25/10/2012 Newsnight


In-depth investigation and analysis of the stories behind the day's headlines with Gavin Esler.

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Tonight, reasons to be cheerful are three. Growth up, unemployment down,


inflation down. But with 1400 British jobs lost at Ford, and no-


one predicting a straight road to recovery, is the Government's


austerity programme really working? From double-dip to Olympic blip,


sources of long-term growth are very hard to find.


We will debate the politics and explore whether the good economic


news depends on where you live. We will hear from economists and


business experts whether scare talk of a triple-dip recession could


move from fantasy to fact. Also tonight, you turn up for a


hospital appointment and find out they have lost your file, and it


ends as more than just a clerical mix-up. I took the tablet involved,


I regained consciousness, I was on the floor, my feet elevated,


receiving an intravenous drip to revive my blood pressure. It did


that much harm. As the long war in Afghanistan comes to close, there


is more than a billion spent in aid, is the British Government about to


abandon the Kabul Government, corrupt, and support local


community groups. We will speak with our guest tonight.


Good evening, for the Government today came the best news on the


economy for a long time. The strongest quartly growth in five


years. -- quarterly growth in five years, bringing an end to the


longest double-dip recession since the 1940s, outpup rose a quarter


per cent up from the previous quarter. Economy has been


flatlining, which dampened any prospect that George Osborne, like


his predecessor, would be singing in the bath to celebrate. Paul


Mason is here with the good news and the bad and the ugly. Tell us


the good news first.Le If there were dinners held and


cocktail parties thrown, and the occasional Gucci handbag given away


to secure the London Olympics, it was worth it. This was the Olympic


effect, 1% growth in a quarter is very, very healthy, and would be


the envy of any developed country. Bu however, it is not a quarter's


growth or rate of change that economists worry about, it is the


amount and size of the economy theself. This is the graph Mervyn


King worries about, and George Osborne should. Here it is, the


size of the UK economy, the amount of output over the last four years,


of output over the last four years, and as it animates. We there it is.


That is the problem, today's 1% surge in a quarter, that is the


last bit there. Really we have a long way to go to recover where we


were before the crash. This is real, because we know 200 jobs were


created in the last three months. Even if they are, as some people


say, part-time shop assistants, whatever, they are real jobs, and


it is real growth. The problem is, can it be sustained? Can it? Is it


sustainable? Look, there is evidence of a bit of a surge of,


what we call, broad money. The money supply in the economy. This


predates the summer of growth that we had. But economists, according


to one theory, if you get a bit of a surge of money, over the next few


months, it should surge into the economy in the form of growth. In


other words, what that might be telling us, might be, is that


quanative easing is working. If it's working we might not need any


more of it. But, ultimately, the fate of the whole economy hangs on


how we get out of the kind of recession we are in. The kind of


recession we are in, spelled out by King only last week, is one where


everything's depressed because of the amount of debt in, in the


economy, in people's own lives, and until that is sorted, even with the


Olympic, as we are about to see, were pretty spectacular, doesn't


turn things round. The crisps you ate, the beer you drank, the gym


you joined, the tickets you might have bought. Today's figures showed


the Olympics did help Britain bounce back out of its double-dip


recession. The Chancellor allowed himself to be mildly pleased.


are plenty of risks out there, look at the data from the euro zone this


week, that shows us there is still a difficult economic situation in


the world. But, if we stick with what we are doing, getting the


deficit down, creating jobs, fixing the deep-seated problems in the


British economy, then I think you can see now that it is going to


deliver the kind of underlying prosperity we want to see in this


country. The breakdown of the big picture


looks like this. A rebound in manufacturing, added 0.2% to GDP in


the last quarter. The continued collapse of construction wiped that


out. But the very strong growth of services, including Government


services, boosted output by 1%. And in case you are interested, Olympic


ticket sales accounted for a fifth ticket sales accounted for a fifth


of that. It is very encouraging that the


economy has pulled out of the recession at last, and the strength


which with which it has refounded as well. The concern is this isn't


necessarily a sign that the economy has momentum and will improve from


here on. In fact, there are a number of indicators that suggest


the economy is losing momentum, that this was just a temporary


bounce, due to the bank holiday effect, and the Olympics, and as we


go towards the end of the year, there is signs that growth,


momentum, will slow. If the euro crisis is ultimately responsible


for depressing growth here, the only certainty is, the Olympics are


over, but the troubles of Europe are not.


