29/05/2013

Download Subtitles

Transcript

:00:14. > :00:17.NHS can schedule your much-needed operation, but it is on a Friday and

:00:17. > :00:23.you are much more likely to die than after the same operation on a

:00:23. > :00:28.Monday. Why is the date of the week a matter of life and death? We will

:00:28. > :00:32.discuss with the medical director of NHS England.

:00:32. > :00:37.David Cameron is looking for friends in Europe as he tries to renegotiate

:00:37. > :00:39.our membership. The Polish foreign minister tells us whether Britain in

:00:39. > :00:46.or out really matters to the rest of the continent.

:00:46. > :00:51.The cosmopolitan world of the Afropolitan, roots in Africa, home

:00:51. > :00:57.in Europe or North America, Taiye Selasi on the nomadic culture of the

:00:57. > :01:01.21st century. No need to worry, termite you see

:01:01. > :01:07.before you the artistic, sensitive side of me.

:01:07. > :01:17.Now, it is one of the BBC's great iconic brands, so why was Doctor Who

:01:17. > :01:17.

:01:18. > :01:22.so badly neglected in the lost decade of the 1980s?

:01:22. > :01:27.Could evening. If you wander into Sainsbury's or Tesco's, you would

:01:27. > :01:32.expect the same range of food and roughly the same service, but if you

:01:32. > :01:37.end up in hospital at the weekend, you do not get the same service as

:01:37. > :01:42.on a weekday. You are more likely to die. Researchers have discovered if

:01:42. > :01:46.your operation is on a Monday, your survival rate is 50% higher than the

:01:46. > :01:51.same procedure carried out on a Friday. This raises questions. Why

:01:51. > :01:57.the discrepancy, and with something approaching seven-day service and

:01:57. > :02:04.the lottery? Whether we are sick during the day

:02:04. > :02:09.or at night on a weekday or at the weekend, we rely on the NHS to treat

:02:09. > :02:13.us the same. But that does not always happen. In the past, research

:02:13. > :02:18.has suggested it is riskier for patients to be admitted over the

:02:18. > :02:22.weekend than it is cheering the week. Now, a new study suggests the

:02:22. > :02:26.same pattern applies when it comes to elective surgery. It is safer to

:02:26. > :02:34.have an operation on a Monday than on Friday. The overall mortality

:02:34. > :02:38.rate is low, 0.67%, but the research found that surgery carried out on a

:02:38. > :02:45.Monday carries the lowest likelihood of death. Using Monday as a base

:02:45. > :02:51.point, this graph shows how the risk increases. Surgery carried out on a

:02:51. > :02:57.Friday carries a 44% greater risk. Weekend surgery is even riskier,

:02:57. > :03:00.though the sample size for smaller. When we looked at the data, we found

:03:00. > :03:07.no difference in the types of patients admitted on Friday

:03:07. > :03:13.competitor Monday, -- prepared to Monday, so we think this effect is

:03:13. > :03:19.likely not to be due to the patients but to the quality of care. If the

:03:19. > :03:25.NHS were to offer a truly seven days a week service, we would expect to

:03:25. > :03:30.see these differences even out. research bears out many patients'

:03:30. > :03:35.experience, what one charity has described as weekend malaise. This

:03:35. > :03:39.woman had a hysterectomy on a Friday morning. A friend came in who was a

:03:39. > :03:45.nurse who noticed that my trip had run out and that my painkiller had

:03:45. > :03:50.run out. She called the nurse, she was overstretched, there was too

:03:51. > :03:58.much to do, not enough time. But eventually, it got sorted. Over the

:03:58. > :04:03.weekend, on the Sunday, they had been let down by an agency nurse, so

:04:03. > :04:09.there were only two nurses on cover. Again, they were struggling. That

:04:09. > :04:18.pattern is not the same everywhere. In Southampton, some surgeons say

:04:18. > :04:22.they do not see that Friday is out. Maureen Cox came in as an emergency

:04:22. > :04:30.late in the week. After a tricky operation, she spent the weekend in

:04:30. > :04:33.intensive care. She is recovering now. It is remarkable.Her surgeon

:04:33. > :04:40.specialises in stomach and oesophagus surgery. We do this three

:04:40. > :04:45.days a week, and we do not see a difference in our outcomes, we

:04:45. > :04:50.scrutinise them, so we are the first to know if there is a problem. If's

:04:50. > :04:57.over the past five years, we have changed the way we deliver the

:04:57. > :05:01.service, so we can provide care around the clock. He says it is not

:05:01. > :05:04.just a question of resources, but the way the hospital is organised.

:05:04. > :05:13.We have a large number of consultants, the economies of

:05:13. > :05:16.scale, and that is the future of the delivery of complex surgery. Within

:05:16. > :05:23.big centres, lots of consultants, providing 24 hour care for completed

:05:23. > :05:27.patients. For many, including obstetricians, that underlines the

:05:27. > :05:32.need for reconfiguration in the NHS, to concentrate services in fewer

:05:32. > :05:36.hospitals, let them become centres of excellence seven days a week.

