:00:18. > :00:23.inadequate, lax. Where is the NHS now failing to many patients?
:00:23. > :00:27.oldest alarm in the world has gone out. A life is in danger.
:00:27. > :00:31.One celebrated as the end of the world, tomorrow an inquiry into
:00:31. > :00:35.high death rates at 14 hospital trusts in England is expected to be
:00:35. > :00:41.brutal. How could one Health Trust given a clean bill of health by
:00:41. > :00:44.inspectors this year then allow this to happen. She hated the
:00:44. > :00:49.nights more than anything. She said the nights are horrific. She would
:00:49. > :00:53.ring the bell in the middle of the night for pain relief screaming in
:00:53. > :00:59.agony, they said they would come back and be away for an hour. And
:00:59. > :01:02.they might just give her a tablet. In the studio doctors, health
:01:02. > :01:05.policy professionals, politicians and bereaved parents.
:01:05. > :01:11.And ahead of tomorrow's report a political row tonight with
:01:11. > :01:15.accusations that in 2010 the Labour Health Secretary, Andy Burnham
:01:15. > :01:19.ignored more than 1500 warnings of failures at these trusts. Also
:01:19. > :01:24.tonight this former soldier is to be extradited to America possibly
:01:24. > :01:34.to face years in prison for fraud. He said he suffers from post
:01:34. > :01:37.
:01:38. > :01:41.traumatic stress disorder, is it right to hand him over? Good
:01:41. > :01:46.evening. The Mid Staffs scandal was a terrible moment for the NHS,
:01:46. > :01:50.people prayed it was a one-off, but it was not. Tomorrow the
:01:50. > :01:56.investigation led by the NHS Medical Director sur Bruce Keogh,
:01:56. > :02:01.will report on 14 other trusts with high mortality rates. Brian Jarman,
:02:01. > :02:05.an advise Tory the Keogh Review, who is here tonight, said there
:02:05. > :02:09.were 13,000 excess deaths at the 14 Trusts between 2050 and 2010. The
:02:09. > :02:12.run-up to the report has become intensely political with Labour's
:02:12. > :02:16.now shadow secretary denying any blame for the failings in the NHS
:02:16. > :02:20.when he was at the helm. But such is the importance of the Keogh
:02:20. > :02:25.Review that it may be a defining moment for the future of the health
:02:25. > :02:31.service in England. One man that hopes it will be the case is James
:02:31. > :02:35.Titcombe, whose baby son Joshua died when a serious infection was
:02:36. > :02:40.missed at Furness General Hospital. What are your hopes tomorrow?
:02:40. > :02:44.hope it is a real light shone on to the 14 Trusts and it exposed really
:02:44. > :02:49.what has been goingen in those Trusts, and hopefully it can lead
:02:49. > :02:54.to recommendations to make sure that things improve pretty quickly.
:02:54. > :02:58.-- Going on in those trusts and hopefully it can lead to
:02:58. > :03:02.recommendations to make sure that things improve pretty quickly.
:03:02. > :03:06.What does it say about that number of deaths? The numbers of deaths in
:03:06. > :03:10.those 14 hospitals exceeded the number that would have taken place
:03:11. > :03:14.had they had the national death rate for age, sex and diagnosis and
:03:14. > :03:19.so on, it is compared to what would have been expected by the national
:03:19. > :03:24.death rates. It is a stark sum then? It is.Do you think we are at
:03:24. > :03:28.a moment in the NHS with Sir Bruce Keogh's report? I think it is a
:03:28. > :03:32.tipping point in the NHS. It is a point where we are beginning to say
:03:32. > :03:36.let's not deny the data, let's actually look at it and make
:03:36. > :03:40.improvements. That to me is a dramatic change from the attitude
:03:40. > :03:44.of the last decade or so. We will be discussing all that and we will
:03:44. > :03:49.be hearing from Sir Brian and James Titcombe and other other guests in
:03:49. > :03:57.a little while. First we report on why it has taken so long for all
:03:57. > :04:03.these problems of patient care and inadequate regulation to emerge.
:04:04. > :04:10.It used to set Britain apart, we could rely on the NHS. It truly is
:04:10. > :04:19.one of our greatest and proudest achievements. But something has
:04:19. > :04:21.gone wrong. After the terrible revelations of neglect of
:04:21. > :04:26.vulnerable patients in Mid- Staffordshire, and with more
:04:26. > :04:35.hospitals still being put on the watch list, we have all been left
:04:36. > :04:40.wondering just how safe our local hospital really is? Tameside is one
:04:40. > :04:44.of 14 Hospital Trusts placed under scrutiny earlier this year. The
:04:44. > :04:48.Medical Director of the NHS in England, Sir Bruce Keogh, picked
:04:48. > :04:53.these 14 because they have higher than expected mortality rates.
:04:53. > :04:58.These urgent reviews go beyond the routine work of the official
:04:58. > :05:00.hospital regulator, the Care Quality Commission, or CQC, which
:05:00. > :05:03.is coming under increasing criticism over why it has taken so
:05:03. > :05:08.long to act. This is the latest hospital to face serious questions
:05:08. > :05:12.over how well it has been caring for patients. But concern over care
:05:12. > :05:17.here isn't new, local people have been trying to raise the alarm for
:05:17. > :05:23.many years and even in the last few months there have been cases that
:05:23. > :05:30.have troubled families. Always had a smile. She was 84, very
:05:30. > :05:36.independent. Mark Burns mother olive had been diagnosed with lung
:05:36. > :05:44.cancer, but in April at Tameside was admitted to A&E with acute pain
:05:44. > :05:49.and unable to walk. It was three weeks it came to light she had a
:05:49. > :05:56.fractured hip. She suffered a stroke at the hospital and
:05:56. > :06:01.contracted the infeck Cdeficile. The staffing levels were
:06:01. > :06:05.unbelievable. Especially at night, my mum said she hated the nights
:06:05. > :06:08.more than anything. The nights are horrific. She would ring the bell
:06:08. > :06:12.in the middlele of the night, screaming in agony, and they would
:06:12. > :06:22.say they would come back to her, and they would be away for an hour.