Obviously has been for the past couple of years, the political


battleground, and will be through to 2015. What are the challenges


for the political parties on this? We are about to hear two


politicians, I doubt we will hear both of them shout, hurray, green


shoots, it is all solved. In fact, the challenges are for policy


makers, the policy being made, primarily, by the Bank of England,


the Bank of England's quanative easing policy, as I said earlier,


what may have ultimately given this some omph and some sustainability.


The question being discussed in the rarified atmosphere of Central


Banking, is do we need more. Do we need more quanative easing, do we


print more money, do we then tear up some of those IOUs that the Bank


of England is buying? In other words, to write off bits of


Britain's debt. That is a serious debate going on. I suspect, and


this number was so big today, and so surprisingly big, that might be


on the backburner, that might have decided that bit of the debate.


Then you have the question which again the Chancellor can't do much


about, it is his own statistician, the Office for Budget


Responsibility, is the Chancellor going to miss his deficit target.


Is he actually going to miss the targets he set himself? Maybe this


1% doesn't answer that one way or another. The implications are we


will have to wait, the next big predictable event is the Autumn


Statement by is the 5th of December? If it is judged that


growth is not strong enough long- term, and this is a blip, for


Britain to meet the targets it has set itself, then the choice will be


more austerity, quite hard to do, given the state of the coalition.


Or some tax cuts paid for by changes in Government policy, or a


slowdown in austerity. There is even talk of a secret stash of �25


billion, sitting in the Bank of England, that is a by-product of QE.


There is all kinds of things that we are about to be discussing in


the next two months. Big strategic things the Chancellor can't do.


What he can't do and hasn't been able to do through policy alone is


to manage growth. That growth was magiced into existence, by the very


act of winning the Olympics. Chris Leslie is on Labour's


Treasury team, and Michael Fallon is the Business Minister, and not


often on the programme talking about good news. The good news will


keep on coming, says the Prime Minister, will it? It is


encouraging news, and what is happening now is all the signs seem


to be pointing in the right direction. We have unemployment


falling and inflation half what it was a year a these good figures


today, better than the City and forecasters expected, Britain


coming out of recession. There is a long way ahead. But the good news


will keep on coming? It is a long road ahead, but the signs of


recovery are there now and pointing in the same direction. Do you not


worry that you will sound complacent when people look at the


last year and in 2011 where we were in the economy? There is no


complacency, that is why we are continuing to rebalance the economy,


and reform in the way we get more house building done, reforming


planning laws, guarantees for infrastructure, and looking at job


creation, getting more finance through to small businesses. Look


at private sector job creation over the last year. Since this


Government came into office, we have created over a million private


sector jobs. There are more people working now than in 1971. Given


that caution, could you say you will rule out a triple-dip


recession? Nobody can rule out the road ahead. You are not ruling that


out? You can't be sure what lies ahead. More problems in the


eurozone, Germany looks as if it is going backwards. What we can say,


is although it is a long way ahead, these are encouraging signs,


pointing in the same direction and Britain is now recovering. The


confidence theself, from today's figures, I think, will be extremely


important. Chris Leslie, growth up, unemployment down, inflation down,


that's three bullets in the Labour Party idea that we need a Plan B,


isn't there? This is positive news, but it is about time we had some


good news, quite frankly, with the state of the economy. We have had


two very long years of flatlining, and with the greatest respect to


Michael. He he talks about it as if we shouldn't worry about it. The


point is, that is a permanent hit to our productive xasty. It has


meant living standards have fallen. We have seen the resilience of the


economy severely hit. When you think what b what is coming.


there anything you can say tonight without talking down the economy?


