16/04/2013 Newsnight


16/04/2013

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


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(explosion) No-one has accepted responsibility for the bombs which

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killed three people and injured 170 others at the Boston Marathon

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yesterday. How do you go about finding the perpetrators of an

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outrage like this. The spirit of this city is today

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defiant, with people determined not to yield a victory to whoever

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brought terror to the marathon. We will speak to a former FBI export

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and a surgeon who has treated many of the victims. In a moment the

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photographer covering a happy sporting event who found himself in

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the middle of a warzone. We speak to the man who took these pictures.

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Also tonight, David Cameron believes this man can save the

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National Health Service. We talk to him about how such a massive

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organisation can ever be made to work perfectly. What proposals will

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he consider to introduce some greater consistency in sentencing.

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It is a wonderful pleasure to be back here at the Labour club in the

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Sedgefield constituency. Why do privileged public school boys think

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that talking estuary gives them authority. What is happening to our

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accents? We have learned a little more about the Boston bombs that

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killed three people last night. We have learned that one of those

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murdered was an eight-year-old boy. We have learned that the bombs were

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packed with schrapnal and nails. But we haven't learned who the

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callous individuals were who planted the bombs, not by what

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perversion of reasons they thought maiming people would advance any

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cause of my kind. We're in Boston. Of course the city was shocked by

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what happened yesterday. You mentioned the loss of the eight-

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year-old boy, tonight just before we went on air, another victim, 29-

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year-old Crystal Campbell was also named from a nearby suburb of the

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city. It is interesting talking to people here that you do get a sense

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of their determination to carry on and to deny whoever did it any kind

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of victory. That, I think is an interesting contrast with this

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country for example after 9/11. Clearly a much greater and more

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shocking event. But you get the sense in some ways that America has

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been inyou are ined to violence to some degree over the intervening

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years, a decade of counter terrorism, also the traumatic

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experience of some of these shootings that have happened here,

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in schools for example. One of which was being commemorated at

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yesterday's event. The crime scene is the subject of minute

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investigation as detectives search for fragments of the bombs that

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might identify who made them. Huge numbers of images are also being

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sifted, trying to find the moment the perpetrator planted them.

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has to be hundreds, if not thousands of photographs or videos

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or observations made down at that finish line yesterday. They are

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sitting down there amongst everyone watching this event this morning. I

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would encourage you to bring forward anything. You might not

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think it is significant but it might add value to this

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investigation. At the scene today the emergency services' union

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representative came to offer a $50,000 reward for information and

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to insist they will find who is responsible. Whoever this person is

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or whatever this person is he will be brought to justice. We will find

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him, we find everybody. We found Osama Bin Laden, we will find this

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person. We will bring him to justice the American way.

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President was briefed by his counter terrorism team but was

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candid enough to admit there is much that is still unknown. What I

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have indicated to you is what we know now. We know there were bombs

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that were set off. We know that obviously they did severe damage.

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We do not who did them. We do not whether this was an act of an

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organisation or an individual or individuals. We don't have a sense

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of motive yet. Everything else at this point is speculation. But as

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we receive more information, as the FBI has more information, as the

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counter terrorism teams have more information, we will make sure to

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keep you and the American people posted. We do know more today that

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there were two bombs rather than the several originally reported,

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but the low explosive was used, possibly old fashioned gun powder

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and the devices could have been encased in pressure cookers, widely

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available T points to a radicalised individual or small group rather

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than some grand international conspiracy. One runner, captured

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yesterday's scenes as the blast killed three and wounded 170. The

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end of the 26-mile course. The eight-year-old boy who died, Martin

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Richard, had been waiting to see his father cross the finishing line.

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The boy's mother and sister waiting with him were also seriously

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wounded by the blast. And how today have people reacted to it? We found

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a quiet determination to deny the perpetrators their benefit. I don't

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think it really affects people in terms of what they or who they

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think this was at this point. Weeks to months to years down the road

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the person or people who did this may impact more global sentiment,

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but I think at an individual level people generally are just horrified

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and it really doesn't matter who it was that did this. Many highlight

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Boston's symbolic role as the place where the struggle for American

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independence started. As a reason why it was targeted and might be

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target targeting is the reason they won't be cowed. I have been here

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many years and there was symbols in 9/11 and there is symbols in this

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event. This is the cradle of liberty, it is the city of Boston,

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where it all began. Even today there have been strenuous efforts

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to clear the marathon debris and reduce the size of the exclusion

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zone around the bomb sites. Boston's answer to the bomber or

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bombers is defiant, a yearning to deny whatever capital was sought by

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an act of terror. Mark, are the authorities as in the

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dark as they suggest about who perpetrated it this? There hasn't

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been a breakthrough. We know they went up a false investigative alley

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yesterday. There was a report that a middle eastern man was one of the

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wounded. Possibly had he been the man that placed the bomb. This was

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a hypothesis they looked at for a while, they raided his flat and