:06:22. > :06:27.
:06:27. > :06:30.They might just give her the tablet. It is just horrendous. Just the way,
:06:30. > :06:35.the whole organisation, the hospital, seems to be upside down
:06:35. > :06:38.to me. Surgery seemed out of the question, and the family
:06:38. > :06:42.concentrated on getting olive home. What effect do you think it had on
:06:43. > :06:47.your mum the quality of the care in the hospital? Probably a week
:06:47. > :06:50.before she finally passed away she said she had enough. She was like
:06:50. > :06:56.she can't cope with this any more. She knew she wasn't going to get
:06:56. > :07:00.any more, she more or less gave up. Olive died the day after leaving
:07:00. > :07:04.hospital, the family has told the Keogh Review about what they see as
:07:04. > :07:08.appalling care. They have put in a hospital complaint but have yet to
:07:08. > :07:11.receive a formal reply. The coroner has called for an inquest and the
:07:11. > :07:21.hospital says it cannot now comment further. Though it is in on going
:07:21. > :07:25.
:07:25. > :07:29.discussions with the Burns family. It is a step in the right direction.
:07:29. > :07:33.Milton is an orthopaedic consultant at Tameside hospital, he has been
:07:33. > :07:36.raising concerns about the quality of care for much of the time he has
:07:36. > :07:42.worked there. He says that has made his working life difficult. He
:07:42. > :07:48.deals with the stress by hill walking. I have been raising
:07:48. > :07:54.concerns since 2002, principally because of low nursing staffing
:07:54. > :08:00.levels. For instance a nurse has been asked to look after up to 24
:08:00. > :08:05.patients. This is not exceptional, it is happening once or twice a
:08:05. > :08:08.month. But even one incident when there is so few nurses to look
:08:08. > :08:13.after patients then that has an impact.
:08:13. > :08:18.He took his concerns to senior staff at the hospital, and all the
:08:18. > :08:22.regulatory bodies, including the Care Quality Commission. When the
:08:22. > :08:28.inquiry into shocking standards of care into Stafford hospital first
:08:28. > :08:33.reported in 2010 it struck a chord. I could not help but think about
:08:33. > :08:39.our own situation at Tameside Hospital and I saw the similarities
:08:39. > :08:45.we had. In many respects internal reorganisation of wards,
:08:45. > :08:51.application for foundation status, Trust-Foundation status. The high
:08:51. > :08:56.mortality. Just two weeks ago the hospital suddenly announced that
:08:56. > :09:00.its chief executive and Medical Director were both to leave. An
:09:00. > :09:04.interim chief executive is now in place and has announced a six-month
:09:04. > :09:09.listening exercise for staff, patients and local people. Overall
:09:09. > :09:16.Milton thinks the hospital is now safe. For planned care. But still
:09:16. > :09:20.has concerns for the safety of emergency patients. Jill Edwards is
:09:20. > :09:25.a lawyer with some 20 clients with complaints against Tameside
:09:25. > :09:28.Hospital. Over a number of years we have seen a pattern of cases coming
:09:28. > :09:31.through from Tameside Hospital. So we have had inquiries from people
:09:32. > :09:35.who have expressed concern about the care that they or a family
:09:35. > :09:40.member have received at Tameside Hospital. It has come as no
:09:40. > :09:44.surprise to me and my colleagues that this is now the focus of
:09:44. > :09:49.attention. We know there are concerns about Accident and
:09:49. > :09:53.Emergency care. But also on the medical admissions unit and in
:09:53. > :09:57.relation to radiology. It is also known that the hospital has had
:09:57. > :10:02.higher than expected mortality rates for at least the past decade.
:10:02. > :10:05.Which is why it was included on Sir Bruce Keogh's list for indepth
:10:05. > :10:11.review. With all these repeated warnings and chances to put it
:10:11. > :10:15.right, why is it only now there has been this special in depth review,
:10:16. > :10:23.and why didn't the official regulator act sooner? Surprisingly
:10:23. > :10:26.in March this year the CQC judged Tameside Hospital to be safe.
:10:26. > :10:31.the Care Quality Commission didn't flag up problems as recently as
:10:31. > :10:37.February 2013 when they gave it a clean bill of health is beyond me.
:10:37. > :10:41.There have been concerns expressed for many years from local MPs, from
:10:41. > :10:49.patient support groups and the CQC were supposed to be there to flag
:10:49. > :10:54.up this sort of problem. They have been in exist since 2009. They had
:10:54. > :10:58.their -- existence since 2009. They had their chance to act. The CQC
:10:58. > :11:01.told Newsnight the early inspection was only limited in focus and today
:11:01. > :11:05.published a new inspection report on Tameside. It now says the
:11:05. > :11:11.hospital fails on three out of four national standards and warns that
:11:11. > :11:17.patients are not always protected from the risks of unsafe care. It
:11:17. > :11:20.noted that emergency staff levels had increased. Tameside told us it
:11:20. > :11:29.had already begun to address the issues and declined the request for
:11:29. > :11:34.an interview. The death of baby Joshua Titcombe at Furness General
:11:34. > :11:40.Hospital in Morecambe Bay has also focused intention on the
:11:40. > :11:44.inadequacies of past inspections by the CQC. Joshua died in 200 from a
:11:44. > :11:50.treatable infection. Two years later the CQC registered the
:11:50. > :11:54.hospital as safe. The absolute tragedy is Joshua's death wasn't
:11:54. > :11:58.learnt from and other babies continue to be put at risk, and
:11:58. > :12:02.other lives were lost. That's something that I find very
:12:02. > :12:06.difficult to come to terms with. the heart of the matter is also the
:12:06. > :12:10.lack of an investigation into the death of baby Joshua Titcombe.
:12:10. > :12:14.CQC now acknowledges it should not have said Furness General was safe.
