17/11/2013 Sunday Politics Scotland


17/11/2013

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Welcome to the Sunday Politics. Downing Street announces an inquiry

:00:35.:00:39.

into allegations of hardball tactics and intimidation by unions in

:00:40.:00:44.

industrial disputes. That's our top story.

:00:45.:00:47.

Thousands dead. Hundreds of thousands without homes. Millions

:00:48.:00:50.

affected. What is Britain doing to help the Philippines in the wake of

:00:51.:00:55.

Typhoon Haiyan? We'll ask International Development Secretary

:00:56.:01:00.

Justine Greening. Winter is coming and so, it seems,

:01:01.:01:03.

is another crisis in England's hospitals. I'll be asking the Shadow

:01:04.:01:06.

Health Secretary how he'd put a stop to the NHS's annual woes.

:01:07.:01:12.

And on Sunday Politics Scotland: We'll be asking the Scottish Health

:01:13.:01:15.

Secretary, Alex Neil, if hospitals here will be able to cope with the

:01:16.:01:17.

pressures of the winter months. Janan Ganesh, Nick Watt and this

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week, Zoe Williams, who'll be tweeting their thoughts throughout

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the programme. The Government has announced a

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review to investigate what the Prime Minister has called "industrial

:01:48.:01:49.

intimidation" by trade union activists. Bruce Carr QC will chair

:01:50.:02:01.

a panel to examine allegations of the kind of tactics that came to

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light during the Grangemouth dispute, when the Unite union took

:02:05.:02:07.

their protests - replete with a giant rat - outside the family homes

:02:08.:02:14.

of the firms' bosses. Earlier this morning the Cabinet office minister,

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Francis Maude spoke to the BBC and this is what he had to say. To look

:02:19.:02:23.

at whether the law currently works and see if it is ineffective in

:02:24.:02:27.

preventing the kind of intimidatory activity that was alleged to have

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taken place around range mouth during the previous disputes --

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Grangemouth. We make no presumptions at the beginning of this. I do think

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it is a responsible thing for the government to establish what

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happened and really do a proper review into whether the law is

:02:51.:02:55.

adequate to meet the needs. That was Francis Maude. This is a purely

:02:56.:03:01.

political move, isn't it? Unite did this a couple of times, it is hardly

:03:02.:03:06.

happening all over the country but the government want to say, we are

:03:07.:03:09.

prepared to investigate Unite properly, Labour isn't. This seemed

:03:10.:03:16.

a lot worse when I thought it was a real rat. I thought it was a giant

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dead rat. I am not sure if you know much about rats but real rats are

:03:23.:03:26.

not this big, even the ones in London. The thing is, obviously it

:03:27.:03:32.

is naked politics but I think it is more intelligent than it looks. They

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are trying to taint Miliband as a week union puppet and that doesn't

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really wash. They hammer away with it and it might wash for some

:03:44.:03:49.

people. But it really castrates Miliband in the important issues he

:03:50.:03:53.

has to tackle. Zero hours, living wage, all of those things in which

:03:54.:03:56.

he needs to be in concert with the unions, and to use their expertise.

:03:57.:04:03.

He is making them absolutely toxic to go anywhere near. It keeps the

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Unite story alive, have to kill -- particularly since Mr Miller band is

:04:16.:04:18.

under pressure to reopen the investigation into what Unite are up

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to -- Mr Miliband. They are frustrated, not only at the BBC but

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the media generally at what they think is a lack of coverage. I see

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the political rationale from that respect. There is a risk. There are

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union members who either vote Tory or are open to the idea of voting

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Tory. All Lib Dem. If the party comes across as too zealous in as --

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its antipathy, there is an electoral consequence. Ed Miliband has been

:05:05.:05:11.

careful to keep a distance. Yes, they depend on vast amounts of

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money. When Len McCluskey had a real go at the Blairites, Ed Miliband was

:05:17.:05:19.

straight out there with a very strong statement. Essentially Len

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McCluskey wanted Blairites in the shadow cabinet sacked and Ed

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Miliband was keen to distance himself or for that is why it is not

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quite sticking. Another story in the Sunday papers this morning, the Mail

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on Sunday got hold of some e-mails. When I saw the headline I thought it

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was a huge cache of e-mails, it turns out to be a couple. They peel

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away the cover on the relationship between Ed Miliband and Ed Balls,

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with some of Ed Miliband's cohorts describing what Mr balls is trying

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to do as a nightmare. How bad are the relations? They are pretty bad

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and these e-mails confirm the biggest open signal in Westminster,

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which is that relations are pretty tense, -- open secret. That Ed

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Miliband doesn't feel that Ed Balls is acknowledging the economy has

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grown that Labour needs to admit to past mistakes. The sort of great

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open signal is confirmed. On a scale of 1-10, assuming that Blair-Brown

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was ten. I think it is between six and seven. They occupy this joint

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suite of offices that George Cameron and -- David Cameron and George

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Osborne had. It is not just on the economy that there were tensions,

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there were clearly tensions over HS2, Ed Balls put a huge question

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over it at his conference. There will be more tensions when it comes

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to the third runway because my information is that Mr balls wants

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to do it and Ed Miliband almost resigned over it when he was in

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government. I don't think Ed Miliband is thinking very

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politically because he has tried live without Ed Balls and that is

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not tenable either. -- life without. He has defined a way of making it

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work. That is where Tony Blair had the edge on any modern politician.

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He didn't want to make Ed Balls his Shadow Chancellor, he had to.