You are. I'm not, it is perfectly reasonable to look at what is


around the corner. If you look at the 80% of cuts still to be felt


from the Chancellor's Spending Review. If you look at the tax


rises around the corner, the living standards, the eurozone, all of


those raise the key question, are we more resilient now because of


Government policy, or are we just hoping this is going to be the


trend for the future. I hope it is, but we need to do far more than


take this complacent attitude. wish you hadn't said all that.


Nobody is complacent. My job as Business Minister is to visit


businesses, up and down the countries businesses are fed up


with politicians like you talking down the economy. We need more


confidence, we need more confidence now, and this growth figure today


will give us a bit more confidence. We need action, an approach to


stimulating the economy, and focusing on growth, instead of


sitting back, crossing your fingers and hoping something will turn up.


Because the strength of the economy is not good enough. We have, not


only have we got a flat economy. There you go again, talking it down.


I hope it will get better. We have to make better progress. You made


that point. But the OBR said austerity reduced real GDP in


2011/2012 by 1.4%, the argument is this Government has made things


harder for people unnecessarily and cut back on growth T would have


been better if you had not done that? We had to get the deficit


under control, we were spending �160 billion more than coming in


taxes, that was a worse deficit than Greece. We had to get that


sorted out. We are slowly doing. That we have dealt with a quarter.


At the expense of growth? We have dealt with a quarter of it all


already. Statement we have been trying to rebalance the economy. --


tailt we have been trying to rebalance the economy. -- at the


same time we have been trying to rebalance the economy, we have too


much expenditure, we are rebalancing the economy,


encouraging the economy. You will hit your fiscal targets, we will


hear in the Autumn Statement? will see from the independent OBR


where we are with the targets, it is not up to us, we have an


independent body that will do that. There is a big point here.


don't know if you have hit the fiscal targets? We will see from


the OBR if we have hit them. Times have been tough over the last


couple of years, a pay freeze ayes cross the public sector, we have


tried to help with the council tax freeze and so on. The signs are we


are coming out of recession. talk as if the last few years don't


matter. There are careers affected and businesses gone under, what


will you do to make up the ground four our lost competitiveness. As


we have been standing still, Germany have been accelerating and


the United States. They have not been accelerating. They have grown


at 3.3% in the last few years, hour growth is 0.6% over a two-year


period. While we have been standing still, the strength of our economy


relative to those other economies has fallen back. We need to regain


ground. I need a strategy Government about regaining the


ground we have lost? Strategy has been there all along, it is to


encourage private sector employment, while you are obsessed with public


spending. It is to back the new technologies and industries,


industries outside London and the south-east. To ensure that new jobs


are being created. We are doing that all the time. The Ford


announcement today was very disappointing for those who make


Transit vans in Southampton, but they committed to the new low-


carbon diesel engine made in Dagenham, a huge commitment by Ford.


Other companies are coming in behind them, and vesting in Britain.


We can't start talking the economy down. On that point, would you like


to take this opportunity to apologise for leaving us with a


structural deficit as Ed Balls, the shadow Chancellor pointed out?


Nobody knew the economic crisis would be. You have been very weak


on this? The Conservatives said they would match the spending plans


of the last Government. Would you like to apologise for getting all


that wrong? All sorts of lessons should be learned. Let me tell you


one thing, the economy was recovering in 2010, we were growing.


You had a worse deficit than Greece. George Osborne pulled that rug of


confidence from underneath the economy, we have been treading


water for two years. That has hit our strength as an economy,


worldwide. There is a serious cost. Where do you think the million new


private sector jobs have come from. You are satisfied with the plan and


the way things are. Tell that to people's living standards have been


severely affected, tell the people whose careers have been hurt by the


policies you have put in play, and, in fact, we have so many more


problems around the corner. There you go again you are talking it


down. You don't think the tax rises are a problem or the public service


cuts, 80% not. It is keeping him going, it is talking the economy


down again. I'm being realistic. You are not, you are talking us


down. On that point of realisim or talking it down, we will leave it


there. Thank you very much. Today's growth figures are an


estimate based on the country as a whole, that means the good news has


not been evenly spread around. Some areas of the country may find


today's talk of recovery a strange notion. We have a sense of what the


economists' figures mean for the real economy. We have been to


Lincoln today. Amid the atrocious weather, which


held back the rest of the UK economy, Lincolnshire also got to


taste the Olympic spirit, as the torch made its way through the city.