:12:14. > :12:19.The current chief executive, in post for a year, faced MPs this
:12:19. > :12:23.month, after a critical independent report found evidence of a possible
:12:23. > :12:26.cover-up of CQC failings. The individuals involved fiercely
:12:26. > :12:29.dispute this. But it was your staff that were carrying out inspections,
:12:29. > :12:34.it was your staff that had to review the action plans, it was
:12:34. > :12:37.your staff that were making important decisions about the
:12:37. > :12:41.status whether it was red, amber, green. I don't wish to be evasive
:12:41. > :12:45.but what the report is saying is there was a lack of rigour and
:12:45. > :12:49.robustness around the work that CQC did in relation to Morecambe Bay.
:12:49. > :12:54.We are changing that, and we are moving on from that. There has to
:12:54. > :12:58.be a recognition that positive CQC inspections, in the past, mean very
:12:58. > :13:03.little. And I think there must be a lot of uncertainty about the actual
:13:03. > :13:08.safety of services in the NHS at the moment. That's just an
:13:08. > :13:12.unacceptable situation. Really we need it look at the CQC
:13:12. > :13:17.transforming in a very short period of time. So that we can actually
:13:17. > :13:21.have confidence that it is doing the job that it needs to be doing.
:13:21. > :13:25.Tomorrow Sir Bruce Keogh will publish his verdict on care at the
:13:25. > :13:30.14 hospital trusts. Newsnight has had access to all of the figures
:13:30. > :13:40.showing numbers of deaths above those expected statistic ically,
:13:40. > :13:52.
:13:52. > :13:56.Basildon and Thurrock is the worst, Most said they will respond once
:13:56. > :14:01.the full Keogh report appears tomorrow. Colchester and Dudley say
:14:01. > :14:07.their death rates are within the expected range. Basildon and
:14:07. > :14:13.Thurrock said they are committed to improving patient care. The data
:14:13. > :14:17.shows that Stafford was not a one- off. Putting all this right will
:14:17. > :14:27.not happen overnight. Though it should be simple to care properly
:14:27. > :14:30.for people when they are at their most vulnerable.
:14:30. > :14:34.Our political editor Allegra Stratton is here. First of all,
:14:34. > :14:38.what developments will happen tomorrow? The Keogh Review will
:14:38. > :14:41.start the summer of mud-slinging and slurs between the political
:14:41. > :14:44.parties. The Conservatives have been quite shocked so far that so
:14:44. > :14:48.far nothing seems to have stuck to the previous Government, even
:14:48. > :14:51.though some of these misdemeanors happened under their watch. So
:14:51. > :14:55.tonight we have and tomorrow we will hear more about it
:14:55. > :14:58.Conservative MPs putting forward what they have got out of the
:14:58. > :15:03.Government, which is in parliament they put down a proper official
:15:03. > :15:06.answer to a question this MP put. Which is that Andy Burnham was
:15:06. > :15:12.given 1500 warnings that there were problems going on around the
:15:12. > :15:16.country and he is supposed to much ignored them. Burn Ham has been
:15:16. > :15:20.drawn into this repeatedly over the last ten days and consistently said
:15:20. > :15:24.if you have proper evidence I will respond to it, until that point I
:15:25. > :15:28.won't. He feels he is being dragged into it when actually possibly this
:15:28. > :15:32.is more political than policy. Conservatives are desperate to land
:15:32. > :15:36.a glove. Why does it matter so much to them? It matters to them because
:15:36. > :15:41.they will never get the lead on the NHS they hankered after, Labour
:15:41. > :15:43.will get that. What has surprised them over the weeks of emerging ref
:15:43. > :15:47.layings about the standard of the NHS that nothing has stuck to the
:15:47. > :15:52.Labour Party. And that lead has actually grown for the Labour Party
:15:52. > :15:57.that they have got further and further ahead on the NHS, not
:15:57. > :16:00.actually shrinking. The Tories are trying to negate that lead. David
:16:00. > :16:05.Cameron once said the three letters that matter to him is the NHS. If
:16:05. > :16:09.he will get that even he needs to turn to the CQC and failings at it.
:16:09. > :16:14.Thank you very much. We are going to discuss all this now with our
:16:14. > :16:18.panel. James Titcombe and Brian Jarman are still here. We're joined
:16:19. > :16:24.by Camilla Cavendish who sits on the board of the Care Quality
:16:24. > :16:27.Commission, Andrew Gwynne is shadow health minister and Dr Bernadette
:16:27. > :16:32.Garrihy is an Accident and Emergency consultant, and Stephen
:16:32. > :16:39.Dorrell a former Health Minister. First of all Andrew, shadow health,
:16:39. > :16:45.a lot of flack is coming your way. A lot of what are called excess
:16:45. > :16:49.deaths happened on your watch, and the accusation is Andy Burnham had
:16:49. > :16:52.1500 indications? Can I just point out that Tameside Hospital that
:16:52. > :16:57.featured in your package is the hospital that covers the majority
:16:58. > :17:02.of my constituency, I know what has happened at Tameside over a period
:17:02. > :17:07.of time very well. You find it shocking? I do find it shocking, I
:17:07. > :17:12.found it shocking in 2009 that led myself and two other Tameside MPs
:17:12. > :17:17.at the time, James Purnell and David Hayes to go and see the
:17:17. > :17:21.Secretary of State, Andy Brunham, I have to say when we met with Andy
:17:21. > :17:25.in his office, and these words stuck with me over the years, he
:17:25. > :17:30.said to his officials who didn't want him to intervene in Tameside.
:17:30. > :17:40.He said the authoritative voice in these matters is the CQC, the Care
:17:40. > :17:40.
:17:40. > :17:43.Quality Commission, he said, and that has proved to be the case they
:17:43. > :17:48.were erroneous, they didn't have their finger on the pulse and they
:17:48. > :17:52.were wrong, he should have listened to those voices? He did listen to
:17:52. > :17:56.those voices. James did he listen to those voices? His words were
:17:56. > :18:04.very clear, he said there is no place in the National Health
:18:04. > :18:07.Service for sub-standard care. And that's when he ordered Monitor, the
:18:07. > :18:10.foundation trust regulator and the Care Quality Commission to go into
:18:10. > :18:14.Tameside Hospital. There is no doubt the previous Government made
:18:14. > :18:18.big mistake, not least the Foundation Trust programme that led
:18:18. > :18:22.to so many of these programmes in the first place. So Sir Brian you
:18:22. > :18:25.talk about the whole denial, the health service being in denial.
