i'm kasia madera with bbc news. our top story: police in hong kong have clashed with protesters angry at a law that would allow suspects to be extradited to mainland china. there were violent scenes when police tried to clear demonstrators from outside the city's legislative council. earlier on sunday as many as one million people marched through the streets in opposition to the extradition plan. one of the leading contenders to become britain's next prime minister has admitted he committed a crime when he took cocaine 20 years ago, before he became a politician. and this story is trending on bbc.com: rafael nadal‘s victory at the french open has put him in the record books. he's become the first player to win 12 singles titles at the same grand slam competition. the spaniard beat dominic thiem in four sets. that's all. stay with bbc world news.

now on bbc news, a special edition of hardtalk recorded at the hay literary festival. welcome to hardtalk with me, stephen sacker. and a wonderful audience here at the hay festival in wales. there is something very special about the human heart. its beet keeps us alive and it ——we would like to think it were our strongest feelings and emotions come from. my guess today is the renowned heart surgeon guess today is the renowned heart surgeon samer naschef. his books give us an extraordinary insight into the highs and lows of a life spent mending broken hearts. applause. samer naschef, a very, very warm welcome to hardtalk. you

have described the heart is a very simple mechanism. you say it is a bag made of muscle. the simplest of pumps. is that really how you see it? -- pumps. is that really how you see it? —— samer nashef. pumps. is that really how you see it? -- samer nashef. that is really how it is. but we invested with so much. do you not, when you look at that heart in the operating theatre, give it in a slightly more mystical terms? well, the mysticalthink about it, that's when it stops you dead so that is quite important but it doesn't like anything like valentines cards and there is no point in making jewellery that looks like it. nobody makesjewellery point in making jewellery that looks like it. nobody makes jewellery that looks like livers or kidneys, as far asi looks like livers or kidneys, as far as i know. and it is simply a pump. there is probably a reason people think it is the seat of emotions because when you have emotions and release adrenaline, they stimulate the heart and it beats faster and

more strongly. so they assume it is the heart that's generating their emotions. the heart isjust simply responding to them but it is a clever poem. —— pump. responding to them but it is a clever poem. -- pump. a clever pump and you have in your matter—of—fact way, described it, being a heart surgeon as way, described it, being a heart surgeon as being dealing with the plumbing of the human bot body. i am wondering what drew you to something which in a sense makes you the human body's plumber? it was a series of strange decisions and mistaken ones, often, and not very intelligent ones. i sort of liked the heart when it was a medical —— when i was a medical student because it was clea n, medical student because it was clean, neat and glamorous. and i wa nted clean, neat and glamorous. and i wanted to become a cardiologist. but i got exasperated by physicians stop cardiologists are physicians. and they drove me up the wall when i was

a heart surgeon and i was asking them to come in and give advice about surgical patients and they wasted an awful lot of my time and argued about silly things and kept on quoting the last paper from this and the last paper from that and one day i thought, if that happens one more time, i will switch to become a surgeon. more time, i will switch to become a surgeon. from those of his vision. from the hospital, the treatment process , from the hospital, the treatment process, the cardiologist will accept —— assess the problem in a broken orfailing hard and you accept —— assess the problem in a broken or failing hard and you will then be given the task of fixing it. that is true to some extent although nowadays the cardiologist can do quite a lot of stuff that is just short of an open heart operation so they can put catheters in the groin and puts stents and stretch holes and puts stents and stretch holes and try to close them so they do quite a and try to close them so they do quiteafair and try to close them so they do quite a fair bit of intervention

stuff but the surgeon who opens the chest and it does the final repair, if you see what you mean ——if you see what i mean. i do and you write about it very graphically but what you also lead us to understand is open—heart surgery which is such a familiar, such a important part of the medical kit bag, it really is, in medical terms, quite a new practice because the technology simply didn't exist before the 1950s to open up the chest and operate upon the heart. well, until about 100 years ago, may more, it was not possible to open the chest, let alone operate on the heart, because something that many people don't realise, your lungs don't breathe by themselves. they need an intact chest wall around them. they are passive. the chest wall muscles stretch and the lungs just follow because they are inside it and the minute you open the chest, you break

