Author, George Saunders, whos won the man booker prize for his novel lincoln in the bardo. Good morning. Its wednesday, the 18th october. Im annita mcveigh. Welcome to bbc newsroom live. The performance of hospitals has slumped across the uk with targets for cancer, a e, and planned operations now being widely missed, according to bbc research. Nationally england, wales and Northern Ireland have not hit one of their three key targets for 18 months. Only scotland has hit one of the targets. The findings are revealed as the bbc launches its online nhs tracker project, which allows people to see how their local service is performing on three key waiting time targets being seen within four hours in a e, cancer care beginning within 62 days of diagnosis, and planned operations taking place within 18 weeks in england and scotland. The target wait time is different in wales and Northern Ireland. To tell us more, were joined from nottingham by our Health Correspondent in the east midlands, rob sissons. Good morning, this is nottinghams queens medical centre, and in common with lots of hospitals they are seeing record numbers of patients. This is a campaign to get patients to access the right care first time. Painful coughs should be at the pharmacy, and minor illness or injury should be at the walk in centre. There are so many ways to access the nhs yet all too often it feels to the staff that people come to a e when sometimes they dont need to be here. We have been behind the scenes at this hospital to see how challenging those targets you mentioned are. Round the clock, the nhs is treating more patients. In the cold light of day, its clear the pressure is mounting. The patients here notice it. Nottingham is home to one of the uks busiest accident and emergency departments. Im in agony and theyre just not quick enough. I could see its under pressure straightaway, when i came in. Theres not enough volume of people turning over very quickly, in order to alleviate this kind of pressure. Dr malik spent seven years on the front line and says patient demand has gone up and up. Certainly from when i started practising emergency medicine, we were on average seeing 400 day, we are now going in excess of 500 a day, which seems like the norm on a daily basis. So definitely the volume, the intensity, the pressures of front line have definitely increased. Now, for the targets to be met nationally, the vast majority of patients have to be seen and treated promptly. Individual trust performance, of course, varies when it comes to a e waits, cancer waits, and routine operations. So, when we look across the uk, what does the bbcs nhs tracker reveal . Four years ago, the key targets were met across england 86 of the time. This year, its 0 . In Northern Ireland, they were hitting the targets 25 of the time. Again, performances got worse. Its also 0 . Wales in 2013 didnt hit the target, and four years on, its the same picture. Scotlands Health Boards previously achieved 42 . Now, the goals are being met 8 of the time, but thats the best in the uk. I think the challenge for lots of hospitals, ours included, has been an increase in demand and the population has got older, with more health needs, so it becomes more difficult every year to achieve some of the targets. We do a heart scan every three months. Cancer services are also under pressure. Nicky was a young mum when she had esophageal cancer. She had timely treatment, but is concerned others face delays. Every day is a really long day when youre either waiting to see the consultant, waiting for results, waiting for a scan. Its another sleepless night. Its another day of worry. Its that uncertainty. Its the not knowing thats really, really hard to deal with. Although most patients are seen within target times, growing numbers are waiting longer for treatment. Rob sissons, bbc news, nottingham. The department of health in england have said they have robust plans in place in the run up to winter, more preparation than ever before. They stress that yes patient numbers are going up. Most people are seen within the target times but the pressures that we are seeing in the nhs are being faced by lots of other countries as well. In scotland the government there say their a e is the best performing in the uk but they do at that some people are waiting too long the treatment. In wales they say they are putting more money into the Health Service and recognise there is still a way to go to improve things. Lets chat now with caroline shaw, the chief operating officer at this trust. Thanks forjoining us. Why are we seeing these targets missed left right and centre . I dont think they are being missed left right and centre. Our tracker showed it has got worse compared to four years ago. The targets are very challenging because there is an increase in demand, the population is getting more elderly and those complex needs so there is huge pressure on the system for patient care. If we take the story of cancer at this trust, you have 22 cancer specialists, theres a shortage and they can only see so many cases in a day, but what surprised me was how much the numbers are going up, the number of cancer cases you are investigating. Yes, we have seen an increase in the number of cases we are investigating and some of the cancers are more complex than in the past. What money to do as a Health Economy and with other trusts and entirely ourselves is to make sure we have appropriate pathways for all oui we have appropriate pathways for all our patients. Its important to see them ina our patients. Its important to see them in a timely manner. He nearly one in five patients is waiting more than the target time of four hours in a e, does it perhaps suggest we should do away with these targets . Absolutely not, they are really important, they give an emphasis on focus in regard to giving timely ca re focus in regard to giving timely care and improving services. Focus in regard to giving timely care and improving serviceslj focus in regard to giving timely care and improving services. I