15/07/2013 Newsnight


15/07/2013

With Kirsty Wark. A look at failings in the NHS on the eve of a damning inquiry report, and the soldier facing extradition who says he has post-traumatic stress disorder.


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Transcript


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inadequate, lax. Where is the NHS now failing to many patients?

:00:18.:00:23.

oldest alarm in the world has gone out. A life is in danger.

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One celebrated as the end of the world, tomorrow an inquiry into

:00:27.:00:31.

high death rates at 14 hospital trusts in England is expected to be

:00:31.:00:35.

brutal. How could one Health Trust given a clean bill of health by

:00:35.:00:41.

inspectors this year then allow this to happen. She hated the

:00:41.:00:44.

nights more than anything. She said the nights are horrific. She would

:00:44.:00:49.

ring the bell in the middle of the night for pain relief screaming in

:00:49.:00:53.

agony, they said they would come back and be away for an hour. And

:00:53.:00:59.

they might just give her a tablet. In the studio doctors, health

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policy professionals, politicians and bereaved parents.

:01:02.:01:05.

And ahead of tomorrow's report a political row tonight with

:01:05.:01:11.

accusations that in 2010 the Labour Health Secretary, Andy Burnham

:01:11.:01:15.

ignored more than 1500 warnings of failures at these trusts. Also

:01:15.:01:19.

tonight this former soldier is to be extradited to America possibly

:01:19.:01:24.

to face years in prison for fraud. He said he suffers from post

:01:24.:01:34.
:01:34.:01:37.

traumatic stress disorder, is it right to hand him over? Good

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evening. The Mid Staffs scandal was a terrible moment for the NHS,

:01:41.:01:46.

people prayed it was a one-off, but it was not. Tomorrow the

:01:46.:01:50.

investigation led by the NHS Medical Director sur Bruce Keogh,

:01:50.:01:56.

will report on 14 other trusts with high mortality rates. Brian Jarman,

:01:56.:02:01.

an advise Tory the Keogh Review, who is here tonight, said there

:02:01.:02:05.

were 13,000 excess deaths at the 14 Trusts between 2050 and 2010. The

:02:05.:02:09.

run-up to the report has become intensely political with Labour's

:02:09.:02:12.

now shadow secretary denying any blame for the failings in the NHS

:02:12.:02:16.

when he was at the helm. But such is the importance of the Keogh

:02:16.:02:20.

Review that it may be a defining moment for the future of the health

:02:20.:02:25.

service in England. One man that hopes it will be the case is James

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Titcombe, whose baby son Joshua died when a serious infection was

:02:31.:02:35.

missed at Furness General Hospital. What are your hopes tomorrow?

:02:36.:02:40.

hope it is a real light shone on to the 14 Trusts and it exposed really

:02:40.:02:44.

what has been goingen in those Trusts, and hopefully it can lead

:02:44.:02:49.

to recommendations to make sure that things improve pretty quickly.

:02:49.:02:54.

-- Going on in those trusts and hopefully it can lead to

:02:54.:02:58.

recommendations to make sure that things improve pretty quickly.

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What does it say about that number of deaths? The numbers of deaths in

:03:02.:03:06.

those 14 hospitals exceeded the number that would have taken place

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had they had the national death rate for age, sex and diagnosis and

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so on, it is compared to what would have been expected by the national

:03:14.:03:19.

death rates. It is a stark sum then? It is.Do you think we are at

:03:19.:03:24.

a moment in the NHS with Sir Bruce Keogh's report? I think it is a

:03:24.:03:28.

tipping point in the NHS. It is a point where we are beginning to say

:03:28.:03:32.

let's not deny the data, let's actually look at it and make

:03:32.:03:36.

improvements. That to me is a dramatic change from the attitude

:03:36.:03:40.

of the last decade or so. We will be discussing all that and we will

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be hearing from Sir Brian and James Titcombe and other other guests in

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a little while. First we report on why it has taken so long for all

:03:49.:03:57.

these problems of patient care and inadequate regulation to emerge.

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It used to set Britain apart, we could rely on the NHS. It truly is

:04:04.:04:10.

one of our greatest and proudest achievements. But something has

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gone wrong. After the terrible revelations of neglect of

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vulnerable patients in Mid- Staffordshire, and with more

:04:21.:04:26.

hospitals still being put on the watch list, we have all been left

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wondering just how safe our local hospital really is? Tameside is one

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of 14 Hospital Trusts placed under scrutiny earlier this year. The

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Medical Director of the NHS in England, Sir Bruce Keogh, picked

:04:44.:04:48.

these 14 because they have higher than expected mortality rates.

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These urgent reviews go beyond the routine work of the official

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hospital regulator, the Care Quality Commission, or CQC, which

:04:58.:05:00.

is coming under increasing criticism over why it has taken so

:05:00.:05:03.

long to act. This is the latest hospital to face serious questions

:05:03.:05:08.

over how well it has been caring for patients. But concern over care

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here isn't new, local people have been trying to raise the alarm for

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many years and even in the last few months there have been cases that

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have troubled families. Always had a smile. She was 84, very

:05:23.:05:30.

independent. Mark Burns mother olive had been diagnosed with lung

:05:30.:05:36.

cancer, but in April at Tameside was admitted to A&E with acute pain

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and unable to walk. It was three weeks it came to light she had a

:05:44.:05:49.

fractured hip. She suffered a stroke at the hospital and

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contracted the infeck Cdeficile. The staffing levels were

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unbelievable. Especially at night, my mum said she hated the nights

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more than anything. The nights are horrific. She would ring the bell

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in the middlele of the night, screaming in agony, and they would

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say they would come back to her, and they would be away for an hour.

:06:12.:06:22.
:06:22.:06:27.

