about winter pressures. delays at hospital are a worry. we're worried about the system becoming overrun. so we've got a category one call, a male who was unconscious. siren wails their first call of the day, and ryan and debbie from the north west ambulance service are on their way to see a critically ill patient. hello, are you 0k? please can we get some pads on him just in case? and then let's get some access. he was really septic and with his heart rate being so low, his blood pressure and saturations and recordable, i believe he was at the stage just before going into cardiac arrest, he was that poorly. right, we are good to go when you are. we're going to go on blue lights. our eta to wigan is six minutes, ever. can you open them eyes for me? hold my hand. ifeel really privileged to do ourjob. it's only a short distance to resus. within minutes of getting the patient into intensive care... do you think you could step out with us and we will get you straight into a chair? i know it's painful. so, resus said they could make room for him in there. ..ryan and debbie are called to help another patient arriving at the hospital. you've had a facial weakness, is that right? we'll take you on blue lights, we'll get you seen straightaway. then another call from control and another medical emergency. his observations are as follows, he's got a heart rate of... since we've been filming with the paramedic crew, it's been nonstop. and the thing about this job is you just don't know what kind of call or where you're going to go to next. they've already been to four calls that have all been potentially life or death and they're only halfway through their shift. good morning, north west 111, sarah speaking. - the pressure in the control room is palpable. but because of the sheer number of calls and as so many ambulances are held up at hospitals, across england the average response time for category two emergency calls such as heart attacks and strokes is still more than 38 minutes — that's more than double the target of 18 minutes. getting paramedics to patients is one stress. getting the patients inside the hospitals is another. i would say least over half of our ambulatory fleet at times can be waiting to hand over patients. and you could be talking at times hours for handovers. how many hours? so this week probably our longest handover was around 11 hours. and often that can be multiple ambulances which really does impact on our ability to manage the risk in the community. and last week across england, nearly 13,000 ambulances were waiting for more than an hour to off—load patients. as ryan and debbie set off on yet another urgent call, they're aware that they're also driving into one of the busiest, most difficult winter is ahead for the nhs. sharon barbour, bbc news. we can speak now to dr layla mccay, who is the director of policy at the nhs confederation. was the situation like in the hospitals? was the situation like in the hospitals?— was the situation like in the hositals? ~ ., , was the situation like in the hositals? �* ., , ., hospitals? about the hospitals and s stem hospitals? about the hospitals and system right _ hospitals? about the hospitals and system right now, _ hospitals? about the hospitals and system right now, everyone - hospitals? about the hospitals and l system right now, everyone working incredibly hard and doing what they can and it is challenging, so it's challenging when we come up to the winter because it increases the demand and system already running at an incredibly high level of demand. and almost full and increasing demand and becomes really difficult and efficiency in securing the 95% full and then you have a jump in the demand, that is why you often see those challenges of trying to bring people into the hospitals quicker than you are able to get people out of the hospital and you see the backlogs that you're hearing about today. backlogs that you're hearing about toda . �* , backlogs that you're hearing about toda .�* . ., backlogs that you're hearing about toda.�* ., gifi backlogs that you're hearing about toda.�* ., ;;::f ., today. always challenging, 3096 of atients today. always challenging, 3096 of patients waiting _ today. always challenging, 3096 of patients waiting for _ today. always challenging, 3096 of patients waiting for the _ today. always challenging, 3096 of patients waiting for the a - today. always challenging, 3096 of patients waiting for the a need - today. always challenging, 3096 of patients waiting for the a need to l patients waiting for the a need to be seen. what is done to the run—up to try to prepare for these challenges.— to try to prepare for these challenges. to try to prepare for these challenues. ~ , , ., ~ ., ., challenges. when we speak to health care leaders — challenges. when we speak to health care leaders across _ challenges. when we speak to health care leaders across the _ challenges. when we speak to health care leaders across the country, - challenges. when we speak to health care leaders across the country, and | care leaders across the country, and he tells planning has been particularly good this year and also the lessons of the learned from previous years were trying very hard to apply them but we need to remember the challenges in which we are doing that and for example, we are doing that and for example, we are facing conditional actions which can really knock off all such plans and need to cancel appointments and challenges and we the statistics that the capital backlog is increased again and it's about 11.6 million in what we are seeing the there is further capacity is challenged because there are boards that happen to be close because prices are being hiked in the equipment and is not the money there to sort out and expand the capacity is much as possible and we see the vacancies across the system in both health and social care at all of those things lead to things being much trickier to achieve the efficiencies that we want which is why it is pretty impressive the data showed us that some of the waiting list of actually managed to go down a bit which really is testament to the huge amount of effort that has been put into this.