups accountable, so you need legislation, and also,

you have got to abolish the PCTs and the SHAs, you cannot do that

without primary legislation. That is why it needs the legislation to

actually make it work. Angela Coulter, you speak for a number of

organisations, I understand in your judgment can it deliver better

patient care? There are 160 organisations representing patients

and carers, and they are, on the whole, very unhappy about the bill.

They have done a lot of lobbying, and are very pleased that the

Government has listened in some cases, and the bill includes more

power for patients, more involvement in decisions about

their care, and so on. But, it is a real distraction from the major

issue, which faces our health system and everybody else's, which

is people with long-term conditions who want joined-up care. The

problem is, that this bill seems to represent, or certainly the concern

of our members is, is it will make care more disjointed, not more

joined up. It is not just a distraction, it is a positive

impediment? Nobody really knows, because the bill is incredibly

complex. There is a real fear. feel similar? It is one of the

major concerns, this emphasis on competition, what we should be

doing is getting the component parts to work with each other, to

collaberate with each other, the Hackneyed, joined up thinking, this

bill will stop that happening. is, I'm afraid. Factually incorrect.

The whole ethos of the bill is putting patients at the centre of

care, and...Built Around the idea of competition? Competition has

always been in the NHS and will continue to be. Competition, based

on quality, can be a force for good. Let me give you a brief example.

Two NHS hospitals within five miles of each other, one of them has a

reputation, through surgeries, for hip replacements, they have short

waiting times for it. There may be other peripheral things, their MRS

A-levels are very low, their mixed sex ward accommodation is very low,

and the hospital five miles away, an NHS one, has a poor record,

clinically, on hip replacements, longer waiting times, with patients

empowered with choice, you will see, probably, many more patients going

to the hospital that is performing better, that will be a spur for the

less performing one, to ask why. That is open it to patients now, we

don't need the bill for that. is a good thing. You can already do

this? You can already do that, if you can find the information about

the quality of the hospitals you can choose to go to the best. We

didn't need a bill for that. have some experience of how

competition works, Kresimir Zubak? I find the debate of -- Stephen

Bubb? I find the debate of are we for the bill origins frustrating.

The majority of people in hospital beds are over 65, long-term

conditions, taking 70% of the health budget, and there are

charities and social enterprises, who want to do more to provide

those services. We want competition to enable that to happen.

You, presumably, you are heavily involved in charities that would

like to do more? I run a social enterprise. I presume you welcome

this, don't you? It is not case of welcome or not welcome. We are

where we are, the fact of the matter is the competition issue is

largely irrelevant, we have had competition in the NHS for a long

time, the question is management of the markets. What worries me is

noft-for-profit organisations, social enterprises, aren't in a

place where they can compete with some of the highly capitalised

private sector organisations. Just giving you an example, if you look

at the provision of community health services in Surrey, that

contract, which was worth �90 million a year, went to a private

sector organisation, when, actually, the best performer, in terms of

delivering community healthcare services was a social enterprise.

But it simply could not compete. I raised this matter with the Prime

Minister. You can't just talk about competition without saying

something about how you manage the market. Just one other thing, it is

the case that where you have limited resource, and we do have

limited resources, unfettered competition can waste those

resources. There are lots of issues about the market and how we manage

the market. Your experience, Ali Parsa, of letting different kinds

of disciplines get to work, is actually rather different, isn't

it? Absolutely. Just explain what you do? We are, I guess, now

Europe's largest partnership of doctors, nurses, healthcare

professionals, who think we should be able to run hospitals, exactly

in the same way that GPs can run GP practices, they are a partnership

of people who have come together and contracted back to the

Government to deliver to them the services the Government want. Why

can we not do that in hospitals. Where we were given the opportunity

to do it, for instance, in Bath, from scratch, without any

Government grant or support, we built a building that won the award

for the best building, globally, we brought people who design luxury

hotels to design the building, and Michelin-starred chef to cook every

day. It can be done. Makes you want to be ill? When you are ill you are

welcome. It can be done. Why do you oppose it? You don't need a bill to

do that, as demonstrated. That is a fair point? To take the Simon's

point, the hospital that is poor needs to be sorted out, patients

still have to go there, you need to sort out bad, inequality of service,

competition won't help that. Actually this bill is costing �3

billion. No it is not. It is taking a huge amount of people's minds off

the care of patients. What do you mean it is costing, the

implementation of the bill? implementation. Can we put it right.