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spoke to the people he lived with, he was judged not to be connected

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with it in any way. One thing that was clear is if they do find leads

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and they begin to act on them, there is likely to be a lag for

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quite understandable reasons between them beginning to act on

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them and what they actually tell the wider public. Thinking back to

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some of the previous incidents, after the Oklahoma bombings, the

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best part of 20 years ago, in that case they were also saying they

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knew very little as the news helicopters were going live to the

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scene of raids in Michigan as they descended on suspects that they had

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actually very quickly followed up on. So at the moment no

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breakthrough. But watch this space, as they say. An expectation

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presumably it will be a pretty drawn out investigation? It could

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be but you know the view here seems to be that a forensic sifting,

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particularly of the imagery around the sites where the bombs were

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planted ought to yield something. CCTV cameras obviously on the day

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of the marathon, many thousands of people taking photographs. In the

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past in some of these investigations, we have seen this

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in the UK after the called Brixton pipe bomber struck, individual

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cameras, the images were linked in order to follow a person back along

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the route they had travelled. To build a bigger picture and get

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better images of that person's face. So all of that could be going on

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and when this does yield clue it is may well be that we see action.

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Thank you. And we are going to be exploring some of that methodology

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of that sort of investigation in a few moments with the former FBI

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investigator. The horror of yesterday's attack though has been

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laid bare and dramatic, moving and stills images of the explosions.

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Some of the most dramatic scenes of the chaos which ensued in the

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aftermath of the twin bombs was taken by the local newspaper

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photographer, John Tlumacki. He was picturing runners coming across the

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line for his newspaper, the boss done Globe, when the explosions

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occurred. He quickly found himself capturing the rescue effort. I

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spoke to him before we came on air and asked what happened when the

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bomb went off. I had my camera raised, I was photographing

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families coming across. The explosion went off. Right in front

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of me was a gentleman who fell to the ground. I instinctually ran

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towards the scene of the first explosion and saw what had happened,

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the carnage and the devastation. How did people react? People

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reacted shocked. People were in disbelief. They were yelling "oh my

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good", this is Boston t can't happen. There was a moment of

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silence, I don't think people knew what to do. The first responders

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were there and looking at each other. They were having a difficult

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time moving the barricades away. It was a sense of like, not so much

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panic, but what do we do? What are the rescuers going to do? There was

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such mass casualties. I witnessed two women with their legs blown off.

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They were obviously in grave danger. You know there was moments where I

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walked around and I had to walk through pools of blood and I don't

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know it is inscribable. I hope nobody sees that ever again.

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you feel at all awkward yourself going around taking photographs

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instead of helping people? I was asked that a couple of times. I'm a

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professional photographer, I work for a newspaper. I'm not trained to

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help, I'm not a paramedic. I think if I was a spectator I would have

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helped but because I'm there to record the event nobody else is

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there that was with me. I felt it was my obligation to show the world

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what really happened. It is not a normal response though is it when

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an explosion happens to run towards it? The normal response would be to

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run away? I know, I know. Maybe it was stupid on my part but in

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retrospect I guess it was a dangerous thing to do. Especially

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when a police officer was yelling at me to get out of here and not

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knowing that he was thinking another bomb might be going off. I

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had a lot of emotions running through me. I think it is an

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adrenaline thing. I ran towards it. I think a lot of journalists would

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have done the same thing. That's what you are trained to do. Have

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you been able to find out anything about some of the badly injured

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people you photographed? I know that several of them are in surgery,

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one of the women who I have in the photograph has passed away. I

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believe she lives in Me dford. I knew that the two women that were

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seriously hurt with their fatal injuries there was a policeman

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standing over them and he had fingers on each one of their necks

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checking their pulses. When I got back and looked at the photos I

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tried to be discreet about showing their faces. Did you ever imagine

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you would see anything like this in your own country? I never thought I

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would see it in Boston. I know it has happened in other parts of our

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country. I mean it was a festive day. I have covered the marathon or

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20 years and that location for five years. The streets are aligned with

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flags from every nation. To see that in the end people were being

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wheeled over the finish line in stretchers that were injured,

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rather than the glorious occasion where people are jubilant crossing

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the finish line because they ran all that distance and they trained

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all year. I never thought I would see that. I hope nobody ever sees

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that and it never happens again. I'm lucky I wasn't injured it is

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life, I guess now in Boston. Boston's police chief today

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confirmed that 176 victims of yesterday as attack were treated in

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hospitals around the city. I'm joined now by Dr Alisdair Conn the

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chief of emergency services at the Massachusetts General Hospital, 32

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patients were admitted there yesterday. Eight of them remain in

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intensive care. Dr Conn thank you for joining us. What sort of wounds

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did they have? Most of them were lower extremity words. The most

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seriously had basically traumatic amputations. Their lower legs were

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sort of completely shattered and almost completely removed by the

