oh alexey hm. yeah and for lead i walk for hours to be able to get here. he came with his family, but i've never been aware about the nicest thing that could happen to us is winning . even though i contina has lots of inflation and the economy is bad. this is filling our hearts to make us forget everything. thank god, we're able to celebrate to day. oh, captain unit. missy has been compared to the room and eleanor throughout his career . now that he has won argentina's 3rd world cup, he will take his place in this country's history. with arden tines, thanking him and he steam for years to come. billy's, i will, i'll deceit up when a silence. ah, hello again, bad lines on al jazeera energy ministers from several european nations have agreed to implement a cap on gas prices. the decision to keep prices at a $180.00 euros

a megawatt hour comes his costs rise, months into russia. invasion of ukraine. dominic cane has more from berlin. the crux of it is that the differing sides in this, the, you long played out solder of one country against another. they've agreed that there should be a cap of $180.00 euros per megawatt hour of gas, which should kick in from the 15th of february of next year. which won't apply to all trades, but which will be there and it will be linked to the price of liquefied natural gas as well. and it is meant to provide some degree of safety net safety valve as it were to the e. u to the 27 countries be high court and london has ruled that then you can't government plan to send the salem seekers to rwanda as legal. the plan deportation policy was suspended in june after a last minute challenge. the dutch prime minister, mark gross, has issued

a historic apology for his country's role and 250 years of slavery. it comes amid a wider consideration of reparations. for those effects, 3 police officers have been shot dead during your rate in the southern jordanian city of mon. the officers were looking for people involved in killing a senior commander during protests against raising fuel prices last week. police officials say one of the suspects was killed during the rate. protesters have gathered into don's capital to him to mark the 4th anniversary of a revolution to toppled former leader almighty this year. there are also calling for an end to military rule security forces to have reportedly fire. it's your gas on stung grenades to disperse the crowd near the presidential palace. those are the headlines on al jazeera coming up next. it's inside story, thanks for watching. bye for now. ah,

accounts by health care workers threatened to disrupt the lives of millions of people in the u. k. the stand off between public service employees and the government shows no sign of a basing. we ask what's going wrong with the u. k, a national health services. this is inside story. ah hello there and welcome to the program. i'm mr. z, a k. now the u. k is national health service has been a source of pride from millions for more than 70 years. but now staff angry about

pay and working conditions are set to go ahead with another round of strikes, leading to even greater disruption for the very people that the institution is meant to serve. now says we'll walk off the job on tuesday for a 2nd time. this month, the government has refused to negotiate with them. ministers, a, their waged, amanda, unaffordable. on wednesday, more than 10000 ambulance workers including paramedics will, down tools, hundreds of military personnel are preparing to step in to help. john hall has worn out from london. britney's pricing for a 2nd week of highly disruptive public sector. industrial action with no sign of the government's willingness to give in to the demands of striking workers already . big numbers are being taught it up around the cost to the economy of this strike action, particularly retail and hospitality in the run up to christmas. and they're very real concerns in the health sector about the effective likely nurses and paramedics ambulance workers strikes on the ability of hospitals like this one behind me to

cope the national health service. already. of course, in the minds of many on the brink of collapse were to go through that list of striking public sectors this week. the nurses across at the big one going on strike on tuesday. the 2nd day of walk out by nurses. and it's historic. it is only the 1st time in the history of the national health service. the nurses have conducted such widespread strike to be followed on wednesday by ambulance workers at paramedics, and then customs and immigration officials, postal and rel workers with firefighters and teachers balloting for potential action in january as this threatened to go on into the new year were for the speaking the union say that their members have for far too long now being affected by low pay, by real terms, wage cox's pay has failed to keep pace with inflation pretty much since the economic crisis of 2010 enough is enough. they say they'll go on for as long as it takes with their members now struggling more than ever in the face of a cost of living crisis. i energy costs and spiraling inflation. equally steadfast,