that a seal and air gets in and then moving the chest muscles will do nothing and whenever surgeons in the past tried to operate on the heart, they of course opened the chest and they of course opened the chest and the lungs would disappear and crumple into a corner and the surgeons would think oh, this is great, lots of space to get access to the heart and then two minutes later the patient is dead and they didn't understand why. so we had to wait for two things before we could operate on the heart. the first one was the invention of a tube which allows you to blow air and oxygen actively into the lungs so you don't rely on the chest wall to ventilate, to breathe. and the second thing we had to wait for was to do with the heart itself because most organs you can do without for a few minutes or half—an—hour or an hour but you can't really do without the hard for half—an—hour because the brain dies.

it was a way to try to find a way to keep the patient alive while working on the heart and this invention happened in the mid—19 50s when a surgeon happened in the mid—19 50s when a surgeon called gibbon working in the united states, made this contraption which contained a pump and an oxygenator through which you could put the blood through and the pump would do the work of the heart and the oxygenator would do the work of the oxygenator would do the work of the lungs and then you can bypass the lungs and then you can bypass the heart completely and then when you fiddle with the heart, the patient stays alive and that, that invention in the mid—19 50s was the start of heart surgery and itjust took off. you say when you reflect on what you do, that in a sense, the technical side of it is actually quite straightforward. more straightforward, for example, than brain surgery. but if the decision—making that is the essence

ofa decision—making that is the essence of a good surgeon and good surgery. so what do you mean by the decision—making? so what do you mean by the decision-making? the technical aspect, they are not easy but they are doable. somebody who is not skilled with their hands can learn to do heart surgery. i'm not particularly skilled. may your patients don't want to know... laughter. i'm just patients don't want to know... laughter. i'mjust being honest. you have to be very careful because tiny m ista kes have to be very careful because tiny mistakes can lead to death but most heart surgery, valves, aorta ‘s, transplants, are actually stitching big things to big things. it is well within the reach of most surgeons. something that differentiates good heart surgeons from ones who are not

so heart surgeons from ones who are not so good is knowing when to do, what to do and how to do it and that is largely decision—making. and that's important. and what you do in the way you write about your work is you bring to life some extraordinary difficult cases where you have had to make in real time and very quickly, you have had to make the most difficult decisions. i am thinking for one in your most recent book the angina monologues, a woman who is pregnant and she has the most terrible aorta problem with her heart. the aorta is wrecked. you have two work out whether to immediately work on who that work on her before she —— because she is dying or get her twins out of the womb. it was a hard decision because putting someone on the heart—lung machine when they are pregnant is very likely to make them lose their

pregnancy. 0n the other hand, that particular condition, the acute aortic dissection, is fatal. it has aortic dissection, is fatal. it has a1% aortic dissection, is fatal. it has a 1% death rate per hour. within a couple of days, half the patients have died. you can't really wait that long. we had to make the decision as to whose life do we put first. we decided that we should probably deliver the baby ‘s first and allow her to take an extra, perhaps, 2—3% risk while this was done. i am interested in the personality of people such as yourself who take on such immense responsibility and its the cliche about life and death work but that is indeed what yours is and some people think that surgeons at this level have a particular set of personality traits and some of them aren't always regarded as particularly nice. you know, i'm looking now at research done by

simon patterson brown who is a former chairman of the patient safety boa rd at former chairman of the patient safety board at the royal college of surgeons in scotland and he talks about arrogance, narcissism, different character traits which sometimes make surgeons very difficult to work with. sometimes make surgeons very difficult to work withlj sometimes make surgeons very difficult to work with. i think you're absolutely right there. that is the early days of heart surgery. for the heart—lung machine work properly and before any of the safety features were introduced, heart surgery was a sort of desperate light —— last ditch attempt for people who were in dire straits and the sort of stuff that people did was horrible and injurious and many patients died as a result. if you survive, it began to look like it would be a feasible option. to be one of the pioneering heart surgeons, you had to be a serious risk taker. you had to be a cowboy. you had to be prepared to