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Somebody said to him, if you make Ed Balls Shadow Chancellor, that will

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be the last decision you take as leader of the Labour Party. Is it as

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bad? I was surprised at how tame the e-mails were. At the FT it is

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compulsory, one French word per sentence! To call him a nightmare,

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compared to what they are willing to say in briefings, conversations,

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bits of frustrations they express verbally come what is documented in

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the e-mails is actually pretty light. It has been a grim week for

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the people of the Philippines as they count the cost of the

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devastation wrought by Typhoon Haiyan. HMS Daring has just arrived

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near the worst hit areas - part of Britain's contribution to bring aid

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to the country. It has been one of the worst natural

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disasters in the history of the Philippines. Typhoon Haiyan hit the

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country nine days ago, leaving devastation in its wake. The numbers

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involved are shocking. The official death toll is over 3600 people, with

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many thousands more unaccounted for. More than half a million people have

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lost their homes and the UN estimates 11 million have been

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affected. David Cameron announced on Friday that the UK government is to

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give an extra ?30 million in aid, taking the total British figure ?250

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million. An RAF Sea 17 aircraft landed yesterday with equipment to

:09:05.:09:07.

help aid workers get too hard to reach areas. HMS Illustrious is on

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its way and due to arrive next weekend. The British public have

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once again dipped into their pockets and given generously. They have

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given more than ?30 million to the Disasters Emergency Committee.

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The International Development Secretary, Justine Greening, joins

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me now for the Sunday Interview. Good morning, Secretary of State.

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How much of the ?50 million that the government has allocated has got

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through so far? All of it has landed on the ground now. HMS Daring has

:09:41.:09:44.

turned up, that will be able to start getting help out to some of

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those more outlying islands that have been hard to reach. We have

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those more outlying islands that seen Save the Children and Oxfam

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really being able to get aid out on the ground. We have a plane taking

:09:56.:10:01.

off today that will not read just carrying out more equipment to help

:10:02.:10:04.

clear the roads but will also have their staff on board, too. We have

:10:05.:10:11.

?50 million of aid actually on the ground? We instantly chartered

:10:12.:10:17.

flights directly from Dubai where we have preprepared human Terry and

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supplies, and started humanity work -- humanitarian supplies.

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A lot of it has now arrived. I think we have done a huge amount so far.

:10:31.:10:37.

We have gone beyond just providing humanitarian supplies, to getting

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the Royal Air Force involved. They have helped us to get equipment out

:10:43.:10:46.

there quickly. We have HMS Illustrious sailing over there now.

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Why has that taken so long? It was based in the Gulf and is not going

:10:52.:10:55.

to get there until two weeks after the storm first hit and that is the

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one ship we have with lots of helicopters. The first decision we

:10:59.:11:03.

took was to make sure we could get the fastest vessel out there that

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was able to help HMS Daring. HMS Illustrious was just finishing an

:11:09.:11:11.

exercise and planning to start to head back towards the UK. We have

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said to not do that, and diverted it. Shouldn't it have happened more

:11:16.:11:21.

quickly? We took the decisions as fast as we were able to, you can't

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just turn a big warship around like the HMS Illustrious. We made sure we

:11:27.:11:30.

took those decisions and that is while it will be taking over from

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HMS Daring come and that is why HMS Daring is ready there. It will be

:11:36.:11:40.

able to provide key support and expertise that has not been there so

:11:41.:11:44.

far. The US Navy is doing the heavy lifting here. The US Navy had the

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USS Washington, there is an aircraft carrier, 80 planes, 5000 personnel

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and they have the fleet, they are doing the real work. We obviously

:11:56.:11:58.

helping but the Americans are taking the lead. It is a big international

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effort. Countries like the US and the UK, that have a broader ability

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to support that goes beyond simply call humanitarian supplies -- have

:12:08.:12:15.

made sure we have brought our logistics knowledge, we have sent

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out our naval vessels. It shows we are working across government to

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respond to this crisis. Why does only just over 4% of your aid budget

:12:26.:12:32.

go on emergency disaster and response? A lot depends on what

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crises hit in any given year. We have done a huge amount, responding

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to the crisis in Syria, the conflict there and the fact we have 2 million

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refugees who have fled the country. We are part of an international

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effort in supporting them. Shouldn't we beginning more money to that

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rather than some of the other programmes where it is harder to see

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the results question of if we were to give more money to the refugees,

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it would be a visible result. We could see an improvement in the

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lives of children, men and women. What we need to do is alongside that

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is stop those situations from happening in the first place. A lot

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of our development spend is helping countries to stay stable. Look at

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some of the work we are doing in Somalia, much more sensible. Not

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just from an immigration but there is a threat perspective. There is a

:13:29.:13:33.

lot of terrorism coming from Somalia. You only have to look at

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Kenya recently to see that. Which is why you talk about what we do with

:13:39.:13:44.

the rest of the spend. It is why it is responsible to work with the

:13:45.:13:48.

government of Somalia. Should we give more, bigger part of the budget

:13:49.:13:54.

to disaster relief or not? I think we get it about right, we have to be

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flexible and we are. This Philippine relief is on top of the work in

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Syria. Where can you show me a correlation between us giving aid to

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some failed nation, or nearly failed nation, and that cutting down on

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terrorism? If you look at the work we have done in Pakistan, a huge

:14:16.:14:17.

amount of work. Some of it short-term. It is written by

:14:18.:14:24.

terrorism. That is -- ridden by terrorism. That is not going to fix

:14:25.:14:32.

it self in a sense. Look at the work that we do in investing in

:14:33.:14:41.

education. The things that little girls like Malala talk about as

:14:42.:14:48.

being absolutely key. We are ramping up our aid to Pakistan, it will be

:14:49.:14:54.

close to half ?1 billion by the time of the election. Why should British

:14:55.:14:59.

taxpayers be giving half ?1 billion to a country where only 0.5% of

:15:00.:15:07.

people in Pakistan pay income tax, and 70% of their own MPs don't pay

:15:08.:15:16.

income tax. It is a good point and that is why we have been working

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with their tax revenue authority to help them increase that and push

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forward the tax reform. You are right, and I have setup a team that

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will go out and work with many of these countries so they can raise

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their own revenues. You really think you will raise the amount of tax by

:15:42.:15:54.

sending out the British HRM see? How many troops I we sending out to

:15:55.:15:59.

protect them? They don't need troops. We make sure that we have a

:16:00.:16:07.

duty of care alongside our staff, but we have to respond to any crisis

:16:08.:16:17.

like the Philippines, and alongside other countries we have two work

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alongside them so that they can reinvest in their own public

:16:24.:16:28.

services. If they can create their own taxes, will we stop paying aid?