But it will take an awful lot more than Olympic ticket sales to raise


average incomes here in Lincolnshire, which currently lie


in the bottom five regions in the country. Average salaries in


Lincolnshire are around �14,500, much less than half those in


central London. Many work in minimum wage jobs, like


construction. But house completions have halved in four years, so it is


tough for builders here to make any money. I think it has been a


struggle for a number of years, to be honest. The levels of activity


that we have got at the moment are only really being sustained by


Government initiatives that are helping out. And the problem with


the Government initiatives is bureaucracy and red tape has


delayed those initiatives? They take a long time to come to from


you i, the New Buy Scheme we applied for six months ago, we are


frustrated we can't put that in place. The other minimum wage


sector is agriculture. Farming now accounts for 6% of Lincolnshire's


income, down from 12%. This year's awful wet weather didn't help


either. Even the warmer third quarter was deemed too dark by many


farmers. And the third minimum wage sector, mass manufacturing, is also


depressing rather than adding to the local economy. The Kimberly


Clarke nappy-making factory said it would close yesterday, a week after


Seven Seas said they would be shutting their Humberside plant.


But if Lincolnshire can get more place like this, they would be --


places like this, they would be very pleased. The smell is medieval,


but the plant brand new. It automatically screens, separates


and pulps 800,000 bottles an hour. It is the largest and most


profitable recycling plant in the world H Coca-Cola not been their


junior partners had might never have been built, due to the banks


being unwilling to lend. This is the finished product, this is the


material that came in the front door as a waste product, gone


through all our processes and now suitable for manufacturing into new


plastic bottles. Would you regard yourself as optimistic?S Absolutely,


I'm a glass -- absolutely, I'm glass half full person, the future


is not just bright for this future, the sector, and the green sector as


a whole. Oil will run out at some point. People should be concerned


about the amount of people on the planet, the consumption going on.


We have to reduce waste and reinvent waste, that is exactly


what we are doing here. It ticks so many boxes, creates jobs, adds


value, it is all good news. Eco Plastics not alone. See minutes


has a turbine engine plant in Lincoln, and it is expanding.


Lincolnshire is no microcosm of the UK economy, it is the least


ethically diversified and the most rural. It is going through similar


pangs of rebalancing away from low tech and into high-tech. If average


incomes continue to stay low, it is hard to see future generations


staying in the county of their birth.


With us to assess all of this are WPP advertising group chief


executive, Sir Martin Sorrell, the director of the think-tank Marquez


and Ann Pettifor from the office of -- Macroeconomics, and Ann Pettifor


from the Office of Budget Responsibility. A few months ago we


were all doom and gloom, and here we are cheery on 1% growth, I don't


take either too seriously what I learned from the Bank of England is


the first estimates of GDP are not where things turn out to be. It


could go down or up. It doesn't change the picture we have for some


time, which is fundamentally this economy is growing a little bit,


but not fast enough. The figures are uneven because of the Olympics,


the Jubilee, lots of special factors. Lots of special factor,


are you cheered up, obviously it is better than the alternatives?


Absolutely, it is good news. But there are three big threats facing


us, still, the first is the vast overhang of debt on the private


banking sector, and the fact that hasn't been handled, restructured


or mgtd. Secondly, synchronised austerity around the world. The


United States, the whole of Europe, and increasingly Japan, and China


unwilling to come to the rescue of the rich western countries again.


For me, thirdly, this links to what Paul was saying, is the failure of


the monetary authorities to co- ordinate and to work with the


fiscal authorities to manage, if you like, this injection of money


into the economy, so that it is used for productive purposes. It is


that failure of those two big institutions and authorities to


come together, that means money is being printed and sprayed around,


and goodness knows where it is going, and those who need money,


the productive end of the economy are not getting it. And the


Government is standing back saying nothing to do with them.