throw caution to the wind in order to get anywhere. nowadays, i think we are a lot more boring. laughter. but probably a lot safer as a result of 50 years of development. and interestingly, you say, in the cause of your career even, you have noticed a change in yourself, that the waves of euphoria that you get when an operation goes well are perhaps not quite as high and dramatic as they were when you were younger and yet you say the degree of regret and self questioning and recrimination that you have when things go wrong, that is just as intense today as it was when you are a young man. that is true. why do you think that is? i'm not sure. napster euphoria reduces because of expectation, because we have been there so long or perhaps the standards have gone up —— perhaps the euphoria. we now operate people

that make operate on people who are much sicker, much older and much more challenging than anything we used to do at the beginning of my training. i don't get such a high when things are going well and i wonder if it is a combination of these reasons or whether i am just getting used to it. the problem is when something does not go well ,, it feels just as awful if not more so. it feels just as awful if not more so. that balance is not so nice and not so positive, and when that time comes, i will retire. do not so positive, and when that time comes, iwill retire. do think not so positive, and when that time comes, i will retire. do think we, as patients, really want the warts and all descriptions of what it is truly like to be a top surgeon that you have given us, that people i have had on the programme not so long ago, henry march, one of britten's leading brain surgeons — make henry marsh. —— henry marsh.

you have both been frank about the fa ct you have both been frank about the fact that you and others have sometimes made mistakes, sometimes you feel you have let patients down. we really want to know all this? well, perhaps i should ask you that. laughter. welcome a good hard to talk question. sometimes i think we would rather not know the degree to which chance is relevant in any serious intervention that you make. i think that is true that in heart surgery, we are i think that is true that in heart surgery, we are extremely honest about the downside. we give patients risks, calculated properly, scientifically, as percentages, we tell them the likelihood of death, likelihood of stroke, likelihood of not getting a good outcome. we tell them the benefits and we tell them to weigh these things so at least we

are being honest. nowadays, patients no longer accept the patriarchal approach of well, you know, that you are, my good man. i know what's best for you. that's not good enough. i certainly wouldn't want to be treated like that as a patient. i wa nt to treated like that as a patient. i want to make decisions. my health, my life. in terms of heart health, we have a different way of looking at how we all live our lives and what is happening to our hearts because we get co nsta nt happening to our hearts because we get constant public health messages telling us that if we eat right, if we exercise right, if we do not drink and do not smoke and do not do all sorts of other things, our hearts should be healthy. i wonder whether you as a heart surgeon feel that we are getting the public health messaging right? no. because? because for the majority of heart disease, unfortunately the risk factors a re disease, unfortunately the risk factors are things that you cannot do anything about. for example, your

genes, yourfamily do anything about. for example, your genes, your family history. do anything about. for example, your genes, yourfamily history. whether there is heart history and your family, you cannot do anything about that. you can't change your parents. the second thing is being male, perhaps you can change that nowadays but that doesn't affect the heart disease symptoms. males do a little bit less well than females in the hot sta kes bit less well than females in the hot stakes and we are talking about co ro nary hot stakes and we are talking about coronary disease primarily which is the lifestyle association that most people think about. you can't do anything about getting old. that is going to happen to all of us and the older you get, the more likely you are to get coronary disease. for those things that affect the heart that you can't do anything about, there's nothing you can do about them and no amount of diet or whatever will make any difference. there are some things that we can do something about. and they are extremely important. for example, smoking is definitely very bad. we shouldn't do it, the evidence is there. you're a smoker won't you?