:16:29.:16:34.

We need to look at that but the new Pakistan Government has been very

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clear it is a priority and we will be helping them in pursuing that.

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Let me show you a picture. Who are these young women? I don't know, I'm

:16:48.:16:54.

sure you are about to tell me. They are the Ethiopian Spice Girls and

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I'm surprised you don't know because they have only managed to become so

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famous because your department has financed them to the tune of ?4

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million. All of the work we do with women on the ground, making sure

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they have a voice in their local communities, making sure they have

:17:15.:17:21.

some control over what happens to their own bodies in terms of

:17:22.:17:30.

tackling FGM, female genital mutilation... Did you know your

:17:31.:17:36.

department has spent ?4 million on the Ethiopian Spice Girls? Yes, I

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do, and we have to work with girls and show them there is a life ahead

:17:44.:17:48.

of them with opportunity and potential that goes beyond what many

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of them will experience, which includes early and forced marriage.

:17:53.:17:57.

It is part of the work we do with local communities to change

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attitudes everything you have just said is immeasurable, and they

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broadcast on a radio station that doesn't reach most of the country so

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it cannot have the impact. It only reaches 20 million people and the

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project has been condemned saying there were serious inefficiencies.

:18:26.:18:33.

That aid report was done a while ago now, and it was talking about the

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project when it first got going, and a lot of improvements have happened

:18:38.:18:41.

since. I would go back to the point that we are working in very

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difficult environments where we are trying to get longer term change on

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the ground and that means working directly with communities but also

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investing for the long-term, investing in some of these girls

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start changing attitudes in them and their communities. Why does the

:19:01.:19:06.

British taxpayers spend ?5 million on a Bangladesh version of Question

:19:07.:19:18.

Time? We work with the BBC to make sure we can get accountabilities...

:19:19.:19:23.

That is bigger then the BBC Question Time Normal -- budget. That includes

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the cost of David Dimbleby's tattoo! We are working to improve

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people's prospects but also we are working to improve their ability to

:19:52.:19:54.

hold their governments to account so that when they are not getting

:19:55.:19:58.

services on the ground, they have ways they can raise those concerns

:19:59.:20:02.

with the people who are there to deliver services for them. In your

:20:03.:20:08.

own personal view, should the next Conservative Government, if there is

:20:09.:20:15.

one, should you continue to ring fence spending on foreign aid? But

:20:16.:20:19.

it is critical that if we are going to spend 7.7% of our national

:20:20.:20:25.

income, we should make sure it is in our national interest and that means

:20:26.:20:30.

having a clear approach to humanitarian responses, in keeping

:20:31.:20:35.

the country safe, and a clearer approach on helping drive economic

:20:36.:20:40.

development and jobs so there is a long-term end of the dependency. Do

:20:41.:20:46.

you believe in an shrine in the percentage of our GDP that goes on

:20:47.:20:54.

foreign aid in law? Yes, and that is a coalition agreement. There have

:20:55.:21:00.

been a lot of agreements that you are sceptical about ring fencing. We

:21:01.:21:05.

are focused on shaking up the economy and improving our public

:21:06.:21:16.

finances. Why haven't you done that? At the end of the day we will be

:21:17.:21:25.

accountable but we are committed to doing that. You are running out of

:21:26.:21:32.

time, will you do it? I hope we can find the Parliamentary time, but

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even if we don't, we have acted as if that law is in place and we have

:21:37.:21:44.

already met 0.7% commitment. If you are British voter that doesn't

:21:45.:21:47.

believe that we should enshrine that in by law, which means that with a

:21:48.:21:55.

growing economy foreign aid will rise by definition, and if you think

:21:56.:21:59.

we should be spending less money on the Ethiopian Spice Girls, for whom

:22:00.:22:03.

should you wrote in the next election? I think we have a very

:22:04.:22:10.

sensible approach. I don't know what the various party manifestoes... The

:22:11.:22:17.

only party who thinks we shouldn't be doing this is UKIP. I think you

:22:18.:22:23.

have to look at the response to both the Philippines crisis and Children

:22:24.:22:36.

In Need. Of all the steps we are taking to get the country back on

:22:37.:22:41.

track, it shows the British people will respond to need when they need

:22:42.:22:46.

it and it is one of the things that makes Britain's special.

:22:47.:22:53.

Thank you. "It's always winter but never Christmas" - that's how

:22:54.:22:55.

doctors describe life inside accident and emergency. The College

:22:56.:22:57.

of Emergency Medicine have warned that this year could bring the

:22:58.:23:02.

"worst crisis on record". If that dire prediction comes, expect a

:23:03.:23:04.

spring of political recriminations, but how prepared are the NHS in

:23:05.:23:09.