You talked about austerity being a straitjacket as far as growth is


concerned. Did you take Michael Fallon's point we had to do it, and


the Government had to do it, and broadly, the strategy is working?


In the short-term I agree what the Government has done. It hasn't


actually lowered spending, it has reduced the rate of increase of


spending, it is up from �700 billion, projected to be �750


billion in four years time. They reduced the rate of increase, lower


interest rates, improved the credit rating and et cetera. We announced


our results, they are the lowest rate of growth across the world we


have seen he across the world for two years, it was poor quarter for


us. The UK was wrong, up about 4-5% in the quarter, this year 3-4%,


last year we have up 8%, added 2,000 jobs. Our position in the UK


has been strong. There are four things people are worried about in


business, September was a pivitol pwhont month, we -- month, we saw a


decrease in business. Brazil, Russia and all the growth economies,


the BRICs, increasing tensions in the Middle East, Syria, Lebanon,


the Israelis attacking, Iranian and nuclear institutions or even visa


versa, last but not least, probably the elephant in the room, is what's


going to happen in the US after the election. What l Romney or a re-


elected Obama -- will Romney or a re-elected Obama, I think Obama has


the advantage, it will be close, there will be a House of


Representatives controlled by the Republicans, and the Democrats


controlling the Senate, we will be in that gridlock. Maybe some


modified plan, along the lines we have seen before, which President


Obama wanted to bring in, and then ignore the report that he wanted to


bring in a Simpson Bowles like after the election. The preliminary


Ications are that we are not masters of our own destiny, that


George Osborne has levers he can pull, but the factors are beyond


his control or any politician's control in this country?


absolutely agree with you. The big threats from the UK economy often


come from abroad. One of the things that went wrong in the decade up to


the financial crisis, is a risk that came up from abroad, problems


in America, that affected us here, we have had big oil price rises,


that is what has held the economy back. It wasn't just austerity. It


is absolutely right. I want to take issue with something Anne said, you


commented on the fact, I feel sensitive about quanative easing,


since I was there when we started it off. It was perfectly good


evidence that it was very helpful to companies in the initial stages,


it helped them borrow more cheaply. It is unfair to say of the


Government they are not doing anything today, the new Funding For


Lending scheme is a good scheme that should help get credit going


in the economy. The truth is, against the head winds they face,


there is a limit to what can be done. Because you can't suddenly


say to businesses, with the background of all the things that


Martin has set out, that everything will be Rosie and let's leave it.


just think that the banks' lending numbers that came out recently are


really bizarre. They show firms in the economy are lending to banks,


and banks are not lending to the real economy. There is negative


lending. That is bizarre. It is almost unheard of in our history.


To some extent that is true. I say this, of course the Chancellor can


do something about the overhang of private debt, but by the utter


focus on public debt, and ignoring the vast overhang of private debt,


the Chancellor is avoiding dealing with what is a real big structural


threat to the economy. You have to give the economy some credit, just


this week the supply chain financing move was an attempt to


try to provide an alternative to bank financing. What we saw,


interestingly, we went to the ECB to see Mario Draghi the week before


last, 23 of the companies out of 25 said they were having a tough


September. What surprised me was the ECB was surprised by that. What


was described as the September *Cliff. I thought that the


quanative easing we saw from Draghi and Bernard, and the quanative


easing we saw from -- Bernanke and the Chinese, signalled they saw


what was happening, and I hoped they had seen it before business


saw it. Lending contracted today businesses in the eurozone in


September, which explains the challenges you face. Businesses are


sitting on �2 trillion -- $2 trillion of net capital. They are


afraid of investing that, firstly, because of austerity, and secondly,


because customers are not walking through the door. The point Michael


Fallon made, was figures like this will boost confidence and release


some cash? I'm not sure that is really true. Partly because, we


have all been talking about the international factor, the worries


about what will happen in the US, post election, the fact that the US


is far from resolved, the fact that China seems to be slowing down.