:05:36. > :05:39.Even those who support this recognise it is hard to sell the

:05:39. > :05:44.idea of closing hospitals to patients. In the large conurbations

:05:44. > :05:48.in the UK, where there are many hospitals, they do have to realise

:05:48. > :05:53.there has to be rationalisation of some of the facilities that

:05:53. > :05:57.hospitals can offer. It is more challenging in parts of the world

:05:57. > :06:02.like where I work, in the West Country, where you have greater

:06:02. > :06:09.distances, and people expect a sick core functions to be provided in

:06:09. > :06:16.their local hospital. But in the cities, there needs to be greater

:06:16. > :06:19.centralisation, as has been shown for conditions like/. The survey's

:06:19. > :06:23.authors did not explain the differences they found, though they

:06:23. > :06:26.said that as the NHS is trying to become more efficient it has two

:06:26. > :06:32.make provision to ensure the best outcomes, especially for vulnerable

:06:32. > :06:38.patients. Bruce Keogh is the medical director

:06:38. > :06:42.of NHS England. We will also hear from Mark Porter from the BMA and

:06:42. > :06:48.Philip Lee, a doctor and a Conservative MP, who thinks the NHS

:06:48. > :06:52.needs a shake-up. How worried are you by the discrepancy? I am worried

:06:52. > :06:59.by any discrepancies that I see. I would like to put this in some

:06:59. > :07:07.context. The results for elective surgery are very good, with

:07:08. > :07:11.mortality less than 1%. Some of the statistics that have been quoted

:07:11. > :07:15.showing higher mortality at different times of the week need to

:07:15. > :07:23.be seen in context. The authors looked at mortality two days

:07:23. > :07:29.following surgery. On a Monday, the number of deaths cost 0.7 per 1000,

:07:29. > :07:36.rising to 0.9 per 1000 on a Friday. Whilst that is quite a big increase

:07:36. > :07:43.in percentage, in general terms, it should not frighten patients.

:07:43. > :07:48.not think it is acceptable, however? No, and you will know that

:07:48. > :07:53.I have been central to trying and raised the debate of how we can

:07:53. > :07:58.improve services, seven days a week. It is my sense that other service

:07:58. > :08:04.industries have moved on and off routine services seven days a week,

:08:04. > :08:10.but healthcare has liked behind. have raised this repeatedly, as have

:08:10. > :08:16.other people, but given that you are the director of NHS England, what is

:08:16. > :08:22.stopping this happening? One of the things is we need to agree a

:08:22. > :08:27.sustainable, clinical model and a sustainable financial model, so on

:08:27. > :08:31.the half of NHS England, I am convening a forum of chief

:08:31. > :08:36.executives, finance directors, clinicians, presidents of colleges,

:08:36. > :08:43.to work out an agreed way forward. Many hospitals have moved in this

:08:43. > :08:46.direction, you have mentioned Southampton, and they are ahead of

:08:46. > :08:51.many hospitals. Others are following. There are some complexity

:08:51. > :08:59.she is. Isn't one of them, if you move to seven-day working with the

:08:59. > :09:06.same resources, and we know the resources problem, you can make

:09:06. > :09:12.things worse? I do not believe that is the case necessarily. It is a

:09:12. > :09:19.matter of working practices. Much of the research which has shown

:09:19. > :09:22.differences in outcomes at the weekend has shown that by delivering

:09:22. > :09:29.services in a different way we can significantly influence outcomes,

:09:29. > :09:32.which has led to the Royal colleges and other professional groups

:09:33. > :09:38.starting to identify potential solutions, like having more

:09:38. > :09:44.consultant residents at the weekend, and improving access to diagnostic

:09:44. > :09:48.services for GPs and hospitals. do you make of the argument that in

:09:48. > :09:52.the end it is going to mean a bit of pain, because what has got to happen

:09:52. > :09:57.is more centres of excellence, more bigger hospitals, so some people

:09:58. > :10:02.will lose out occurs hospitals that do not provide surgery will have to

:10:02. > :10:06.close? That is a realistic possibility. In some specialties,

:10:06. > :10:15.centralising services, bringing expertise together, improves

:10:15. > :10:18.outcomes. An example would be /services in London, there were 32

:10:18. > :10:25.hospitals at one point, but after the reorganisation, there will only

:10:25. > :10:28.be paid hospitals -- only eight hospitals were left, and the result

:10:28. > :10:35.is a lower death rate, better outcomes, more patients returning

:10:35. > :10:41.home, a shorter length of stay, and tens of millions of pounds saved.