England? And what do they make of this autumnal speculation? Giles has

:23:10.:23:16.

been to Leeds to find out. This winter has already come to our

:23:17.:23:21.

hospitals. It had an official start date, November the 3rd. That is when

:23:22.:23:30.

weekly updates are delivered to the NHS's most senior planners, alerting

:23:31.:23:35.

them to any sudden changes in patient numbers coming in. Where do

:23:36.:23:43.

they numbers register most then A They are the barometer for what

:23:44.:23:48.

is going on everywhere else, and they are the pressure point, so if

:23:49.:23:53.

the system is beginning to struggle then it is in the A department

:23:54.:23:59.

that we see the problems. It is not that the problems are the A

:24:00.:24:05.

departments, but they are the place where it all comes together. Plans

:24:06.:24:11.

to tackle those problems start being drawn up in May and they look at

:24:12.:24:16.

trends, even taking notice of any flu epidemics in New Zealand. They

:24:17.:24:29.

also look at the amount of bets. But the weather, economic realities,

:24:30.:24:34.

structural reforms, and changes to the general health of the

:24:35.:24:38.

population, are all factors they have to consider. We get huge

:24:39.:24:43.

amounts of information through the winter in order to help the NHS be

:24:44.:24:49.

the best it can be, but we had to redouble our efforts this year

:24:50.:24:52.

because we expected to be a difficult winter. We know the NHS is

:24:53.:24:59.

stretched so we are working hard to be as good as we can be. That means

:25:00.:25:04.

they are looking at winter staffing levels, plans to ask for help from

:25:05.:25:11.

neighbouring hospitals, and dovetailing help with GP surgeries,

:25:12.:25:15.

and still having the ability to move up an extra gear, a rehearsed

:25:16.:25:22.

emergency plan if the NHS had to face a major disease pandemic. You

:25:23.:25:28.

spend any time in any of our hospitals and you realise the NHS

:25:29.:25:32.

knows that winter is coming and they are making plans, but you also get a

:25:33.:25:36.

palpable feeling amongst health workers across the entire system

:25:37.:25:41.

that they do get fed up of being used as a political football.

:25:42.:25:47.

Doctors and all health care professionals are frustrated about

:25:48.:25:51.

the politics that surrounds the NHS in health care. They go to work to

:25:52.:25:57.

treat patients as best as they can, and the political knock-about does

:25:58.:26:03.

not help anyone. I find it frustrating when there is a

:26:04.:26:06.

commentary that suggests the NHS does not planned, when it is

:26:07.:26:12.

surprised by winter, and wherever that comes from it is hard to take,

:26:13.:26:16.

knowing how much we do nationally and how much our hard working front

:26:17.:26:27.

line staff are doing. When the Coalition have recently tried to

:26:28.:26:34.

open up the NHS to be a more independent body, it is clear the

:26:35.:26:40.

NHS feel they have had an unhealthy dose of political wrangling between

:26:41.:26:46.

parties on policy. The NHS is not infallible or making any guarantees,

:26:47.:26:51.

but they seem confident that they and their patients can survive the

:26:52.:26:54.

winter. Joining me now from Salford in the

:26:55.:26:56.

Shadow Health Secretary, Andy Burnham. Tell me this, if you were

:26:57.:27:07.

health secretary now, you just took over in an emergency election, what

:27:08.:27:14.

would you do to avoid another winter crisis? I would immediately halt the

:27:15.:27:21.

closure of NHS walk-in centres. We heard this week that around one in

:27:22.:27:27.

four walk-in centres are closed so it makes no sense whatsoever for the

:27:28.:27:32.

Government to allow the continued closure of them. I would put nurses

:27:33.:27:37.

back on the end of phones and restore an NHS direct style service.

:27:38.:27:43.

The new 111 service is not in a position to provide help to people

:27:44.:27:50.

this winter. I think the time has come to rethink how the NHS care is

:27:51.:27:56.

particularly for older people so I propose the full integration of

:27:57.:28:00.

health and social care. It cannot make any sense any more to have this

:28:01.:28:05.

approach where we cut social care and let elderly people drift to

:28:06.:28:10.

hospitals in greater numbers. We have two rethink it as a whole

:28:11.:28:19.

service. So you would repeal some of the Tory reforms and move

:28:20.:28:22.

commissioning to local authorities so the NHS should brace itself for

:28:23.:28:28.

another major top-down health reorganisation? No, unlike Andrew

:28:29.:28:33.

Lansley I will work with the organisations ie inherit. He could

:28:34.:28:45.

work with primary care trusts but he turned it upside down when it needed

:28:46.:28:49.

stability. I will not do that but I will repeal the health and social

:28:50.:29:03.

care act because last week we heard that hospitals and health services

:29:04.:29:07.

cannot get on and make sensible merger collaborations because of

:29:08.:29:12.

this nonsense now that the NHS is bound by competition law. Let me get

:29:13.:29:17.

your views on a number of ideas that have been floated either by the

:29:18.:29:21.

press or the Coalition. We haven't got much time. Do you welcome the

:29:22.:29:31.

plan to bring back named GPs for over 75s? Yes, but it has got harder

:29:32.:29:40.

to get the GP appointment under this Government because David Cameron

:29:41.:29:42.

scrapped the 48-hour guarantee that Tony Blair brought in. He was

:29:43.:29:48.

challenged in the 2005 election about the difficulty of getting a GP

:29:49.:29:53.

appointment, and Tony Blair brought in the commitment that people should

:29:54.:29:57.

be able to get that within 48 hours. That has now been scrapped.

:29:58.:30:04.

Do you welcome the idea of allowing everyone to choose their own GP

:30:05.:30:08.

surgery even if it is not in our traditional catchment area? I

:30:09.:30:15.

proposed that just before the last election, so yes. Do you welcome the

:30:16.:30:20.

idea of how a practice is being rated being a matter of public

:30:21.:30:25.

record, and of us knowing how much, at least from the NHS, our GP earns?

:30:26.:30:31.

Of course, every political party supports transparency in the NHS.

:30:32.:30:35.

More information for the public of that kind is a good thing. Do you

:30:36.:30:40.

welcome this plan to make it will form the collect in an NHS hospital

:30:41.:30:47.