know in my time in covering health, when i chat to front line staff at various hospitals, some will say there is an obsession with it but it doesnt tell you anything about the quality of care. I think it is important to define the quality of ca re important to define the quality of care but also to offer timely care to our patients and good Patient Experience and there is a link between timely care and quality of care. Winter is looming, how concerned are you that these targets will slip away from you even more as we head towards winter, as it gets more challenging . I think it will be a challenging winter but im pleased to say that in nottingham and nottinghamshire we are a good position with robust plans we have really worked ha rd position with robust plans we have really worked hard as a Health Economy and social economy to have the plans to monitor demand. Thanks for joining the plans to monitor demand. Thanks forjoining us. There will be a bbc 0ne documentary filmed next year, it is called hospital, they are coming behind the scenes at the height of winter to show you what is going on at this trust. That promises to be a fascinating watch, thank you. Joining me now is nigel edwards, chief executive of the health think tank, the nuffield trust. Thank you forjoining us. 0bviously the level of demand on services is an issue, money is in issue. You have done research on the amount of money hospital gets to treat a patient and that is very interesting when you compare 2010 onwards, isnt it . We have had many years of austerity and we are starting to see the impact of that. If we assume the case costs £1000 per case in 2010, in real terms now hospitals are getting something more like £760 per case so in many ways theres been an impressive improvement in efficiency but to be honest that gap between what it costs to care for people and what it costs to care for people and what hospitals are being paid is showing up in deficits. You were saying to me a second ago that even if there was more money in the system, stuffing, recruitment and retain meant as a problem. Yes, the pressure of work seems to be causing problems, people not that keen in working in a e, in acute medicine, the bulk of what a lot of hospitals do, which is caring for people with complex medical conditions. There is very high levels of vacancies and the numbers of nurses on the register has been falling. I think theres a major concern about whether one can staff these units at a level that is safe and sustainable. We have all known for a number of years that stuffing, money, level of demand, these are all issues but nobody seems to have come up with a solution that is reversing the trend of hospitals failing to meet performance targets. Are there any ideas out there about how this might be achieved . Are there any ideas out there about how this might be achievemm are there any ideas out there about how this might be achieved . It is surprising to me hospitals have done as well as they have done. They are treating a lot more people, arent they . Frankly i was expecting things to have got worse a lot more quickly, it given the austerity to which they have been exposed. The problems are very significant. Which they have been exposed. The problems are very significantm there an argument for changing performance targets, the waiting times hospitals are expected to meet for various services . Not really, no. The big issue is how these targets a re no. The big issue is how these targets are met, the culture of bullying and working around the targets rather than meeting the spirit of them rather than just hitting the numbers. We see some not very good behaviours in some parts of the system as a consequence of that but the idea of having clear targets which make clear what would looks like is certainly one that is worth doing. Which makes clear what good looks like. Thank you. To find out how your local Hospital Service is performing on waiting times for cancer, a e and planned operations go to the bbcs nhs tracker at www. Bbc. Co. Uk nhstracker you just need to enter your postcode. The work and pensions secretary, david gauke, has said that people will no longer be charged for calling the governments universal credit helpline. It follows criticism that callers are being charged up to 55p a minute when they ring with questions about payments. Labour is calling for the system, which merges six benefits into one, to be paused and mps will debate the issue this afternoon. We can speak to our assistant Political Editor norman smith. So the helpline will become a free phone number, is that the forerunner of more change to come . Not if what david gauke had to say this morning is anything to go buy it because he had grilling by mps on the work and pensions select committee, repeatedly pressed about perhaps the most contentious area, namely the six week delay that new universal credit claimants have to wait to get the money. A lot of pressure including from more than 20 or so tory mps to bring that down to four weeks. David gauke really gave no ground there but he did go to meet the other big concern which is over this premium phone helpline where claimants at the moment face a charge of 55p per minute. This is what david gauke told the committee. In recent days theres been criticism over the telephone charges that exist in respect of universal credit. Now, as weve previously said, universal credit 0345 numbers are charged at local rate, which is included in the call package in most mobile and landline phone deals. Contrary to some reports, these are not premium lines. Dwp does not make a profit from these lines. Nonetheless, given the recent attention and concern that this could place a burden on claimants, i have decided this will change to a freephone number over the next month. As you will be aware, it has been dwps long standing position to operate local line charges for benefit inquiry lines, but having reviewed this matter more widely, i will be extending the freephone numbers to all of dwps phone lines by the end of the year. I