:10:41. > :10:46.be clear, the outcome would be better for all of us in general, but

:10:46. > :10:53.it would mean some hospitals would have to close because they would be

:10:53. > :10:57.no place for them? I would not say that, but some services would have

:10:57. > :11:01.to be centralised. People like to have hospitals and services near

:11:01. > :11:07.their home. It is important we do not deprive people of that. But

:11:07. > :11:13.where there is clear evidence that centralisation of services would

:11:13. > :11:18.revive better outcomes for patients, that is an area that we

:11:18. > :11:24.need to explore. We have got a slight problem with the sound, we

:11:24. > :11:29.will try to fix that. That last bit was music to your ears, because you

:11:29. > :11:34.are doing something that MPs are not going, campaigning for a closure of

:11:34. > :11:40.a hospital in your area? I and the only one, I have been doing it for

:11:40. > :11:43.three years in the Thames Valley. My constituency is practical, but I

:11:43. > :11:49.have worked in the Thames Valley for almost ten years, I have looked

:11:49. > :11:54.after 50,000 patients, I have long thought we needed a more

:11:54. > :12:00.consolidated acute service on the M4, with more community hospital

:12:00. > :12:06.locations doing the chronic care. Before I became an MP, Mike argued

:12:06. > :12:11.for it, and since I have been giving it, I have done the same thing.

:12:11. > :12:16.big hospital and others lose the right to do surgery, so they will be

:12:17. > :12:21.closed or diminished? diminished, I would say changed. The

:12:21. > :12:26.majority of expenditure is on chronic care, and most of that can

:12:26. > :12:32.be delivered closer to home. With the advances of telemedicine, we can

:12:33. > :12:39.be in the home or in the GP practice or in the community. The impression

:12:39. > :12:44.is that a lot of MPs are responsive to the people in their area, they

:12:44. > :12:49.say, do not close, do not change. the past, it was good politics to

:12:49. > :12:54.defend services that were indefensible. Now, it is good

:12:55. > :12:58.politics to save lives. You are a lone voice. At the moment.

:12:59. > :13:03.Colleagues share my view, but they are reluctant because of the way in

:13:03. > :13:09.which you describe politics. Do you see the system is being an

:13:09. > :13:16.anachronism, and in the 21st century we need something different? No, it

:13:16. > :13:20.has been planned, not centrally from the start, it has grown up according

:13:20. > :13:25.to local need, with specialties provided in different places. But it

:13:25. > :13:30.is not just there, it delivers an excellent service that we need to

:13:30. > :13:35.continue to improve. This research gives us information about the sort

:13:35. > :13:40.of things we need to do to continue improving. What about the things

:13:40. > :13:45.Philip Lee was talking about, that way forward? The important thing is

:13:45. > :13:48.getting a balance between local delivery of services and the

:13:48. > :13:53.necessity to follow the evidence where it exists, to make sure we are

:13:54. > :13:57.not actually delivering below standard care for conditions where

:13:57. > :14:03.we can show that centralisation is best, but in other conditions, the

:14:03. > :14:11.clinical evidence may show that it is not necessary to centralise, we

:14:11. > :14:14.can deliver everywhere. What do you say to this view that part of the

:14:14. > :14:19.NHS are run more for the benefit of people who work there rather than

:14:20. > :14:24.patients? That is putting it badly? That is something that anybody in

:14:24. > :14:33.any work face has to think about, are you serving the people who use

:14:33. > :14:37.the service? That is the argument? The NHS has a mould of working that

:14:37. > :14:44.mirrors what happens in the rest of society and we talked about

:14:44. > :14:48.supermarkets being open all day and at weekends and the NHS is open all

:14:48. > :14:53.day and night and takes people, whatever the need or the time.

:14:53. > :14:58.about seven-day working? I am in favour of that by directly knows

:14:58. > :15:02.that in order to deliver that, you need fewer sites because to have a

:15:02. > :15:06.life outside of work, you cannot have a long list of district

:15:06. > :15:11.hospitals in which we expect consultants to work seven days every

:15:11. > :15:16.week. With a consolidated service, like with Southampton, you can have

:15:16. > :15:22.more consultants and they only do so many weekends every year so in order

:15:22. > :15:28.to deliver seven days, care which would address the figures that have

:15:28. > :15:33.come out, you need fewer acute surgical sites. Do you accept that?

:15:33. > :15:36.In some specialties, the evidence points that way. The key is to

:15:36. > :15:42.follow the evidence, and where it can be shown that this specialising

:15:42. > :15:48.helps, do so but that does not mean we must move to is simple solitary

:15:48. > :15:57.system. That would not serve the population well. I hope the line has

:15:57. > :15:59.been re-established. The political context of this is we have had the

:15:59. > :16:04.Mid Staffordshire report and reports suggesting nurses should care more

:16:04. > :16:08.for patients and cheap keys are not prepared to work outside of their

:16:08. > :16:17.powers and so on, so the politics science that patients of being

:16:17. > :16:20.softened up. -- are being. The NHS is owned by the people and it is

:16:20. > :16:27.there to serve the people and rightly there will be vigorous

:16:27. > :16:32.debate about the direction of travel for the NHS over the next few years.