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explosion. All we did is basically completed those amputations. The

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other critical ones had lower extremity wounds. We were able to

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do a blood vessel reconstruction and keep, we are hoping to salvage

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that limb. But then again we had a lot of wounds in which the small

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ball bearings and metal fragments in the arms and legs and abdomen of

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some patients. These were ball bearings and other pieces of metal

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that had presumably been driven by the force of the blast, they were

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in the bomb or something? That's what we think. The first time I saw

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the gras and the CTs scan -- X-rays and the CT scans we noted how many

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of the small metal fragments there were. We wondered if they were

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enclosed in some sort of device and used to produce a lot of damage. As

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you probably know when you have an explosion these small fragments act

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like little bullets and can penetrate theish tues and provide a

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lot of damage to the tissues -- tissues, and provide a lot of

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damage to the tissues. difficult is it for a doctor to

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deal with? It depends in these patients we had to take them to the

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operating room and try to remove any dead or damaged tissue. When we

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did that we were able to remove some of the metal fragments and

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obviously gave them to the FBI and the appropriate authorities. We are

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hoping they can use this to perhaps determine where these metal

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fragments came from, perhaps give us a lead in terms of who caused

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this tragedy. Some of the patients will need to go back to the

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operating room over the next few days and have further dressings of

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the wounds. These wounds were mainly you say in the lower part of

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their bodies? Yes. The vast number of patients who came in had

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devastating injuries to their lower exfremties. As far as you could

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tell from -- extremities. As far as you could tell from the remains of

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their clothing were they mainly spectators or runners or what?

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of the patients we received and admitted to the hospital were

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spectators. Obviously fairly close to the finish line and were caught

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in the explosion when it occurred. We did treat some runners. But

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those were from heat exshaugs and dehydration. None of the patients

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we received had drawatic injuries that were runners. -- Traumatic

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injuries that were runners. Did all your patients survive? We still

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have seven critical patients but we are hopeful that all of them will

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survive. Four of them have unfortunately traumatic amputations

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of one of the lower extremities. None of the patients at the

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Massachusetts General have had both legs needed to be amputated.

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joined by Chris Swecker, formerly number three at the FBI and has

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experience with bombings in the US and the Middle East. With us is

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Jane Harman, a Democrat, former Congresswoman who served on all of

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Congress's national security committees, and now sits on the

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Pentagon's defence review board. Mr Swecker, how do you go about

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discovering what happened from what's left afterwards? It is a

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methodical forensic investigation. They will look out the entire area

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of the street and look at every inch of territory there. They are

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looking for tiny fragments of mettleal. They are looking for

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evidence of a detonation device. There are, there is an extensive

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library of these types of impro- advised explosive devices. They can

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do a lot with that material. important is the first 48 hours or

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so of an investigation like this? Very critical. Usually there are

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very good leads developed in the first 48 hours, if not the first 24

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hours. I had high hopes that some video would have been produced by

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now that would have shown some things. At least had a suspect out

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to the public, a photo out to the public at this point. I'm taking

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that to mean they are still going through the video and haven't found

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anything significant yet. I will come to you in a second

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Congresswoman, in I may, I just want to check, what they are doing

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Mr Swecker is asking people to send in any pictures, any images at all

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they may have. By that it means you build up a comprehensive picture,

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is that what's going on? Yes it is. They are even canvasing people if

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they are leaving at the airport to see if they might have video or

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pictures that might be helpful. Apparently they did get some good

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forensic evidence in terms of understanding what kind of

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container was utilised. Apparently it was pressure cookers. We have

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seen that before. What conclusions do you draw? Well we no that the

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Inspire Magazine that was produced in English by Samir Khan on the

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Internet and touted at open source Jihad provided these very

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directions on how to build a bomb out of every day kitchen devices

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and materials. So in particular reference was made to pressure

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cookers. Is this the new information you just referred to

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about the nature of the containers, pressure bookers? That's correct.

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What can you tell us about that? They are reporting in the US the

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recent press conference in the last 20 minutes. They reported that they

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had some evidence that some pressure cookers were, the

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containers for the bombs. In other words you can create a bomb by

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putting schrapnal, material, ball bearings and that sort of thing

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inside a pot and creating a detonation device and you have got

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a homemade bomb. Now Jane Harman, Mr Swecker was referring to the

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press conference, the news conference. There were a very large

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number of representatives of different organisations on the

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podium there. How much of a problem is that in this sort of

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investigation? I don't think it is a problem. In fact there is a whole

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Government approach to investigating this crime. That is

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what we want. I was in Congress during 9/11 and I watched agencies

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of Government operate in their own silos, and in fact 9/11 was an

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example of that. We had the firefighters climbing the towers in

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New York as they were glowing red with the NWPD respects overhead and

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they couldn't communicate with each other. We lost additional lives

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because of that. I want to comment on the Internet material, I have an

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example, this is from this Inspire Magazine. This is how to build a

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bomb in the kitchen. Hold it a bit more in front of you, we can't

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quite see it, that's it, fine. That's the pressure cooker and here

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is the detonator, it is on here too. Here it is which is a typical clock

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which may have been used. One of the things I want to say about this

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this is not ...put the clock back? No, we want to see your face now we

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have seen the pictures. Thank you, this is not the only source of

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material, something called the Anarchist Cook Book, prepared in

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the early 70 by somebody offended by the Vietnam War, an American.