-- make wilful neglect a criminal offence. It is important to say you

:30:48.:30:52.

can't pick and mix these recommendations, you can't say we

:30:53.:30:56.

will have that one and not the others. It was a balanced package

:30:57.:31:00.

that Sir Robert Francis put forward. My message is that it must be

:31:01.:31:04.

permitted in full. If we are to learn the lessons, the whole package

:31:05.:31:09.

must be addressed, and that includes safe staffing levels across the NHS.

:31:10.:31:14.

Staff have a responsible to two patients at the government

:31:15.:31:45.

People forget that when it came in, there was a shortage of GPs. Some

:31:46.:31:53.

people but lack the contract helped that. What I would say is that this

:31:54.:31:57.

myth that the government has built all year that the 2004 GP contract

:31:58.:32:03.

is responsible for the ANC crisis is eight spin of the worst kind. --

:32:04.:32:11.

A You would we do that contract now? It was redone in our time in

:32:12.:32:16.

government and changed to make it better government -- value for

:32:17.:32:26.

money. Not so great if you cannot get 24-hour access to your practice.

:32:27.:32:33.

I agree with that, but we brought in evening and weekend opening for

:32:34.:32:37.

GPs, another thing that is gone into reverse under Mr Cameron. It is

:32:38.:32:41.

harder to get a GP appointment under him and that is one reason why it

:32:42.:32:47.

A are under pressure. Two things that aren't on dealer direct sphere

:32:48.:32:51.

of your portfolio, what do you make of the government's review into

:32:52.:32:56.

intimidator eat tactics used by unions? If there has been

:32:57.:33:01.

intimidation, it is unacceptable and it should apply to unions as well as

:33:02.:33:06.

to employees. Was unite wrong to turn up at that manager 's house? I

:33:07.:33:11.

don't know the details of that. Presumably, the review will look

:33:12.:33:15.

into it. I need reassurance that this is not a political call by Mr

:33:16.:33:20.

Cameron designed to report here the election. We will see how it

:33:21.:33:25.

develops. Are you sponsored by Unite? No. Do you get any money from

:33:26.:33:32.

unite all for yourself or for your constituency office? No. It seems

:33:33.:33:40.

most others seem to be getting something from Unite, it seems odd

:33:41.:33:43.

that you don't get anything, I will put in a word with Len McCluskey.

:33:44.:33:48.

What I think is the scandal with funding is that to private health

:33:49.:33:52.

care companies who between them have given ?1.5 million in donations to

:33:53.:33:57.

the Tory parties have won ?1.5 billion in NHS contracts since the

:33:58.:34:01.

last election, I wonder why don't spend as much time talking about

:34:02.:34:05.

that as you do on trade union funding. We are happy to talk about

:34:06.:34:10.

that as well do you know. Briefly and finally, we see some -- from

:34:11.:34:16.

some e-mails that Mr Miliband's closest advisers regard Mr Ed Balls

:34:17.:34:20.

as a bit of a nightmare, quote, do you think there is a nightmare? No,

:34:21.:34:26.

I don't. He is a very good friend and I cannot believe, to be honest,

:34:27.:34:30.

that you are talking about those e-mails on a political programme, my

:34:31.:34:34.

goodness, you are busy scraping the barrel today. I had been on the

:34:35.:34:38.

front line for 20 years, I cannot under the front bench and indeed the

:34:39.:34:43.

wider party be as united as it is today, that is a great credit to Ed

:34:44.:34:47.

Miliband and Ed Balls. We are a united team. It was worth spending a

:34:48.:34:54.

few seconds just to establish that you are not having nightmares, we

:34:55.:34:58.

wouldn't want the Shadow Health Secretary to have them. It has just

:34:59.:35:03.

gone 11:30am, you are watching Sunday Politics.

:35:04.:35:11.

Good morning and welcome to Sunday Politics Scotland. Coming up on the

:35:12.:35:18.

programme: Experts from across the UK are gathering here in Edinburgh

:35:19.:35:21.

at the Royal College of Physicians to discuss the problem, we will look

:35:22.:35:24.

at the answer. They've called for an end to

:35:25.:35:28.

patient's being farmed out to the wrong wards and for the NHS to be

:35:29.:35:31.

fully operational seven days a week. We'll put that to the Health

:35:32.:35:34.

Secretary Alex Neil. And from Cameron wearing a condom to

:35:35.:35:37.

Salmond with his saltire, the wit and lampooning of political figures

:35:38.:35:41.

over the centuries. A group of medical experts is this

:35:42.:35:45.

morning calling for an end to the practice of boarding in the NHS,

:35:46.:35:48.

that's when patients are farmed out to wards inappropriate for their

:35:49.:35:51.

care when hospitals are busy. Research indicates being treated in

:35:52.:35:54.

the wrong ward makes you more likely to die. At a time when NHS services

:35:55.:35:59.

are facing increasing pressure, the specialists are calling for

:36:00.:36:01.

clinicians and support staff to extend seven-day working. Here's

:36:02.:36:13.

Andrew Kerr. It is coming up to that time of year, when the pressure on

:36:14.:36:15.

the NHS. The Scottish government admitted

:36:16.:36:19.

that they need to improve norovirus and flew at eight indeed

:36:20.:36:25.

departments. Doctors say they are now experiencing winter pressure all

:36:26.:36:30.

year around. The Royal College of Physicians of Edinburgh is

:36:31.:36:37.

concerned. They say 124% bed occupancy in Fife was reported and

:36:38.:36:44.

101% in Lothian. A symptom of this overcapacity is boarding, patients

:36:45.:36:46.

being farmed out to ward inappropriate for their care.

:36:47.:36:53.

