there's been a surgeon cases since badging abandoned, did. strict pandemic controls pakistan. security forces, same operation to free hostages from taliban fighters is now over. troops stormed a high security detention center in the north west of the country where gum and have been holding several people since sunday efforts to negotiate with the hostage takers failed nurses in the u. k or on the picket lines for the 2nd day this month, demanding better pay and conditions up to 100000 nurses are taking part in the unprecedented strikes. they're demanding salary increases of up to 19 percent. the u. s. supreme court has extended a controversial trump era immigration policy. the rules imposed in 2020 allowed the government to use coven 19 protocols to block the entry of migrants on the border with mexico. a us panel investigating last year's january 6 capitol hill attack says donald trump should face criminal charges. the his role in the riot, the former president says, the move is to block us 2024 run for the white house. a court in germany has given a 2 year suspended sentence to a 97 year old for nazi war crimes. one of the countries last holocaust trials and got 1st served as a secretary at a concentration camp in poland. between 943 and 1945. she's been found guilty of complicity in the murder of more than 11000 people and woke up. when is that pain i have arrived home except it crowds gathered to greet the players on their way from the airport. 1000 have already gathered in the center of this. one is there is waiting for the official parade lanka, champions bait front on penalties in casa millions are expected to be on the streets to celebrate with the captain lamb l messy and his team on a national holiday. all right, those are the headlines. i'm emily angland. the news continues after inside story. ah oh, counts by healthcare workers threatened to disrupt the lives of millions of people in the u. k. the stand off between public service employees and the government shows no sign of a basic. we ask what's going wrong with the u. k. national health services. this is inside story. ah hello there and welcome to the program. i'm natasha tay. now the u. k. is national health service has been a source of pride from millions for more than 70 years. but now staff angry about pay and working conditions are set to go ahead with another round of strikes, leading to even greater disruption for the very people that the institution is meant to serve. nurses will walk off the job on tuesday for a 2nd time this month. the government has refused to negotiate with them. ministers a their waged, amanda, unaffordable. on wednesday, more than 10000 ambulance workers including paramedics will, down tools, hundreds of military personnel are preparing to step in to help. john hall has worn out from london. britney's pricing for a 2nd week of highly disruptive public sector industrial action. with no sign of the government's willingness to give in to the demands of striking workers already . big numbers are being taught it up around the cost to the economy of this strike action, particularly retail and hospitality in the run up to christmas. and there are very real concerns in the health sector about the effective, likely nurses and paramedics ambulance workers strikes on the ability of hospitals like this one behind me to cope the national health service. already. of course, in the mines with many on the brink of collapse were to go through that list of striking public sectors. this week the nurses are closer to the big one going on strike on tuesday. the 2nd day of walk out by nurses and it's historic. it is only the 1st time in the history of the national health service. the nurses have conducted such widespread strike to be followed on wednesday by ambulance workers at paramedics, and then customs and immigration officials, postal and rail workers with firefighters and teachers balloting for potential action in january as this threatened to go on into the new year, were for the speaking the union say that their members have for far too long now being affected by low pay, by real terms, wage cox's pay has failed to keep pace with inflation pretty much since the economic crisis of 2010 enough is enough. they say they'll go on for as long as it takes with their members now struggling more than ever in the face of a cost of living crisis, i energy costs and spiraling inflation. equally steadfast, of course, is the government that warns that higher pay will only few inflation itself already eating into the pay packets of ordinary workers. and it warns that higher pay will have to be paid for with higher taxes. while the any chess itself is a state funded health system founded in 1948 back then in cost around $20000000000.00 a year to operate by 2021 and cost about 337000000000 according to government figures. and then the pandemic head, the and i just needed an additional 6000000000 dollars each year for frontline services. so now it has more funding and more stuff than it did pre curve at 19. despite that, in october, more than 7000000 people were on a waiting list, that means nearly 12 percent of the population in england is waiting for help consultation. and there's also the increase in energy costs and touring inflation has reduced the value of its budget. this means the health service must now do more with significantly less the well, it is now bringing out guests from london were joined by oak santa pisec. she's a pharmacist and also electra at the u. c. l. school of pharmacy from copenhagen, denmark. we have jeff lazarus, he's a research at the boss, atlanta institute for global health, and also from london is jonathan porters. he is a professor of economics and public policy and the department of political economy at kings college london. i will welcome to will thank you so much for joining us on inside story town. i want to start with you, you know, sitting in london and i want to talk a little bit about the working conditions for nurses and other health cast off at the time. because this isn't just about pay. but they're also talking about what it's like to work there. what's it like at the moment on an any kind of average day for health care professionals? where are the biggest challenges? well certainly we see that the backlogs from the co, the 19 hyundai mac has put a huge pressure on any chest hole service. and this is all across from really community level and g. p. appointments are also here in the u. k. recently there have been pressures and pharmacies with antibiotics, shortages and stroke bay outbreaks and at the hospital levels as well. so