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Let's not assume that if these materials were used and if they

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were, because they are easily available on the Internet that

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there is a connection necessarily to some Yemeni terrorist, there may

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not be. Unfortunately these materials are widely available,

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even if you don't buy the hoax cuss poke cuss at the front end telling

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you why you should follow Jihad, you might just follow the

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instructions for a different reason. We have to be careful not to leap

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to conclusions about who did this and why they might have done it. It

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seems as though a back pack contained a pressure cooker bomb or

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series of bombs with some kind of timer and it was dropped in trash

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cans or something of that nature. We have seen this before. I wanted

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today say that pipe bombs, a variation of this were used in

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Atlanta during the Olympics in the mid-1990s. It took seven years to

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find the guy who did it. We first false low accused somebody else. It

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took -- falsely accused somebody else. The only way we found him was

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he used pipe bombs in other states similar to the Atlanta bombs. We

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will find out who did this, but it is not an easy problem to solve. If

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they were acting alone particularly. It is striking that no-one has

0:24:170:24:21

attempted to claim responsibility for it yet? That is true. That is a

0:24:210:24:24

hallmark of international terrorist organisations. They are very proud

0:24:240:24:27

of their work, they are very quick to take credit for their work. That

0:24:270:24:34

is the point of terrorism. To strike here in people and target

0:24:340:24:38

iconic events like this. That is an interesting angle. The former

0:24:380:24:42

Congresswoman is correct. This could very well be domestic

0:24:420:24:45

terrorism. I don't believe anybody has taken their eye off that

0:24:450:24:49

possibility. What is your experience as a former senior FBI

0:24:490:24:53

figure about the number of agencies that are involved in an

0:24:530:24:59

investigation of this kind. What is your experience? Well there are

0:24:590:25:02

joint terrorism task forces across the country. There are only a few

0:25:030:25:09

prior to 9/11. There are over 100 of them now post 9/11. They are

0:25:090:25:12

designed to create an interagency environment and eliminate all of

0:25:120:25:16

that getting to know you, who is in charge sort of thing. That should

0:25:160:25:21

not be happening here. It looks to me like this is very harmonious.

0:25:210:25:24

There is great co-operation here and I think they have worked well

0:25:240:25:27

together in the past. This is not the first time they have had to

0:25:270:25:33

work together. It is striking I think looking at President Obama's

0:25:330:25:38

comments that he has been very, very measured in what he has said,

0:25:380:25:42

hasn't he? This is President Obama, let's understand he's a highly

0:25:420:25:45

trained lawyer, he used to teach constitutional law. It was

0:25:450:25:48

interesting he gave a press conference last night and did not

0:25:480:25:52

call what happened terrorism, he gave one this morning and did call

0:25:520:25:55

it terrorism. I think by any garden variety definition of terrorism

0:25:550:26:00

this was terrorism. The question is by whom and for what motive? I'm

0:26:000:26:05

cautioning again that we need to be very careful before we stigmatise a

0:26:050:26:10

group or engage in some very discriminatory behaviour, because

0:26:100:26:15

we could be wrong. Mr Swecker does this lead to brief politicians on

0:26:150:26:20

what is happening. How difficult is that for an investigator? Well, as

0:26:200:26:24

you saw at the press conference there it is a cast of thousands. It

0:26:240:26:28

is quite difficult to try to run an investigation and keep local

0:26:280:26:34

politicians up to speed on what's going on. But you know they are

0:26:340:26:39

used to doing this. The agent is charge is very competent. He has

0:26:390:26:43

been down this road before. I don't think it is particularly

0:26:430:26:48

troublesome at this point. Thank you very much. Yes, please, Jane

0:26:480:26:51

Harman? I argue it is important to keep politicians briefed,

0:26:510:26:55

especially Congress. These are voices that can assure people who

0:26:550:26:59

are enormously anxious. The Mayor of Boston is a beloved figure, he

0:27:000:27:04

has served longer than any other mayor in Massachusetts history,

0:27:040:27:10

having him leave his hospital bed, he is apparently quite ill and have

0:27:100:27:14

him preside over a press conference means a lot to those who were just

0:27:140:27:18

deaf vase tated by yesterday as attacks.

