♪ >> this is al jazeera. these are our top stories. a panel investigating the attack on the u.s. capitol called for criminal charges against donald trump. this follows an investigation into his role in the january 6 riot. the former president denounced the charges as fake and said it was an attempt to block his white house run. >> in addition to be unlawful as described in our report, this was an utter moral failure and a clear dereliction of duty.

evidence can be seen in the testimony of president trumps white house counsel and several other white house witnesses. no man who would behave that way at that moment in time can never serve in any position of authority in our nation again. he is unfit for any office. >> the supreme court has put a temporary block on the removal of trump era immigration restrictions at the mexican border following a legal challenge by republican lead states to maintain the measures. eu energy ministers agreed to impose a cap on gas prices, to curb an increase in energy prices since moscow reduced gas exports to europe. they have been trying to reduce reliance on russian gas since the invasion of ukraine. the high court in london ruled the u.k. governments plans to send asylum-seekers to rwanda is

legal. the policy was suspended in june after a last minute challenge. the court said the cases of eight asylum-seekers must be reconsidered. china reported its first two covid related deaths since it began rolling back strict pandemic controls. they are facing shortages of drugs to treat the virus and is trying to import more. argentina's champion foot dollars are on their way home after one of the most thrilling world cup finals ever. excitement in the capital, and people are flocking to the airport to welcome home the team. inside story is next. ♪

>> walkouts by health care workers threaten to disrupt the lives of millions in the u.k. the standup shows no signs of abating. what is wrong with the national health service? this is inside story. ♪ >> hello and welcome to the program. the uk's national health service has been a source of pride for millions for more than 70 years. now, staff, angry about pay and working conditions, are set to go ahead with strikes leading to greater disruptions. they will walk off the job on tuesday for a second time this

month. the government refused to negotiate. ministers say the demands are unaffordable. more than 10,000 ambulance workers, including paramedics, put down tools on wednesday. military personnel are prepared to step in to help. >> britain is bracing for a second week of disruptive public sector industrial action with no sign of the government's willingness to give into the demands of striking workers. already, big numbers are being put up of the cost to the economy of this strike. there are real concerns in the health sector about the effect of nurses and paramedics, ambulance workers striking on the ability of hospitals like this one to cope. the nhs, already on the brink of collapse in the minds of many. going through the list of striking public sectors, nurses going on strike tuesday, the second day of walkouts by

nurses. it is historic, the first time in the history of the national health service that nurses have conducted widespread strikes. they are followed wednesday by ambulance workers and paramedics, then customs and immigration officials, postal and rail workers, firefighters and teachers validated in january if this threatens to go on into the new year. the unions say members have for far too long been affected by low pay, wage cuts as pay has failed to keep pace with inflation since 2010. enough is enough, they say. they will go on as long as it takes with members struggling in the face of a cost-of-living crisis, high energy costs and spiraling inflation. equally steadfast is the government that warns higher pay will fuel inflation already eating into the pay packets of ordinary workers. it warns higher pay would have

to be paid for with higher taxes. >> they nhs is a state-funded health system founded in 1948. back then it costs $20 billion to operate. by 2021 it cost $337 billion according to government figures. then the pandemic hit. the nhs needed $6 billion each year for front-line services. now it has more funding and more staff than it did pre-covid-19. despite that, in october, 7 million people were on a waiting list. 12% of the population in england is waiting for a health consultation. there is also the increase in energy costs and inflation that has reduced the value of the budget. the health service must do more with less. let's bring in our guest from london. we are joined by a pharmacist.

from copenhagen, we have a researcher at the barcelona institute for global health. from london, a professor of economics and public policy and the department of political economy at kings london. welcome. i want to start with you. you are in london and i want to talk about the working conditions for nurses and health care staff. this isn't just about pay. they are talking about what it is like to work there. what is it like on an average day for a health care professional? what are the biggest challenges? >> we see the backlog from the covid pandemic has put a huge pressure on the nhs health service. this is across community level, gp appointments, also here in the u.k. there have been pressures on pharmacies with

antibiotic shortages. at the hospital levels, as well. nearly half of all health care workers say they are working, they don't have the resources available to them to do their job to the extent they think is needed. that is a worrying statistic to see more than half of health care workers saying they can't do their job to the standard they normally would. on top of a health care system that has taken a huge beating through the pandemic and health workers themselves, also very burned out. >> i want to get to the psychological toll in a minute. but staffing shortages, is this about staffing shortages or about money? i guess they are related. let me throw that to you. talking about pay demands that are far apart, how does that go anywhere towards talking about are dealing with staffing shortages?