of course, is the government that warns that higher pay will only few inflation itself already eating into the pay packets of ordinary workers. and it warns that higher pay will have to be paid for with higher taxes. while the any chess itself is a state funded health system founded in 1948 back then in cost around $20000000000.00 a year to operate by 2021 and cost about 337000000000 according to government figures. and then the pandemic head, the and just needed an additional 6000000000 dollars each year for frontline services. so now it has more funding and more stuff than it did pre covered 19, despite that in october, more than 7000000 people were on a waiting list. that means nearly 12 percent of the population in england is waiting for help consultation. and there's also the increase in energy costs and touring inflation has reduced the value of its budget. this means the health service must now do more with significantly less

the. let's now bring it out. guests from london were joined by oak santa pisec. she's a pharmacist and also electra at the u. c. l. school of pharmacy from copenhagen, denmark. we have just lazarus, he's a research at the boss, atlanta institute for global health, and also from london is jonathan porters. he is a professor of economics and public policy and the department of political economy at kings college london will welcome to will. thank you so much for joining us on inside story town. i want to start with you, you know, sitting in london and i want to talk a little bit about the working conditions for nurses and other health cast off at the time. because this isn't just about pay. but they're also talking about what it's like to work there. what's it like at the moment on an any kind of average day for health care professionals? where are the biggest challenges? well, certainly we see that the backlogs from the co, the 19 kinda mac has put a huge pressure on the and

a chest hole service. and this is all across from really community level. and g. p appointments are also here in the u. k. recently there have been pressures and pharmacies with antibiotics, shortages strip a outbreaks, and at the hospital levels as well. so nearly half of all health care workers stay that they are working on. they don't have the resources available to them to do their job. to the extent that they think is needed. so that's really worrying statistic to see that more than half of health care workers say they can't do their job up to the standard that they normally would do on top of a health care search system. as taking a huge beating through the pandemic and health workers themselves also very burned out. of course, i want to get to some of the psychological toner just a moment. but just touching on what you were saying, eric santa, about stopping shortages, is this really about stopping shortages or about money?

because i guess they both related. but jonathan, let me throw that one to you because we're talking about pay demands here that a very, very far apart. how does that go anyway towards talking about what we're dealing with a staffing shortage if that's one of the biggest issues. well, no nurses have seen their pay cut by about coming out now to 15 or 20 percent in real terms over the past 10 years in common with much of the public sector actually where there were pay freezes. so it's important to remember that what we're seeing in the public, not just in the, in h s, but public services hall, isn't just about the post pandemic. obviously, the pandemic is made things considerably worse for the l sector. but it is really the product of 12 years of under funding of public services and pressure on public sector pay, which has been particularly bad. i think, although low paid workers have not done so badly. it sort of middle range nurses

and other similar workers as when the public sector, who of course are sort of in some sense, the backbone of what actually gets done in any public sector. people who've been there long enough to actually know their job and know where they're doing, but not that long enough that they've become elevated the rates of senior management, where they don't have to do work directly. so it's those people who have come under most pressure and i think for a lot of them, it's just become too much. so pay as you said, it is a very, very large part of the problem. and hence, sold money to solve it is a large part of the solution, but it's not the only thing by any means. it's there sort of progressive rundown of public services, which are very much pre dated the pandemic. and i think sort of trying to relate this just to what's happening to the last year or so is quite wrong or, or at least misleading. this is something which has been going on for, for quite a while, and i think is now showing up in the public consciousness. we're beginning to realize that actually, you know, if we want decent quality public services,

we are going to have to pay for them. and that is going to mean somewhat higher taxes and that, of course, is very difficult political message to sell. so, and in, you mentioned that, that nasa, the theme pay cuts in real time. and a lot of that they're arguing has to do with inflation. and part of what they're asking for now is an inflation related pay rise. and jeff, let me ask you about this, because i'm curious about how other countries are approaching this. and tying pay rises to and facing seems like a possibly quite dangerous thing to do. yes, not just, you're tying it always to inflation, but your workers receive a cost of living adjustments. and we've seen unusually high inflation as, as everyone knows. so with this massive inflation, the, it's, you know, maybe there's been declines in real wages, but people also exhausted. they've been running a marathon through the pandemic. and just as it looks like things are getting better, they're hearing that there won't be new resources. some people are leaving the field. there are nurses who do not want to stay in health care because they're not