0:27:190:27:22

Later on Newsnight the rain in Spain has nothing much to do with

0:27:220:27:28

it. Why are Posh and Becks getting posher, while ministers want to

0:27:280:27:35

talk like barrow boys? It ought to be the first thing you are entitled

0:27:350:27:38

to expect when putting yourself in the hands of doctors and nurse, as

0:27:380:27:43

Hippocrates put it, "first that they do no harm ". A succession of

0:27:430:27:46

scandals in the National Health Service, most recently the

0:27:460:27:50

appalling and unnecessary suffering of hundreds of people at Stafford

0:27:500:27:54

Hospital has shown how that promise has been betrayed in this country.

0:27:550:27:58

The principle of zero harm is an objective in companies across the

0:27:580:28:02

land. How to achieve it in an organisation as vast as the

0:28:020:28:06

National Health Service? David Cameron has given answering that

0:28:060:28:16

question to President Obama's favourite healthcare expert, Donald

0:28:160:28:26
0:28:260:28:26

Boawick. This is a safety huddle. At the

0:28:260:28:30

start of every shift here at Salford Royal Hospital the ward

0:28:300:28:34

sister makes sure everybody knows which patients need a little extra

0:28:340:28:41

help. Ulcers bed 11. Staff here say the safety huddle is one of the

0:28:410:28:44

ways they have managed to make this one of the safest hospitals in the

0:28:440:28:50

UK. Ward sisters are also promoted to ward matron if they meet set

0:28:500:28:56

standards. Salford Royal is a beacon hospital. They claim the

0:28:570:29:00

fifth-lowest mortality rate in the country. And 98% of patients would

0:29:000:29:08

recommend to family and friends. David Cameron visited in January

0:29:080:29:11

last year. And the director of nursing and chief executive here

0:29:110:29:16

are part of a team helping the Government work out how other

0:29:160:29:20

hospitals can improve patient safety.

0:29:200:29:24

The public inquiry into patient neglect at Mid Staffs said the

0:29:240:29:28

culture of the NHS must change to put the patient first. And with the

0:29:280:29:34

central ten knit of "zero tolerance" of harm. -- tenet of

0:29:340:29:38

"zero tolerance" of harm. You have to start by respecting the staff on

0:29:380:29:41

the frontline. Most of the solutions to reducing harm are

0:29:410:29:44

going to be found in our ward and clinical environments amongst the

0:29:450:29:49

staff who work there. They are not going to be found in a chief

0:29:490:29:52

executive's office. One of the most devisive issues to

0:29:530:30:01

be resolved is how best to ensure that poor care is corrected. Making

0:30:010:30:06

sure staff feel they are able to report instances of harm and they

0:30:060:30:10

know no blame will be associated with them if they do report. It has

0:30:100:30:14

been open to our patients and families if things go wrong, and

0:30:140:30:17

occasionally they do, that we should immediately say that. We

0:30:170:30:21

should apologise for it and seek an explanation. We should learn from

0:30:210:30:25

what went wrong. Director of nursing, Elaine

0:30:250:30:32

Inglesby-Burke showed us the safety board of key stas at the entrance

0:30:320:30:36

of each ward -- statistics at the entrance of each ward. It tells me

0:30:360:30:42

how safe the ward is and how safe the ward is for patients and

0:30:420:30:46

families. We have MRSA infections, it is over a year since one has

0:30:460:30:52

been acquired on the ward. We have falls, which you do experience in

0:30:520:30:55

an elderly care facility. We are working really hard to reduce them.

0:30:550:31:00

It has been one day. Previously I was up here last week it was 19

0:31:000:31:03

days since they had a fall. From a ward perspective, from the staff,

0:31:030:31:07

this is really, really important to them that this is publicly

0:31:070:31:17

displayed. They are accountable for the safe care in this area.

0:31:170:31:21

Good morning Cliff, are you feeling OK today? Staff here say something

0:31:210:31:26

called intentional rounding is also key. That's doing regular checks on

0:31:260:31:32

patients to pre-empt problems. As the percentage of the population

0:31:320:31:37

aged over 65 rises, care will become more complex. About a

0:31:370:31:41

quarter of hospital beds are currently occupied by people with

0:31:410:31:51
0:31:510:31:53

dementia. Would you like a fork or spoon? We went to the Friarage

0:31:530:31:56

Hospital near Middlesborough, they are reaching out to local

0:31:560:32:01

volunteers to help when demands are high, such as meal times.

0:32:010:32:04

I wonder what you think about the idea of having volunteers in

0:32:040:32:07

hospitals? Very good idea. think it is sensible? I think so,

0:32:070:32:11

yes. How about the idea that you are not worried they are not

0:32:110:32:20

nurses? I thought you might be asking that. Yes, no I don't it

0:32:200:32:24

will bother. They have the sense to say hang about and dash off and get

0:32:240:32:28

a nurse haven't they. If you didn't have that help would you it be

0:32:280:32:34

quite a struggle? I could manage myself. I do have a bit of struggle

0:32:340:32:44
0:32:440:32:44

with the cream to get the corner off. I stab -- the salad cream

0:32:440:32:49

packet to get the corner off, I stab it with the fork. Some people

0:32:490:32:53

just want a chat, we hold their hands if they want to talk.