Everybody knows the big spending cuts, in a sense, are still to come


in the UK. The fiscal tightening will worsen next year, against that


background companies may invest a bit more. One day in the recovery


we will surprise and the recoverly will emerge. I would be surprised


if today's data is the move on to that summit upwards. If the


Chancellor does miss his targets, Autumn Statement could result in,


presumably, tax rises, further spending cut, more austerity, one


way or another, or him saying fiscal targets don't matter? He's


certainly not going to say they don't matter. He might say, and


personally I think this would be a reasonable thing to say, that


various things happen, particularly the eurozone crisis, since they


came into office, and he will take a little bit longer, that would


seem perfectly sensible. There was this lost decade and we wouldn't


see a return until 2018. reduced to predict a double-dip


recession, I will give you the opportunity toe predict a triple-


dip recession? No, we are bouncing along the bottom, it is corrugated


and it is painful. There is a painful analogy, but we will be


bumping along the bottom, in western Europe, including the UK,


less so UK and Germany, they are bookends with France, Italy and


Spain, sandwiched inbetween in more difficulty. Anne, triple-dip?


think there will be, because we precisely have not dealt with the


banking crisis, and precisely because of synchronised austerity,


I'm with the IMF, very scared about the synchronised austerity, and


with the Governor of the Bank of England, who said yesterday, unless


the private banking sector was prepared to take losses, we will


never be able to address the crisis, because we have the overhang of


debt which is the real drag on the real economy. I kind of agree with


that. I'm not sure we have had a double-dip recession, but whether


or not growth goes up or down, we have an extended period in front of


us of sluggish growth, where we have to slowly get to grips with


these problems. It is not going to be easy and there is not much


Governments can do about it. Corrugated bottoms all round! It is


a tale sadly for many of us, you turn up for the hospital


appointment, and the records are not there and the test results are


lost. Now medical bodies, backed by the Government, hope to avoid, that


by giving you, the patient, access to your own medical note. They call


it giving patients control. Some fear it is a means of shifting


responsibility for the failings of the health service, on to the


patients themselves. The first year has revealed what we


all expected, a vast amount of silent good work, a great deal of


relief, and a great deal of gratitude. Nye Bevan's devotion to


establishing the National Health Service was inspirational, Don


Atwell was one of the multitudes he inspired. His direct influence


inspired me to become a trainee administration manager in the


National Health Service. That was at 16 years of age. You were


working with medical records from the beginning? Booking outpatient


appointments, meeting the patients, and checking them in. 60 years on


Don's talent for keeping records is a skill that is helping his very


survival. Every week three million people use the NHS, the notes


relating to their treatment are stored in depots many niels away,


on many, many sheets of paper. This is a typical medical records


library. There are scores like this, all over the country. This is in


Birmingham, where there are 1.4 million patients' medical records


being kept. They go back decades. But the system is cumbersome,


complicated, and it is collapsing under the weight of so much vital


information stored on paper. It is just not working.


In my experience, notes are never where you want them to be. If you


want them in cardiology, they are in orthopaedics, or the kidney team,


et cetera. Patients with multiple problems, under many departments,


may have their notes all over the hospital. Maybe two, three or four


files in different places. It is causing real problems for patients,


is it? It causes terrible problems for patients. You can imagine


coming to clinic with a complex medical problem, and seeing a


doctor who has got one, thin, folder with a blank sheet of paper


saying "temporary notes, can't find notes". For 25 years Don has had a


chronic heart condition, these days he minutes and logs every hospital


appointment and test results for himself. He has learned, from


experience, when he goes for treatment, and he has been


everywhere, too often his medical records won't turn up. From his


local hospital in Chester, he has been to London, Liverpool,


Cambridge, Cheshire, Bristol, Manchester, back and forth, again


and again. The health service should have


built up a large fail on him, but if they did, we will never know.


arrived at the hospital and greeted with the comment, I'm sorry we have


bad news, you can't make this up, but we have lost your records.


your records? Lost your records. What sort of records? 25 years of


clinical records have got lost. As Don will tell you, when the


records aren't there, there can be trouble. I'm in the cardiac ward


and a consultant says to me, I want you to take this tablet. I said I


can't tell take that, it -- I can't take that, it will have an adverse


reaction. He said he wouldn't give me pain medication if I didn't take


it. So I took it. He regained consciousness, on the floor, feet


up, and receiving an intravenous drip to relieve my blood pressure.