wanted the committee to be the first to hear of this approach and i think that is helpful to the committee. All this of course before the debate in the commons this afternoon on this issue of universal credit and whether the roll out should be paused. How has david gaukes concession gone down this morning . Im joined by sarah wollaston, one of the tory rebels. I presume you are pleased by the announcement the premium phone line has gone . Absolutely, there was no justification for that whatsoever but the fundamental concern remains about the length of delay claimants are experiencing and the concern that this puts people into debt right at the start of the process. I support universal credit but its being undermined by a failure to address a serious flaw at the heart of the system. So how much difficulty is the government in over this, if any . There 20 or sale of you unhappy with this stance, but is there any sign they will rethink on this critical issue of the six week delay . I and some of my colleagues will keep making the case to say it is undermining the principles universal credit because if people get into debt and have real difficulty at the start of the process, they are unlikely to re cove r. Process, they are unlikely to recover. Including the issue of getting into arrears on housing and this could be addressed by shortening the delay at the start of the process. It simply isnt enough to give people a three week advance for a six week wait because it leaves some Vulnerable People with three weeks with nothing. It is great they are raising awareness and there is greater uptake but it doesnt address the fundamental problem that if you have brought that gap forward you wouldnt need to have so many people requiring those advances in the first place. We are talking about rolling this out to families and very Vulnerable People so im afraid i cannot support it moving forward until we have addressed those fundamental flaws. We know there have been similar rows that have hit David Camerons government over tax credits and personal independent payments, how much damage do you believe it could do to the reputation of this government if there is no movement on this issue . Of course because we are all here to look after the interests of the most vulnerable in society. We are talking about families and Vulnerable People with other underlying issues who have difficulty dealing with this complex syste m difficulty dealing with this complex system in the first place. We are here to make sure their voice is heard at the heart of government and i support the principle of universal credit, i understand its benefits, but it is being undermined by this fundamental flaw about delays in initial payment. Sarah wollaston, thank you. We will get more sense if there will be any movement during prime ministers questions or during the debate this afternoon, but so far there has been give on the premium phone line but not on the critical issue of the delay before people can get universal credit. Norman, thank you. The headlines on bbc newsroom live hospitals across the uk are missing targets for cancer care, a e and planned operations, new bbc analysis finds. The government says its scrapping charges to call the universal credit benefits helpline, as labour presses for the whole scheme to be put on hold. Game of thrones actress lena headey becomes the latest Hollywood Star to accuse producer Harvey Weinstein of sexual harassment. And in sport. Very good results for spurs, Manchester City and liverpool in the Champions League last night. Alex 0xlade chamberlain scored his first goal for liverpool, as they recorded the biggest away win or an english team in the history of the competition, beating slovenian champions maribor 7 0. Tonight, manchester united, chelsea and celtic are all in action. Jose mourinho takes his team to his native portugal to face their champions benfica, having won both their opening games. And a great win for Britains Heather Watson at the luxembourg 0pen. Shes into the quarterfinals after beating estonian third seed Anett Kontaveit in straight sets. Ill be back with more on those stories later. Unemployment has fallen to a 12 year low but pay Growth Continues to fall behind inflation, new figures show. Unemployment fell by 52,000 between june and august to 1. 4 million. Average earning increased by 2. 2 in the year to august, unchanged from the previous month. But thats slower than the rate of inflation which was announced yesterday at 3 . The Northern Ireland secretary says progress on the political crisis at stormont has stalled. Speaking to a committee of mps he said the prospects of a deal to restore devolution dont look positive. He said the latest date for an executive jet to be formed to pass the budget is the week beginning the 6th of november. Its one of the most important set piece speeches, made by one of the most powerful men in the world. The leader of the Chinese Communist party xijinping has said his country has made great accomplishments in the last five years, despite challenges from a very weak global economy. President xi received rapturous applause from the congress as he outlined the future role his country should play in the world, one in which china he said would take centre stage. Translation we need to work further towards achieving socialism with chinese characteristics to build a well off country and to build a great power in the world. It is also the age for the party, for the people to unite together and to strive for a better off life. It is time for older generation of chinese to realise rejuvenation and to realise our chinese dream. It is time for us to take the centre stage in the world and to make greater contribution for the humankind. Our china correspondent John Sudworth is in beijing. John, it was confident speech, and in which the president alluded to chinese socialism com paring rather well to western democracy. Yes, a note of triumphalism perhaps, slightly more nationalistic in tone than some had been expecting, but of course as you