0:32:530:32:58

Johnson has seen hospital care from both side. She's a former nurse,

0:32:580:33:03

she's 59 now and was diagnosed with early on set Alzheimer's seven

0:33:030:33:07

years ago. What have you found most difficult about being in hospital

0:33:070:33:11

yourself? They should assess a patient to see what the patient

0:33:110:33:16

needs help with. For example Ann what do you need? I have problems

0:33:160:33:22

with things like tap. Some you lift, some you turn, some you push. What

0:33:220:33:27

do I do with the tap, how do I flush the toilet. They should

0:33:270:33:30

assess the patient needs taking to the toilet and bringing back.

0:33:300:33:37

Sometimes what's needed is simple. Dignity and respect is so important.

0:33:370:33:44

Just love me for who I am and that will go a long way. This is a

0:33:440:33:49

generational opportunity out of tragedy for nursing to stand up, be

0:33:490:33:54

bold and to reclaim their territory, if you like. To actually prove to

0:33:540:33:57

the country that care and compassion is at the heart of

0:33:570:34:01

everything we do. Many hospitals are not as glowing

0:34:010:34:05

as Salford Royal and have a long journey before they can be

0:34:050:34:11

confident they are not causing patients harm.

0:34:110:34:14

The Professor advising the Government on how to improve

0:34:140:34:19

patient safety is here with me now. First of all, what is it you are

0:34:190:34:25

seeking? I was asked by the Government and service to form a

0:34:250:34:29

committee to take under advisement the detailed and impressive report

0:34:290:34:34

that has already been done on Mid Staffordshire, and digest them into

0:34:340:34:39

some actionable recommendations. This target of zero harm, what is

0:34:390:34:45

zero harm? It is an aspiration. As you said when we go to get help in

0:34:450:34:47

healthcare we should have an expectation that everything that

0:34:480:34:52

can be done to help us can be done, and nothing will be done to harm us.

0:34:520:34:58

Harm is almost always unintentional. But the correct safety system is

0:34:580:35:03

one which everyone at work every day takes no harm as inevitable.

0:35:030:35:07

achievable? It is important to hold the aspiration. Whether it is

0:35:070:35:10

achievable over any period of time I can't say. There are places that

0:35:100:35:14

have achieved remarkable results, you saw some in the initial opening

0:35:150:35:18

week. We can go a year without certain kinds of infections, that

0:35:180:35:22

is good. It is an enormous enterprise the National Health

0:35:220:35:27

Service. You are never going to get all of it at zero harm are you?

0:35:270:35:32

Probably not. But the minute one admits to any harm is inevitable

0:35:320:35:39

the game is lost. The attitude in a culture or complex system is to

0:35:390:35:43

work and everything every day to make it safe. Harm is inevitable

0:35:430:35:47

isn't it? It depends on the exact kind of harm we are talking about.

0:35:470:35:52

It depends on the degree of energy that one puts into actually

0:35:520:35:56

intercepting the harm. Error is inevitable, we are all human, not

0:35:560:36:00

every error has to result in injury. What has gone wrong in the NHS that

0:36:000:36:05

we can't take zero harm for granted? I think gone wrong in the

0:36:050:36:09

NHS is not how I would think about it, it is what can the NHS improve.

0:36:090:36:16

How can we be better every day. Something has gone wrong if you

0:36:160:36:20

can't be certain of zero harm? Something has gone wrong when

0:36:200:36:24

leaders and the work force don't intend every day and try every day

0:36:240:36:27

to achieve safer care. Something can be set right. It is possible

0:36:270:36:32

with proper leadership and the energy we see in the best of the

0:36:320:36:40

NHS to ri chief -- achieve astounding results. To a layman is

0:36:400:36:43

seems remarkable this situation could have come about. There was

0:36:430:36:47

one particular scandal here at Stafford Hospital that has

0:36:470:36:52

horrified many, many people. It is clearly not unique. Unique on that

0:36:520:36:56

scale perhaps, but it is not unique that things go wrong, there are

0:36:560:37:03

errors, harm is done. Yet you have said publicly you love the NHS? It

0:37:030:37:08

is a romance for you? I don't know how you reconcile these two things?

0:37:080:37:14

When the NHS was founded in this country you made a magnificent step

0:37:150:37:17

towards establishing healthcare as a human right, I deeply respect

0:37:170:37:23

that. This is a nation completely committed to the NHS as a service.

