of the 1960 the decade of change across the middle east and north africa in the seconds of a 3 part series, l g 0. well, explores the explosion of ox and culture. intellectuals we're building new dreams. an idea is because the revolutions of the 1964, the political parts of the mind for music to tv, the poetry of protest and revolution, they make the 60s in the arab culture. oh no jews here the new pay is national health service turned 75, but the n h s is facing serious challenges and a great deal of criticism. so how did it get to this point? and how does this revolutionary health system compare with other is in the west. this is inside storage, the

hello and welcome to the program. i'm several then yay. the new case, national health service has been a source of pride for millions of britons. it was created 75 years ago with the goal of providing quality health care paid for by the government through the taxes is collect. but the british public now is worried. the british medical association has worn the dna chest is collapsing, access to health care is getting worse, and the qualities are also worsening and stark. differences across the country, leaving large sections of the population behind. so can be in a chest prosper without drastic changes. we'll put that to our guests shortly. first though, this report never far from the spotlight you pays national health service, better known as the n h. s. is under even more scrutiny as it turn 75, the officials warrant as many as 500 people could die each week because of delays and emergency care. and the demands placed on the chest today far surpassed those

during its early years. this something that was revolutionary when it began, and in many ways it was absolutely revolutionary to provide universal health care. that was comprehensive cover, basically everything that the founders could think of and almost everything they couldn't think of. and for everyone at the point of need, no bills to pay, you already paid for it in your taxes. that was revolutionary. did a just the state funded health system found in 1948 back then it costs around $20000000000.00 a year in today's money to operate. last year the government spent more than 350000000000. but as of last january, more than 7000000 people are on a waiting list, a record number. the government is committed to reducing waiting list, but little progress has been made. rising energy costs and inflation mean the health service must do more with significantly less the n h s is also coping with

an aging population. a large number of people now live with chronic health conditions like heart disease and diabetes. there's also a short of staff and proper equipment. the king son recently compared the chest and 19 countries around the world, including a tobacco european countries. the us and japan, the sonata i, leader or la god, really. it comes in the middle and last areas, but it does do poorly. hands compared to countries like france and germany on the number of hospital beds and the number of doctors. and this is on a number of seats in m r. i scanners, the cobra 19 pandemic severely tests at the and h. s at optima is still posing many challenges. health officials and experts for and for the u. k. is national health service to survive. it needs to innovate and reform. vince and monahan for inside story. the alright, let's bring in our guess,

we're all joining us from london today sir. and then to see the chief analyst at the king's fund and independent u. k. health charity organization to which put out a report on the state of the an h. s. recently. we'll be talking about that dr. sonya out of sorry, joins us to your and a chest doctor and a campaigner. and jenny hale is ceo of pathfinders, neuromuscular alliance run entirely for and by people with physical disabilities. and your organization offers social and support services, a warm welcome to all of you to the program today. thank you very much for coming on. a simple, let's start with you. is it a happy birthday to the in a chest at a 75 years on? i think it's a really mixed best thing to be honest with you because as you're a pull highlighted, image just finds itself on it, something's fit, but the moment a real real strain, i mean wasting time talk is for how long you should be in a 90 department or how long you should wait for a kind of costs to procedure would routine and you might even as recently as 10

years ago. and now those targets being routine, you felt up and down the country. they used to be a credit be read was his star. it's the even one critical stop current to go out on industrial action and not on every every significant stuff company and a chest is going out on industrial option. so it's, it's clear that the chest is under tremendous pressure at the moment. so a mixed birthday celebration at best on the se, sonya dr. out of saw, or what's the conversation among health practitioners on this, on this 75 year anniversary. the image as well because of the straight edge of the image as well, cuz often feel i'm angry, i'm not supposed to be not able to deliver the cabinet. we know our patients deserve. so i'm a g p a but i can general practice and like money basis, traipsing and upsetting when i see that my patients having to wait sometimes 6 months, sometimes a year, sometimes 2 years to get the car that they need. and i don't think there was a distraction there because as you know, as soon as said,