The cost of it, as the impact assessment shows is up to �1.3

billion, a one-off cost, as a result of that, between now and

2015, the savings will be �4.5 billion, to reinvest in the health

service. For the rest of the decade �1.5 billion, per an number, all to

be reinvested in the -- peran number, all to be reinvested in the

health service. You are changing the subject now? This is the risk

of this legislation. You asked about money, he told you about

money, now you are talking about the risk register? I think if you

put clinicians in the driving seat of reorganising healthcare, we

understand the product of healthcare in a way professional

managers don't always. I'm abs lout low certain that my colleagues, and

-- absolutely certain that my colleagues, and a lot of young

doctors are coming forward with solutions for improving services

for patients. The NHS is not perfect, there are areas where we

can do better, and we know where they are. We don't need a lot of

data, we speak to patients on daily basis, we understand what needs to

be fixed. We are the best placed people, clinicians working in

partnership with hospitals and colleagues to do this best. We have

to remind ourselves this is the NHS and social care bill, it is not

just about clinicians deciding what populations want. What it should be

about is commissions and populations deciding how they

provide an integrated health and social care system. Hang on, let me

finish, which is about commissioning. And so far, just a

point I'm making, I'm not saying I disagree with any of you, I'm

making the point that we have talked about the NHS as though it

is about hospitals and clinical interventions, the NHS and social

care bill. We're not going to save �20 billion unless we integrate

health and social care. Are all of these a conspiracy against the

public, the NHS should be about patients? That is my point, it is

the NHS and social care bill. also about citizens. It is the

citizens in charge. It is care, well co-ordinates and meets their

need. Absolutely. That is the challenge. This shake-up of the NHS

is putting organisation against organisation, it is dividing

professionals, it is actually not helping. It is going to take about

four years before the commissioning groups really learn how to do it.

It will take some time to settle in. All major change takes time? A lot

of people will be ill and need better co-ordinated care. You look

at countries according to the OACD, have the best healthcare quality in

the world, France, Germany, Switzerland. And the UK. They are a

co-operation between the private sector, public sector, private

sector in Germany runs more hospitals, more healthcare

provisions than the public sector does T does it in a regulated

market, in which people can't "cherrypick", in which people need

to focus on the patients. That is what we need to focus on. The

British public is not concerned on whether the service is provided by

public sector, private sector, the Government, it is concerned about

whether it is fair, it is accessible, it is free at the point

of delivery. We should focus on making sure that happens, and when

that happens, when that happens everything will be fine. By the way,

for those who think that the private sector, or the social

enterprises just take the cherry, let me say it here and now, please,

give us all your potatoes, keep the Cheries, we love to have what you

don't want. France and Germany spend 2% more of GDP on healthcare.

The British healthcare system is the most cost effective service in

the world. But not the best. haven't had much of a shout. Can we

have an opportunity perhaps, now we are in this state where we are

starting to have a dialogue with our local authorities. This is

starting now. Let's give us the oxygen we need to make it happen.

We need the space, the time to make this happen. I wonder if you feel,

as a practising GP, that, in a sense, this is rather missing a

point. We can have the organisational changes, but there

is a real crisis in this country about how on earth we carry on

paying for healthcare, giving the increasing demand? Unless we change

what we are doing, we will get into difficulty. I believe only by laifg

the dialogues at this level and in- - having these dialogues and at

this level and intensity can we find our way out of where we are at

the moment. A lot of this debate is often dominated by a professional

view. There is nothing wrong with that, but the citizen view doesn't

often get in. To give you an example of this, we want more

choice in the NHS. The NHS institution guarantees choice, but

doesn't deliver it. If at the end of your life you want to die at

home or in a hospice, you are often denied that choice. The majority of

people who want to die in a hospice or at home, they die in a hospital

bed. There are charities out there, hospices that would love to provide

that care, they are not commissioned, and the system needs

to be opened up, so that those organisations can be commissioned

and provide that choice to people. That's what people want. That will

happen under your bill, will it? is already happening. It is already

happening. It isn't, because the majority of people at the end of

their life are dying in a hospital bed, they wish to die in a hospice

or home. Let's support charities that provide that for them.