Research shows that patients are looked after in the wrong department

:36:54.:36:57.

are at a greater risk of dying. Patients who are boarded, they have

:36:58.:37:03.

significantly increased length of stay, risk of readmission and

:37:04.:37:09.

mortality at 30 days compared to patients who aren't boarded. It is a

:37:10.:37:13.

major problem. Experts have been gathering in Edinburgh to try to

:37:14.:37:18.

work out how to solve it. Why our hospitals so busy? Increasing

:37:19.:37:22.

numbers of elderly people need treatment and patients have high

:37:23.:37:27.

expectations. Doctors are more cautious and patients are be sent

:37:28.:37:30.

for more tests. The number of beds has been cut to treat more people in

:37:31.:37:35.

the community. The debate and discussions are going on here at the

:37:36.:37:38.

Royal College of Physicians in Edinburgh. It can be very stressful

:37:39.:37:42.

for a patient being in a busy hospital, but it can be very shy

:37:43.:37:48.

school for the staff, too. As a numbers game down, so did staff

:37:49.:37:53.

numbers. The Royal College of Nursing says that 1800 nursing posts

:37:54.:37:57.

were lost in the three years until last Christmas. This is now being

:37:58.:38:02.

reversed. There has been a number of workforce cuts. That led to us and

:38:03.:38:08.

producing the number of students in training. We then found ourselves

:38:09.:38:14.

having to put more beds into the system and we need to now find more

:38:15.:38:18.

qualified nurses. Unfortunately, this boom and bust approach that our

:38:19.:38:26.

members talk about is not good for morale or for when you are trying to

:38:27.:38:29.

find the right numbers of qualified nurses. Scottish Labour picked up on

:38:30.:38:35.

the starting point at First Minister's questions. We have seen a

:38:36.:38:39.

number of things being exposed, for example, a 62% in the -- city could

:38:40.:38:48.

increase in the use of... The Conservatives say why not try to

:38:49.:38:53.

produce the rush to the front door. It will require us to have a more

:38:54.:38:58.

responsible attitude to avoidable conditions to, like addictions or

:38:59.:39:03.

obesity and how do we combine a need to provide a service information to

:39:04.:39:07.

that without necessarily referring everyone to a hospital? The experts

:39:08.:39:15.

recommend sweeping reforms to end boarding. They're calling for an

:39:16.:39:19.

extension to seven-day working and for patients to be carefully

:39:20.:39:23.

monitored during their stay. We are very much looking at how you can

:39:24.:39:29.

take patients from the community through the hospital and back into

:39:30.:39:33.

the community with the smallest chance of having to be really

:39:34.:39:37.

admitted. If we can that, appropriately across the health

:39:38.:39:42.

boards, then we are looking at the most appropriate system for these

:39:43.:39:47.

patients. Health Secretary is now looking -- considering all of the

:39:48.:39:50.

comments to try to ensure that patients are treated quickly and end

:39:51.:39:56.

up in the right place in hospital. Joining me now in the studio is the

:39:57.:40:00.

Cabinet Secretary for Health and Wellbeing, Alex Neil. Why does it

:40:01.:40:06.

happen? It is about the flow of patients through the hospital. The

:40:07.:40:10.

flow of patients is one of the crucial challenges in our system. It

:40:11.:40:13.

has not received the same attention previously when you had such a high

:40:14.:40:17.

rate of hospitalisation for dealing with all sorts of problems. Now

:40:18.:40:21.

there is much more focus on the flow of patients. For example, sometimes

:40:22.:40:25.

you have patients going into medical wards that should be in surgical

:40:26.:40:29.

wards and vice versa. We set up this study because we suspected that it

:40:30.:40:34.

was having a damaging impact on patient health outcomes and also

:40:35.:40:37.

because we wanted to manage the flow of patients better which is why we

:40:38.:40:40.

have the recommendations that we are delighted with. Your own figures

:40:41.:40:46.

suggest that those who are in this position are more likely to die,

:40:47.:40:51.

that must be worrying for patients. The iMac absolutely. That is why we

:40:52.:40:54.

are trying to eliminate it altogether, ideally. Were developing

:40:55.:41:04.

a bed management capacity to. Let me give you an example. One of the

:41:05.:41:07.

areas of research that we have done in the last year after the problems

:41:08.:41:12.

we had last winter was looking at the patient flow. What we found out

:41:13.:41:16.

is that in many wards in hospitals the percentage of patients being

:41:17.:41:20.

discharged, ready for discharge, clinically ready for discharge, but

:41:21.:41:26.

only about 6% in some wards were being discharged before lunchtime

:41:27.:41:28.

with most of them being discharged in the evening. The reason that

:41:29.:41:35.

those delays were taking place was because the pharmacy services

:41:36.:41:38.

weren't available, the transport home was not available, what we have

:41:39.:41:45.

done as part of our is to look at these parts and puts the part in

:41:46.:41:51.

place. In the incident where it is now closer to 25%. That frees up

:41:52.:41:57.

their beds for people coming in through unplanned or planned care.

:41:58.:42:03.

Can you eradicate this practice? I believe we can. What time frame? We

:42:04.:42:14.

are looking at that. It is one of the priorities and has been a

:42:15.:42:17.

priority for the last year in improving the management of a bed

:42:18.:42:21.

capacity in hospitals. We have slightly increase the capacity in

:42:22.:42:25.

the last year. They are today 400 more beds in the National Health

:42:26.:42:28.