absolutely. french cigarettes. when did you stop? about 30 years ago. so you get in your heart —— so you've given your heart a decent chance? a heart doctor who's got a dodgy heart isa heart doctor who's got a dodgy heart is a fascinating phenomenon. will get to that in a roman. before we get to that in a roman. before we get there, i've noticed in your writing you are very critical of certain, for example, dietary instructions that have been given. you say that salt, for example has set a very bad rap. people have suggested that it's bad for the body but in particularfor the heart. suggested that it's bad for the body but in particular for the heart. you say, no real evidence. no, there is no real evidence. there is one extraordinary story that you tell when you discovered she was suffering, you felt after you had been to the gymnasium. the first thing you did was go to the pub and have a beer and a burger to think

about your condition. what else is there to do? some people might have taken the condition to think that beer and burgers were the problem. there is no connection. there is only a connection between how many burgers. 0besity as well as smoking a very bad. that is proven. type ii diabetes often results from obesity forced paper attention is also a consequence. all of these things are bad for you. you can control them, this quite a few things you can do about cholesterol if you are in a high risk group. but nobody has ever proven that eating a burger causes heart disease. by itself or that putting salt on your chips causes heart disease. don't get me wrong, i'm not here to advertise the benefits of salt chips and burgers. there are foods that i would rather eat far more than that but i think what matters is that when we do give

m essa g es to what matters is that when we do give messages to patients and to the public, that we should concentrate on the messages that are backed by solid evidence. let me ask you about an aspect of the public health. the nhs is self, free at the point of delivery healthcare system. polls suggest that the great majority of people are immensely proud of it. are you worried about the state of the nhs today? i'm worried about a lot of things in their nature, but one thing that worries me the most is the funding. we do not spend enough on health, i'm sorry, but thatis enough on health, i'm sorry, but that is true. if you look at most advanced countries, there after spending anything from 12—18, 19%. we at the moment are spending eight or 8.5%. ijust pulled this we at the moment are spending eight or 8.5%. i just pulled this from we at the moment are spending eight or 8.5%. ijust pulled this from a

research document, the us spends more than twice as much per capita on health as the uk. it amounts to $10,000 per person in the us, in the uk the equivalent is barely 4000. you've worked in the us, but they don't have a public healthcare system as we do. and many would argue that to healthcare in the us is much poorer, much more defined by money. that's true. so, money isn't really the answer. no, money is not the answer and the us although it spends more than twice as much on healthcare, it does not go to twice as good healthcare. the main reason the nhs care is so good is because it's relatively cheap and amazingly efficient. there are no people in the middle making money out of it. there is no insurance companies, no schemes, new profit—making organisations, the money comes from the government to the healthcare service. the healthcare service

delivers the service. so we are very efficient, however, patients are unpredictable and medicine is unpredictable and medicine is unpredictable and medicine is unpredictable and all it takes is one thing to go wrong and you are 100% occupancy —— occupancy of the intensive care unit leads to 20 operations been cancelled. paying doctors and nurses and staff to sit there twiddling their thumbs is inefficient. so how? in point do you feel your nhs, our nhs to be today? it already suffers from lack of funding to the extent that it actually affects patient care. heart surgery, actually affects patient care. heart surgery, for example, a lot of the ha rd surgery, for example, a lot of the hard operations we do, we do them because we want to make people feel better. it would have pain, breathlessness, or that sort of stuff. but a lot of the operations that we do also help people live longer. if you have to wait a year foran

longer. if you have to wait a year for an operation to help you live longer, you might die during that year from the condition that you are trying to treat. that's not right. i'm wondering whether you feel the british system is well—placed to exploit the very latest medical technology? artificial hearts, for example. replacing the transplant idea with creating artificial hearts stop is that going to come and we have the money to fund the research to that happen? there is research funding and the nhs which is quite good because of the national institute of research. there is money available for people with projects, that get properly funded, the research gets properly paid for which is wonderful because before that happened, research was basically done on a shoestring by people in their spare time. so we have improved research quite a bit —— quitea have improved research quite a bit —— quite a lot. artificial hearts will happen, it's just a technology issue. to get them right that is allowing us. but there will be available on the shelf probably

within about 10—15 years. we would have an off—the—shelf treatment for half —— heart failure which is a massive killer and that will change the face of the speciality quite a lot. because transplants were never meeting the mark. because of limited supply? it's also a treatment that requires a young, fit person to die. so when a sick one lives, it's not great as a solution. no, i want to end with this thought that i planted earlier about what it's like to be one of the world ‘s eating hot surgeons and to discover that you have your own rather serious heart problem. because you suffered from angina and you needed to see a specialist. how difficult was it for you to accept that your own heart was beginning to let you down? slightly offputting. how difficult was it for any of your colleagues to ta ke was it for any of your colleagues to take you one as a patient? that's perhaps a bit more interesting. i was fortunate, at the end of the day