seeing that it's a good place to work anymore. people are very busy as like santa mentioned with the backlog and we've had lower cases, lower numbers of people diagnosed, diagnosed for many different conditions, fewer people initiated on treatment. so this, this sense of, you know, we've been overwhelmed for so long, but now things are getting better. it's, you know, they've come to the end of the marathon and been told you have to run a couple of kilometers. and on top of that, you have to carry, you know, a rucksack full of weights, which is, you know, the, the salary issue because of the current inflation. we're seeing this in spain, there's been protests and madrid. there's protests planned for, for january. and there's concern, i think, all across europe that the conditions for the health care system are not truly being addressed and that we haven't really not to be cliche but built back better like so many had hopes and data. and this is also not just the health care sector, but many other public sectors as well. jonathan, just before we depart from the,

the specific pay issue, finances i was just, it really struck me how large the differences between what the nasa they're asking for and what the government is talking about. 19 percent versus. and i'm the closer to 4 percent in your mind, what's actually realistic? um, i think what you, i, i, i'm not in the negotiating room. the nurses have made clear that they are willing to settle for considerably less than the 19 percent. the government has not made has said that it is absolutely refusing to talk, so we're not at the moment at the moment in that sort of territory of saying, well if you go off a couple of percent, all calm down a few percent were in the position where the nurses have said, yes, we made a very large demand which reflects what we think we deserve quote, but we know that that's unrealistic and will settle for less and the government is saying, you are going to take what you're given. we're not interested in even in any further

discussion. so in some sense, saying what that a realistic level is, is slightly academic because the government is just saying, we are not prepared to budge an inch at present when they do move off that position . if they do move, all that position will be when we can sort of talk about what's realistic. but i think the best way of looking at this overall is to say, look how your eyes is in the public sector. are currently running your own average earnings in the public sector. i've gone up by about 2 and a half percent to 3 percent of the last year. earnings in the private sector have gone up by $6.00 to $6.00 and a half percent. inflation has been about 10 percent. so this idea that an increasing public sector pay is what's going to set off a wage pri spiral, or add to the inflationary pressures that are already there. it simply does not add off of the economic perspectives. it's just smote the smokescreen from the government. frankly, it's not worth that he's here is late. so the reticent then of the government to

even negotiate with masses that changes the tone of the discussion somewhat. jeff, you mentioned the what exhausted you talked about how this has been like a marathon on how much do you think the psychological toll of the pandemic and, and living through and working through that is playing into what we're seeing now. again, looking back to what our earlier panelist said, of course this is we had 12 years over a decade of austerity in any chest budget cuts, etc. and then a global health crisis that really demanded so much from everyone within the health care system. so, and you know, everyone here in the u. k. stood outside their doorstep and applauded our health workers. but then when they are asking for something that is really quite fair because in the u. k, a nurses are paid quite low. if you compare that to international standards, their pay less, that colleagues and other countries, it just so in this instance,

so demoralizing for health work your staff to, to go through some thing that was absolutely traumatizing for so many where they had to say good health people say good bye to love ones through i phones and i pans . we didn't even have sufficient p. e at the beginning of the pandemic. and really for what is supposed to be a quite developed health care system. those budget cuts that lead up into the pandemic, played out quite severely. we saw that actually, we were not in a good place when the pandemic hit. and then all of the crack started to, to even grow during that time. and now because we went at went into the week, i think now it's on its knees, particularly if nurses continue to on strike and, and they have the right to make the demands for, for what they're worth. and we need to absolutely value all health workers who