:18:25. > :18:31.There is no doubt that a lot of the problems happened during Labour's
:18:31. > :18:35.watch? Yes. After the Bristol inquiry, I was medical member of
:18:36. > :18:40.that, we decided we needed to do something. Every year we published
:18:40. > :18:44.in national newspapers these figures. Tameside was higher way
:18:44. > :18:48.back in 2001. It has been higher pretty well all the way through.
:18:48. > :18:51.They have known and we went to the Department of Health many times to
:18:51. > :18:55.try to get them to do something about it. It really was a
:18:55. > :19:01.continuous process of denial of the information. For someone who has
:19:01. > :19:06.been involved in the health service for so long was it profoundly
:19:06. > :19:11.depressing? I have always, I mean I went to the states and part of my
:19:11. > :19:16.training was there I was a medical resident in the states, I used to
:19:16. > :19:21.give lectures about how marvellous the NHS and of to Harvard students.
:19:21. > :19:25.About five years ago I decided I could no longer do it. I'm very
:19:25. > :19:27.much in favour of the principle of the National Health Service in that
:19:28. > :19:31.people are covered. No-one has to worry about the cost of their
:19:31. > :19:34.healthcare, compared with the states that is fantastic. But we
:19:34. > :19:38.can't make it poor care. Camilla Cavendish you were going to come on
:19:38. > :19:43.to a report you did on care workers in a moment, but you are on the
:19:43. > :19:47.Care Quality Commission now? Yes, I have just gone on to the board.
:19:47. > :19:50.it has a very, very tainted history? Of course, yes. Everybody
:19:50. > :19:53.has said it. It missed Mid Staffs, it missed add whole lot of other
:19:53. > :19:57.things, it probably missed hospitals we don't even know about
:19:57. > :20:01.yet. It was using generalists instead of experts to go into these
:20:01. > :20:04.hospitals. One of those people, Amanda Pollard, former inspector,
:20:04. > :20:07.has talked about how she was an expert in infection control, she
:20:07. > :20:12.was taken off doing that, sat in front of a computer and licensing
:20:12. > :20:16.all the bodies it had to license. It was not listening clearly to
:20:16. > :20:21.complaints from people, it failed. Even when it was meant to be
:20:21. > :20:28.reformed, you know, within the last nine months, look at Tameside. Is
:20:28. > :20:31.it still making mistakes? The point is how can patients have any faith
:20:31. > :20:35.in a regulatory system which even though it is under scrutiny is
:20:35. > :20:40.still failing? Well I think the answer to that is they are trying
:20:40. > :20:43.very hard to build a totally new system. So it used to have a
:20:43. > :20:46.thousand indicators, which was crazy, they are now reducing those
:20:46. > :20:49.indicator, they are hiring experts to go in rather than generalists,
:20:49. > :20:54.they have got a new Chief Inspector of hospitals who is coming on board
:20:54. > :20:58.this week. It is a tanker. It takes some time to turn it round. They
:20:58. > :21:05.are running as fast as they K but there is a risk. The major problem
:21:05. > :21:10.in the CQC, they say from 2009 they do not investigate poor care? How
:21:10. > :21:16.can you believe that our regulator does not investigate instances of
:21:16. > :21:22.poor care? It has a whole series of...What Is really happening, from
:21:22. > :21:25.2009 when the CQC and Monitor had Tameside Hospital on its radar at
:21:25. > :21:29.the insistence of Andy Burnham, every report they have published
:21:29. > :21:34.they have highlighted concerns about Tameside. What is baffling in
:21:34. > :21:38.March this year all of a sudden it is given a clean bill of health. I
:21:38. > :21:42.don't understand that as a Tameside MP. This whole point about not
:21:42. > :21:45.investigating poor care, do you understand why this is not
:21:45. > :21:49.happening, Stephen Dorrell? I don't understand why the CQC doesn't
:21:49. > :21:52.accept responsibility for looking at the quality of care delivered by
:21:52. > :21:55.each healthcare provider. I also think there is a huge trap in this
:21:55. > :22:01.which is is to imagine that the CQC is the solution to the whole
:22:01. > :22:05.problem. What we have to remember here is that Brian Jarman has been
:22:05. > :22:08.a very courageous campaigner determined to throw light op what
:22:08. > :22:12.goes on in the health service so that -- on what goes on in the
:22:12. > :22:16.health service so we face the truth about an institution that all of us
:22:16. > :22:19.are deeply committed to. It is that willingness to face the truth that
:22:19. > :22:23.the health service has found difficult over a long period.
:22:23. > :22:29.want to talk now about the whole patient experience and the patient
:22:29. > :22:34.care at ward level. You are a senior consultant in A&E and you
:22:34. > :22:40.have repeatedly voiced concerns about the level of patient care and
:22:40. > :22:43.what they experienced in being a patient? There is no doubt about it
:22:43. > :22:47.the Accident and Emergency service throughout the UK has been building
:22:47. > :22:52.towards a crisis for a number of years. We have been highlighting it
:22:52. > :22:55.in a number of ways. It was very difficult to meet with any positive
:22:55. > :22:58.response until very recently when a group of us in the Midland got
:22:58. > :23:03.together and found we were experiencing exactly the same
:23:03. > :23:07.problems. It is a critical mass?It was. In Susan's film you have
:23:07. > :23:11.Milton in the film saying he was repeatedly and had problems in his
:23:11. > :23:15.job for repeatedly bringing up problems about 24 patients to one
:23:15. > :23:20.nurse. Is there not a culture of coming together and airing these
:23:20. > :23:25.problems. The idea that whistle blowing is still a bad thing in the
:23:25. > :23:28.NHS? I think it is very hard for individuals whistle blow. What made
:23:29. > :23:33.it easier for us, but it gave our message more power was the fact
:23:33. > :23:35.that we could come together. We weren't necessarily criticising our
:23:35. > :23:39.individual organisations, because there were some very good things
:23:39. > :23:43.going on, but we were highlighting a problem that our speciality has,
:23:43. > :23:46.and a crisis. It is only recently a number of you got together. From
:23:46. > :23:52.the parents' point of view, when Joshua was very little and your
:23:52. > :23:55.wife had an infection and your son had an infection, you repeatedly
:23:55. > :23:59.said to the midwives there is something wrong? The concern was
:23:59. > :24:04.could Joshua have an infection, we asked about that and we were
:24:04. > :24:10.repeatedly told he was sign. Sadly he died as a consequence of that.