we've seen dna testing the cabinet. we are giving the klein over the past decade and not to them. it just because we have been speaking out about they've been speaking out about this new, relentlessly speaking out, saying that as the stand zip code to aging the conditions of deteriorating and it's becoming more, more difficult for us to give the cat that we want to deliver to our patients and, and, you know, i think there is the fact that you see so many image as well because now for cma transform in a consultants to our business drive is the fact that people everyone is going on strike. that's just, that's it. we've been driven to that and i think that we've been driven to the of speeding or what else can we do? doesn't seem to be any, was listening, this thing has to, to age and, and, and it just works of going out and strikes, trying to get in for this government to listen to me. your thoughts on this. i think your perspective is mixed right on the, on the states and the benefits versus the disadvantages of the n h s. and so i think we need,

say benefits. this is disadvantages. i would say it's more the benefits of the at night just on the ways of which the event guess is being filed by government and defending and therefore is not able to weigh a lot is or if the potential benefits from a patient is active and from the respective of running an organization that represents a number of people with quite significant and physical impairments. this an enormous sense of rectitude and an awareness that we wouldn't be why we without the at 8 just saving lives, sustaining lives, giving us the fun thing we need to live in the community. it's also a series of horror stories of appointments being canceled white's engagement, particular appointments that says, just being best slide. people don't being given the funding, they need to have the cab id to defend that, right. and times i the sense that we are all on the staff towards with a stretch medical professionals. and it's very clear to me as

a patient that the medical professionals, i see, often call them if the kinds that they want to be giving effective the hospital grab on how to sit down and just best to detest. because she's so restrained, overstretched, and working on it on the staff was no medical professional wants to be in that position. civic your organization, the king's fun just produced a report on the state of the n h. s. what were the main findings of hearing from all 3 of you? clearly there's under funding, there's understaffing and there's a long waiting list as the main symptoms of the, the deterioration of the an h. s. what did your report fine or so you're right. what we did was look at how the you case health care system in which is a cost on there to buy the. and i chess compares to the health systems of 18 of the countries and other countries to acquiring comes industrialized nations. and we found a few things, i suppose. the 1st obvious thing is that the u. k. health care system has fewer key

resources that you need to go to a good quality healthcare with just the average them how much we spend per person on health care. this country, we have few hospital beds, we have to you in terms of cabinets. we have few a, c, t and i'm or ice guys. i'm probably most important me. we're very, very though on the number of doctors in the us as another key professional groups compared to all the countries. now i need health care system in the world is going to struggle under these conditions. and so it's on surprising the and it shows the struggling to get the high quality health care outcomes. so how long patients wait for kind of the quality of care they receive when they are in the system is not as good as op is. i'm probably saying the launch pot and that's because of the got to have resources that the health system is given when you say or appears to be clear, because our viewers will be watching this from all around the world with and, and, and they will be experiencing in their countries, very different health care systems, depending on where they're watching from your study compared the u. k. to a group of about 20 or so comfortable countries is that find it?

i read it. there were a lot of western european countries, new zealand, the us, canada, those are the countries you were comparing the u. k. 2. yeah, you're absolutely right. so it's, it's countries like from the countryside suite in the united states, canada, australia, and use even countries that are either coast political, economic neighbors or possibly youngest. yeah. so it does, it's going to do on the positive good. but those, those are the countries we would respond to be towards the top of the task at all. and unfortunately, best are in the middle, accept some resources, but to be honest, which was the ultimately table dr. add a saw or it can you give us as a practitioner, can you give us a just tell us stories of, of what it's like to provide care in this environment. and yeah, and i mean, it is the 1st thing i like to say is that where we say is going to just past day. and there was also things to celebrate about the an h s. m. and i guess flu

international view is that the main thing that i loved the most about was giving it to us is that it doesn't matter whether someone has, is a, you know, as a millionaire or has no money, a tool when they come in to see me in the clinic, they get, they get treated equally and sadly say we don't help you know, insurance based systems like i have another european countries where if you pay more, you get quicker access a bunch of cash and everyone gets treated equally in the health care service to think this one is quite unique and very special to the n h s. and which makes it very, you know, which is why i'm do loved working in the health of s. and, but i guess it was a caviar to that if i can jump in, which is more and more people are choosing to pay more to get better care and go private. is that fair? yeah, in the, in the us was just about to say, so, increasingly, particularly, i think in the past 2 years, i've noticed this of my clinic and i was, cannot stick in imply pool area of london. but i've seen people actually people who don't really can't afford to be having to actually like do you know they've been to the savings because, you know, i had, i had a, i had a case of