They might just give her the tablet. It is just horrendous. Just the way,

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the whole organisation, the hospital, seems to be upside down

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to me. Surgery seemed out of the question, and the family

:06:35.:06:38.

concentrated on getting olive home. What effect do you think it had on

:06:38.:06:42.

your mum the quality of the care in the hospital? Probably a week

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before she finally passed away she said she had enough. She was like

:06:47.:06:50.

she can't cope with this any more. She knew she wasn't going to get

:06:50.:06:56.

any more, she more or less gave up. Olive died the day after leaving

:06:56.:07:00.

hospital, the family has told the Keogh Review about what they see as

:07:00.:07:04.

appalling care. They have put in a hospital complaint but have yet to

:07:04.:07:08.

receive a formal reply. The coroner has called for an inquest and the

:07:08.:07:11.

hospital says it cannot now comment further. Though it is in on going

:07:11.:07:21.
:07:21.:07:25.

discussions with the Burns family. It is a step in the right direction.

:07:25.:07:29.

Milton is an orthopaedic consultant at Tameside hospital, he has been

:07:29.:07:33.

raising concerns about the quality of care for much of the time he has

:07:33.:07:36.

worked there. He says that has made his working life difficult. He

:07:36.:07:42.

deals with the stress by hill walking. I have been raising

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concerns since 2002, principally because of low nursing staffing

:07:48.:07:54.

levels. For instance a nurse has been asked to look after up to 24

:07:54.:08:00.

patients. This is not exceptional, it is happening once or twice a

:08:00.:08:05.

month. But even one incident when there is so few nurses to look

:08:05.:08:08.

after patients then that has an impact.

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He took his concerns to senior staff at the hospital, and all the

:08:13.:08:18.

regulatory bodies, including the Care Quality Commission. When the

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inquiry into shocking standards of care into Stafford hospital first

:08:22.:08:28.

reported in 2010 it struck a chord. I could not help but think about

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our own situation at Tameside Hospital and I saw the similarities

:08:33.:08:39.

we had. In many respects internal reorganisation of wards,

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application for foundation status, Trust-Foundation status. The high

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mortality. Just two weeks ago the hospital suddenly announced that

:08:51.:08:56.

its chief executive and Medical Director were both to leave. An

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interim chief executive is now in place and has announced a six-month

:09:00.:09:04.

listening exercise for staff, patients and local people. Overall

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Milton thinks the hospital is now safe. For planned care. But still

:09:09.:09:16.

has concerns for the safety of emergency patients. Jill Edwards is

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a lawyer with some 20 clients with complaints against Tameside

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Hospital. Over a number of years we have seen a pattern of cases coming

:09:25.:09:28.

through from Tameside Hospital. So we have had inquiries from people

:09:28.:09:31.

who have expressed concern about the care that they or a family

:09:32.:09:35.

member have received at Tameside Hospital. It has come as no

:09:35.:09:40.

surprise to me and my colleagues that this is now the focus of

:09:40.:09:44.

attention. We know there are concerns about Accident and

:09:44.:09:49.

Emergency care. But also on the medical admissions unit and in

:09:49.:09:53.

relation to radiology. It is also known that the hospital has had

:09:53.:09:57.

higher than expected mortality rates for at least the past decade.

:09:57.:10:02.

Which is why it was included on Sir Bruce Keogh's list for indepth

:10:02.:10:05.

review. With all these repeated warnings and chances to put it

:10:05.:10:11.

right, why is it only now there has been this special in depth review,

:10:11.:10:15.

and why didn't the official regulator act sooner? Surprisingly

:10:16.:10:23.

in March this year the CQC judged Tameside Hospital to be safe.

:10:23.:10:26.

the Care Quality Commission didn't flag up problems as recently as

:10:26.:10:31.

February 2013 when they gave it a clean bill of health is beyond me.

:10:31.:10:37.

There have been concerns expressed for many years from local MPs, from

:10:37.:10:41.

patient support groups and the CQC were supposed to be there to flag

:10:41.:10:49.

up this sort of problem. They have been in exist since 2009. They had

:10:49.:10:54.

their -- existence since 2009. They had their chance to act. The CQC

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told Newsnight the early inspection was only limited in focus and today

:10:58.:11:01.

published a new inspection report on Tameside. It now says the

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hospital fails on three out of four national standards and warns that

:11:05.:11:11.

patients are not always protected from the risks of unsafe care. It

:11:11.:11:17.

noted that emergency staff levels had increased. Tameside told us it

:11:17.:11:20.

had already begun to address the issues and declined the request for

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an interview. The death of baby Joshua Titcombe at Furness General

:11:29.:11:34.

Hospital in Morecambe Bay has also focused intention on the

:11:34.:11:40.

inadequacies of past inspections by the CQC. Joshua died in 200 from a

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treatable infection. Two years later the CQC registered the

:11:44.:11:50.

hospital as safe. The absolute tragedy is Joshua's death wasn't

:11:50.:11:54.

learnt from and other babies continue to be put at risk, and

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other lives were lost. That's something that I find very

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difficult to come to terms with. the heart of the matter is also the

:12:02.:12:06.

lack of an investigation into the death of baby Joshua Titcombe.

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CQC now acknowledges it should not have said Furness General was safe.

:12:10.:12:14.

The current chief executive, in post for a year, faced MPs this

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month, after a critical independent report found evidence of a possible

:12:19.:12:23.

cover-up of CQC failings. The individuals involved fiercely

:12:23.:12:26.

dispute this. But it was your staff that were carrying out inspections,

:12:26.:12:29.

it was your staff that had to review the action plans, it was

:12:29.:12:34.

your staff that were making important decisions about the

:12:34.:12:37.

status whether it was red, amber, green. I don't wish to be evasive

:12:37.:12:41.

but what the report is saying is there was a lack of rigour and

:12:41.:12:45.

robustness around the work that CQC did in relation to Morecambe Bay.