:16:32. > :16:36.All healthcare systems are in the grip of a triple pincer of

:16:36. > :16:42.increasing costs and escalating demand and tight fiscal

:16:42. > :16:47.environments. Those things can be very difficult to balance. What this

:16:47. > :16:52.does is it provides an impetus for us to focus on new, different ways

:16:52. > :16:57.of delivering services and I believe that with appropriate public rebate

:16:57. > :17:03.and the intellectual capital that resides within the people who work

:17:03. > :17:08.in the NHS, we can solve this. Philip, you have not blamed staff

:17:08. > :17:14.but some have and the implication of some reports has been that. If the

:17:14. > :17:19.basis of the reforms is trust staff more, give clinicians more power,

:17:19. > :17:24.how does that square with some reports that seemed to undermined

:17:24. > :17:30.the confidence of some doctors? The reforms to years ago by the

:17:30. > :17:34.collation were more about trusting primary-care physicians to construct

:17:34. > :17:41.services to suit patients so it was not necessarily about hospital

:17:41. > :17:45.consultants. But what I must emphasise is that all I am

:17:45. > :17:49.interested in is clinical outcomes, the best outcomes, and I am not

:17:49. > :17:57.convinced that we have the structure, hospitals and clinics in

:17:57. > :18:06.place to deliver the best outcomes. Thank you all very much. Thank you.

:18:06. > :18:14.In a moment. The legacy of the 1980s version of Doctor Who. Was it really

:18:14. > :18:16.rubbish? Today the European Commission continued its tiptoeing

:18:16. > :18:23.away from austerity, giving France and five other countries extra time

:18:23. > :18:27.to cut their deficits. But if the big European plan isn't austerity,

:18:27. > :18:30.what is it? Most are waiting for the German elections in September to

:18:31. > :18:33.give some kind of answer to that. But some are also nervously awaiting

:18:33. > :18:36.a British referendum. The Polish Foreign Minister, Radek Shikorski,

:18:36. > :18:42.is here, briefly a contemporary of David Cameron at both Eton and

:18:42. > :18:48.Oxford. But first, our diplomatic editor, Mark Urban. In terms of a

:18:48. > :18:54.sturdy, is the commission moving the goalposts? This is a journey and in

:18:54. > :19:00.December 2011, this was meant to be tough stuff with legally enforceable

:19:00. > :19:02.limits on deficit spending. We get to the report card today and the

:19:02. > :19:08.European commission says that several countries have not made

:19:08. > :19:13.those limits. Will they give them more time? Portugal and the

:19:13. > :19:18.Netherlands, if you like, being given one more year. And another

:19:18. > :19:24.group of countries, further out of line, being given two more years.

:19:24. > :19:30.That includes France, one of the cheerleaders of the pact, it was a

:19:30. > :19:35.different president, Spain and Poland. Not in the Eurozone at the

:19:35. > :19:40.moment, they want to join but public opinion is difficult on that issue.

:19:40. > :19:48.You wonder where this leaves the dreams of further European

:19:48. > :19:52.integration? It is fascinating. Isn't it? David Cameron has built a

:19:52. > :19:57.lot of his politics are around the referendum issue. On the assumption

:19:57. > :20:01.that there must be some mean negotiation of the European treaties

:20:01. > :20:04.and this thinking, when it first came into being 20 months ago, was

:20:04. > :20:08.based on the idea that Eurozone countries needed closer integration

:20:08. > :20:13.to save the euro, what about the rest? Their rights are to be

:20:13. > :20:18.protected. This provides him with a template to open up a conversation

:20:18. > :20:26.in return for helping out Eurozone countries. And the UK might get

:20:26. > :20:27.concessions. Recently, key people in the -- in the EU, they seem less

:20:27. > :20:33.certain that this type of fundamental renegotiation is

:20:33. > :20:35.feasible and desirable. Where does this leave the support of Mr

:20:36. > :20:41.Cameron? He has been doing courting of some leaders, where is the

:20:41. > :20:47.support? He has had some displays of support from some governments, the

:20:47. > :20:52.Netherlands, Denmark and Sweden have been helpful, at least not in

:20:53. > :20:58.putting down his ideas. Angela Merkel has given him some room for

:20:58. > :21:03.manoeuvre. But there is the feeling among many Europeans that there is a

:21:03. > :21:08.loss of influence. Radek Shikorski in January talked about written from

:21:08. > :21:12.a country which was a natural member of the triumvirate kibble of ruling

:21:12. > :21:16.the EU and has moved to the category of a country of special concern.

:21:16. > :21:23.That is the key thing in the coming months. What influence can Britain

:21:23. > :21:30.exert in these delicate negotiations? Indeed. Thank you.