To avoid such catastrophes, University College Hospital


Birmingham has been one of the first hospitals to transfer all


records on toe confusion. It means confusion over drug doses has been


dramatically reduced. Are you saying it makes a difference to


patients' mortality on computer rather than paper? We have just


published something in a scientific journal that demonstrates a more


than 16% reduction in mortality emergencies, which results in the


misdosage of drugs, give patients the drugs they are described and


fewer die. We have 100 patients a year fewer dying in this


organisation than we did three years ago. In Birmingham they say


computerisation has helped. They are going further, trying to give


patients access to their records on-line. This woman, who has


rheumatoid arthritis, is one of the first to benefit. What you can get


on the system now is they will show a little graph over time, my iron


levels being a perfect example, started dropping off around


November last year. It wasn't quite so obvious until you could see it


in graph format, there it was. Plain as day. Do you feel better


informed? I do. I have more of a basis for asking questions. But he


willen works in the NHS as an information -- Elln works in the


NHS, and has been aptitude for statistics. Patients are given


freer access to their own medical records. It is an idea increasingly


popular with medical bodies, like The Royal College of Physicians.


Others argue in the long-term, it will simply mean doctors shuffling


their responsibility, on to those least able to cope, their patients,


the sick. The Government has said, by getting


access to their notes, patients will have control over their


treatment. It is right in line with Government thinking. And leading


doctors' groups are also keen. most, I think, it is very welcome.


They want to move in this direction. But it is because they want


patients to have the opportunity to manage their own disorder, to make


decisions. It is opportunity but is it responsibility? It carries


responsibility. So the patient has responsibility rather than the


physician? Not rather than, as well as. Duncan Diamond, a consultant


for 40 years, says patients should be informed, but warns full access


to their records will create further problems. I struggle to see


how that will put the patient in control. A lot of the medical


records will use terminology and numbers that nobody outside the


medical profession is familiar with. That seems to me to introduce yet


another potential gremlin into a difficult system. What about the


notion that the patients could at least be the backstop, at least


they would have control over their own? How do they co-ordinate it.


They can come in and say hello doctor X, and I saw doctor. A and B,


here are the records that your organisation is unable to find, I


have got them. It is still a terrible indictment of the system,


that relies upon someone who is ill and vulnerable, and maybe not at


their best, worried, anxious, with anxious, worried relative to tro


dues an add minutes -- relatives, to produce an administrative task


that hospitals should do. Many think patients will need a


degree of sophistication. What about those patients who aren't


able? Those patients won't pick up the challenge and will continue to


feel they want to be managed on a rather one-sided basis. What will


happen to them? We will continue to do it that way, for those patients


who want to engage much more in shared decision-making, shared


management, we are right up for it and we want to see that. Some, like


Don, see this as blind stumbling towards a two-teir health service w


patients in the know, like him, OK, but the rest left floundering..


Because I have argued and chased, but you can't expect the ordinary


person to do that. It is not feasible. And ever more removed, he


fears, from the dreams he still nurtures for the NHS.


Britain has spent more than billion pounds in aid to Afghanistan. But a


report by MPs raised the sposability that it may have been


better -- possibility that it may have been better to give less to


the Government and more to the local groups. The litmus test on


whether British and US troops have succeeded is whether the lives of


women have been improved for the better.


My guests are with me. Laura Jane Patient of the British


Are the people of Afghanistan significantly better off now than a


few years ago? They are better off, but there is a long way to go on


things like women's rights. I think of the project on improving women's


rights in Afghanistan as maybe 10- 20% of the way achieved since 200.


