it needs to be an hours to grad, turned communist travel, only to be disappear, of families. tragedy entwined with a violent chapter, your country's history. what do you see to say, is that going to be my blood on? that was to a nice long search for answers and close finding salon. witness on out easy or the new k 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 story, [000:00:00;00]

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 tax is, 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 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 dna. just as a 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 service must do more with significantly less the an 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 u. s. and japan, the sonata leader or la god, really. it comes in the middle and lots of 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 nurses on a number of seats in m. r. i scanners the cobit 19 pandemic severely tests at the end. 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, all right, let's bring in our guess we're all joining us from london today, silva and then to see the chief and list of the kings fund an 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, 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 civil. 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 your report highlighted, the image just finds itself on it. something's 5th birthday, i'm moment of real, real strain. i mean, waiting time talk is for how long you should be in the 90 department or how long

you should wait for con coastal procedure would routine. we might even as recently as 10 years ago. and now those targets being routinely felt up and down the country . they used to be a credit be read, which has started to even one critical stop grant to go out on industrial action and now and every, every significant start frequently i'm a chest is going out on industrial options. so it's very clear that the ice is under tremendous pressure at the moment. i'm so mixed birthday celebration at best on the side me 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. so 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 berlin. this is speaking out saying that it's a stand zip code to aging the conditions of deteriorating and it's becoming more, more difficult for us to give the cad 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 course the image 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. we're seeing k to 28 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. to say, 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. jess is being filed by government and the funding 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. there's an enormous sense of gratitude and an awareness 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 in practical appointments. that's as just being by slide people adult being given the funding. they need to have the cab id to defend that writing times. the sense that we are on, on the staff,

towards with other stretch medical professionals. and it's very clear to be as a patient that the medical professionals, icy, often call them if the kinds that they want to be giving effective the hospital grammar and had to sit down and just best to to, because she's so restrained, overstretched, and working on it on the staff was a no bicycle professional wants to be in that position. civic your organization, the king's fun just produced a 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 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 u. case health care system, which is a cost on there to buy their nitrous compares to the health systems of $18.00 of the countries and other countries to acquire and 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 do you spend per person on health care in this country? we have few hospital beds, we have 2 intensive cabinets. we have few a, c, t, and i'm, are i, scholars, i'm probably most and for me we're very, very though on the number of tops isn't this isn't all the key professional groups compared to other 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, 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 figures and countries likes me to 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 basketball. 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. 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 click lots as a bunch of cash. and everyone gets treated equally in the health care service to think of something it's quite unique and very special to the in a chest, 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 the size of increasing me, particularly i think in the past 2 years, i've noticed as of my clinic and i was cannot stick in imply pool area of london. i've seen people. i see people who don't really can't afford to,

but having to say like, 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, 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 named off on insults. pause for a 2nd 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? the yeah, so the best difficulties of the 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 is becoming more and more difficult for people to get g p appointment. so the delay that then that so you come and see me as a g p, i think, but you need specialists, 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 few years. and as he said, of that stuff, the program we have, you know, 7000000 people waiting for routine. we quoted, routine cavalry. we say routine care. this is often, you know, it's in very, very important because the people need to be the most beth of the disabilities of the pay, you know, to, to, to really 20 them of the conditions. and what by increasingly saying is that actually people wall spacing together treatment and sometimes that could be 6 months. so that can be a yeah. like between a 2 year, sometimes i'm seeing patients that conditions get was the be coming,

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 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 that where we know that the treatment will improve political places and improve people's ability to survive, even then best thing 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 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 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 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, 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 by and it just lead cuz it's getting angry because we, we want our patients to get the cabinet. they does. we don't want people to get home because they're not able to get test on time and i think is where i could do what. 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 full of testing could even be arranged on this. is that the something that our members is struggling with as well, and why people have complex conditions and might be under both of those special isms 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 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 even the cadets gift card they need, which would save staff college and improve the experience for patients because certainly things call and keep going the way that going from. and that's one of the major concerns, particularly in wouldn't to is just infections. many of us use forms of ventilation either overnight or 24 hours a day. full of people who. ringback have which is just 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 that, that environment needs to have the stuff, time and capacity to weigh the address of the patient in the context of that full