:21:30. > :21:34.Radek Shikorski is here. You know this country very well and you have

:21:34. > :21:40.lived here, how important is it to the people of Poland whether they

:21:40. > :21:50.are in or out? It does matter, particularly to those who admire

:21:50. > :21:55.Britain. You are a voice for liberal economics and for common-sense

:21:55. > :22:01.approaches and you will be missed in Europe. But it is a free union and a

:22:01. > :22:07.voluntary one so if you decide to leave, we will miss you and we hope

:22:07. > :22:11.it will not come to that! You have been here for quite a while, this

:22:12. > :22:18.debate has gone on for quite a while and are quite a few people saying,

:22:18. > :22:22.make up your mind. Would that we a good idea? To decide? It would be

:22:22. > :22:27.nice to resolve this. I spoke to Deputy Prime Minister this

:22:27. > :22:33.afternoon, Nick Clegg, who told me that it is extremely unlikely that

:22:33. > :22:38.Britain would vote to leave. When you talk about us being a country of

:22:38. > :22:46.special concern, the implication of that quote, is that that we have

:22:46. > :22:50.blown it? We could have been a bigger player? And we are not? It is

:22:50. > :22:58.difficult to lead a club when you're considering whether to stay in or

:22:58. > :23:02.out. So, yes, in that sense, you have weakened your hand. But not

:23:02. > :23:08.everything is lost, some of your concerns are being impressed, like

:23:08. > :23:14.the fisheries policy. And other reddish objections are relatively

:23:14. > :23:21.easy to address, the working time directive, for example. That is

:23:21. > :23:25.something you are getting sympathy from. Do you think we could be

:23:25. > :23:30.moving towards a situation where Mr Cameron will re-negotiate certain

:23:30. > :23:37.things which would amount to less that major treaty change? The

:23:37. > :23:42.premise of the referendum might not be right? It would not necessarily

:23:42. > :23:48.mean a change in the treaty? Well, the conditions have not been stated,

:23:48. > :23:56.I understand that some of these things don't even require treaty

:23:56. > :24:00.change, for example the working time directive which is the outcome of a

:24:00. > :24:07.verdict of the European court of justice. And that could be addressed

:24:07. > :24:10.at that level. In terms of European politics, it might mean that a

:24:10. > :24:15.number of countries want to re-negotiate and they could come to

:24:15. > :24:19.an agreement and that would require treaty change and the premise that

:24:19. > :24:25.Mr Cameron has launched, this view of having some referendum, might not

:24:25. > :24:30.be necessary? He has also, I understand, predicated the

:24:30. > :24:39.referendum on his party winning an outright majority in the next

:24:39. > :24:42.election. But on that point, then, you understand very well the

:24:42. > :24:48.domestic political concerns and not just domestic, but within his own

:24:48. > :24:53.party? I am confident that when the arguments are deployed and it is

:24:53. > :25:03.explained to the Tory party that the European commission is a force for

:25:03. > :25:04.

:25:04. > :25:10.opening markets, for competition, for no monopolisation, when this is

:25:10. > :25:14.explained how much influence Britain gets as a multiplier, in foreign

:25:14. > :25:19.policy, when it is explained that America would take a very dim view

:25:19. > :25:25.of Britain leaving the EU, when it is explained that European

:25:25. > :25:30.directives are not just invented by the European commission. They are

:25:30. > :25:36.agreed by member states. And when the alternative path is sketched

:25:36. > :25:40.out, Britain going it alone, while the rest of us are making a

:25:40. > :25:46.transatlantic free-trade area with America, I hope the British people

:25:46. > :25:50.will take the sensible decision. That is a very interesting list.

:25:50. > :25:57.a reflection on how things and Poland might see our debate here,

:25:57. > :26:05.that has not been at the forefront? Our opposition is against us joining

:26:05. > :26:09.the Eurozone. So nothing unusual about that. I think and hope that we

:26:09. > :26:16.shall get a mature debate in Britain with a real argument being

:26:16. > :26:20.addressed. But if you look at the state of the Eurozone, which we will

:26:20. > :26:26.come onto, if you look at the state of that, nobody in Britain is making

:26:26. > :26:33.any argument that we should join, it is seen really as either a dead duck

:26:33. > :26:37.or continuing trouble and staggering towards more trouble. We are not

:26:37. > :26:42.eager to join either until it fixes itself but remember, Eurozone gave

:26:42. > :26:47.members one decade of extremely cheap money. And when it overcomes

:26:47. > :26:53.those problems, those interest rates might converge again to something

:26:53. > :26:56.like German levels and then it will be an official again to be a member.

:26:56. > :27:03.You have called for more German leadership, which given the shared

:27:03. > :27:13.history, could be... And they have provided that. But we are waiting on

:27:13. > :27:14.

:27:14. > :27:17.what will happen with the German electorate in September. It will be

:27:17. > :27:23.harder fast troubled countries carry out their reforms. In Poland, we

:27:23. > :27:30.introduced because of judicial limit -- constitutional limit. Some other

:27:30. > :27:36.countries are only now fixing their public sector and the issue of

:27:37. > :27:40.competitiveness. Yes, I think bold decisions will become possible in

:27:40. > :27:46.Germany after the election but the real work is to be done in the

:27:46. > :27:55.troubled economies because the Eurozone is like the gold standard,

:27:55. > :27:58.it magnifies your competitiveness or lack thereof. Thank you very much.