nearly half of all health care workers stay that they are working on. they don't have the resources available to them to do their job, to the extent that they think is needed. so that's really worrying statistic to see that more than half of health care workers, they, they can't do their job up to the standard that they normally would do on top of a health care search system. as taking a huge beating through the pandemic and health workers themselves also very burned out. of course i want to get to some of the psychological tone and just a moment. but just touching on what you were saying there at santa about staffing shortages. is this really about staffing shortages or about money because i guess they are both related. but jonathan, let me throw that one to you because we're talking about pay them on here that a very, very far apart. how does that go anywhere towards talking about what we're dealing with a staffing shortage if that's one of the biggest issues i'm well ah, nurses have seen their pay cut by about coming out now to $15.00 or 20 percent in real terms over the past 10 years. in common with much of the public sector actually where there were pay phrases. so it's important to remember that what we're seeing in the public, not just in the, in a chest, but public services. the hall isn't just about the post pandemic. obviously the pandemic is made things considerably worse for the health sector, but it is really the product of 12 years of under funding of public services and pressure on public sector pay, which has been particularly bad. i think i'm, although low paid workers have not done so badly, it sort of middle range nurses and other similar workers as when the public sector, who of course are sort of in some sense, the backbone of what actually gets done in the public sector. people who've been there long enough to actually know the job and know where they're doing, but not that long enough that they've become elevated the rates of senior management, where they don't have to do work directly. so it's those people who have come under most pressure and i think for a lot of them it's just become too much. so pay as you said, it is a very, very large part of the problem. and hence, sol, money to solve. it is a large part of the solution, but it's not the only thing by any means. it's this sort of progressive rundown of public services, which are very much pre dated the pandemic. and i think sort of trying to relate this just to what's happening to the last year or so is quite wrong or, or at least misleading. this is something which has been going on for, for quite a while, and i think is now showing up in the public wants to do this. we're beginning to realize that actually, you know, if we want decent quality public services, we are going to have to pay for them. and that is going to be somewhat higher taxes and that of course, is very difficult political message to sell. so indeed, you mentioned there that now says if seen pay cuts in real time, and a lot of that they're arguing has to do with inflation. and part of what they're asking for now is an inflation related pay rise. and jeff, let me ask you about this, because i'm curious about how other countries are approaching this, and tying pay rises to and facing things like possibly quite dangerous thing to do . yes, not just you're tying it always to inflation, but your workers receive a cost of living adjustments. and we've seen unusually high inflation as, as everyone knows. so with this massive inflation, the ex, you know, maybe there's been declines in real wages, but people are also exhausted. they've been running a marathon through the pandemic, and just as it looks like things are getting better, they're hearing that there won't be new resources. some people are leaving the field. there are nurses who do not want to stay in health care because they're not seeing that it's a good place to work anymore. people are very busy as like santa mentioned with the backlog and we've had lower cases, lower numbers of people diagnosed, diagnosed for many different conditions, fewer people initiated our treatment. so this, this sense of it, we've been overwhelmed for so long, but now things are getting better. it's, you know, they've come to the end of the marathon and been told you have to run a couple of kilometers. and on top of that, you have to carry, you know, a rucksack full of weights, which is, you know, the, the salary issue because of the current inflation. we're seeing this in spain. there's been protests in madrid. there's protests planned for january. and there's concern, i think, all across europe that the conditions for the health care system are not truly being addressed and that we haven't really not to be cliche but built back better like so many had hopes and data. and this is also not just the health care sector, but many other public sectors as well. jonathan, just before we depart from the, the specific pay issue, finances i was just, it really struck me how large the differences between what the nasa they're asking for and what the government is talking about. 19 percent versus. and i'm the closer to 4 percent in your mind, what's actually realistic? um, i think what you, i, i know in the negotiating room the nurses have made clear that they are willing to settle for considerably less than the 19 percent. the government has not made has said that it is absolutely refusing to talk, so we're not at the moment at the moment in that sort of territory of saying, well if you go off a couple of percent, all calm down a few percent were in the position where the nurses have said, yes, we made a very large demand which reflects what we think we deserve quote, but we know that that's unrealistic and will settle for less and the government is saying, you are going to take what you're given. we're not interested in even in any further discussion. so in some sense, saying what that a realistic level is, is slightly academic because the government is just saying, we are not prepared to budge an inch at present when they do move off that position . if they do move, all that position will be when we can sort of talk about what's realistic. but i think the best way of looking at this overall is to say, look how your eyes is in the public sector. are currently running your on average earnings in the public sector. i've gone up by about 2 and a half percent to 3 percent of the last year. earnings in the private sector have gone up by $6.00 to $6.00 and a half percent. inflation has been about 10 percent. so this idea that increasing public sector pay is what's going