history and the practical risks balls at that and just having to speed for the patients 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 it's doing for keeping us a lot. and i think facing the, for the community for funding drugs, the absolute game changes for people with conditions that are progressive and that would otherwise have continued to progress. so there is that why this, that there is progress in 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 is climbing and you're at high risk of heart failure, you don't want to wait 6 months to see a cardiologist best. as i read it 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? yeah, and so if i was going to pick one area, i think i pick the same one that you take, which is a weight for mortality, emma 2 different bits of avoid for mortality. the 1st is preventable mortality on the 2nd is truthful mortality. and i'll say why both are important, truthful mortality because that's where we're trying to get an effective health care treatments. death could be divided. yeah. so you've heard of thoughts and heart, but you need can unfortunately ask me about it from sonia. that doesn't always happen. but with rapid high quality care, you can say someone's eyes on the u. k. forms very, very closely on especially compared to our peers on the other measure, which is predictable mortality which is you know,

try and prevent the person having a heart attack from the 1st prize or stroking the test case through interventions that help us need help you guys maintain or how, and unfortunately the, the, you take those pull the again. so without turning people is statistics. the unfortunate reality is in this country, we're 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 rate 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 of 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 800000 people. 11 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 some kind of a vascular 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 in a chest dr. out of sar. i guess it is the best thing that's most important is stuffing that we because live a 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 and the stuff and, and any vacancy rates me and it just them because that's what getting a getting was small, getting back to. so we need to be thinking about how we train of colds. train will train malware cause but also how we retain workers. and this is a massive problem. a senior managers right now, we have doctors in the us is leaving the n h s, and they are leaving. then it says, i've taken a gaze of training and here's the divisions this up is because of the conditions and physical to, to reach what conditions or because 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 cast 6 of as well. and secondly as well. you know, i would, i would, you know, prevention is such an important thing and we talked about an adult, but it might take you 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 saving the unexpressed, a lot of money in the long term. so the investing down prevention and 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. 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. 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've said we need exactly sonya so to invest in all health care with for stuff whole healthcare workforce. but another big positive level, mental health status backs is reducing demand by helping people read healthy lives on some of the top 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 have a time of a price permanency orleans and make it harder to find them or you can 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 the smoking and 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 to 90 states and things like that. but when you have focus groups for the public, when you look at holiday, i think the public option is to face, you know, is a shared responsibility for individuals to maintain the health. i'm for the state to pray that it's role in helping us eat healthier as 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 join dr. 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 experience. and the bios administrative and staffing 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 kind of 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, are beholden to 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 cab budgets to employ the facial kind of well because they need to have 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 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 at us are and a chest, dr. and campaigner, and jamie hale, c o pathfinders, newer 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 yan,

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sets the forest right there. and there's nothing between the how you have a human habitat, nothing to live together on how to 0, how many people here have seen a tiger really growing up in greece means taking action. welcome to generation change a playful series. it seems to understand the challenge, the idea is mobilizing, use around the world. we need to a political party that we'll talk about our problems, know how come from a generation because 0 is being seem the groups the size of the system as know for most the interest of working class people, there is a difference between being able to participate in the system and actually being represented them as a 5th generation change on al jazeera, launching new research into the debt, to discover more about the call that the scientists of grabbing much from the sea floor to analyze the tri, the creatures within it. one to find how much carbon they can move store pedestal,

which is like these. and the sea creatures that live in them could provide 6 foot fence if they're called in georgia. and that's needed for the rise and global temperatures to 1.5 degrees. the 19 different species they found studied individually. the next step is to identify how vulnerable they are to human activities. much deeper benefit to the seascape and know that to protection controller. the i'm several venue in the hall when you're a headlines on alpha 0. l version presidents, alexander lucas shameka says the leader of russia's wagner, mercenary group, has returned to russia, suggesting he is in saint petersburg. he also says the offer to have wagner fighters stationed in his country, still stands. if getting precaution had gone into exile island bella roost after his brief me, it's any in a deal agreed with russian president vladimir putin stock sites. as for you if can