:27:58. > :28:01.There's an old Bob Dylan song, I Pity the Poor Immigrant, which

:28:01. > :28:03.reflects on the rootlessness of people who move from one culture to

:28:03. > :28:06.another and could have roots everywhere but end up with roots

:28:06. > :28:09.nowhere. The London born novelist Taiye Selasi reflects on precisely

:28:09. > :28:16.that in her work, coining the phrase Lost in Transnation and the

:28:16. > :28:19.suggestion that she, among others, is an Afropolitan. One of Granta's

:28:19. > :28:29.young stars and a protege of Toni Morrison, she'll explain what she

:28:29. > :28:30.

:28:30. > :28:36.means in a moment. A full biography of Ty Selassie 's life would require

:28:36. > :28:42.a small novella. She is London born, American educated but with a deep

:28:42. > :28:48.attachment to parents's West African homeland. He still way behind him

:28:48. > :28:52.all those decades ago with the Ocean beside and he followed him

:28:52. > :28:58.everywhere since. Why are we not filming his life or the life of the

:28:58. > :29:04.men who he wishes to be? A writer and photographer, her debut novel

:29:04. > :29:08.has earned her a spot in Granta's stages list of Best Young British

:29:08. > :29:14.novelists. Her writing and photography raise questions about

:29:14. > :29:17.the nature of identity itself. Her concept of the Afropolitan has come

:29:17. > :29:24.to define a new generation of dynamic young Africans with complex

:29:24. > :29:27.heritage, one foot mounted in the heartlands of Africa, the other in

:29:27. > :29:32.their new Cosmopolitan lives in Western Europe and America. In the

:29:32. > :29:41.Bob Dylan song, the poor immigrant wishes he stayed at home. But the

:29:41. > :29:47.real question is where home might actually be.

:29:47. > :29:54.You have gone they Nigerian roots, Britain, United States... Where is

:29:54. > :30:01.home? I have got four of them! feels like home? There are four

:30:01. > :30:05.places. It has nothing to do with geography, it is personal, which is

:30:05. > :30:13.the case for the characters in this novel. When you are moving around

:30:13. > :30:20.like I do and my family, home because it's -- home becomes

:30:20. > :30:27.emotional, not geographical. There is a Roman India, a Roman New

:30:27. > :30:31.Jersey... Some people would see all of that as enriching, because you

:30:31. > :30:38.can dip into cultures, but it might be destabilising, and that is part

:30:38. > :30:45.of what you write about. You can enjoy the richness of it, but you

:30:45. > :30:51.are slightly uncertain of yourself, perhaps. In 2005 I wrote an essay,

:30:51. > :30:56.what is an Afropolitan? Those of us who have a fraught time and touring

:30:56. > :31:03.the question, where are you from? You say, I was born in London, I

:31:03. > :31:07.speak with an American accent... One can become self-conscious of the

:31:07. > :31:14.fact that everybody else can give a simple answer, but you are stuck in

:31:14. > :31:24.between. You have written about the nature of colour itself, blackness

:31:24. > :31:26.

:31:26. > :31:34.and beautiful round skinned people. -- round skinned. You consciously do

:31:34. > :31:40.this. Why do I reject the label Black? It is a fiction. The idea of

:31:40. > :31:47.race, blackness and whiteness, is an invention, it has been doggedly

:31:47. > :31:52.sustained over time and reinforced in institution, which is the best

:31:52. > :31:59.way to keep things going, especially if you can get songs and slogans

:31:59. > :32:07.involved, but it is a myth. I live in Rome at the moment, and I have a

:32:07. > :32:10.friend who is a white American, blond haired, blue-eyed, marrying a

:32:10. > :32:16.girl from Sardinia, so in the States, we would call her Italian

:32:16. > :32:24.Emma and we would call him white, but my Sardinian friend's father

:32:24. > :32:34.said, few marry a white men -- if you marry a white man, I will be so

:32:34. > :32:36.

:32:36. > :32:41.new. So what are you? When you peel back the layers of the fiction of

:32:41. > :32:47.racial identity, you end up with what is more salient and human, in

:32:48. > :32:51.during, and that is culture. other thing that struck me about

:32:51. > :33:01.your writing, notions of beauty, the weight that is a construct, the

:33:01. > :33:01.

:33:01. > :33:07.Barbie culture, what's it that society gets wrong? There is a

:33:07. > :33:12.character, the youngest of the four children, she has a moment when she

:33:12. > :33:16.reflects that, growing up, she is aware that she wanted to look like a

:33:16. > :33:26.Barbie doll, but being the daughter of an African immigrant, she does

:33:26. > :33:29.

:33:29. > :33:33.not. She says she looks like a doll when she would not have wanted. This

:33:33. > :33:37.was an allusion to a study when the young African-American girls were

:33:37. > :33:47.shown a black doll and a white doll and they all preferred the white

:33:47. > :33:48.