0:37:230:37:27

It is large undertaking and it is never done. You are on a continuous

0:37:270:37:31

process to making the NHS ever better. Isn't part of the problem

0:37:310:37:36

that in this country it is almost treated a secular religion? People

0:37:360:37:40

value it in all countries, especially in this country. I

0:37:400:37:45

notice the degree of embrace of the NHS. You saw it in those remarkable

0:37:450:37:50

Olympic ceremonies as your counselrated. Danny boil has

0:37:500:37:55

exactly the same religion you have -- Danny Boyle has the same

0:37:550:37:59

religion you have got, he loves the NHS? I deeply respect it, when you

0:37:590:38:05

have an enterprise of 1.4 million employees and serving a country of

0:38:050:38:09

millions, you have to work very hard, it is not automatic. Isn't

0:38:090:38:18

that where the complace sense comes in? -- Complace cy comes in?

0:38:180:38:21

Sometimes things go wrong and the attention of leaders is needed

0:38:210:38:25

every day to maintain excellence and see it improves. Let me ask you

0:38:250:38:30

about another aspect that has come up recently this duty of candour.

0:38:300:38:33

The proposal is that be applied at an institutional level, should it

0:38:330:38:37

apply to individuals? I had the privilege of chairing a committee

0:38:370:38:41

whose report is due in July, I won't prejudice their answer. We

0:38:410:38:45

are lucky to have a remarkable group of experts deeply committed

0:38:450:38:48

to understanding what to do. Our report will speak to that. My own

0:38:480:38:52

view right now is based on the science of safety and improvement.

0:38:520:38:55

What we know is in order to have a safe environment whether it is a.

0:38:550:38:58

Ho, a nuclear power plant or an aircraft carrier, you have to have

0:38:580:39:02

openness, people have to be able to say what they see and be encouraged

0:39:020:39:08

and celebrated to do it, even to report their own mistakes. If duty

0:39:080:39:14

of candour means a bias towards sharing information, absolutely. As

0:39:140:39:19

an essential property. Not if it make them liable to their own

0:39:190:39:22

mistakes? Leadership needs to build an environment that means people

0:39:220:39:27

aren't fearful to speak up. You may see something today and if you are

0:39:270:39:31

frightened we have a problem. The idea is transparency and openness.

0:39:310:39:35

You are with the Health Secretary, Jeremy Hunt? I don't know which

0:39:350:39:38

aspect of his position you are talking about. Afterall we have a

0:39:380:39:43

committee at work to decide what to do. What I am sure about from the

0:39:430:39:48

science of safety is that a safe environment is by definition an

0:39:480:39:53

open one, where we can talk about what we see. But if it renders

0:39:530:39:57

somebody personally liable, that's a big issue, isn't it? People do

0:39:570:40:02

what makes sense, if it takes sense to speak up and share what one sees

0:40:020:40:06

if that is valued by one's peers and culture one will do that. If

0:40:060:40:12

peer isam beeent and people are frightened --am beeant and people

0:40:120:40:18

are frightened when they speak you will get the situation that comes

0:40:190:40:26

from that. You have seen and more of the N sh. S, warts and all, I'm

0:40:260:40:29

not suggesting you didn't know previously. Has it affected how you

0:40:290:40:36

feel about it at an emotional level? Nobody can read the Mid

0:40:360:40:38

Staffordshire report without empathy and sympathy for the

0:40:380:40:42

patients, carers and staff that suffered. People really suffered,

0:40:420:40:47

it tears your heart out. Maybe it gives me more energy that I have

0:40:470:40:51

had before to say no. We can be better than that, you can be and

0:40:510:40:55

have a service that is devoted every single day for safety. We

0:40:550:40:59

know technically how to do that. It has refuelled my tank. It hasn't

0:40:590:41:08

made you feel any less of it? a great human endeavour, I would

0:41:080:41:12

love to see this country succeed with healthcare that sets a

0:41:120:41:17

standard for the whole world. Linguist students at Manchester

0:41:170:41:22

University proudly announced today that they discovered that David and

0:41:220:41:26

Victoria Beckham are talking more posh than they used. They have

0:41:260:41:32

changed their hair colour and tattoo, why not accents. Received

0:41:320:41:37

pronunciation, as it used to be called, signified a higher class

0:41:370:41:41

than a different accent. That is where Margaret Thatcher went on to

0:41:410:41:45

sound like the Duchess of Devonshire. When a public schoolboy

0:41:450:41:55
0:41:550:42:00

gets to Downing Street he wants to "tall loi tha".

0:42:000:42:04

Elocution, articulate, social mobility.

0:42:040:42:08

# You say either # I say either

0:42:080:42:14

# You say neither # I say neither

0:42:140:42:18

High spirits at the BBC deportment college, did you spot Fiona Bruce.

0:42:190:42:22

Manners make the man and woman. What about speech? People with no

0:42:220:42:26

shortage of time on their hands reckon David Beckham is talking

0:42:260:42:30

posher now. REPORTER: David are you happy to go to Real Madrid? Yeah.