going to have to stop you, I'm afraid, we have to get on to

something else. Thank you very much. Now, it's perhaps one of the least

surprising bits of corporate news this year, James Murdoch, the man

whose father gave him a media empire, is quitting ASBOS of News

of the World. He hopes there by to step out -- quitting as boss of the

News of the World. He hopes to step out and set up somewhere Aspel a

television executive. Whether that will be -- Where as a television

executive. Whether that will be enough, we will see.

On a week where one Murdoch Sun went, another rose.

James Murdoch was nowhere near his father's corporation when the

hacking went on at News of the World, why do many believe it was

he have table he would step down. Some say he was in charge when he

tried to limit the damage. Some say he either tried to cover up how far

hacking went, in that case he had to go, or on the other hand, he had

no idea what was going on in the company, in which case, he had to

go. There has been criminal wrongdoing on a large scale in this

company for many years. Now the police investigation is beginning

to unearth those networks and Leveson is beginning to show the

methods deployed by some of the journalists working for the company.

Not all of them. And yes, I think the day of judgment is coming for

James and Rupert Murdoch. Until very recently, News International

maintained hacking was the work of one rogue journalist, the royal

editor of the News of the World, Clive Goodman. But the company had

information that the practice was far more widespread. Just this week

the Leveson Inquiry into practices, saw an internal e-mail showing 110

victims could have been involved. James Murdoch agreed a huge pay-off

to one of the victims, �700,000 to gord dond Taylor, then of the

professional Football Association. If he had read the paperwork that

accompanied the pay-off, he would have known many more victims were

involved. Although he was sent e- mails, he maintains he didn't read

them. You embarked on a sustained cover-up, the accusation against

you, because you know how widespread it was and you didn't

want it to come out? There was a particular settlement I authorised,

and I have said was made with information that was incomplete.

James Murdoch has been dogged by this question ever since. Did you

see, or were you made aware of the "for Neville" e-mail, the

transcript of the apt voicemail message? No, I was not aware of

that at the time. But Mr Murdoch has been contradicted by two of his

former executives. Although he quits as chief of News of the World,

he remains CEO of News Corporation based in New York. Many there say

he's no longer credible. Does it worry you that his explains in all

of this was, sorry, I didn't read my e-mail? That is at best, that is

if nothing else, if he is found incompetent to read his e-mails,

that doesn't make him fit to be chief executive of any company we

are investing in. You can't have people like this. 100 years ago it

would be a cluby person on the board, they have to be high-

performing individuals. How do we read the departure, is it evidence,

as some believe, a victory for News Corporation shareholders, who don't

like the messy, low tech, newspaper business, and particularly the

reputational damage it is doing to their interests. Or is it evidence

that Rupert Murdoch has decided to take personal charge of the

operation here in Britain. Just like he did in the old days.

It was, afterall, Rupert, not James Murdoch, who launched the Sun on

Sunday this week. However, the big news of the week, that you wouldn't

necessarily have read about in the Sun, was the revelation at the

Leveson Inquiry, that the Sun was running a network of corrupt public

officials, including the police, spending tens of thousands of

pounds on bribes. There also appears to be a culture at the Sun

of illegal payments, and systems have been create today facilitate

these payments, while hiding the identity of the officials receiving

the money. Some believe this is a game changer, opening News

Corporation in America, to poosable, federal investigation under the

Foreign and Corrupt Practices Act. Some believe it is all about

isolating and limiting this damage. Joining us now from New York, the

former editor of the Sunday Times and Times, Sir Harold Evans, whose

book about working for Murdoch, is about to be reissued, including the

events of last year. Did he jump or was he pushed, James Murdoch?