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We are changing that, and we are moving on from that. There has to

:12:49.:12:54.

be a recognition that positive CQC inspections, in the past, mean very

:12:54.:12:58.

little. And I think there must be a lot of uncertainty about the actual

:12:58.:13:03.

safety of services in the NHS at the moment. That's just an

:13:03.:13:08.

unacceptable situation. Really we need it look at the CQC

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transforming in a very short period of time. So that we can actually

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have confidence that it is doing the job that it needs to be doing.

:13:17.:13:21.

Tomorrow Sir Bruce Keogh will publish his verdict on care at the

:13:21.:13:25.

14 hospital trusts. Newsnight has had access to all of the figures

:13:25.:13:30.

showing numbers of deaths above those expected statistic ically,

:13:30.:13:40.
:13:40.:13:52.

Basildon and Thurrock is the worst, Most said they will respond once

:13:52.:13:56.

the full Keogh report appears tomorrow. Colchester and Dudley say

:13:56.:14:01.

their death rates are within the expected range. Basildon and

:14:01.:14:07.

Thurrock said they are committed to improving patient care. The data

:14:07.:14:13.

shows that Stafford was not a one- off. Putting all this right will

:14:13.:14:17.

not happen overnight. Though it should be simple to care properly

:14:17.:14:27.

for people when they are at their most vulnerable.

:14:27.:14:30.

Our political editor Allegra Stratton is here. First of all,

:14:30.:14:34.

what developments will happen tomorrow? The Keogh Review will

:14:34.:14:38.

start the summer of mud-slinging and slurs between the political

:14:38.:14:41.

parties. The Conservatives have been quite shocked so far that so

:14:41.:14:44.

far nothing seems to have stuck to the previous Government, even

:14:44.:14:48.

though some of these misdemeanors happened under their watch. So

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tonight we have and tomorrow we will hear more about it

:14:51.:14:55.

Conservative MPs putting forward what they have got out of the

:14:55.:14:58.

Government, which is in parliament they put down a proper official

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answer to a question this MP put. Which is that Andy Burnham was

:15:03.:15:06.

given 1500 warnings that there were problems going on around the

:15:06.:15:12.

country and he is supposed to much ignored them. Burn Ham has been

:15:12.:15:16.

drawn into this repeatedly over the last ten days and consistently said

:15:16.:15:20.

if you have proper evidence I will respond to it, until that point I

:15:20.:15:24.

won't. He feels he is being dragged into it when actually possibly this

:15:25.:15:28.

is more political than policy. Conservatives are desperate to land

:15:28.:15:32.

a glove. Why does it matter so much to them? It matters to them because

:15:32.:15:36.

they will never get the lead on the NHS they hankered after, Labour

:15:36.:15:41.

will get that. What has surprised them over the weeks of emerging ref

:15:41.:15:43.

layings about the standard of the NHS that nothing has stuck to the

:15:43.:15:47.

Labour Party. And that lead has actually grown for the Labour Party

:15:47.:15:52.

that they have got further and further ahead on the NHS, not

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actually shrinking. The Tories are trying to negate that lead. David

:15:57.:16:00.

Cameron once said the three letters that matter to him is the NHS. If

:16:00.:16:05.

he will get that even he needs to turn to the CQC and failings at it.

:16:05.:16:09.

Thank you very much. We are going to discuss all this now with our

:16:09.:16:14.

panel. James Titcombe and Brian Jarman are still here. We're joined

:16:14.:16:18.

by Camilla Cavendish who sits on the board of the Care Quality

:16:19.:16:24.

Commission, Andrew Gwynne is shadow health minister and Dr Bernadette

:16:24.:16:27.

Garrihy is an Accident and Emergency consultant, and Stephen

:16:27.:16:32.

Dorrell a former Health Minister. First of all Andrew, shadow health,

:16:32.:16:39.

a lot of flack is coming your way. A lot of what are called excess

:16:39.:16:45.

deaths happened on your watch, and the accusation is Andy Burnham had

:16:45.:16:49.

1500 indications? Can I just point out that Tameside Hospital that

:16:49.:16:52.

featured in your package is the hospital that covers the majority

:16:52.:16:57.

of my constituency, I know what has happened at Tameside over a period

:16:58.:17:02.

of time very well. You find it shocking? I do find it shocking, I

:17:02.:17:07.

found it shocking in 2009 that led myself and two other Tameside MPs

:17:07.:17:12.

at the time, James Purnell and David Hayes to go and see the

:17:12.:17:17.

Secretary of State, Andy Brunham, I have to say when we met with Andy

:17:17.:17:21.

in his office, and these words stuck with me over the years, he

:17:21.:17:25.

said to his officials who didn't want him to intervene in Tameside.

:17:25.:17:30.

He said the authoritative voice in these matters is the CQC, the Care

:17:30.:17:40.
:17:40.:17:40.

Quality Commission, he said, and that has proved to be the case they

:17:40.:17:43.

were erroneous, they didn't have their finger on the pulse and they

:17:43.:17:48.

were wrong, he should have listened to those voices? He did listen to

:17:48.:17:52.

those voices. James did he listen to those voices? His words were

:17:52.:17:56.

very clear, he said there is no place in the National Health

:17:56.:18:04.

Service for sub-standard care. And that's when he ordered Monitor, the

:18:04.:18:07.

foundation trust regulator and the Care Quality Commission to go into

:18:07.:18:10.

Tameside Hospital. There is no doubt the previous Government made

:18:10.:18:14.

big mistake, not least the Foundation Trust programme that led

:18:14.:18:18.

to so many of these programmes in the first place. So Sir Brian you

:18:18.:18:22.

talk about the whole denial, the health service being in denial.

:18:22.:18:25.

There is no doubt that a lot of the problems happened during Labour's

:18:25.:18:31.

watch? Yes. After the Bristol inquiry, I was medical member of

:18:31.:18:35.

that, we decided we needed to do something. Every year we published

:18:36.:18:40.

in national newspapers these figures. Tameside was higher way

:18:40.:18:44.

back in 2001. It has been higher pretty well all the way through.