:24:10. > :24:13.Nine days laterment you asked to see a doctor? We asked is Joshua OK,
:24:13. > :24:21.we were told he was. We accepted that reassurance that the people
:24:21. > :24:24.that were looking after him were the experts and we accepted that.
:24:24. > :24:29.We shouldn't have and should have done something about it. Do you
:24:29. > :24:34.think the whole question of the NHS is there is not institutional low a
:24:34. > :24:37.lack of compassion, but compassion is not rated -- institutionally a
:24:37. > :24:41.lack of compassion, but compassion is not rated highly and compassion
:24:41. > :24:46.has gone out of the health service? I would say there is a culture of
:24:46. > :24:49.contempt in some parts of the health service for patient. I'm an
:24:49. > :24:53.associate editor of the Sunday Times, we have started a campaign
:24:53. > :24:57.on seven-day working, I have a slew of e-mails from people who arrived
:24:58. > :25:01.on a Saturday or Sunday and whose complaints have been ignored and
:25:01. > :25:05.not listened to. Some of the stories. They are not as terrible
:25:05. > :25:09.as James's story, but it is repeated. One person wrote to me
:25:09. > :25:14.and said the cleaners were more caring than any of the other staff
:25:14. > :25:18.in the hospital. This is because the caring isn't really valued.
:25:18. > :25:23.are hearing that firsthand there, why do you think that happens?
:25:23. > :25:27.think that most people in the NHS certainly going into it wanting to
:25:27. > :25:31.do a really good job, and go in every day wanting to care for
:25:31. > :25:34.people, what is really important is that if you haven't got the
:25:34. > :25:37.resource to do your job properly, if you haven't got the skills, if
:25:37. > :25:43.you haven't got the man power, if you haven't got the equipment, you
:25:43. > :25:47.need to be able to highlight that. That is where a lot of the issues
:25:47. > :25:50.arise. Camilla's recording care workers, there was an inadequacy of
:25:50. > :25:54.training and imbalance of training? The most important thing is to
:25:54. > :25:57.challenge poor care. What we found was junior people were not being
:25:57. > :26:01.listened to. That is the problem with the culture. So there is no
:26:01. > :26:04.sense in which junior people actually should have a say? Well, I
:26:04. > :26:08.think you know this discussion, there are two major problems,
:26:08. > :26:11.number one with regard to the doctors, if you report a complaint,
:26:11. > :26:16.a problem of the health service, and you have tried locally, and you
:26:16. > :26:25.tried to bring it to the attention of the authorities and so on
:26:25. > :26:29.outside, that doctor will be dismissed. They will have to sign a
:26:29. > :26:33.gagging clause to get any compensation for dismissal. Second
:26:33. > :26:37.of all regarding complaints, up to 2004 any person who made a
:26:37. > :26:42.complaint and it went beyond the hospital they were investigated by
:26:42. > :26:45.a local independent panel coroner and so on. From 2004 on wards all
:26:46. > :26:51.complaints, it is almost impossible to believe this, all complaints,
:26:51. > :26:56.except for less than one third of 1% have been thrown into a national
:26:56. > :26:59.waste paper basket, they have not been independent. Why did that
:26:59. > :27:05.happen? They haven't been fully investigated. Why?What happened
:27:05. > :27:11.was that they got rid of the independent review panel. And now
:27:11. > :27:15.they have gone to the primary Health Service Ombudsman, out of
:27:15. > :27:22.13,000 last year she fully investigated 222. That is shocking
:27:22. > :27:26.isn't it? Out of that only 232 got investigated? Mid Staffs for
:27:27. > :27:30.example between 2008-2011 there were 79 complaints to the ombudsman,
:27:30. > :27:34.she investigated two of them. That's what I'm talking about. That
:27:34. > :27:38.is lessons going unlearned. We did a review of the complaint process
:27:38. > :27:42.within the Select Committee. Where does the pressure come from? There
:27:42. > :27:47.used to be three tiers of examination of complaints when
:27:47. > :27:52.something went wrong in hospital. What's now, the system was
:27:52. > :27:57.simplified in order to require, first of all, the hospital to
:27:57. > :28:00.investigate its own complaints. Then with an appeal to the
:28:00. > :28:03.ombudsman. That is how the system is supposed to work. I entirely
:28:03. > :28:08.accept that it doesn't work properly, that is why we issued a
:28:08. > :28:12.report two years ago now. Which said that one of the problems of
:28:12. > :28:17.the qulure in the health service is that when a complaint arises of a
:28:17. > :28:21.patient -- culture, in the health service is that when a patient
:28:21. > :28:25.makes a complaint the first instance is explain what happened
:28:25. > :28:29.rather than investigate openly and honestly what went on that needs to
:28:29. > :28:33.be addressed. That is the cultural issue, let's look at the economic
:28:33. > :28:38.issue, economic and demographic pressures the NHS faces over the
:28:38. > :28:43.next 20 years, the line-up going steeply on this graph shows how
:28:43. > :28:47.much extra money would need to be spent just to keep the current
:28:47. > :28:54.level of service for our growing and ageing population. The straight
:28:54. > :28:59.line at the bottom is what happens if we keep spending frozen. The gap
:28:59. > :29:05.by 2020 is �54 billion. We are joined now by Fraser Nelson the
:29:05. > :29:09.Edgaror of the Spectator. This model, is it sustainable? Of course
:29:09. > :29:12.not. We have seen over the last decade the NHS's budget was more
:29:12. > :29:15.than doubled. If money was the answer we wouldn't be sitting here
:29:15. > :29:19.now having this conversation. Wait it is run is the problem. And this
:29:19. > :29:23.chart looks a bit suspicious to me, it looks like another demand for
:29:23. > :29:27.money. Sure, you can put a computer model and say, yes, we need X
:29:28. > :29:31.amount of money, but is the NHS twice as God as it was at the
:29:31. > :29:40.beginning of the last decade. I don't think anybody would say so.