Service in Scotland than there were 12 months ago. Numbers were reducing

:42:29.:42:33.

previously. We had the same situation with nurse numbers. Do you

:42:34.:42:37.

accept the point that was being made in that film that there is a boom

:42:38.:42:45.

and bust element? That is why we have introduced a mandatory to that

:42:46.:42:49.

every health board has two planet using the planning tool for planning

:42:50.:42:55.

nursing staff. -- planning. Let me explain in terms of what happens and

:42:56.:42:59.

what has happened in terms of staffing. First of all, we have more

:43:00.:43:04.

qualified nurses and midwives in the national health service than we did

:43:05.:43:07.

when we came in a number of years ago. There are three reasons why the

:43:08.:43:12.

number of beds has gone down. This happened under the previous

:43:13.:43:18.

Administration 's. The rate has gone down significantly and that this

:43:19.:43:21.

Administration. Number one, you have the transfer from care in hospital

:43:22.:43:25.

to care in the community. Secondly, you have a much higher incidence now

:43:26.:43:30.

of day surgery, for example, we do 35,000 cataract operations every

:43:31.:43:37.

year. The vast bulk of those after nailing a surgery basis. -- done on

:43:38.:43:46.

hate. It does sound like you have on -- overestimated the benefits of

:43:47.:43:49.

some of these changes in terms of bed numbers. They did not actually

:43:50.:43:53.

gets the ratio right. I would not agree with that. There are examples.

:43:54.:43:59.

Planning ten years ago for the new Victoria in Fife and the new

:44:00.:44:05.

Edinburgh Royal Infirmary grossly overestimated the decline in the

:44:06.:44:09.

population and the need for beds. As a result of that, we reinstated bed

:44:10.:44:14.

capacity significantly in Edinburgh and five. Apart from that, the issue

:44:15.:44:18.

is not a strategic shortage of beds. The issue is better management of

:44:19.:44:24.

the bed capacity that we have. Is there still the potential for a

:44:25.:44:28.

crisis in our hospitals this winter? We heard about the

:44:29.:44:32.

norovirus, an increase in in the number of flu cases. Could the same

:44:33.:44:40.

thing happened this year? The norovirus... We had 25 wards closed

:44:41.:44:44.

on Christmas Eve because of it. We also had a high incidence of

:44:45.:44:54.

respiratory disease. That led to a major surge in A and one third of

:44:55.:44:58.

all of the people who went into A were also admitted to hospital. It

:44:59.:45:03.

could happen this year, but we are much better prepared. I announced an

:45:04.:45:08.

unscheduled care plan so that, for example compared to last year we

:45:09.:45:14.

have 400 more beds, we also have a capacity for additional search beds

:45:15.:45:18.

if they are required. We have recruited more nurses and we have

:45:19.:45:23.

increased the numbers of the -- A consultants. Over the years we have

:45:24.:45:27.

been in power, we have doubled the number of A consultants. One of

:45:28.:45:33.

your ambitions, shared with the Royal College of Physicians, is to

:45:34.:45:38.

gear up the NHS to be a seven-day week operation. That has

:45:39.:45:43.

implications of cost, doesn't it? . The reason we are doing it is that

:45:44.:45:47.

one of the reasons that we have the problem is that is a Fife and others

:45:48.:45:52.

refer to is that our hospitals are often planned on a five-day working

:45:53.:45:57.

week basis. The result of that is that towards the end of every week,

:45:58.:46:00.

there is a major increase in activity and again at the start of

:46:01.:46:04.

the week instead of an even flow. During the week, people are kept in

:46:05.:46:10.

hospital unnecessarily over the weekend because the pharmacy

:46:11.:46:14.

department is not staffed up to provide the pharmacy products that

:46:15.:46:19.

they need to go home. How much extra will this plan cost? In some ways it

:46:20.:46:26.

will save money. It cost about ?4600 per week to keep somebody in N

:46:27.:46:31.

hospital. If you multiply the number of times we are unnecessarily

:46:32.:46:34.

detaining people in hospital over the weekend, if we don't do that it

:46:35.:46:41.

will save a significant amount of money. But you will have to pay

:46:42.:46:46.

staff more. We are sitting down with staff to work out about better

:46:47.:46:50.

management of the resorts, rather than just putting more people in. It

:46:51.:46:57.

is about better management and safety management. If you look at

:46:58.:47:03.

the contract, doctors don't have too formed nonemergency work at 8pm and

:47:04.:47:06.

at the weekends. If you are asking them to do that, they will rightly

:47:07.:47:15.

expect some recompense. A lot of people are already on call. They are

:47:16.:47:19.

being paid to be on call at home. I think it is better and they think it

:47:20.:47:23.

is better that they are paid to come in and do work in the hospital. It

:47:24.:47:27.

is about a different way of working. We'll sits down with all of the

:47:28.:47:32.

people, we will do it by negotiation and consensus. We will not impose

:47:33.:47:38.

it. The biggest rate two out of -- out of hours is the pension reform.

:47:39.:47:45.

We have a real problem amongst GPs. Many of them are telling me that

:47:46.:47:49.

because of the daft reforms that have been introduced to the pension

:47:50.:47:53.

scheme by the UK government, many feel they are being forced to retire

:47:54.:47:57.

early and many feel that it is not worth their while doing out of hours

:47:58.:48:01.

because of the disincentive of the pension scheme. But they do as they

:48:02.:48:05.

get overtime. There was a report last week that in a four-year

:48:06.:48:10.

period, ?40 million was spent in less than four years on overtime

:48:11.:48:13.

payments for consultants in hospitals. Out of a budget of ?12

:48:14.:48:20.

billion, that is a reasonable figure. I don't know any modern

:48:21.:48:25.

industry that does not use an element of overtime to manage the

:48:26.:48:30.

flow and to manage when you get spikes in the flow of patients, ?10

:48:31.:48:35.

million in the great scheme of things is... It leads to better

:48:36.:48:41.

patient care. Some consultants are taking an extra ?150,000 because of

:48:42.:48:48.

the triple time. These contracts were negotiated in 2004. We have

:48:49.:48:53.

inherited the contracts. I would like to sit down and have already

:48:54.:48:56.

started the process of sitting down with the GPs to make sure that we

:48:57.:49:02.

have people working as much as they possibly can and at weekends and in

:49:03.:49:06.

the evenings as well and during the day, manage the workflow. On the one

:49:07.:49:12.

hand, better resorts, on the one hand, a better flow of patients

:49:13.:49:16.

through the system and on the other hand, we don't have overload and

:49:17.:49:24.

overwork. Another story in the newspapers today, saying you are

:49:25.:49:29.

looking at whether all not those who wilfully neglect patients might face

:49:30.:49:35.

jail terms, a move being introduced by the health department for those

:49:36.:49:38.

who work in the NHS in England. What do you think of that? We already

:49:39.:49:46.

have a law that says that, as far as full report patients are concerned.