:18:44.:18:48.

They have known and we went to the Department of Health many times to

:18:48.:18:51.

try to get them to do something about it. It really was a

:18:51.:18:55.

continuous process of denial of the information. For someone who has

:18:55.:19:01.

been involved in the health service for so long was it profoundly

:19:01.:19:06.

depressing? I have always, I mean I went to the states and part of my

:19:06.:19:11.

training was there I was a medical resident in the states, I used to

:19:11.:19:16.

give lectures about how marvellous the NHS and of to Harvard students.

:19:16.:19:21.

About five years ago I decided I could no longer do it. I'm very

:19:21.:19:25.

much in favour of the principle of the National Health Service in that

:19:25.:19:27.

people are covered. No-one has to worry about the cost of their

:19:28.:19:31.

healthcare, compared with the states that is fantastic. But we

:19:31.:19:34.

can't make it poor care. Camilla Cavendish you were going to come on

:19:34.:19:38.

to a report you did on care workers in a moment, but you are on the

:19:38.:19:43.

Care Quality Commission now? Yes, I have just gone on to the board.

:19:43.:19:47.

it has a very, very tainted history? Of course, yes. Everybody

:19:47.:19:50.

has said it. It missed Mid Staffs, it missed add whole lot of other

:19:50.:19:53.

things, it probably missed hospitals we don't even know about

:19:53.:19:57.

yet. It was using generalists instead of experts to go into these

:19:57.:20:01.

hospitals. One of those people, Amanda Pollard, former inspector,

:20:01.:20:04.

has talked about how she was an expert in infection control, she

:20:04.:20:07.

was taken off doing that, sat in front of a computer and licensing

:20:07.:20:12.

all the bodies it had to license. It was not listening clearly to

:20:12.:20:16.

complaints from people, it failed. Even when it was meant to be

:20:16.:20:21.

reformed, you know, within the last nine months, look at Tameside. Is

:20:21.:20:28.

it still making mistakes? The point is how can patients have any faith

:20:28.:20:31.

in a regulatory system which even though it is under scrutiny is

:20:31.:20:35.

still failing? Well I think the answer to that is they are trying

:20:35.:20:40.

very hard to build a totally new system. So it used to have a

:20:40.:20:43.

thousand indicators, which was crazy, they are now reducing those

:20:43.:20:46.

indicator, they are hiring experts to go in rather than generalists,

:20:46.:20:49.

they have got a new Chief Inspector of hospitals who is coming on board

:20:49.:20:54.

this week. It is a tanker. It takes some time to turn it round. They

:20:54.:20:58.

are running as fast as they K but there is a risk. The major problem

:20:58.:21:05.

in the CQC, they say from 2009 they do not investigate poor care? How

:21:05.:21:10.

can you believe that our regulator does not investigate instances of

:21:10.:21:16.

poor care? It has a whole series of...What Is really happening, from

:21:16.:21:22.

2009 when the CQC and Monitor had Tameside Hospital on its radar at

:21:22.:21:25.

the insistence of Andy Burnham, every report they have published

:21:25.:21:29.

they have highlighted concerns about Tameside. What is baffling in

:21:29.:21:34.

March this year all of a sudden it is given a clean bill of health. I

:21:34.:21:38.

don't understand that as a Tameside MP. This whole point about not

:21:38.:21:42.

investigating poor care, do you understand why this is not

:21:42.:21:45.

happening, Stephen Dorrell? I don't understand why the CQC doesn't

:21:45.:21:49.

accept responsibility for looking at the quality of care delivered by

:21:49.:21:52.

each healthcare provider. I also think there is a huge trap in this

:21:52.:21:55.

which is is to imagine that the CQC is the solution to the whole

:21:55.:22:01.

problem. What we have to remember here is that Brian Jarman has been

:22:01.:22:05.

a very courageous campaigner determined to throw light op what

:22:05.:22:08.

goes on in the health service so that -- on what goes on in the

:22:08.:22:12.

health service so we face the truth about an institution that all of us

:22:12.:22:16.

are deeply committed to. It is that willingness to face the truth that

:22:16.:22:19.

the health service has found difficult over a long period.

:22:19.:22:23.

want to talk now about the whole patient experience and the patient

:22:23.:22:29.

care at ward level. You are a senior consultant in A&E and you

:22:29.:22:34.

have repeatedly voiced concerns about the level of patient care and

:22:34.:22:40.

what they experienced in being a patient? There is no doubt about it

:22:40.:22:43.

the Accident and Emergency service throughout the UK has been building

:22:43.:22:47.

towards a crisis for a number of years. We have been highlighting it

:22:47.:22:52.

in a number of ways. It was very difficult to meet with any positive

:22:52.:22:55.

response until very recently when a group of us in the Midland got

:22:55.:22:58.

together and found we were experiencing exactly the same

:22:58.:23:03.

problems. It is a critical mass?It was. In Susan's film you have

:23:03.:23:07.

Milton in the film saying he was repeatedly and had problems in his

:23:07.:23:11.

job for repeatedly bringing up problems about 24 patients to one

:23:11.:23:15.

nurse. Is there not a culture of coming together and airing these

:23:15.:23:20.

problems. The idea that whistle blowing is still a bad thing in the

:23:20.:23:25.

NHS? I think it is very hard for individuals whistle blow. What made

:23:25.:23:28.

it easier for us, but it gave our message more power was the fact

:23:29.:23:33.

that we could come together. We weren't necessarily criticising our

:23:33.:23:35.

individual organisations, because there were some very good things

:23:35.:23:39.

going on, but we were highlighting a problem that our speciality has,

:23:39.:23:43.

and a crisis. It is only recently a number of you got together. From

:23:43.:23:46.

the parents' point of view, when Joshua was very little and your

:23:46.:23:52.

wife had an infection and your son had an infection, you repeatedly

:23:52.:23:55.

said to the midwives there is something wrong? The concern was

:23:55.:23:59.

could Joshua have an infection, we asked about that and we were

:23:59.:24:04.

repeatedly told he was sign. Sadly he died as a consequence of that.