:29:40. > :29:43.There is massive demographic pressures on the NHS. An ageing
:29:43. > :29:47.population and no more money. Problems of old age increasing, how
:29:47. > :29:51.will we deal with those? The rest of the developed world is dealing
:29:51. > :29:54.with these problems, they do not give a health service run by a
:29:54. > :29:58.massive and failing bureaucracy that we have at the moment. There
:29:58. > :30:01.are ways of running health services better than we do. Just look
:30:01. > :30:06.anywhere, Ireland literally anywhere else in the world.
:30:06. > :30:10.Bernadette you accept there has to be change and the model isn't
:30:10. > :30:14.sustainable? Within emergency medicine we are under incredible
:30:14. > :30:18.pressure, we have increasing attendances, and the numbers don't
:30:18. > :30:21.reflect the increasing complexity of cases we are seen, eld low
:30:21. > :30:27.people with a multiple health and social and mental problems. There
:30:27. > :30:31.needs to be a crossover with health and social care to help these
:30:31. > :30:36.people properly. The pressure will be massive on the money, so you
:30:36. > :30:40.would say some A&Es would close, will services have to go by the
:30:40. > :30:45.bored on the NHS? I certainly think in emergency medicine we can't
:30:45. > :30:48.continue with the current model, we can't have 250 departments across
:30:48. > :30:52.the UK providing 24/7 cover. It is not safe at the moment, we haven't
:30:52. > :30:58.enough staff to do it. If we give them all the money in the world, we
:30:58. > :31:02.haven't enough trainees coming through. We have to -- We have to
:31:02. > :31:08.accept and fess up to that? We have to, trying to do 250 trauma units
:31:08. > :31:10.around the country leads to poor care. We need a hierarchy that
:31:10. > :31:14.ensures that...Don't We have to have politicians to be honest and
:31:14. > :31:18.say this is going to happen. Of course when it comes to
:31:18. > :31:24.constituency by constituency no MP wants to lose the service, but we
:31:24. > :31:29.are going to have to speak honestly? If the service is sub-
:31:29. > :31:33.standard any MP should want high- quality care for constituents, what
:31:33. > :31:36.we have have do is ensure the health service changes
:31:36. > :31:38.fundamentally to deliver high- quality care. What happened at
:31:38. > :31:42.Morecambe Bay and what is happening tomorrow with the Keogh Review is
:31:42. > :31:47.the scales will finally fall from our eyes, I think. We will lose the
:31:47. > :31:49.romance of the NHS and say we are now going to be open-minded about
:31:50. > :31:54.how to make it better. We haven't been until now. That whole question
:31:54. > :31:59.of the romance, it is just over a year ago since Danny Boyle's 2012
:31:59. > :32:03.Olympic ceremony included this tribute to the role of the NHS
:32:03. > :32:08.played in British life. Some regard the celebration we saw at the
:32:08. > :32:13.Olympics as part of the problem. Do we actually fail to notice
:32:13. > :32:23.fundamental problems in healthcare because we do, as Camilla says row
:32:23. > :32:24.
:32:24. > :32:27.Manchester United size the NHS. -- -- romanticise the NHS? We do make
:32:27. > :32:31.it romantic, we are wanting a health service free at the point of
:32:31. > :32:34.use, don't give it to a failing bureaucracy to run. That is the
:32:34. > :32:38.problem. What everyone is striving for is fine but the way we are
:32:38. > :32:43.doing it is from the last century. I'm incredibly proud of much of
:32:43. > :32:47.what the NHS does, and what people working in the NHS do, Kirsty, it
:32:47. > :32:52.would be very unfair on a lot of very dedicated staff, nurses,
:32:52. > :32:56.doctorss and support workers to say it is all rotten. Because actual it
:32:56. > :33:00.isn't. That is a given. But the problem is, the very things you are
:33:00. > :33:04.saying are almost romanticising, and you are part of the problem?
:33:04. > :33:08.They are not romanticising, beau actually most people's experience
:33:08. > :33:11.of the -- because most people's experience of the NHS is good.
:33:11. > :33:21.Where we have poor care we need to move in and quickly and not accept
:33:21. > :33:23.
:33:23. > :33:27.the second-rate care. That is a failure of the NHS values. The NHS
:33:27. > :33:31.is national religion and the Tories are unbelievers, is that the
:33:31. > :33:38.problem? The problem is both parties are competing to see who
:33:38. > :33:47.the biggest believer in the last few years. When Labour reformed the
:33:47. > :33:57.NHS the Tories said hands off the NH S. We are finally seeing only
:33:57. > :33:57.
