when a war crime is committed, who is it coming to the houses, it will follows that goes in the human rights investigator on his unprecedented journey to the french high court. there's a pretty place to make sure that it's close. taking on the arms trained it is fine for justice, for innocent palestinians and their families made in front. oh no, just see if the new k is national health service turned 75 for the n h. s is facing serious challenges and a great deal of criticism. so how can it get to this point? and how does this revolutionary health system compare with others in the west? this is inside store, the

. busy welcome to the program. i'm several then. yay! but you 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 tresses collapsing, access to health care is getting worse, and the qualities are also worsening and stark difference is 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 1st. so this report never far from the spotlight. u. k. is 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 cost and inflation mean the health

surface 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 and adjusted 19 countries around the world, including a tobacco european countries, the u. s. and japan, the sonata leader or la god, really. it comes in the middle and last areas, but it does do poorly hand compared to countries. i've found some gemini on the number of hospital beds and the number of doctors and nurses on a number of seats in m. r. i scanners, the coven, 19 pandemic, severely. tested dna chest at optimum 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 bins and monahan for inside story. the alright, let's bring in our guess,

we're all joining us from london today. see about and then to see the chief on the list of the kings fund, an independent u. k. health charity organization, 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 join just to your and a chest dr. and a campaigner. and jenny hale is ceo of pathfinder, is near a muscular 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 begin 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 5th birthday i'm. i'm in 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 con. cluster procedure would routine and you might even as recently as 10 years

ago. and now those targets being routinely felt up and down the country. these to be a credit be read was his star. it's the even one critical stop current to go out on industrial action and now and every, every significant stuff manage us has gone 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 a 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. 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 get the cat 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 us and they transform into 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, but seeing had to, to aids and, and, and it just works of going out and strikes, trying to get in for this government to listen. jimmy, 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 in which the event jess 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 perspective and from the respective of running an organization that represents a number of people with quite significant physical impairments, this it, and all of a sudden subtract, issued, and then the wireless that we wouldn't be why we, without the at 8, just saving lives, sustaining lives, giving us the funding. we need to live in that community. it's also a series of horror stories of appointments being canceled. whites engaged our particular appointments. that's as just being this slide. people don't think if and the funding they need to have the cab, they need to defend that right. and times the sense that we are on, on the staff towards with a stretch medical profession. it was,

and it's very clear to be as a patient, that the medical professionals, i see, often call them if the cat that they want to be giving effect to the hospital, grab and had to sit down and just best to because she's so restrained, overstretched, and working on it on the staff was no medical professional wants to be in that position. so the, your organization that kings fund just produced the report on the state of the an 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 long waiting lists 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 u. case health care system, which is a cost on there to buy the and excess compares to the health systems of $18.00 of the countries and other countries to acquiring comes industrialized nations. and we found a few things i specify sophia's thing is that the u. k. health care system has fewer

key resources that you need to get a good quality healthcare with just the average and how much we spend per person on healthcare in this country. we have few hospital beds, we have few intensive cabinets. we have few a, c, t and i'm or i, scott, i'm probably most and for me with very, very low on the number of doctors and nurses and all the 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 launch pod. that's because if they've 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, 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 figuring countryside suite in the united states, canada, australia, and he's even countries the u cuz 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, at best, we're in the middle, acceptable resources, but to be honest, which was the bottom of the table. dr. add a, sorry. 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. so yeah, and i think it is the 1st thing i like to say is that where we say it is and it 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 of somebody's quite unique and very special to the an h s. and which makes it very, you know, which is why i'm do love working in the house 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. and that, and that's what was just about to say is that increasing me particularly, i think in the past 2 years, i've noticed as of my clinic and i was cannot stay in a quiet pool area of london. i've seen people, i see people who don't really can't afford to having to say like in addition to those savings because you know, i had a headache. 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 trespass over a year. and so this poor gentleman in existence so much pain and become increasingly debilitated. chose in a chose to apply that, use his savings, try and get to get that surgery done quicker. and we increasingly seeing that. so the latest research shows that up to, you know, go on and false posts for us. i can 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 dental dental practices 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. so all the 30 to the hospital to get that done and the way some times now in the hospitals, i've been increasing significantly over the past 2 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 because the people need to be the most that of the disabilities or the pay you know, to, to, to really 20 them of their conditions. and will be increasingly saying, is that actually people walkway seem to get their treatment and sometimes that can be 6 months. so that can be a yeah. like between a 2 year, sometimes i'm seeing patients that conditions get was to be coming live, living in pain and they'd be calling 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 we needed to, we 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 things that need to be treated as a nice so even with things like cost where we know that the treatment will improve political places and improve people's ability to survive, even then we're seeing delays and kathy but not being staying 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 assessment conditions. well, 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 must be problem. and we bought in a winter's in ice and made people think, when does they fall away? 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 work cuz it's getting angry because we, we want our patients to get the cabinet a does that. 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, a personal capacity that you have seen deteriorate over the last decade,