>> nurses have seen their pay cut by about 15%-20% in real terms over the past 10 years. in common with much of the public sector, where there were pay freezes. it is important to remember what we are seeing in public service as a whole isn't just about post-pandemic. the pandemic has made things worse for the health sector but it is the product of 12 years of underfunding of public services and pressure on public-sector pay, which has been particularly bad i think, although low-paid workers haven't done so badly. it is middle range nurses and similar workers who are the backbone of what gets done in the public sector, people who have been there long enough to know their job and know what they are doing but not long

enough to where they become elevated to the ranks of senior management. it is those people who have come under the most pressure. for a lot of them it has become too much. the pay is a very large part of the problem. money is a large part of the solution, but it is not the only thing. it is the progressive rundown of public services, which very much predated the pandemic. i think trying to relate this to what has happened in the last year or so is wrong, or at least misleading. this has been going on for quite a while. it is now showing up in the public consciousness. we are realizing that if we want quality public services, we will have to pay for them and that will mean higher taxes. that is difficult to sell. >> you mentioned nurses have seen pay cuts in real terms and a lot of that, they are arguing,

has to do with inflation. part of what they are asking for is an inflation-related pay raise. jeff, i'm concerned about how other countries are approaching this, tying pay raises to inflation. that seems dangerous. >> it is not tying it to inflation, but workers receive a cost-of-living adjustment and we have seen unusually high inflation as everyone knows. with these massive inflation, may there have been declines in real wages but people are also exhausted. they have been running a marathon through the pandemic. as it looks like things are getting better, they are hearing there won't be new resources. people are leaving the field. there are nurses who don't want to stay in health care because they don't see that it is a good place to work. people are busy with the backlog. we have had lower numbers of people diagnosed for many

different conditions. fewer people initiated on treatments. this sense of, we have been overwhelmed for so long but things are getting better, we have been told we have to run a couple kilometers at the end of the marathon and you have to carry a rucksack full of weights. that is that salary issue because of the inflation. we see this in spain, there have been protests in madrid and protest planned for january. there is concern across europe that the conditions for the health care system are not truly being addressed and not to be cliche, but we haven't built back better like many had hoped. >> this is not just the health care sector, but many public sectors. before we depart from the specific pay issue for nurses, it struck me how large the difference is between what the government is talking about and what nurses are asking for.

19% versus 4%, in your mind what is realistic? >> i think -- i'm not in the negotiating room. the nurses have made clear they are willing to settle for considerably less than 19%. the government has not said it is refusing to talk. at the moment, we are not in that territory of saying if you go up, i will come down. we are in the position where the nurses have said we made a very large demand which reflects what we think we deserve, but we know that is unrealistic and we will settle for less. the government is saying you will take what you are given, we aren't interested in any further discussion. in some sense, saying what a realistic level is, is academic. the government is saying we aren't prepared to budge. when they do move off that position, if they do, we will

talk about what is realistic. the best way of looking at this overall is to say, pay rises in the public sector are currently on average, earnings and the public sector have gone up by about 2.5 percent-3% over the past year. in the private sector they have gone up by 6%-six point 5% and inflation has been about 10%. the idea that increasing public-sector pay is what will set up a wage price spiral or add to inflationary pressures simply doesn't add up from an economic perspective. it is just a smokescreen from the government. it does not worth taking seriously. >> the reticence of the government to negotiate with nurses changes the tone of discussions. you mentioned the word exhausted. how much do you think the psychological toll of the pandemic and living through and

working through that is playing into what we see now? >> looking back to what our earlier panelist said, we had 12 years, over a decade of austerity in the nhs and budget cuts. then a global health crisis that really demanded so much from everyone within the health care system. so everyone here in the u.k. stood outside their door and applauded our health workers, but then when they are asking for something that is really fair, because in the u.k., nurses are paid quite low if you compared that to international standards. they are paid less than their colleagues in other countries. in this instance, it is so demoralizing for health workers to have to go something -- through something that was traumatizing for so many, where

they had to help people say goodbye to loved ones through iphones and ipads, we didn't even have sufficient ppe at the beginning of the pandemic. and really, for what is supposed to be a developed health care system, those budget cuts that led up to the pandemic played out severely. we saw that we were not in a good place when the pandemic hit . and then, all of the crocs started to grow during that time. because we went into it, i think now it is on its knees, particularly if nurses continue to strike. they have the right to make demands for what they are worth. we need to 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 think morale is now at its

lowest point. >> we also saw services cut during the pandemic in order to make way for emergency services. you said earlier that has left more than 7 million people on waiting lists, 12% of the population. i know the nhs, for all its failings, we have said it is one of the -- one of the best things about it is that it provides equal and relatively good access. that is obviously no longer the case. how does it measure up now? >> it was inevitable. one hospitals were overwhelmed because of covid-19, dealing with the virus, they weren't able to carry out their regular services. we are seeing this across europe, waiting lists, backlogs. we went from a period when people were literally applauding, in spain and the u.k. and other places, applauding health-care workers and nurses, two messages that,

you need to keep on working. your real salaries are worth less because of an nation -- because of inflation. we aren't putting more money into health care. it is demoralizing. we were advertising for a couple nurses on a project i run in spain and it was difficult to get any applicants. i don't think the message we are sending is, become a nurse, we need you. we respect you. we are happy to have you in the system. it is, we are going to overwork you and when you ask for more salary because of real inflationary issues, we aren't going to negotiate. >> we talked about salaries. it goes deeper than that. we talked about how there has been chronic underfunding but there are other structures that have been problematic. there was a lot of red tape and bureaucracy specifically in the nhs and that disappeared during the pandemic. to do rapid emergency care, i'm hearing from health-care care