to set off a wage pri spiral, or add to the inflationary pressures that are already there. it simply does not add off for good economic perspectives. it's just smote the smokescreen from the government. frankly, it's not worth taking seriously. so the reticent then of the government to even negotiate with masses that changes the tone of the discussion somewhat. jeff, you mentioned the what exhausted you talked about how this has been like a marathon on a how much do you think the psychological toll of the pandemic and, and living through and working through that is playing into what we're seeing now. again, looking back to what our earlier panelist said, of course this is we had 12 years over a decade of austerity in any chest budget cuts, etc. and then a global health crisis that really demanded so much from everyone within the health care system. so, and you know, everyone here in the u. k. stood outside their doorstep and applauded our health workers. but then when they are asking for something that is really quite fair because in the u. k, a nurses are paid quite low. if you compare that to international standards, their pay less, that colleagues and other countries, it just so in this instance, so demoralizing for health work yourself to, to go through some thing that was absolutely traumatizing for so many where they had to say good health. people say good bye to love ones through i phones and i pans. we didn't even have sufficient p. e at the beginning of the pandemic. and really for what is supposed to be a quite developed health care system. those budget cuts that lead up into the pandemic, played out quite severely. we saw that actually, we were not in a good place when the pandemic hit. and then all of the crack started to, to even grow during that time. and now because we went at went into the week, i think now it's on its knees, particularly if nurses continue to on strike and they have the right to make the demands for, for what they're worth. and we need to absolutely value all health workers who really it is a matter of life or death when we have quality care and delivery of these important services. but i do think morale is now at a lowest point. well, we also saw services cut during the pandemic in order to make way for emergency services. and we were saying earlier that that's left what more than 7000000 people on waiting lists, 12 percent of the population, not enormous. i know that the n h s for all of its failings when you compare it to other systems, had always said that one of the best things about it was that it provided equal and actually relatively good access. a jeff that's obviously no longer the case. how does it measure up now? yeah, i mean, it was inevitable when hospitals were overwhelmed because of covered 90 dealing with the virus. they weren't able to carry out their regular services. so we're seeing this all across your waiting lists, backlogs, and you know, we went from a period where people were, you know, literally applauding is like santa said, not just in the u. k, but in spain and in other countries. applauding, health care workers, applauding nurses to messages that well you need to keep on working. your real salaries are worth less because of inflation. we're not putting more money into the health care services, so it is very dirt demoralizing. we were advertising for a couple of nurses on a project. i run in spain and it was very difficult to get any applicants. i don't think the message we're sending is, you know, become a nurse. we need you, we, we respect you. we're, you know, we're happy to have you in the system it's, we're going to overwork you and when you ask for more in salary, because of real inflationary issues, we're not gonna even negotiate with you. so we've talked a little bit about salaries, but it goes much deeper than that. it seems. we've talked about how there's been chronic under funding, but there are also other structures in place that have been problematic by my understanding. there was a lot of red tape and bureaucracy specifically in the n. h. s. a lot of that disappear during the pandemic. and in order to be able to do really rapid emergency care, and i'm hearing from health care professionals that a lot of that is now back, i believe. what last year? $12600.00 operations were canceled because of administrative areas. jonathan, how much of a structural weakness is the red tape and bureaucracy that exists in the system in international terms that is not over bureaucratized, it has considerably less in terms of management. you're the ratio of management to actual hands on health care stuff is actually rather low in the n h s. i think the problem is not that the h as is as towards too many bureaucrats. it's rather that the efficiency of its processes and procedures is not what it could be. and so in particular that there have been significant issues with it. there are significant issues with the respectful i t systems. and of course, we all know from our own jobs and from dealing with, with any service that when the i t doesn't work, that has a terribly negative effect on the productivity of the actual people who are trying to deliver the service. oh well ok. so let me throw that one to you, then do nurses and other health care professionals feel that the money that's being spent, the money that is already that is being spent appropriately because there was more money spent in the system during the pandemic. and now than before, so is not just not being spent in the right places. and clearly the nurses are communicating that it isn't b like the right places because it's not getting into the hands of the workers themselves that are giving the care to our patients. so in order for that to occur, of course i, we do need greater investment. so it's, we've tried doing restructuring and finding efficiencies within the system itself. and that attempt has happened several times, but in the end you can continue to restructure and reshape a budget. but you will just eventually need to have a greater influx of investment to match what the needs in this real time throughout still the fall out of who in 19 demand. so i think really the workers are speaking out loud that you know that the system as it is now isn't working. i feel like this is a really complex issue though, because a large number of people analyze number of organizations have looked at this and there are plenty of reports. and in, in the public area about this, the institute for fiscal studies and one of their import specifically on the annette chest, said that despite the fact that stuff undoubtedly feel stretched,