a lovely gentleman who had a bad arthritis suit. so it was the insignificant pain in his head, it was an impressing his ability to walk and the weights in time for the operation only in a chest was over yet. um, so this pull, gentleman ex, isn't so much pain and become increasingly debilitated. chose, you know, you chose to go private, use his savings, try and get to get that surgery done quicker. i mean, increasingly seeing that. so the latest research shows that up to you in a gospel and false post for a 2nd. get both for a 2nd because this is such a vital part of the landscape today of the an h s and getting getting health care in the u. k. talk to us about that patient. what, what is the process of trying to get an appointment? and who tells you you're going to have to wait a year and how does that get decided? yeah, so the fast difficulties, it loads with finding it difficult to get a g p appointment. and that's because general general practice is becoming

increasingly unsustainable. we have to be practiced as closing across the country. it's becoming more and more difficult for people to get a g p appointment. so the delay that then that so you come and see me as a g p, i think, but you need specialist treatment, ill scans and the hospital. it's all with the to the hospital to get that done and the way some times now in the hospitals, i've been increasing significantly over the past few years. and that'd be said of the stuff, the program we have, you know, 7000000 people waiting for routine. we quoted routine cavalry when we say routine care, this is often, you know, in very, very important have the people need to be some of the, of the disabilities of the pay you know, to, to, to really 20 them of their conditions. i'm gonna be increasingly saying is that actually people, well spacing together treatment and sometimes that can be 6 months that can be a yeah. that between the 2 years, sometimes i'm seeing patients that conditions get with us to become a live living in pain and then becoming more debilitated as conditions get less. and so the thing is supposed to be private. so as a g p,

then when you refer your patients to a specialist, you know, and you gave us the case of this patient who needed to who had arthritis. you know, that the patient may not get treatment for 6 months or a year. yeah, i know that with a lot a lot of conditions, the weights and times of that launch and even, you know, even with actually the things that need to be treated as a nice so even with things like cost that where we know that the treatment will improve political places and improve people's ability to survive. even then addressing delays and kathy, but not being seen within 2 weeks. and people are not getting the treatment within a timely manner. so we've seen this throughout the, in a chest. and then also we have to talk about emergency kind of as well people. and then when you go to the emergency department, you would expect you should be seen very quickly and it should be treated quickly. and that's because as such and conditions where if you're not treated quickly, then it increases your risk of dying. and unfortunately, we saw this, particularly in the winter in the and it just stopped people not getting,

getting treatment quickly enough people to come to a home visit result. you know, i have a, i have someone that is a family friend of mine that sleep passed away because they didn't get the cancel that hoss stuck in time. now that's a massive problem. and we bought it winters in ice and made people think windows baseball way, but that's 6 months away. we need to be having now full that to make sure that people get the kid that they receive in a timely manner. cuz otherwise people will be, you know, it's, and this is what i mean my and it just web cuz it's getting on. great, because we, we want our patients to get the cabinet a to we don't want people to get home because they're not able to get to on time. and i think is where i could do work. so that's how i see that my colleagues every day. okay, but as you get it, we need the conditions to be able to deliver that to jamie, on this particular issue of waiting list. is that something either in a professional personal capacity that you have seen deteriorate over the last decade? plus i think i can safely say that in both capacities. i'd say that the

terry right of that from my past office back dave, i have been on an increasingly extended waiting list. i think it took about 18 months for one in particular with arrow to guide you through to the consultant before testing could even be arranged. and this is certainly something that our members is struggling with as well. and why people have complex conditions and might be under both of those specialism is if they are a lot they will be under. i think they'll credits that. can coordinate all of this . but many of our members see different specialists at different hospitals with different regularities. so then to compound the long whites for appointments, the long whites to kind of classes the lights, the tests and procedures that credit. so that's not necessarily looped in with what each other is doing, which could add increasing complexity increase in size. why we should have