think we shouldn't spent too much time on James Murdoch, actually, he

was a very able executive of Sky. I think he's blundered awfully, I'm

not absolutely convinced he orchestrated the cover-up. That may

have been the work of sloppyness and negligence of him. I'm not sure

he did. I think more important, other than the faith of James

Murdoch, is the faith of the Murdoch empire given the very

serious charges of bribery, not just by one journalist, buying a

cop a drink. But by a whole series of systematic payments. I think,

myself, don't forget Rupert Murdoch and I parted, not on the best of

terms, he pushed me out of the Times, you have to bear in mind I'm

some what prejudiced. I'm also prejudiced for decent reporting,

honesty, and not invading people's minds. What is running through the

whole thing from beginning to end is the rotten smell of corruption.

It has been there for years, and only encouraged by slack and

corrupt politicians who wanted favours from him. It is really an

indictment, not just of James Murdoch, which is actually small

fry in many ways, but the whole Murdoch corporation, of the cosines

between slack politicians, and Rupert, who knew how to manipulate

them. It raises the question of how the owners of these properties here

will regard their investment? a terrific investment in terms of

cashflow. You have to look at the News Corporation businesses, they

are extremely well run, highly profitable, and the question is how

big is a shareholder's soul. If he cares about integrity in the news,

he will care a lot. On the other hand, if the Murdoch corporation

faces a prosecution under the corrupt practices act in the United

States, that is very serious trouble. Because it was that the

Murdoch corporation would have to lose, if they were indicted and

convicted, they would have to lose control of very valuable

investments, that depend on Government licenses, cable

television and the like. That is the really serious issue here. Also

bear in mind the other serious issue is the terrible blow that

these activities have done to the reputation of journalism generally.

Just leaving that to one side, the question of the reputation of

journalism as a whole, the future of the Murdoch empire, Rupert

Murdoch, a man who, whatever his failings, believed in newspapers.

James Murdoch, a man who doesn't believe so much in newspapers, but

clearly blofs in other forms of media. Why -- believes in other

forms of media. Why Hong on to newspapers here? It is a good

question. A little bit of my heart goes out to him, I'm a romantic

newspaper man myself. But the rest of my heart, and most of my head

said, I would rather he had nothing to do with newspapers, he does not

bring enough to them, apart from money. He doesn't thing integrity

to them. In some sense, as I say, I'm personally slightly torn about

it. I think it would be a good idea if he devested himself from the

newspapers, it would be good for the shareholders, and in the end,

for journalism. The smell now is so intense, I don't think it can be

eradicated by any more apologies, revelations keep coming out and

coming out. The public, I think, is sick to death of it.

Thank you very much for joining us. Tomorrow morning's front pages,

James Murdoch is on most of them. There he is on the front page of

the Guardian. Also he's on the front page of the Independent and

the Financial Times. On the front page of the Telegraph

is a picture of Davey Jones of the That's all from Newsnight tonight.

A man in a chip shop in Worthing gave me a free gherkin today. There

will be all manner of pickles and preserves on tomorrow night,

preserves on tomorrow night, overseen by Mr Gavin Esler.

Good evening, a cooler start to tomorrow than the last few days.

Misty and foggy towards the south. Most brightening up through the day.

Sunny spells developing in plane areas. Holding on to a lot of cloud

across southern areas. To the east of the Pennines, to the Midlands

and the south, the morning cloud and mist, it clears, the cloud

breaks, sunny spells developing. It will be a mild day under light

winds. Temperatures peaking at around 14.15. Sunny spells in the

south west and through many parts of Wales.

On the west we could see one or two showery bursts of rain. In the

south-east of Northern Ireland, holding on to bright, if not

sunnier weather. After a wet start across the Highlands in Northern

Ireland, brighter and dryer, some of the patchy rain pushing into

other parts of Scotland with a drop in temperature. That rain fizzling

out. Cloud on Friday, with temperatures dropping a degree or

so down. Across England and Wales a lot more cloud for the end of the

week. Again, temperatures down a notch. Still above average for the