:24:04.:24:10.

Nine days laterment you asked to see a doctor? We asked is Joshua OK,

:24:10.:24:13.

we were told he was. We accepted that reassurance that the people

:24:13.:24:21.

that were looking after him were the experts and we accepted that.

:24:21.:24:24.

We shouldn't have and should have done something about it. Do you

:24:24.:24:29.

think the whole question of the NHS is there is not institutional low a

:24:29.:24:34.

lack of compassion, but compassion is not rated -- institutionally a

:24:34.:24:37.

lack of compassion, but compassion is not rated highly and compassion

:24:37.:24:41.

has gone out of the health service? I would say there is a culture of

:24:41.:24:46.

contempt in some parts of the health service for patient. I'm an

:24:46.:24:49.

associate editor of the Sunday Times, we have started a campaign

:24:49.:24:53.

on seven-day working, I have a slew of e-mails from people who arrived

:24:53.:24:57.

on a Saturday or Sunday and whose complaints have been ignored and

:24:58.:25:01.

not listened to. Some of the stories. They are not as terrible

:25:01.:25:05.

as James's story, but it is repeated. One person wrote to me

:25:05.:25:09.

and said the cleaners were more caring than any of the other staff

:25:09.:25:14.

in the hospital. This is because the caring isn't really valued.

:25:14.:25:18.

are hearing that firsthand there, why do you think that happens?

:25:18.:25:23.

think that most people in the NHS certainly going into it wanting to

:25:23.:25:27.

do a really good job, and go in every day wanting to care for

:25:27.:25:31.

people, what is really important is that if you haven't got the

:25:31.:25:34.

resource to do your job properly, if you haven't got the skills, if

:25:34.:25:37.

you haven't got the man power, if you haven't got the equipment, you

:25:37.:25:43.

need to be able to highlight that. That is where a lot of the issues

:25:43.:25:47.

arise. Camilla's recording care workers, there was an inadequacy of

:25:47.:25:50.

training and imbalance of training? The most important thing is to

:25:50.:25:54.

challenge poor care. What we found was junior people were not being

:25:54.:25:57.

listened to. That is the problem with the culture. So there is no

:25:57.:26:01.

sense in which junior people actually should have a say? Well, I

:26:01.:26:04.

think you know this discussion, there are two major problems,

:26:04.:26:08.

number one with regard to the doctors, if you report a complaint,

:26:08.:26:11.

a problem of the health service, and you have tried locally, and you

:26:11.:26:16.

tried to bring it to the attention of the authorities and so on

:26:16.:26:25.

outside, that doctor will be dismissed. They will have to sign a

:26:25.:26:29.

gagging clause to get any compensation for dismissal. Second

:26:29.:26:33.

of all regarding complaints, up to 2004 any person who made a

:26:33.:26:37.

complaint and it went beyond the hospital they were investigated by

:26:37.:26:42.

a local independent panel coroner and so on. From 2004 on wards all

:26:42.:26:45.

complaints, it is almost impossible to believe this, all complaints,

:26:46.:26:51.

except for less than one third of 1% have been thrown into a national

:26:51.:26:56.

waste paper basket, they have not been independent. Why did that

:26:56.:26:59.

happen? They haven't been fully investigated. Why?What happened

:26:59.:27:05.

was that they got rid of the independent review panel. And now

:27:05.:27:11.

they have gone to the primary Health Service Ombudsman, out of

:27:11.:27:15.

13,000 last year she fully investigated 222. That is shocking

:27:15.:27:22.

isn't it? Out of that only 232 got investigated? Mid Staffs for

:27:22.:27:26.

example between 2008-2011 there were 79 complaints to the ombudsman,

:27:27.:27:30.

she investigated two of them. That's what I'm talking about. That

:27:30.:27:34.

is lessons going unlearned. We did a review of the complaint process

:27:34.:27:38.

within the Select Committee. Where does the pressure come from? There

:27:38.:27:42.

used to be three tiers of examination of complaints when

:27:42.:27:47.

something went wrong in hospital. What's now, the system was

:27:47.:27:52.

simplified in order to require, first of all, the hospital to

:27:52.:27:57.

investigate its own complaints. Then with an appeal to the

:27:57.:28:00.

ombudsman. That is how the system is supposed to work. I entirely

:28:00.:28:03.

accept that it doesn't work properly, that is why we issued a

:28:03.:28:08.

report two years ago now. Which said that one of the problems of

:28:08.:28:12.

the qulure in the health service is that when a complaint arises of a

:28:12.:28:17.

patient -- culture, in the health service is that when a patient

:28:17.:28:21.

makes a complaint the first instance is explain what happened

:28:21.:28:25.

rather than investigate openly and honestly what went on that needs to

:28:25.:28:29.

be addressed. That is the cultural issue, let's look at the economic

:28:29.:28:33.

issue, economic and demographic pressures the NHS faces over the

:28:33.:28:38.

next 20 years, the line-up going steeply on this graph shows how

:28:38.:28:43.

much extra money would need to be spent just to keep the current

:28:43.:28:47.

level of service for our growing and ageing population. The straight

:28:47.:28:54.

line at the bottom is what happens if we keep spending frozen. The gap

:28:54.:28:59.

by 2020 is �54 billion. We are joined now by Fraser Nelson the

:28:59.:29:05.

Edgaror of the Spectator. This model, is it sustainable? Of course

:29:05.:29:09.

not. We have seen over the last decade the NHS's budget was more

:29:09.:29:12.

than doubled. If money was the answer we wouldn't be sitting here

:29:12.:29:15.

now having this conversation. Wait it is run is the problem. And this

:29:15.:29:19.

chart looks a bit suspicious to me, it looks like another demand for

:29:19.:29:23.

money. Sure, you can put a computer model and say, yes, we need X

:29:23.:29:27.

amount of money, but is the NHS twice as God as it was at the

:29:28.:29:31.

beginning of the last decade. I don't think anybody would say so.