professionals that a lot of that is back. last year 12,000 600 operations were canceled because of administrative errors. how much of a structural weakness is the red tape and bureaucracy in the system? >> in international terms, the nhs is not over-bureaucracy ti -- beureaucratized. it is not that the nhs has too many bureaucrats. it is rather that the efficiency of its pros to -- processes and procedures is not what it could be. there have been inspected effect -- there have been issues with the id systems. we know from dealing with any service that when the i.t. doesn't work, that has a negative effect on the product and the people trying to deliver

the service. >> let me throw that one to you. do nurses and health care professionals feel the money being spent, that is already there, is being spent appropriately? there was more money spent in the system during the pandemic and now than before. is that not being spent in the right places? >> the nurses are communicating that it isn't being spent in the right places because it isn't getting into the hands of the workers themselves that are giving the care to our patients. for that to occur, we need greater investment, and we have tried doing restructuring and finding efficiencies within the system itself. that attempt has happened several times. in the end, you can restructure and reshape budgets but you will eventually need to have a greater influx of investment to

match what the needs in this real-time, throughout the fallout of covid-19, demand. the workers are speaking out loud that the system as it is now isn't working. >> i feel like this is complex. a large number of people, a large number of organizations have looked at this and there are reports in the public area about this. the institute for fiscal studies specifically said despite the fact that staff undoubtedly feel stretched, it isn't obvious that adding more staff or money would immediately unclog the system. jeff, looking at the u.k. from outside and comparing it to other systems, what is the problem with the system? >> what i'm seeing in spain and denmark and countries, it is similar. there is a capacity. you have to bring in people, you

have to improve systems. last year during the pandemic i had an opportunity to spend a day shadowing a gp and seeing how many people were going to get turned away at the end of the day. if they had one more person there wasn't necessarily space for that person. more than one thing needs to change to improve the system. i don't know specifically what the problem is. we have seen during the pandemic , shortages of staff due to sickness, both covid and other, not necessarily always being quickly replaced. people are exhausted. they are overwhelmed. there is more and more care that needs to be provided because it wasn't provided during the pandemic. >> we are dealing with an aging population who aren't in the best shape. when you compare the u.k. to other populations, people worry

about this demographic. do you think this demographic bomb has exploded in the u.k.? >> the demographic pressures have been going on for some time. i think what you have is a combination of demographic pressures, but also wider social and economic forces. in the u.k., up until the early 2010s, we had life expectancy increasing. it was increasing across the board and healthy life expectancy was also increasing. what we have seen since around the turn of the 2010s is that the life expectancy increase has slowed sharply and gone into reverse for people who are poor and sicker. for them, healthy life expectancy is not going up. we have had a widening of the socioeconomic divides. and the way in which healthy

life expectancy has progressed. that adds to the pressures on the nhs. you are right, it is not just about money but money does matter quite a bit. people forget, as recently as 2010, the nhs had among its highest satisfaction ratings in its entire life. wait times for treatment were basically entirely under control. and that was the consequence of 10 or 12 years of quite sustained funding and staffing increases, which unfortunately have slackened off a little bit. i don't think money will solve everything. but it is an essential ingredient. the point we haven't mentioned that i think is well-recognized, a particular blockage that the nhs, one of the reasons for the delays is they lack beds and one

big reason it lacks beds is because it is hard to move elderly but relatively healthy people out of hospital into social care because of the separate but quite frankly even worse problems in the social care system. the social care system is considerably less under the the nhs. >> let me ask you about how one might spend money differently. if we are asking for more resources to be funneled into the nhs, when you look at other countries like spain and denmark, would a more devolved global system work better? would more focus and funding for social and community care work better? is that what is lacking? >> i think so. the nhs, the u.k. has community pharmacies. this needs to be expanded. we need to reduce reliance on going to hospitals. the pandemic showed that clearly. in general, having community

pharmacies where you can go and get some of the care that might have been provided by agp and get that at the pharmacy. using the hospitals more as a last resort. we have seen the role of community centers, community care, social care, community-based ngos reaching the most marginalized. things are worse for everyone, but they are much worse for the most marginalized populations, the poorest of the poor. >> a think tank in the u.k. said this is a narrow window of opportunity potentially for reform. there was potentially a lack of political will or funding. in your mind, is this that moment? >> i think so. when we look at per head, the u.k. government spends less on the nhs then many other

comparable countries. there are you were beds and doctors per head when we look at comparable countries. nurses have gripped the attention of not only the u.k., but this news has made headlines around the world because it is the first strike in its history. this is, the pressure is culminating and the time for investment and appropriate response is now. >> we will see if it is that moment. thank you to all of our guests. and thank you for watching. you can see this program again any time by visiting our website. for further discussion, go to our facebook page. join the conversation on twitter. for me and the whole team, goodbye for now. ♪

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