0:42:300:42:36

Let's see for ourselves. If we play well and I play well we could beat

0:42:360:42:40

them, we knew we was the better team. We done that and we come back

0:42:400:42:44

from the 1-0 deficit and the character shone through. It is a

0:42:440:42:49

special moment for the country, for the team and a special moment for

0:42:490:42:57

myself to be involved in this. This programme's worthless if it

0:42:570:43:06

isn't an analytical tool, we turned to the director of the London

0:43:060:43:16

Speech Workshop. Something instead somethin, and "t "on the end of

0:43:160:43:21

words. I think he sound better in the second clip. It has been

0:43:210:43:25

exciting and honouring and touching. The impression he makes has changed

0:43:250:43:28

an awful lot. That is the key thing. It is pretty obvious that is his

0:43:280:43:32

purpose in doing voice work, which I'm fairly sure he has done. Is to

0:43:320:43:37

actually change the impression he makes. Let's look at how some other

0:43:370:43:41

great voices of these islands have changed, and what that might tell

0:43:410:43:45

us. I nearly went over the edge I was down on the floor with ten

0:43:450:43:48

people on top of me and looking down on this crowd I was seething

0:43:480:43:53

underneath. What would be your favourite spot

0:43:530:44:00

in the UK? The silly Isles looks lovely, you can't get any further

0:44:000:44:07

west than "tha". My strong suspicion is in private Sir Mick

0:44:070:44:11

Jagger sounds not unlike our blessed Prime Minister, or somebody

0:44:110:44:16

like that. The travelling preacher of social observation on the

0:44:160:44:23

Rolling Stones frontman Mick Jagger. He is obliged, in his public

0:44:230:44:28

persona to maintain something of the sort of mockney nasal whine

0:44:280:44:32

that he developed as a suburban London middle-class boy who had

0:44:320:44:39

gone to the LSE. He developed that in order to be a popstar. Eggs

0:44:390:44:43

specially for myself and my brother, you ain't ever going to find

0:44:430:44:47

someone to jump into the position they would hold, simple as that.

0:44:470:44:53

think the way Prince Harry sounds is today's sort of Sloane sound,

0:44:530:45:01

which is more knocked back than a previous cohort of Sloanes and

0:45:010:45:06

people from his class. I think that there is also the requirement to be

0:45:060:45:15

"one of the lads". It is a lowering, not a raising? Enough is enough.

0:45:150:45:20

that's it. To say to the Government of the day, enough is enough.

0:45:200:45:24

the eve of her funeral, we have to mention Baroness Thatcher and her

0:45:240:45:29

voice coaching. What did she say was her greatest achievement? Oh

0:45:290:45:35

yes, new Labour! Some treated with relative leniency, others in the

0:45:350:45:40

Norfolk case with some severity. tell you what I like, I'd like one

0:45:400:45:49

of those. He has gone from very posh and heightened up, to this

0:45:490:45:58

nasal trail, "severity", and this "a" on the end instead of "e", to

0:45:580:46:04

almost Cockney, "I tell you what I loike". For too long we have a

0:46:040:46:07

system where people who do the right thing, who get up in the

0:46:070:46:11

morning and work hard felt penalised for them. Out of all of

0:46:110:46:21
0:46:210:46:21

them that's the most painful. Why?'S Dropping his "h", "we've ah".

0:46:210:46:26

David Beckham felt authentic but that feels inauthentic for me.

0:46:260:46:33

one of our vocally madeover politician put it, it is all about

0:46:330:46:43
0:46:430:47:05

"elocution, elocution elocution". "elocution, elocution elocution".

0:47:060:47:12

That's all, innit, bye! Good evening, more windy weather over

0:47:120:47:15

the next couple of days. Some strong wind on Wednesday,

0:47:150:47:19

especially to the north and west. We have got some rain, again it is

0:47:190:47:24

Northern Ireland, Scotland starting off with the wettest as the weather

0:47:240:47:27

moving slowly northwards by the afternoon. A few showers in

0:47:270:47:32

Northern Ireland by 4.00pm. Temperatures about 123. Outbreak of

0:47:320:47:37

rain for parts of Scotland. Temperatures through the central

0:47:370:47:43

lowlands up to 11. The rain heavy in Galloway by the afternoon and

0:47:430:47:47

affecting Cumbria. Further south it should be dryer. Sunshine for

0:47:470:47:50

Yorkshire, Lincolnshire. Through the East Midlands and temperatures

0:47:500:47:55

to the south-east could lift around 19, 20 degrees. A small chance of a

0:47:550:47:58

shower, most places missing those and staying dry. A little more

0:47:580:48:03

cloud across south-west England. Here a fine afternoon. For Wales

0:48:030:48:07

the wettest of the weather around guard began bay.

0:48:070:48:10

Temperatures really a little bit above average on Wednesday, despite

0:48:100:48:18

those strong wind. They drop back on Thursday, more typical array of

0:48:180:48:21

temperatures, a mixture of sunshine and showers. The showers heaviest

0:48:210:48:24

the further north and west you are being blown in by another strong

0:48:240:48:27

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