:29:31.:29:40.

There is massive demographic pressures on the NHS. An ageing

:29:40.:29:43.

population and no more money. Problems of old age increasing, how

:29:43.:29:47.

will we deal with those? The rest of the developed world is dealing

:29:47.:29:51.

with these problems, they do not give a health service run by a

:29:51.:29:54.

massive and failing bureaucracy that we have at the moment. There

:29:54.:29:58.

are ways of running health services better than we do. Just look

:29:58.:30:01.

anywhere, Ireland literally anywhere else in the world.

:30:01.:30:06.

Bernadette you accept there has to be change and the model isn't

:30:06.:30:10.

sustainable? Within emergency medicine we are under incredible

:30:10.:30:14.

pressure, we have increasing attendances, and the numbers don't

:30:14.:30:18.

reflect the increasing complexity of cases we are seen, eld low

:30:18.:30:21.

people with a multiple health and social and mental problems. There

:30:21.:30:27.

needs to be a crossover with health and social care to help these

:30:27.:30:31.

people properly. The pressure will be massive on the money, so you

:30:31.:30:36.

would say some A&Es would close, will services have to go by the

:30:36.:30:40.

bored on the NHS? I certainly think in emergency medicine we can't

:30:40.:30:45.

continue with the current model, we can't have 250 departments across

:30:45.:30:48.

the UK providing 24/7 cover. It is not safe at the moment, we haven't

:30:48.:30:52.

enough staff to do it. If we give them all the money in the world, we

:30:52.:30:58.

haven't enough trainees coming through. We have to -- We have to

:30:58.:31:02.

accept and fess up to that? We have to, trying to do 250 trauma units

:31:02.:31:08.

around the country leads to poor care. We need a hierarchy that

:31:08.:31:10.

ensures that...Don't We have to have politicians to be honest and

:31:10.:31:14.

say this is going to happen. Of course when it comes to

:31:14.:31:18.

constituency by constituency no MP wants to lose the service, but we

:31:18.:31:24.

are going to have to speak honestly? If the service is sub-

:31:24.:31:29.

standard any MP should want high- quality care for constituents, what

:31:29.:31:33.

we have have do is ensure the health service changes

:31:33.:31:36.

fundamentally to deliver high- quality care. What happened at

:31:36.:31:38.

Morecambe Bay and what is happening tomorrow with the Keogh Review is

:31:38.:31:42.

the scales will finally fall from our eyes, I think. We will lose the

:31:42.:31:47.

romance of the NHS and say we are now going to be open-minded about

:31:47.:31:49.

how to make it better. We haven't been until now. That whole question

:31:50.:31:54.

of the romance, it is just over a year ago since Danny Boyle's 2012

:31:54.:31:59.

Olympic ceremony included this tribute to the role of the NHS

:31:59.:32:03.

played in British life. Some regard the celebration we saw at the

:32:03.:32:08.

Olympics as part of the problem. Do we actually fail to notice

:32:08.:32:13.

fundamental problems in healthcare because we do, as Camilla says row

:32:13.:32:23.
:32:23.:32:24.

Manchester United size the NHS. -- -- romanticise the NHS? We do make

:32:24.:32:27.

it romantic, we are wanting a health service free at the point of

:32:27.:32:31.

use, don't give it to a failing bureaucracy to run. That is the

:32:31.:32:34.

problem. What everyone is striving for is fine but the way we are

:32:34.:32:38.

doing it is from the last century. I'm incredibly proud of much of

:32:38.:32:43.

what the NHS does, and what people working in the NHS do, Kirsty, it

:32:43.:32:47.

would be very unfair on a lot of very dedicated staff, nurses,

:32:47.:32:52.

doctorss and support workers to say it is all rotten. Because actual it

:32:52.:32:56.

isn't. That is a given. But the problem is, the very things you are

:32:56.:33:00.

saying are almost romanticising, and you are part of the problem?

:33:00.:33:04.

They are not romanticising, beau actually most people's experience

:33:04.:33:08.

of the -- because most people's experience of the NHS is good.

:33:08.:33:11.

Where we have poor care we need to move in and quickly and not accept

:33:11.:33:21.
:33:21.:33:23.

the second-rate care. That is a failure of the NHS values. The NHS

:33:23.:33:27.

is national religion and the Tories are unbelievers, is that the

:33:27.:33:31.

problem? The problem is both parties are competing to see who

:33:31.:33:38.

the biggest believer in the last few years. When Labour reformed the

:33:38.:33:47.

NHS the Tories said hands off the NH S. We are finally seeing only

:33:47.:33:57.
:33:57.:33:57.

too late when both parties have been going back and forth. It is

:33:57.:34:03.

not the workers but the bureaucracy. I would put in a great drive from

:34:03.:34:06.

patients and clinicians who would then employ the managers to make

:34:06.:34:12.

sure that our aim is to live within whatever we are given from the

:34:12.:34:16.

resource allocation from parliament to having got that amount it is to

:34:16.:34:22.

improve the quality of care. Not managers doinging it. To improve

:34:22.:34:26.

the quality of care but the extent of the care, do we have to be

:34:26.:34:30.

realistic at the extent of the care? Look we have only just under

:34:30.:34:37.

the European average of GDP. How can you have a system whereby acute

:34:37.:34:42.

abdominal pain, acute chest pain is managed by 111, a computer. When I

:34:42.:34:48.

for 28 years was visiting patients, if I did not examine the patient

:34:48.:34:51.

with acute abdominal pain I would be struck off and rightly so. This

:34:51.:34:55.

is incredible that these managers can run this system like that. How

:34:55.:34:58.

did we let that happen? What you have done is provided the

:34:58.:35:03.

information. The power here is the information. Once people, for years

:35:03.:35:06.

doctors have known which hospitals they wouldn't be treated in. The

:35:06.:35:09.

rest of us haven't known that. Once we get the manufacturing out there

:35:09.:35:13.

we will empower people to make -- manufactures out there we will

:35:13.:35:17.

empower people to make the right choices. What will it take to

:35:17.:35:22.

restore your faith in the NHS? complaints system that work, a

:35:22.:35:26.

system where when something tragic goes wrong the NHS doesn't cover up

:35:26.:35:30.

and the NHS concerns something about it and does something about

:35:30.:35:37.

it, and learns about it, and effective regulation. McIntyre is a

:35:37.:35:40.

former soldier who served in Northern Ireland, Bosnia, Iraq and

:35:40.:35:44.