because it was a very minor single ru ptu red because it was a very minor single ruptured plug in a coronary artery which has healed and i don't have angina anymore and i am very, very well. i thank my lucky stars in her bed carries on like this for a long time. but at the time, everything is possible. it was quite likely that i would need an angioplasty, possibly ste nts, would need an angioplasty, possibly stents, drilling holes in the co ro nary stents, drilling holes in the coronary artery to make the stent fit, if that didn't work, an open heart operation, i chose my surgeon for that, one of my colleagues, he's a welsh man. he is a very pale bass man but he became a lot more pale when i asked him if he would. it was not a particular fun time. but when i asked him if he would. it was not a particularfun time. but in the end i believe that's all it was. just as a final thought, it gave you a deep understanding of what your

patients are going through? absolutely, i much more sympathetic to the mall. samer nashef it has been an extraordinary pleasure having you one hardtalk. thank you very much indeed. hello there. we've got some heavy rain in the forecast over the next few days, particularly targeting parts of england and wales where there's a risk of localised flooding. that rain has already begun to develop across northern france where an area of low pressure has formed. that wet weather moves into east anglia, southeast england and could be as far west as hampshire by the first part of monday morning. so, something to watch out for. this area of low pressure and this heavy rain is driven by the very big temperature contrast we've got

at the moment. with warm, moist air being driven in from north africa, the mediterranean into central europe, that's colliding with much cooler air coming down from polar regions, and it's those temperature contrasts that are making an area of low pressure form and a very active weather front. the amount of rain we get on monday will vary a lot from place to place, but the met office has issued a warning and some areas could see 60 millimetres of rain, which is getting on for a month's worth of rain during the day. there is a risk, then, of some localised surface water flooding and through the day, that wet weather will pour its way westwards into the midlands, eventually reaching western parts of england and wales through the afternoon. for the far north of england, northern ireland and for scotland, the weather will be similar to what we had on sunday. sunshine and a few heavy, thundery, slow—moving showers. the forecast as we go through monday night is that area of low pressure stays with us, the rain continues to pour down overnight and will last right into tuesday as well. with the heaviest rain likely across northern england, and across wales, too. but there could still be some downpours elsewhere,

perhaps some showers coming into parts of the south—east. northern ireland and scotland at this stage staying clear of the worst of the wet weather but quite a bit of high cloud making for some bright conditions. the only real change is with that weather front drifting a little bit further northwards. the risk area where we could get flooding has moved into parts of northeast england as well. and there it stays, really, through tuesday, wednesday, and perhaps into thursday as well. there is some uncertainty how far northwards this band of rain gets on wednesday, it could be that itjust stays across northern england, and doesn't quite reach scotland and northern ireland, so we will be firming up on the details with that. southern england and wales, some very heavy, thundery downpours are quite likely to develop. 0ur area of low pressure stays with us through to the end of the week, it drifts a bit further westwards and fills, so it becomes a little bit less potent but that doesn't mean we're done with the rain. towards the end of the week, that rain will be arriving across scotland and northern ireland where it still could be pretty heavy. england and wales, prone to seeing some very heavy, thundery downpours that continue

to bring the threat of localised surface water flooding. a lot of cloud in the sky, limited brighter spells between these downpours. that's your latest weather.

i'm sharanjit leyl in singapore, the headlines: clashes in hong kong — after a day of protests against a new extradition law. earlier, as many as a million people marched against beijing's move to tighten its control over the autonomous region. i think it is the most serious challenge to the autonomy of hong kong and the rule of law in hong kong and the rule of law in hong kong since we left in 1997. i'm kasia madera in london. also in the programme: one of the leading contenders to become britain's next prime minister admits committing a crime when he took cocaine 20 years ago. and we meet one of the london—based students whose idea for helping rice farmers

in asia has won them