There is a huge way to go, which is why the continued support of the


international community, after 2014, is so crucial. But the question is,


where should that support be directed? Do you think that after


2014, those advances, modest though they may be, are going to be


sustainable, or Afghanistan will just go back to the way it was?


think there is a real danger of the progress that's been made turning


around and going back and in the wrong direction. I think in terms


of what the best way is to prevent that, what the best way is to


deliver services, it varies from sector to sector and region to


region, across the country. What donors need to do, they need to


look hard at what is going to be the most effective way of


delivering services to the people who need them. Sir William, the


argument, according to the argument appearing to be made by MPs today,


is the Afghan Government is fundamentally pretty useless and


pretty corrupt, we all know that. Perhaps more money and more effort


should be spent on other people, NGOs and so on, avoiding the


Government where possible. What do you make of that argument? I think


it is a forked choice. You have to do both. The reality is, if you


only invest in NGOs, and there is a capacity problem here, not many


NGOs can effectively do what we want them to do, those who are


effective we are supporting, I say "we", I'm no longer responsible for


this. The Government is definitely supporting. Unless you try to help


the Government. The structure of the state in Afghanistan and to


improve it, whatever you do through an NGO network will be short lived.


Isn't part of the problem that the British and American Government,


because of justifications for the war, in keeping troops and losing


lives in the war, have had to be a bit softer on the Kabul Government


in public, than they were in private, and you know some of the


terrible difficulty with that Government, it is not really


functioning very well is it? would all love the Kabul Government


to be more effective and less corrupt. But it is a country which


has had a Government which for 30 years has been in internal conflict.


So overnight it won't be reformed. I disagree with the premises that


the lit tus test will be the situation of women after don litmus


test will be the situation of women over ten years. The reason we went


in was to free Afghanistan from a terrorist organisation. The litmus


test will be leaving a functioning state that has the prospect of


succeeding. We have to address women's issues. There are five


million kids in school, 40% of them are girls. Education for girls is a


fundamental building block for the future. What do you make of that


argument, that women are not the reason why we went into Afghanistan


and not the reason why billions were poured into the country?


don't agree, there was a lot of rhetoric about the evils of the


Taliban and the horrible state of women, it was used very stragically


as way to justify the war. I feel like a lot of people, including


people like Tony Blair, and Cherie Blair, made promises to Afghan


women at the time of the invasion, and this is the moment where we


really see whether those promises will be kept or not. Do you see the


point that you can, of course, fund NGO, but you can't stuff them full


of money. And without a functions state, not much they will do will


last. There is there has to be a functioning state left behind in


Afghanistan, or the whole project will crumble? I think it is, of


course, important to have a functioning state. Is it possible


for the UK to create a functioning state in Afghanistan. I don't think


it is within the UK's power. The state may be functioning or not, it


may continue to function or not. There are a lot of unknowns ahead.


But this report that came out today does a really good job of


illustrating some of the ways in which NGOs can deliver services on


the ground, in areas that the Government just can't achieve that.


So I don't see any reason to be sceptical about funding NGOs, and I


don't see funding NGOs as undermining the role of the


Government. We see services delivered through NGOs in many


countries. The Government has a role in regulating those NGOs,


licensing them, providing quality assurance. That doesn't undermine


or go around the Government. William, do you worry that when


British people see the news tonight, and two more British soldiers named


victims of the fighting there. And they will look on that money that


has been spent, and they will look with some concern to the future and


what happens after 2014 a lot of people thinking it is a waste?


understand it, I don't think it will have been a waste. I think at


the end of 2014 which the time the troops withdraw. It is not end of


our time in Afghanistan, it is the combat engagment. We will continue


to work on things, building the state, making sure they can collect


taxes. I think it is false choice. I'm not arguing we shouldn't


support NGOs and only the state. We are actually doing both. And I


think that's the important thing to remember. That at the same time you


are trying to support women's groups, empower civil society, and


do what you can, you are also, at the same time, trying to make sure


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