:49:47.:49:51.

We will consider whether we need to extend that to cover everybody. --

:49:52.:49:55.

vulnerable patients. First that would only apply in an extreme

:49:56.:50:00.

circumstance. Second, legislation to deal with something that has already

:50:01.:50:04.

happened, as that legislation would be, is not the answer. Is is because

:50:05.:50:11.

it was brought in after mid Staffordshire. Yes but we should be

:50:12.:50:18.

under no illusion that it is a substitute for quality care. We have

:50:19.:50:22.

had a safety programme over the last five years and the professor who

:50:23.:50:25.

drew up many of these proposals for David Cameron, and who is an adviser

:50:26.:50:31.

to President Obama, he describes the Scottish health service as the

:50:32.:50:35.

safest in the world. What is your own personal view on this subject?

:50:36.:50:39.

Is there a need for legislation and would it ultimately protect the

:50:40.:50:47.

vulnerable? There is sense in extending the legislation we already

:50:48.:50:50.

have for everybody so that in these extreme cases, if it did happen in

:50:51.:50:54.

Scotland, we could do the necessary. But we need to look at

:50:55.:51:00.

the implications but I am certainly minded to introduce that

:51:01.:51:05.

legislation. So extending it right across the NHS? Yes. Thank you.

:51:06.:51:13.

Politics is a serious business but there are people employed to make

:51:14.:51:16.

sure politicians do not take themselves too seriously. Satirical

:51:17.:51:20.

cartoonists can be found poking fun at those in charge from the pages of

:51:21.:51:25.

many newspapers. The practice goes back centuries. Two exhibitions are

:51:26.:51:31.

being held in Aberdeen looking at two of the greatest cartoonists of

:51:32.:51:39.

all time. It is an art form that few

:51:40.:51:43.

politicians have escaped from. Those at the top know nothing is beyond

:51:44.:51:47.

the tip of the satirical cartoonist's pencil. But it can be

:51:48.:51:51.

damaging, especially for egos. That has been the case for a long time.

:51:52.:51:59.

David Lowes' repeated caricatures of Hitler for the Evening Standard work

:52:00.:52:09.

not popular in Berlin. Hitler found it humiliating. He complained about

:52:10.:52:14.

it to British politicians at the time. He tried to get them banned as

:52:15.:52:21.

well. This resulted in David Lowe being put on the Gestapo death list.

:52:22.:52:27.

The idea of satirical cartoons goes back centuries. Historians argue

:52:28.:52:31.

this was its heyday, with William Hogarth and Garth Cruickshank among

:52:32.:52:36.

the key figures. Nowadays, the newspapers provide a mass market for

:52:37.:52:40.

cartoonist, but in the 17th century, it would have been the shop window

:52:41.:52:44.

of the local printers that would have done the same thing. People

:52:45.:52:47.

would have congregated around them in large numbers to see the latest

:52:48.:52:52.

images and have a good early laugh. Electoral corruption provides the

:52:53.:52:56.

focus for this 18th century Hogarth piece and it is awash with detail.

:52:57.:53:07.

Must -- it is incredibly detailed. Lots of little details. Even today

:53:08.:53:15.

there is no escape, despite the decline in newspaper sales and the

:53:16.:53:20.

prevalence of 24 avenues. The cartoonists' acid in lives on,

:53:21.:53:26.

poking fun at politics being a past time we are unlikely to tire of.

:53:27.:53:30.

I am joined by award-winning cartoonist Steve Bell. What would

:53:31.:53:34.

you say the lasting influence of those early cartoons is? As well as

:53:35.:53:40.

the great pictures they produce, there is the attitude which

:53:41.:53:46.

underlies it under which goes back really to me the late 18th century,

:53:47.:53:52.

when satire got really rude. I am thinking of Gilroy in particular,

:53:53.:53:57.

who was a supremely political cartoonist. Probably the first real

:53:58.:54:02.

satirical political cartoonist. He creates figures which we now

:54:03.:54:08.

remember more through their caricatures and through the real

:54:09.:54:13.

images. People like William Pitt, George III, George IV. We remember

:54:14.:54:19.

them or us caricatures than as official images. And these images

:54:20.:54:23.

that influenced your own work, or was it more contemporary cartoons

:54:24.:54:27.

when he first started? Certainly, it is this sort of stuff is in your

:54:28.:54:34.

much green, but the bubbly I am more influenced directly by

:54:35.:54:36.

contemporaries. I was probably brought up on the Beano, so I was

:54:37.:54:39.

more influenced by that than anything else. I do strip cartoons.

:54:40.:54:44.

That is what I love to do. But the more I found out about these guys,

:54:45.:54:51.

like Cruickshank and Hogarth, the more I marvelled at what they did.

:54:52.:54:55.

Especially acres of Gilroy, what he got away with at the time. There was

:54:56.:54:59.

no freedom of the press at the time. He got away with this

:55:00.:55:02.

Political magazine presented by Andrew Neil and Andrew Kerr.


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