Afghanistan. Now he's set to be extradited to the US on eight

:35:44.:35:51.

charges of fraud relating to a contract putting Quantum Risk, a

:35:51.:35:56.

security firm he ran in Baghdad in 2009 and the US Institute of Peace.

:35:56.:36:04.

The allegations of overcharging to the tune of $100,000, which he

:36:04.:36:09.

denies, emerged when he was serving with the royal military police, he

:36:10.:36:13.

was flown home to face charges. In a moment we will speak to him.

:36:14.:36:20.

First here is our report. David McIntyre was a soldier in the

:36:20.:36:23.

Queen's Lancashire Regiment, doing tours in Bosnia and Northern

:36:23.:36:26.

Ireland. He served in the royal military police in Afghanistan. But

:36:26.:36:31.

it was after he left the army, during his time as a contractor in

:36:31.:36:35.

Baghdad, providing security to American clients, such as the US

:36:35.:36:40.

Ambassador, that he's alleged to have carried out this fraud.

:36:40.:36:47.

Overcharging the American NGO, the United States Institute of Peace,

:36:47.:36:51.

by �65,000. The US indictment alleges that David McIntyre

:36:51.:36:59.

conspired knowingly and willfully to de advise and attempt to devise

:36:59.:37:05.

a scheme to fraud the NGO. David McIntyre is fighting all the

:37:05.:37:12.

charges, and his defence is on health grounds as he has been

:37:12.:37:16.

diagnosed with post traumatic stress disorder. Colonel McAlastair

:37:16.:37:20.

said that David McIntyre was at high-risk of suicide around the

:37:20.:37:27.

time, and that thoughts of his family may not be sufficient to

:37:27.:37:32.

counter the grave and immediate danger he may pose to himself.

:37:32.:37:37.

David McIntyre is not the first person to fight extradition on

:37:37.:37:40.

mental health grounds. Gary MacKinnon, accused by the United

:37:40.:37:45.

States of carrying out the biggest military computer hack of all time

:37:45.:37:48.

eventually won his battle against extradition when the Home Office

:37:48.:37:54.

said he was at high risk of suicide. But the Home Office is unconvinced

:37:54.:37:57.

that David McIntyre's condition is severe enough to prevent

:37:57.:38:02.

extradition. Saying it was treatable without the need for in-

:38:02.:38:06.

patient care. But there was no suggestion it couldn't be managed

:38:06.:38:11.

in custody either in the UK or the US. And the letter concluded that

:38:11.:38:14.

extradition would not be incompatible with his rights under

:38:14.:38:21.

the European convention. In 2006 these British businessmen, the

:38:21.:38:25.

NatWest 3, who were implemented in the Enron scandal were extradited

:38:25.:38:31.

and jailed in the US. One of them, David Birmingham, served time in

:38:31.:38:35.

five American prison, he's worried that David McIntyre will not get

:38:35.:38:39.

treatment in an American jail. have been in prison up close and

:38:39.:38:44.

personal with a number of people with very, very difficult

:38:44.:38:48.

psychiatric conditions who went absolutely completely and utterly

:38:48.:38:52.

untreat. It is desperate frankly. It is not the place to be if you

:38:52.:38:58.

have any kind of a mental disorder. I would not fancy being in Mr

:38:58.:39:02.

McIntyre's shoes in this particular scenario. David McIntyre's legal

:39:02.:39:06.

team has 14 days to consider whether to apply for a judicial

:39:06.:39:16.
:39:16.:39:16.

review. David McIntyre joins me now. First of all you deny the eight

:39:16.:39:22.

charges, what is the American case against you? Unsubstantiated, and

:39:22.:39:25.

yeah I categorically deny all the charges against me. You know the

:39:25.:39:29.

charges as they exist? I know they have been read out to me from the

:39:29.:39:35.

documentation from the US. So they are quite specific, overcharging

:39:35.:39:39.

for a villa's rent when you could have got it more cheaply, you paid

:39:39.:39:43.

a bribe toe the contractors according to the indictment, and

:39:43.:39:48.

suddenly in mid-June you upped sticks from Baghdad and abandoned

:39:48.:39:54.

the contract and came away with $100,000? I didn't abandon the

:39:54.:39:58.

contract, back in the UK I lost my business and I was back in the UK.

:39:58.:40:03.

I insured the US IP could continue their mission in Iraq, in Baghdad,

:40:03.:40:06.

specifically in the villa I organised for them. So I didn't

:40:06.:40:10.

walk away from it at all, that isn't in the indictment that they

:40:10.:40:14.

have sent across from the US. During that time in Baghdad there

:40:14.:40:18.

was all sorts of rumours that things were done with cash in hand

:40:18.:40:22.

and the odd bribe, it might not have been called a bribe. Was it a

:40:22.:40:28.

lax system? To be honest I couldn't comment on that because obviously I

:40:28.:40:33.

couldn't comment, I wasn't privvy to everything that went on. It was

:40:33.:40:36.

certainly talked about but I wasn't privvy to everything that went on.

:40:36.:40:40.

Why, if they are asking you to face these charges you think you

:40:40.:40:43.

shouldn't be extradited? It is not that I don't want to face the

:40:43.:40:49.

charges, I'm happy to face ep this. I'm not happy to be put over to the

:40:49.:40:52.