mentioned, this is a set piece speech in a set piece event. Passing the detail, there is little surprise. Nonetheless, i think you get a hint of the broad themes of what china will look like over the next five years. One thing in particular stands out and that is xijinping revisiting his preoccupation with corruption, the idea that unless china cleans up corruption in the communist party itself is threatened, the reason he so concerned about that is again we hear it in this speech, his feeling that it hear it in this speech, his feeling thatitis hear it in this speech, his feeling that it is only the communist party that it is only the communist party that can deliver china its destiny, the place in the world, this centre stage that he was speaking in a clip we heard there. I think what it really does for me is the idea that used to be held widely that with trade and Economic Engagement would come political freedom. Trade and Economic Engagement would come politicalfreedom. That has now long gone. Xijinping is saying no way, not on my watch, and he is building the worlds most powerful economy without any of the associated Political Freedoms economy without any of the associated politicalfreedoms people used to think would come naturally. John, thank you very much. The american short story writer, George Saunders, has won the man booker prize. Lincoln in the bardo, his first novel, is about abraham lincolns grief, following the death of his 11 year old son in 1862. And George Saunders is here now. Welcome and congratulations. Thank you so much. I was reading an article you wrote earlier this year andi article you wrote earlier this year and i want to read to our viewers what you wrote. You describe how you got the idea for this novel 20 years ago and then in 2012 you decided to ta ke ago and then in 2012 you decided to take a ago and then in 2012 you decided to takea run ago and then in 2012 you decided to take a run with it. You wrote, you didnt want to be the guy whose own gravestone would read afraid to embark on scary artistic project he desperately longed to attempt. So at what point did the change come and was it scary . It was very scary. Its such a beautiful idea for a story and i didnt feel like i delayed. At some point you reached a crossroads where the where you ta ke crossroads where the where you take the leap or you dont. At 5051 might live a few more years so i should keep myself as an artist. Up until that point you had been writing short stories, hadnt you . Was the transition difficult to manage . I kept waiting for the big trumpet blast of being a novelist, but i spent my life learning to make custom yu rts but i spent my life learning to make custom yurts and somebody said can you build a mansion and i said yeah, ican you build a mansion and i said yeah, i can put a bunch of yurts together it isa i can put a bunch of yurts together it is a good analogy. Tell our audience is more about what this book is like. Bardo is the tibetan form of purgatory . Yes, the bardo is negotiable, a dead person can come to an understanding about his life, then be freed and go on to heaven but the story is basically when lincoln was president supposedly, his son passed away and he went into the crypt on several occasions to view the body so that spoke to me, just the level of grief that would drive a person to do that. Then of course he had to leave and fight the war so just the profundity of that evening, you know. It was a fairly chance remark on a visit to washington that planted the seed of this idea in your mind . Yes, we were driving by a graveyard and my wifes cousin said did you know, and told the story. It got into my head but i didnt think i could write the book, soi didnt think i could write the book, so i stored it at the 20 years and in 2012 i said, if its not now, when . You are very modest and self deprecating in the things i have read about you, so how does it feel to be awarded this prize . Do you think of it as validation . As somebody with lifelong low self esteem, it is very validating. What you try to do is take the very generous response, plough it under and say i dont deserve it but im going to try to, and i will try to make the next work even better. L little bit of pressure then for the next work another novel or short stories . I dont know, my approach is very ad hoc so i will go home and see whats interesting. Its a pleasure to meet you, thank you for coming to talk to us and congratulations again. George saunders, the winner of the man booker prize 2017. The headlines are coming up on the bbc news channel. In a moment we say goodbye to viewers on bbc two first we leave you with for a look at the weather. It is quite cloudy out there for many of us at the moment. We have outbreaks of rain affecting the south east of england too but as you can see from the satellite picture this cloud moving northwards. Still some brighter skies across parts of northern england, north wales, Northern Ireland as well and there will be sunnier spells here during the afternoon. But towards the south and the east, the cloud remains with outbreaks of rain continuing in parts of south lincolnshire into the midlands, towards norfolk and suffolk. Further north and west we could see brightness here and there, temperatures 13 16d. This evening the rain will continue to move northwards, rain moving into scotla nd northwards, rain moving into scotland and Northern Ireland, then during thursday we have the heavier rain affecting central and eastern parts of england. A slice of dry weather but then we will see this rain spreading to Northern Ireland into the south west of wales, south western parts of england as well. Some of that rain will be particularly heavy during thursday afternoon. There will be a strengthening wind as well. Some brightness in between those weather systems, maximum temperature tomorrow 18 celsius. As we go through friday into the weekend it will remain unsettled and could be stormy potentially on saturday. I will have more details on that in about 25 minutes. Goodbye