:33:48. > :33:57.doll. Intellectually, she gets it, suffering, she has a skinny blonde

:33:57. > :34:03.best friend that she would rather be. That comes from the expressions

:34:03. > :34:11.of hegemony, every time that she opens a magazine or tones on the TV

:34:11. > :34:16.or watches a film, what is considered beautiful looks one-way,

:34:16. > :34:21.and the poor immigrant looks the other way. These basic images that

:34:21. > :34:28.are thrown at young brown girls are something that I try to combat with

:34:28. > :34:35.documentary films and photography. We will have tomorrow's front pages

:34:35. > :34:40.before the end of the programme, but prestigious is the way Peter Davison

:34:40. > :34:44.chose to demonstrate the BBC's current attitude towards Doctor Who.

:34:44. > :34:47.It will mark its 50th anniversary later this year, and the British

:34:47. > :34:53.Film Institute has been screening stories from each incarnation of the

:34:53. > :35:02.Doctor. This month, it reached the 1980s, when prestigious hospital

:35:02. > :35:05.last word BBC bosses would have used to describe it. But it managed to

:35:05. > :35:15.stay on air until 1989, despite the reputation that it was a bit

:35:15. > :35:18.

:35:19. > :35:26.rubbish. We ask Shaun Ley to go back to the 80s and explain.

:35:26. > :35:34.It looks just like a body of quarry. In fact, this is another world. Put

:35:34. > :35:37.this back on! OK, it is a muddy old quarry in the Home Counties. During

:35:37. > :35:44.the heyday, places like this would have been full of alien invasions

:35:44. > :35:48.and rubber monsters. But it has still managed to scare the living

:35:48. > :35:58.daylights out of generations of kids, this one included. Then

:35:58. > :36:00.

:36:00. > :36:05.something changed. For this was the 1980s. It was a rough ride in the

:36:06. > :36:09.1980s. It was not just the police box which dated Doctor Who. Star

:36:09. > :36:19.Wars and other films delivered science-fiction with panache.

:36:19. > :36:20.

:36:20. > :36:25.Meanwhile, Doctor Who. On the small screen, it had a old, glossy new

:36:25. > :36:31.look, but the way it was made had not received a makeover. People

:36:31. > :36:34.blade used to a faster pace, more complex characters, and there was a

:36:34. > :36:38.simplicity about the way it was doing things that was making it look

:36:38. > :36:45.increasingly out of step. In studios, several cameras covered the

:36:45. > :36:51.same scene. It relied on special effects, recorded in the same weight

:36:51. > :36:57.as a courtroom drama or a soap. I was a timelord and we had no time.

:36:57. > :37:06.We had to do things by pulling the plug at ten o'clock, and if we did

:37:06. > :37:16.not get the scene in, it did not go in. Once more, please. We cannot.

:37:16. > :37:16.

:37:16. > :37:20.sorry, it is ten o'clock. Fire again! A film would have been a bit

:37:20. > :37:30.more subtle in lighting this futuristic sea bass, but time and TV

:37:30. > :37:32.

:37:32. > :37:38.tradition served to expose the limits of the budget. Just a few

:37:38. > :37:44.weeks after the green sea monster came this, a relatively new director

:37:44. > :37:51.stirring things up. His Doctor Hugh debut so -- showed the programme

:37:51. > :37:58.could changed. He even got the lights turned down. I knew the way

:37:58. > :38:02.to present it cost to use a single camera, more than it had been used.

:38:02. > :38:06.Instead of doing a whole scene at once, cutting between several

:38:06. > :38:16.cameras, he tried to record like a film, one shot at a time, editing

:38:16. > :38:23.

:38:23. > :38:28.the accolade of a special showing at the BFI on London's South bank, part

:38:28. > :38:32.of celebrations for the 50th year. It is the relentlessness of the pace

:38:32. > :38:37.of the story, it starts off high and goes up from there. It is so

:38:37. > :38:43.exciting. It has got a punch, there is a grittiness. It begs the

:38:43. > :38:49.question, could 80s Doctor Who have been made this way all the time?

:38:49. > :38:55.Could I do this in the time given? had a good try! But after the first

:38:55. > :39:05.block, when I got myself into serious trouble and did not

:39:05. > :39:07.

:39:08. > :39:11.complete, I have to use four or five cameras per scene. But at least he

:39:11. > :39:20.did get the opportunity to put his directorial stamp on a moment that

:39:20. > :39:23.is uniquely Doctor Who, the change of lead actors. I must have been

:39:23. > :39:33.listening to a fantastic piece of music by the Beatles, and at the

:39:33. > :39:43.end, the orchestra driving itself bonkers, to a big explosion of a big

:39:43. > :39:50.