United States and put in solitary confinement immediately and face 20

:40:53.:40:57.

years in a US pen tensionry. There is no way you to face these charges

:40:57.:41:07.
:41:07.:41:11.

here. My Government isn't prepared to allow me to do that.

:41:11.:41:15.

At the very beginning that was not brought up your team when it could

:41:15.:41:19.

have been? This post traumatic stress disorder? I was serving in

:41:19.:41:23.

Afghanistan, I was taken into a room in uniform, I was taken on to

:41:23.:41:29.

a plane 45-minutes later, I was thrown into the UK 36 hours later I

:41:29.:41:33.

was in court in Westminster in uniform. My life had just gone into

:41:33.:41:37.

spiral. Unfortunately I do now know that I have been suffering from

:41:37.:41:40.

PTSD for several years. But it is not something you like to talk

:41:40.:41:46.

about in an open forum. But then that is surely if you raised it

:41:46.:41:50.

early, it seems that there were several times when your counsel

:41:50.:41:54.

could have raised in September, January and March, it was only

:41:54.:41:57.

raised at the 11th hour, if you raised it early, right at the

:41:57.:42:01.

beginning when you knew you had post traumatic stress disorder your

:42:01.:42:04.

case might have gone differently? You are quite correct. Why didn't

:42:04.:42:10.

you raise it? I didn't raise it because I'm an ex-soldier and if

:42:10.:42:14.

I'm told to go somewhere I did it. I listened to my legal counsel at

:42:15.:42:18.

the time, I had no concept of the procedure. I was told to be at a

:42:18.:42:23.

court at a particular time and date. I arrived there. My counsel was

:42:23.:42:27.

absolutely useless to that end this is why I asked for a change of

:42:27.:42:32.

counsel. In all the papers, did you know that you could raise the

:42:32.:42:37.

medical situation, because you raised the fact of a broken tendon

:42:37.:42:41.

or trained tendon at the beginning. Did your legal -- a strained tendon

:42:41.:42:48.

at the beginning. Did your legal team tell you could raise post

:42:48.:42:51.

traumatic stress disorder, if it was going to be material to your

:42:51.:42:54.

case, wouldn't you try everything in your armour to make sure your

:42:54.:43:00.

case was as strong as it could be? Yes you would do and I'm trying to

:43:00.:43:05.

do that now and is being put forward. Like I said my legal team

:43:05.:43:09.

was absolutely useless. I have subsequently found out potentially

:43:09.:43:14.

this wouldn't have got this car, it could have been can I Bosched the

:43:14.:43:20.

first day I was back in the UK if I had decent representation. What is

:43:20.:43:23.

the procedure? I have got 14 days where the Home Office ask for my

:43:23.:43:30.

removal to the US. I will be taken by US mash shells in a plane in

:43:30.:43:35.

shackle, taken into solitary confinement and given a piece of

:43:35.:43:40.

paper in front of me and I will be offered a plea bargain. It will be

:43:40.:43:46.

sign here, three years in a US jail or don't sign and 20 years in a US

:43:46.:43:50.

jail and never see your family again. In terms of what will happen

:43:50.:43:54.

in the next few days is it to get your case together for a judicial

:43:54.:43:58.

review? I'm still coming to terms with the fact that the Home

:43:58.:44:00.

Secretary, who hasn't read anything about the case, but just had a

:44:01.:44:04.

piece of paper put in front of her and signed it, she knows nothing

:44:04.:44:09.

about it. How will you cope?Again my life has gone into spiral and my

:44:09.:44:13.

family are going with me into spiral. It is difficult to put it

:44:13.:44:18.

into words how you are able to cope. Tomorrow morning's front pages now.

:44:18.:44:28.
:44:28.:45:00.

The Guardian on the right-hand side That's all tonight, we leave you

:45:00.:45:07.

with 101 female skydivers in Russia, the latest jump called Pearls in

:45:07.:45:12.

the Sky, formed a flower in memory of the leader who died last year.

:45:12.:45:22.
:45:22.:45:45.

It is open in the middle to Hello, more fine weather, more

:45:45.:45:50.

sunshine and more heat to come for England and Wales this Tuesday. For

:45:50.:45:54.

Northern Ireland perhaps a bit more cloud than we started the week with.

:45:54.:45:57.

Cloud across western Scotland bringing patchy outbreaks of rain.

:45:57.:46:01.

In the far north-east through the middle of the day, around the

:46:01.:46:06.

midday 1.00 time, there could be an isolated thunderstorm. We should

:46:06.:46:09.

see sunshine through eastern Scotland and that could bolster our

:46:10.:46:13.

temperature up here well into the mid-20s. For northern England a lot

:46:13.:46:17.

of sunshine, temperatures again widely in the mid-20s, we hot

:46:17.:46:20.

things up further as we slide further south. Around the coasts

:46:20.:46:23.

always a bit fresher thanks to a sea breeze, across parts of the

:46:24.:46:26.

Midlands and through into the south-east we are talking about the

:46:26.:46:32.

high 20s, perhaps even 31 or 32 degrees. A little bit cooler around

:46:32.:46:35.

some of our coasts to the south west of England and Wales, partly

:46:36.:46:40.

because of a sea breeze, we may just fetch on the shore some low

:46:40.:46:44.

cloud mist and fog. Even through the middle part of the week the

:46:44.:46:47.

sunshine continues to burn down on England and Wales, if anything it

:46:47.:46:50.

could be a hotter day still. Looking further north towards

:46:51.:46:53.

Scotland and Northern Ireland, we keep quite a bit of cloud around

:46:54.:46:57.

here for the middle part of the week, there will be outbreak of

:46:57.:47:00.

A look at failings in the NHS on the eve of a damning inquiry report, and the soldier facing extradition who says he has post-traumatic stress disorder

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


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