really it is a matter of life or death when we have quality care and delivery of these important services. but i do think morale is now at a lowest point. well, we also saw services cut during the pandemic in order to make way for emergency services. and we were saying earlier that that's left what more than 7000000 people on waiting lists, 12 percent of the population, not enormous. i know that the n h has for all of its failings when you compare it to other systems, had always said that one of the best things about it was that it provided equal and actually relatively good access. a jeff that's obviously no longer the case. how does it measure up now? yeah, i mean, it was inevitable when hospitals were overwhelmed because of covered 90 dealing with the virus. they weren't able to carry out their regular services. so we're seeing this all across your waiting lists, backlogs, and you know, we went from

a period where people were, you know, literally applauding is like santa said, not just in the u. k, but in spain and in other countries. applauding, health care workers, applauding nurses to messages that well you need to keep on working real salaries are worth less because of inflation. we're not putting more money into the health care services, so it is very dirt demoralizing. we were advertising for a couple of nurses on a project. i run in spain and it was very difficult to get any applicants. i don't think the message we're sending is, you know, become a nurse. we need you, we, we respect you. we're, you know, we're happy to have you in the system it's, we're going to overwork you and when you ask for more in salary because of real inflationary issues, we're not gonna even negotiate with you. so we've talked a little bit about salaries, but it goes much deeper than that. it seems. we've talked about how there's been chronic under funding, but there are also other structures in place that have been problematic by my

understanding. there was a lot of red tape and bureaucracy specifically in the n. h. s. a lot of that disappear during the pandemic. and in order to be able to do really rapid emergency care, and i'm hearing from health care professionals that a lot of that is now back, i believe. what last year? $12600.00 operations were canceled because of administrative areas. jonathan, how much of a structural weakness is the red tape and bureaucracy that exists in the system in international terms that is not over bureaucratized, it has considerably less in terms of management. you're the ratio of management to actual hands on health care stuff is actually rather low in the n h s. i think the problem is not that the h as is as towards too many bureaucrats. it's rather that the efficiency of its processes and procedures is not what it could be. and so in particular that there have been significant issues with it. there are significant issues with the

respectful i t systems that of course, we all know from our own jobs and from dealing with, with any service that when the i t doesn't work, that has a terribly negative effect on the productivity of the actual people who are trying to deliver the service. oh well ok. so let me throw that one to you. then do nurses and other health care professionals feel that the money that's being spent, the money that is already that is being spent appropriately because there was more money spent in the system during the pandemic. and now than before. so is not just not being spent in the right places and clearly the nurses are communicating that it isn't b like the right places because it's not getting into the hands of the workers themselves that are giving the care to our patients. so in order for that to occur, of course i, we do need greater investment. so it's we tried doing restructuring and finding efficiencies within the system itself. and that attempt has happened

several times, but in the end you can continue to restructure and reshape a budget. but you will just eventually need to have a greater influx of investment to match what the needs in this real time throughout still the fall out of who in 19 demand. so i think really the workers are speaking out loud that you know that the system as it is now isn't working. i feel like this is a really complex issue though, because a large number of people analyze number of organizations have looked at this and there are plenty of reports. and in, in the public area about this, the institute for fiscal studies and one of their import specifically on the annette chest, said that despite the fact that stuff undoubtedly feel stretched, it's not obvious that adding more staff or money would immediately unplug the system. so let me ask you, jeff, looking at the u. k, from outside and comparing it to other systems. what's the problem with the system

that, why is it sort of cogs? what i am seeing though, in spain, denmark countries were work better is probably a bit similar. there's an absorbed capacity. you know, you have to bring in people, you have to improve systems storing on the pandemic. last year i had an opportunity to spend a day shadowing a g p and just seeing how many people were going to get turned away at the end of the day. yet if they had it on one more person, there wasn't necessarily space for that person. so things you know, more than more than one thing, needs to change to improve the system. so again, i don't know specifically what the problem is. i'm in the n h s. we've also seen there during the pandemic, shortages of staff, due to sickness, both covered and, and other and not as leo is being quickly replaced. but as i mentioned and you know, people are exhausted, they're overwhelmed and there's more and more care that needs to be provided