plus the things i can say, they say that and by this capacities, i'd say that the terrier, right? of that from my personal perspective, i have been on the increasingly extended waiting lists. 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 wait for appointments, the lights, the kind of glasses, the lights, the tests and procedures that credit. so that's not necessarily looped in with what each other's doing, which could add increasing complexity in place and denies why we should have

a system that is incredibly joined up and the interests that patients being seen across lots of sites. obviously from the connected gift card they made, which would save staff colleagues and improve the experience for patients because certainly things call and keep going the way that going from. and that's why that's the major concerns, particularly in waiting to. ringback 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 n n i in the environment. and that, that environment needs to have the stuff, time and capacity to weigh the address of the patient, didn't they call the types of that full history and the practical risks balls at

that, and just having to speed through asians as quickly as possible. 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 its doing for keeping us alive. and increasingly, for the community, for funding drugs, 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 that there is probably aggressively at 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 quite 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? the yeah i'm so if i was going to pick one area, i think, i think the 2nd one but you to 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, but you need quick 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 dryscal mortality, which is, you know, try and prevent the person having

a heart attack and 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 pac. i mean you rated 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 not in you can, that can fuel and trying to book some fuel to be you can change your performance, you know, resort tests from cancer and some kind of ask you a 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 up, 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. as 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. but 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, then it says off to, you know, did the 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 out loud outflows. 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 projects 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 or something like smoking done so yes, absolutely. we need exactly sonya so to invest in our health care workforce, 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 pack se sodas, sweets that the kids will flock to buy, but they're actually terrible for their health. absolutely. so you even time price, permanency orleans, make it harder to buy them or even cars through that pricing, the manufacturers to reformulate the drinks or the foods to make them healthy. yeah . or you, you do things like on the smoking public crisis that we've already done. so these are things where, you know,

we haven't really seen to debate in this country over the 90 states and things like that. but when you have focus groups with the public, when you look at the whole thing, i think the public option is to face, you know, is a shared responsibility for individuals to maintain the health. i'm from the state to pray its role in helping us need help you with ours. jamie, your thoughts on priority measures. you would like to see a british government take to improve the interest to say, while going to be agreeing with that 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 bowl that people have carriers joined up across health and social cast services including education. why that is relevant for children, 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, the back to the patient, takes variance. and the load, the by the step by descriptive and stuff and demand. and then in terms of past

lives, ation, one of the key costs with that. and by see how to address that and to this i shall cast that stuff is out of the 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 chest of local authorities to hold it into the right set by private agencies to some extent. whereas the other approach it, the 5 ball pass lies. i'm the give people the control over that cad budgets to employ the facial kind of workers they need to. they've independently improve outcomes of people while saving money. so i think boy 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 science, they had a chest and the adult social cost extra money. i radio best way for what for me. mm

. let's 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 sar and a chest, dr. and campaign or, and jamie hale, c o pathfinders, new or muscular lines. i want to think 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 don't bye, the

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