:39:50. > :39:54.piano chord. So I used that as my casting quality mix used by John

:39:54. > :40:00.Turner, producer for the whole of the 1980s, to keep it in the public

:40:00. > :40:04.eye. The programme attracted some amazing names, but sometimes the way

:40:04. > :40:10.they were directed all dressed undermined the fact that they were

:40:10. > :40:20.good at is. If they were being encouraged to camp it up. Sometimes

:40:20. > :40:22.

:40:23. > :40:32.the programme looked less drama, more pantomime. How evil! Some

:40:33. > :40:34.

:40:34. > :40:38.grumbled. I played my spoons on her front, and it bounced! I arrived

:40:38. > :40:44.with my bag of tricks and started playing them all, but as we went

:40:44. > :40:49.through, I realised, there is more, this is a great acting role, one of

:40:49. > :40:56.the best on television, because you can go so many places. There was a

:40:56. > :41:06.pantomime aspect, you have the glutinous and camp, and it is deeply

:41:06. > :41:08.

:41:08. > :41:17.sinister. You make sweets that kill people? There is a danger that

:41:17. > :41:20.people only see the surface. A more contemporary travelling companion

:41:20. > :41:26.allowed Doctor Who to engage in social commentary, exploring issues

:41:27. > :41:33.like racism. The companion was too often there to ask the question and

:41:33. > :41:37.trip over and lead to get rescued, and audiences were tired of that. It

:41:37. > :41:47.was only towards the end of the decade that a hint of emotional

:41:47. > :41:54.intelligence krypton. An emotional cripple, a social misfit! She was

:41:54. > :42:00.the first step to what we have now. It is not true. But there is nothing

:42:00. > :42:06.like a Doctor Who monster to scupper a writer's Scott -- subtext.

:42:06. > :42:16.thought there would be a subtle but discernible lesbian subtext between

:42:16. > :42:20.her and Cara. The subtlety of that was conveyed in the face and the

:42:20. > :42:30.close-up and the movement, and this was buried under the teddy bear

:42:30. > :42:30.

:42:30. > :42:35.heads, which was slightly disappointing. Bold ideas like that

:42:35. > :42:41.are one answer to the question, was 80s Doctor Who rubbish? Michael

:42:41. > :42:45.grade could not see beyond the effects. I thought it was pathetic.

:42:45. > :42:51.I had seen Star Wars, and close encounters of the third kind, and

:42:51. > :43:01.ET, and then I had to watch these cardboard things clunking across the

:43:01. > :43:01.

:43:01. > :43:08.floor. If he moves really badly, poorly animated... But she looks

:43:09. > :43:13.great. The rocks are plastic holders that do not weigh anything at all,

:43:13. > :43:23.it is the dichotomy of the show, the good design and the bad design in

:43:23. > :43:27.the same shop. Even a quarter of a century later, in an age of CGI,

:43:27. > :43:37.some of the effects work still stands up to scrutiny. I remember

:43:37. > :43:39.

:43:39. > :43:45.this. It was a high Marsh to Indiana Jones. It is very effective. It was

:43:45. > :43:49.brilliantly done, so simple. Very well made from wax, and they got

:43:49. > :43:59.hairdryers on either side of the camera and blew onto it. It was

:43:59. > :43:59.

:43:59. > :44:05.glorious. Doctor! Soon, British TV viewers would enjoy the delights of

:44:05. > :44:11.reality TV instead, something Doctor Who addicted, and like the people in

:44:11. > :44:20.charge on Doctor Who, the BBC decided it would be better off

:44:20. > :44:25.without the doctor. The execution of Doctor Who in the 80s did not always

:44:25. > :44:28.live up to the bold ideas, but the youngsters who grew up with it are

:44:28. > :44:34.the ones making the multi-award-winning programme now.

:44:34. > :44:44.Perhaps 80s Doctor Who was the catalyst.

:44:44. > :45:14.

:45:14. > :45:17.To not have nightmares! The front That is it for tonight, we leave you

:45:17. > :45:22.with pictures of the highest base jump ever to mark the 60th

:45:22. > :45:32.anniversary of the conquest of Everest, Valery Rozov jumped from

:45:32. > :46:02.

:46:02. > :46:08.the North face at a height of 23,000 are continuing with sunshine to the

:46:08. > :46:16.West, thicker cloud further east. Patchy rain first thing in the

:46:16. > :46:21.morning. One or two showers might be heavy. Sunshine is abundant across

:46:22. > :46:27.Northern Ireland. The North West of Scotland stays fine and dry. Further

:46:27. > :46:33.east, a bit more cloud. The temperatures creeping up into double

:46:33. > :46:37.figures along the east coast of England. A cold day. Moved inland,

:46:37. > :46:43.some holes in the cloud, come the afternoon. A better chance of this

:46:43. > :46:53.sunshine, we have the showers. One ought to have the potential to be

:46:53. > :47:00.

:47:00. > :47:05.slightly. Scotland and Northern Ireland start to see their

:47:05. > :47:10.temperatures dropping away, as cloud arrives. Further south, across

:47:10. > :47:16.England and Wales, things should write an up and warm up on Friday,