:33:57. > :34:03.too late when both parties have been going back and forth. It is
:34:03. > :34:06.not the workers but the bureaucracy. I would put in a great drive from
:34:06. > :34:12.patients and clinicians who would then employ the managers to make
:34:12. > :34:16.sure that our aim is to live within whatever we are given from the
:34:16. > :34:22.resource allocation from parliament to having got that amount it is to
:34:22. > :34:26.improve the quality of care. Not managers doinging it. To improve
:34:26. > :34:30.the quality of care but the extent of the care, do we have to be
:34:30. > :34:37.realistic at the extent of the care? Look we have only just under
:34:37. > :34:42.the European average of GDP. How can you have a system whereby acute
:34:42. > :34:48.abdominal pain, acute chest pain is managed by 111, a computer. When I
:34:48. > :34:51.for 28 years was visiting patients, if I did not examine the patient
:34:51. > :34:55.with acute abdominal pain I would be struck off and rightly so. This
:34:55. > :34:58.is incredible that these managers can run this system like that. How
:34:58. > :35:03.did we let that happen? What you have done is provided the
:35:03. > :35:06.information. The power here is the information. Once people, for years
:35:06. > :35:09.doctors have known which hospitals they wouldn't be treated in. The
:35:09. > :35:13.rest of us haven't known that. Once we get the manufacturing out there
:35:13. > :35:17.we will empower people to make -- manufactures out there we will
:35:17. > :35:22.empower people to make the right choices. What will it take to
:35:22. > :35:26.restore your faith in the NHS? complaints system that work, a
:35:26. > :35:30.system where when something tragic goes wrong the NHS doesn't cover up
:35:30. > :35:37.and the NHS concerns something about it and does something about
:35:37. > :35:40.it, and learns about it, and effective regulation. McIntyre is a
:35:40. > :35:44.former soldier who served in Northern Ireland, Bosnia, Iraq and
:35:44. > :35:51.Afghanistan. Now he's set to be extradited to the US on eight
:35:51. > :35:56.charges of fraud relating to a contract putting Quantum Risk, a
:35:56. > :36:04.security firm he ran in Baghdad in 2009 and the US Institute of Peace.
:36:04. > :36:09.The allegations of overcharging to the tune of $100,000, which he
:36:10. > :36:13.denies, emerged when he was serving with the royal military police, he
:36:14. > :36:20.was flown home to face charges. In a moment we will speak to him.
:36:20. > :36:23.First here is our report. David McIntyre was a soldier in the
:36:23. > :36:26.Queen's Lancashire Regiment, doing tours in Bosnia and Northern
:36:26. > :36:31.Ireland. He served in the royal military police in Afghanistan. But
:36:31. > :36:35.it was after he left the army, during his time as a contractor in
:36:35. > :36:40.Baghdad, providing security to American clients, such as the US
:36:40. > :36:47.Ambassador, that he's alleged to have carried out this fraud.
:36:47. > :36:51.Overcharging the American NGO, the United States Institute of Peace,
:36:51. > :36:59.by �65,000. The US indictment alleges that David McIntyre
:36:59. > :37:05.conspired knowingly and willfully to de advise and attempt to devise
:37:05. > :37:12.a scheme to fraud the NGO. David McIntyre is fighting all the
:37:12. > :37:16.charges, and his defence is on health grounds as he has been
:37:16. > :37:20.diagnosed with post traumatic stress disorder. Colonel McAlastair
:37:20. > :37:27.said that David McIntyre was at high-risk of suicide around the
:37:27. > :37:32.time, and that thoughts of his family may not be sufficient to
:37:32. > :37:37.counter the grave and immediate danger he may pose to himself.
:37:37. > :37:40.David McIntyre is not the first person to fight extradition on
:37:40. > :37:45.mental health grounds. Gary MacKinnon, accused by the United
:37:45. > :37:48.States of carrying out the biggest military computer hack of all time
:37:48. > :37:54.eventually won his battle against extradition when the Home Office
:37:54. > :37:57.said he was at high risk of suicide. But the Home Office is unconvinced
:37:57. > :38:02.that David McIntyre's condition is severe enough to prevent
:38:02. > :38:06.extradition. Saying it was treatable without the need for in-
:38:06. > :38:11.patient care. But there was no suggestion it couldn't be managed
:38:11. > :38:14.in custody either in the UK or the US. And the letter concluded that
:38:14. > :38:21.extradition would not be incompatible with his rights under
:38:21. > :38:25.the European convention. In 2006 these British businessmen, the
:38:25. > :38:31.NatWest 3, who were implemented in the Enron scandal were extradited
:38:31. > :38:35.and jailed in the US. One of them, David Birmingham, served time in
:38:35. > :38:39.five American prison, he's worried that David McIntyre will not get
:38:39. > :38:44.treatment in an American jail. have been in prison up close and
:38:44. > :38:48.personal with a number of people with very, very difficult
:38:48. > :38:52.psychiatric conditions who went absolutely completely and utterly
:38:52. > :38:58.untreat. It is desperate frankly. It is not the place to be if you
:38:58. > :39:02.have any kind of a mental disorder. I would not fancy being in Mr
:39:02. > :39:06.McIntyre's shoes in this particular scenario. David McIntyre's legal
:39:06. > :39:16.team has 14 days to consider whether to apply for a judicial
:39:16. > :39:16.
:39:16. > :39:22.review. David McIntyre joins me now. First of all you deny the eight
:39:22. > :39:25.charges, what is the American case against you? Unsubstantiated, and
:39:25. > :39:29.yeah I categorically deny all the charges against me. You know the
:39:29. > :39:35.charges as they exist? I know they have been read out to me from the
:39:35. > :39:39.documentation from the US. So they are quite specific, overcharging
:39:39. > :39:43.for a villa's rent when you could have got it more cheaply, you paid
:39:43. > :39:48.a bribe toe the contractors according to the indictment, and
:39:48. > :39:54.suddenly in mid-June you upped sticks from Baghdad and abandoned
:39:54. > :39:58.the contract and came away with $100,000? I didn't abandon the
:39:58. > :40:03.contract, back in the UK I lost my business and I was back in the UK.
:40:03. > :40:06.I insured the US IP could continue their mission in Iraq, in Baghdad,
:40:06. > :40:10.specifically in the villa I organised for them. So I didn't
:40:10. > :40:14.walk away from it at all, that isn't in the indictment that they
:40:14. > :40:18.have sent across from the US. During that time in Baghdad there
:40:18. > :40:22.was all sorts of rumours that things were done with cash in hand
:40:22. > :40:28.and the odd bribe, it might not have been called a bribe. Was it a
:40:28. > :40:33.lax system? To be honest I couldn't comment on that because obviously I
:40:33. > :40:36.couldn't comment, I wasn't privvy to everything that went on. It was
:40:36. > :40:40.certainly talked about but I wasn't privvy to everything that went on.