a system that is incredibly joined up and the interests that patients being seen across lots of sites. obviously even the cut out the gift card they need, which would save staff college and improve the experience for patients. because that's of late things call and keep going, the why that going from. and that's why that's the major concerns, particularly in waiting to is just infections. many of us use forms of ventilation, either overnight or 24 hours a day, full of people who have, which is very true function like myself. and that means that even a simple chest infection can very quickly become life threatening. and it requires that somebody is seen and free to put k and i in the environment and the environment needs to have the stuff, time and capacity to weigh the address the patient didn't they call them types of that full history and the practical risks balls at that and just having to speed

for the patients as quickly as possible. ringback because that and things got best for patients with more, more complicated conditions. and i think as a community, we are also grateful for the, at a dress for both it's doing for keeping us a lot. and i think facing the, for the community for funding drugs, the absolute guiding changes for people with conditions that are progressive and that would otherwise have continued to progress. so there is that why that's the dumbest progressive the night just alongside the deterioration. but at this point, we are finding that people are increasingly going private, full time sensitive appointments, scans and treatments. because if your blood pressure has caused meghan, you're a high risk of heart failure. you don't want to wait 6 months to see a cardiologist lessons every day. i said, i'm going to go back to you there. there are a lot of numbers that you can crunch to try and measure the performance of a, of a given health care system,

especially when you're trying to compare between countries. i don't want to bury your viewers and numbers, but there's one that really stands out to me and it's in your report. it's about avoidable mortality rates. do you want to talk to us about that? you yeah, i'm so if i was going to pick one area, i think, i think the same one that you take, which is a voice for mortality. i'm at 2 different bits of avoidable mortality. the 1st is preventable mortality on the 2nd is truthful mortality. and i'll say why both are important, truthful mortality because not square with time with you and effective health care treatments just could be before that. yeah. so you've heard of hodson type do you need can unfortunately, as me, earlier from sony about doesn't always happen. but with rapid high quality care, you can say someone's eyes. and do you take photos very, very closely on this special competitive um, yoga measure, which is predictable mortality which is, you know, try and prevent the person having a heart attack to the 1st place or stroke in the test case through interventions

help us need healthy. you guys maintain our health, and unfortunately the, the u. k. does pull the again, so without trying to people is statistics. the unfortunate reality is in this country, we are not very good at keeping people healthy or treating them when they get now, which is obviously the ultimate point and really should be the, the, the primary objective of any health care system. i want to put those there so telling i want to put those numbers up on the screen. so when it comes to avoidable mortality rates, the united states stands at the highest has the highest rate, which means the worst performance with 88 percent of avoidable mortality. rate just behind is the u. k. 69 percent avoidable mortality rate in canada is middle of the pack. i mean, you rate at your organization. the king's fund looked at about 20 plus countries. we're just going to show a few here candidates, middle of the pack, 56 percent. the lowest avoidable mortality rate is australia in your ranking, at 46 percent. so again,

46 percent for the best countries. 69 percent for the u. k. it's a massive gaps of a it says there's 2 spanish on these, but i says that's a 100000 people when one thing psycho is that you can, that can feel intractable, can feel to be you can change your performance, you know, resort tasks from cancer. and deaths from cardiovascular disease in this country rock could we refuse when serious investment was may 20 times 5 years ago. so it is a serious issue. we are not where we would want to be on to the table, but you can move out. you can improve your performance, and in some cases like survival from breast cancer, it was a story of improvement. unfortunately, even the improvements and now storing. let's talk a little bit about how to improve this because it's not like successive british governments haven't been made aware of these issues and poll after poll reminds british leaders that this is something british voters care about so deeply what

needs to be done, what say, maybe top to top 3 steps that need to be taken to improve the state of the image has dr. out of sar. i guess it was the best thing that's most important is the thing that we because the live cat we weren't having and it has to be done and have enough stuff. that's doctors and nurses do. and, but also even in the cast that to coworkers, what we need to have enough stuff and, and in a vacancy rates me and it just them because that's what getting a, getting what smoke getting back to. so we need to be thinking about how we train of colds. train will train the workers, but also how we retain workers, and it's the most appropriate missing. and then it just what now we have doctors in us is leaving the n h s, and they are leaving images of taken a days of training. and here's the divisions this up is because of the conditions and physical to, to reach what conditions or the cause of but out. so we can, we can put in the government, can do things like now to try and stop the outflow,