because it wasn't provided during the adamic. well, we're also dealing with an aging population who wanted the best shape to take lee and the u. k, when you compare it to other european populations, people have wanted this demographic fun. and jonathan, i want to ask you, do you think that this demographic bond has now exploded in the u. k? well, i mean, the demographic pressures have been going on for some time, and i think the, the, the, again, what you have here is a combination of demographic pressures, but also some wider social and economic forces. so in the u. k. off until about to that, the early 2010, we had life expectancy increasing, but it was increasing across the board. and healthy life expectancy was also increasing. what we've seen since around the turn of the 2010. so is that that life expectancy increase has, has slowed very sharply and indeed gone into reverse for people who are poorer and sicker and for them healthy life expectancy is not going up. so we've had this sort

of widening of the socio economic dividers and i, and full in their way in which healthy life expectancy has progressed in previous years. and that of course, does add significant late to the pressures india knight. yes, i'm so, i mean, more broadly, you're right, it's not, it isn't just about money, but money does matter quite a bit. and i think, you know, people forget that as recently as 2010, the n h s had among its highest satisfaction ratings in its entire life. and actually, i'm white for treatment were basic lay entirely under control. and that was the consequence of, i'm 10010 or 12 years of quite sustained on being and staffing increases which, which then unfortunate late awe slackened off a bit. so i don't think money would solve everything in the i f as is right. of course it would pay to time j through good is probably an essential ingredient. i'm

the one point which we haven't mentioned, which i think is very well recognized that i was, is a particular blockage that the n h s. one of the reasons for the delays at the moment is the i just simply like spans and a big reason it simply likes beds, is that it's hard to move elderly, but relatively healthy people out of hospitals into social care because of the separate. but quite frankly, even worse problems in the social care system or the social care system, which is considerably less well funded ne chest is having a big knock on effect on demand for the n h s. well, let me ask you, then jeff, about how one might spend money differently. so for asking for more resources to be funneled into the n h s. when you look at how this has played out in other countries, like spain, like denmark and would, and more devolved local system, what best that would more focus and funding for social and community care? what better is that? what's lacking? i think so i'm in the n h s, at least the u. k. has community pharmacies,

i think this needs to be expanded. we need to reduce our reliance on going to hospitals. the pandemic really showed that clearly, but in general you have a community pharmacies where you can go and get some of the care even care that might have been provided by a g p and get that at the pharmacy. so that's called tasks shifting to do the pharmacy using the hospitals more last resort. and we've seen in other areas the role of community centers, community care, social care, and community based and jose reaching the most marginalized because as was mentioned, there, things are little worse for everyone, but they're much worse for the most marginalized population is the, the poorest of the poor. well, i say that the northfield trust, i think tank in the u. k. has said that this is a narrow window of opportunity potentially for reform where there was potentially a lack of political well or funding asana in your mind. you're sitting in london

very briefly. is this that moment? well, i think so when we look at a per head, the government you case spends less on the n h us than many other comparable countries. there are less beds and doctors per head as well when we look at comparable countries. so now that certainly nurses have group the attention of not only do you k but, but you know, this news has made headlines around the world because it's the 1st strike and it's in its history. and that this is that the pressure is really culminating and the time for investment and appropriate response is now. well, we'll see if it is indeed that moment talks on a thank you to all of our guests on a pic, jeff lazarus and jonathan pushes and thank you to for watching. you can see this program again, any time by visiting our website that's out there or dot com. and for further discussion do go to our facebook page. that's facebook dot com, forward slash ha inside story. and you can also join the conversation on twitter

handle is at a inside story for me and associates a and the whole team here. and uh huh. bye for now. and ah, a join the debate. when we talk about climate change in africa, we should focus on adaptation knocked mitigation on air or online at your voice. it shouldn't be explaining that what that love, what not is being right now is being everything that is going to benefit them more revealing new perspectives like getting this out of proportion. no, no. his reach and has power is what is this proportionate?

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