:40:40. > :40:43.Why, if they are asking you to face these charges you think you
:40:43. > :40:49.shouldn't be extradited? It is not that I don't want to face the
:40:49. > :40:52.charges, I'm happy to face ep this. I'm not happy to be put over to the
:40:53. > :40:57.United States and put in solitary confinement immediately and face 20
:40:57. > :41:07.years in a US pen tensionry. There is no way you to face these charges
:41:07. > :41:11.
:41:11. > :41:15.here. My Government isn't prepared to allow me to do that.
:41:15. > :41:19.At the very beginning that was not brought up your team when it could
:41:19. > :41:23.have been? This post traumatic stress disorder? I was serving in
:41:23. > :41:29.Afghanistan, I was taken into a room in uniform, I was taken on to
:41:29. > :41:33.a plane 45-minutes later, I was thrown into the UK 36 hours later I
:41:33. > :41:37.was in court in Westminster in uniform. My life had just gone into
:41:37. > :41:40.spiral. Unfortunately I do now know that I have been suffering from
:41:40. > :41:46.PTSD for several years. But it is not something you like to talk
:41:46. > :41:50.about in an open forum. But then that is surely if you raised it
:41:50. > :41:54.early, it seems that there were several times when your counsel
:41:54. > :41:57.could have raised in September, January and March, it was only
:41:57. > :42:01.raised at the 11th hour, if you raised it early, right at the
:42:01. > :42:04.beginning when you knew you had post traumatic stress disorder your
:42:04. > :42:10.case might have gone differently? You are quite correct. Why didn't
:42:10. > :42:14.you raise it? I didn't raise it because I'm an ex-soldier and if
:42:15. > :42:18.I'm told to go somewhere I did it. I listened to my legal counsel at
:42:18. > :42:23.the time, I had no concept of the procedure. I was told to be at a
:42:23. > :42:27.court at a particular time and date. I arrived there. My counsel was
:42:27. > :42:32.absolutely useless to that end this is why I asked for a change of
:42:32. > :42:37.counsel. In all the papers, did you know that you could raise the
:42:37. > :42:41.medical situation, because you raised the fact of a broken tendon
:42:41. > :42:48.or trained tendon at the beginning. Did your legal -- a strained tendon
:42:48. > :42:51.at the beginning. Did your legal team tell you could raise post
:42:51. > :42:54.traumatic stress disorder, if it was going to be material to your
:42:54. > :43:00.case, wouldn't you try everything in your armour to make sure your
:43:00. > :43:05.case was as strong as it could be? Yes you would do and I'm trying to
:43:05. > :43:09.do that now and is being put forward. Like I said my legal team
:43:09. > :43:14.was absolutely useless. I have subsequently found out potentially
:43:14. > :43:20.this wouldn't have got this car, it could have been can I Bosched the
:43:20. > :43:23.first day I was back in the UK if I had decent representation. What is
:43:23. > :43:30.the procedure? I have got 14 days where the Home Office ask for my
:43:30. > :43:35.removal to the US. I will be taken by US mash shells in a plane in
:43:35. > :43:40.shackle, taken into solitary confinement and given a piece of
:43:40. > :43:46.paper in front of me and I will be offered a plea bargain. It will be
:43:46. > :43:50.sign here, three years in a US jail or don't sign and 20 years in a US
:43:50. > :43:54.jail and never see your family again. In terms of what will happen
:43:54. > :43:58.in the next few days is it to get your case together for a judicial
:43:58. > :44:00.review? I'm still coming to terms with the fact that the Home
:44:01. > :44:04.Secretary, who hasn't read anything about the case, but just had a
:44:04. > :44:09.piece of paper put in front of her and signed it, she knows nothing
:44:09. > :44:13.about it. How will you cope?Again my life has gone into spiral and my
:44:13. > :44:18.family are going with me into spiral. It is difficult to put it
:44:18. > :44:28.into words how you are able to cope. Tomorrow morning's front pages now.
:44:28. > :45:00.
:45:00. > :45:07.The Guardian on the right-hand side That's all tonight, we leave you
:45:07. > :45:12.with 101 female skydivers in Russia, the latest jump called Pearls in
:45:12. > :45:22.the Sky, formed a flower in memory of the leader who died last year.
:45:22. > :45:45.
:45:45. > :45:50.It is open in the middle to Hello, more fine weather, more
:45:50. > :45:54.sunshine and more heat to come for England and Wales this Tuesday. For
:45:54. > :45:57.Northern Ireland perhaps a bit more cloud than we started the week with.
:45:57. > :46:01.Cloud across western Scotland bringing patchy outbreaks of rain.
:46:01. > :46:06.In the far north-east through the middle of the day, around the
:46:06. > :46:09.midday 1.00 time, there could be an isolated thunderstorm. We should
:46:10. > :46:13.see sunshine through eastern Scotland and that could bolster our
:46:13. > :46:17.temperature up here well into the mid-20s. For northern England a lot
:46:17. > :46:20.of sunshine, temperatures again widely in the mid-20s, we hot
:46:20. > :46:23.things up further as we slide further south. Around the coasts
:46:24. > :46:26.always a bit fresher thanks to a sea breeze, across parts of the
:46:26. > :46:32.Midlands and through into the south-east we are talking about the
:46:32. > :46:35.high 20s, perhaps even 31 or 32 degrees. A little bit cooler around
:46:36. > :46:40.some of our coasts to the south west of England and Wales, partly
:46:40. > :46:44.because of a sea breeze, we may just fetch on the shore some low
:46:44. > :46:47.cloud mist and fog. Even through the middle part of the week the
:46:47. > :46:50.sunshine continues to burn down on England and Wales, if anything it
:46:51. > :46:53.could be a hotter day still. Looking further north towards
:46:54. > :46:57.Scotland and Northern Ireland, we keep quite a bit of cloud around
:46:57. > :47:00.here for the middle part of the week, there will be outbreak of