outlook nature as well as in the, in the health sick. so in the classic too, as well. and 2nd is what you know, i would, i would, you know, prevention is such an important thing and we talk about an adult, but they might tend to be doing a practice most in the majority of the conditions. and we know things like heart disease and side the teeth. these are things the project will conditions and we could, if we invest now to try and prevent these conditions happening, will be saved in the attic trust, a lot of money in the long term. so the investing down prevention would be, would be, is, is really very important noticed the patients, but also, but financially, to, to bring money back into the health service for silver. any thoughts on that? i think the numbers are pretty clear on that. it is cheaper for any government to prevent a disease rather than have to treat it. oh yeah, absolutely. yeah. and i, i would say, you know, when i look back at the end of my career, i do wonder if the single biggest thing that the u. k. would have done to improve

the health and wellbeing of the population is something like smoking done. so yes, i see we need exactly sonya so to invest in our health care with forced the whole health and care workforce. but another big part of level mental health status back to is reducing demand by helping people who need help you guys and some of the more investments. but some of it can be done through regulation. things like sugar types of salt taxes. taking action on buy one, get one free or waste your time all tax for people who are not familiar with that concept is you're going to tax say. so does sweets that the kids will flock to buy, but they're actually terrible for their health. absolutely. so you have a time prize penalty or i'm going to make it harder to find them or you and car is through that pricing the manufacturers to reformulate the trains or the foods to make them help you know, or you, you do things like on smoking, public crisis out before the time. so these are things where, you know, we haven't really seen to debate in this country over to 90 states and things like

that. but when you have focus groups with the public, when you look at polling, i think the public option is to pay, you know, is a shared responsibility for individuals to maintain the health. i'm for the state to pay its role in helping us eat healthy is ours. jamie, your thoughts on priority measures. you would like to see a british government take to improve the an h s to say while going to be agreeing with the various because on and staffing being vital. i think the of the to the i would want to address joined up the cat and personalization, the bold people's carriage joined up across health and social cast services, including education. why that is relevant for children and young people. the board that we could reduce duplication of flight by the board that we could increase the ability to spot problems as they arise. and the back to that could be the cation back to the patient's experience. and the by the step by descriptive and stuffing

demand. and then in terms of past lives, ation, one of the key costs with that. and by see how to address that and did this, i shall cast that stuff is adult safe, okay. and health care packages for disabled people living in often in the community . and why that is kept packages done for the private care agencies. it becomes an increasing the expensive way of delivering cap, in which he had a dress of local authorities. the hold it into the right set by 5 agencies to some extent. whereas other approaches, the 5 ball pass lies. i'm the give people the control over that cad budgets to employ the facial kind of well because they need to have independently improve outcomes of people while saving money. so i think board invest, been involved in out these increased aspects of past motivation that way the empower disabled people to take control over that house. and that size, they had a chest on the adult social costs. extra money are very obvious way for what for me

. mm. a look. thank you very much to all of you. that's where we're going to end this conversation. uh it's, it's been really interesting to hear all your insights. sit on on the see the chief analyst at the kings fund, dr. sonya, out of star and a chest doctor, and campaigner, and jamie hale. c o pathfinders, neural muscular lines. i want to thank all of you for joining us on the program today and thank you to for watching. you can see the program again any time by visiting our website alpha 0 dot com. if a further discussion on this do go to our facebook page at facebook dot com forward slash a inside story. you can also join the conversation on twitter or handle as a inside story from me. so then, yeah, and from the entire team here and go home to

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this is where we live from out is there is a mobile app available in your favorites. apps to just set for it and have to move the new app from out to 0 new at using is it the or on terry johnston inc though ha, the top stories now and i'll just air thousands have attended funerals for those killed and as well as to day a, so it's on jeanine 12 palestinians, and one is where the soldier were killed. hundreds of people were injured. un human rights sex, but say the attack on that in the refugee camp may constitute a war crime. they called for israel to be held accountable under international duel for its illegal occupation and findings against civilians. certainly we

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