— been put into this. down to 7.71 million to _ been put into this. down to 7.71 million to 7.70 _ been put into this. down to 7.71 million to 7.70 about _ been put into this. down to 7.71 million to 7.70 about the - been put into this. down to 7.71| million to 7.70 about the impact on patients we talk about a third of people in a hospital by ambulance for more than 30 minutes instead of the target 50 minutes to be seen by a&e and the huge pressures of people who work hereunder but people are potentially dying waiting times. the focus is on potentially dying waiting times. tue: focus is on patient potentially dying waiting times. tte: focus is on patient safety potentially dying waiting times. tt2 focus is on patient safety and everyone is aware of the challenges making all sorts of decisions in order to keep people safe as possible but you are right that he discussed challenges and everyone working together across the whole system in general practice and emergency hospital and being able to discharge people and ordering parts of the system working together to try to get people into the hospital when they need to be there and out of the hospital when the ready ago and it's something that a lot of planning is going into and hopefully, be able to achieve that so many other things that are impeding the success in everyone's working flat but it's a difficult time. ., ., , ., , working flat but it's a difficult time. ., ., , ., ~ time. could have you with us. thank ou. time. could have you with us. thank yom around — time. could have you with us. thank you. around the _ time. could have you with us. thank you. around the world _ time. could have you with us. thank you. around the world and - time. could have you with us. thank you. around the world and across i time. could have you with us. thank| you. around the world and across the uk, this is bbc news. the belief he should be suspended after being caught in the lobbying scandal in the house of commons agrees the recommendation will trigger a recall petition which can lead to a by election in his constituency. the father, step—mother and uncle of ten—year—old sara sharif — who died at her home in woking in august — have pleaded not guilty to her murder. urfan sharif, beinash batool and faisal malik appeared at the old bailey by videolink. they also pleaded not guilty to a second charge of causing or allowing the death of a child. the first to declare his candidacy to lead welsh labour party and become the next first minister of wales. he said he had strong support across the party. president biden�*s national security adviser is in israel — to repeat us calls for restraint in the war against hamas. he's been meeting the israeli prime minister benjamin neta nyahu in tel aviv. there was no let—up in israel's bombing of the gaza strip in the hours before his visit. this is the aftermath of a strike in rafah in the south of the gaza strip. the hamas—run health ministry says, at least 2a people have been killed in air strikes on two houses in rafah today. mr sullivan also met israel's defence minister yoav gallant. he told mr sullivan that war could last for several more months. it follows mounting international criticism of israel over the number of civilian casualties, and the un general assembly overwhelmingly voting in support of a ceasefire. israel's ambassador to the uk has said "absolutely no" to israel accepting a two—state solution with the palestinians when the war with hamas in gaza ends. the "two—state solution" to the israeli—palestinian conflict is an internationally backed formula that envisages an independent palestinian state in the west bank and gaza, with eastjerusalem as its capital, alongside israel. earlier, i spoke to mark regev, senior adviser to the israeli prime minister, and asked him whether mr netanyahu. right—wing coalition parties and with in this war started, the coalition was expanded and includes the party as well. different voices are in and the prime minister and his position is that, as i said, all the powers to rule themselves and of the powers to rule themselves and of the powers to threaten israel. a the israeli public to get behind that. how does that sit with israel's allies because in the us they were this crisis, there has to be a vision of what comes next this to be a two state solution the prime minister said to the ambassador, will be sticking towards long—term position in the eu backing that stance, how concerned are you the position of the prime minister may be far apart from your allies and cause restraint in the relationship and their support for your country? it's more of a semantic disagreement the nonsubstantive disagreement the nonsubsta ntive disagreement because the nonsubstantive disagreement because if you speak to the americans and british friends, it is clear to them they have to have security arrangements and there has to be a demilitarisation in palestine if you reach an agreement with them. it has been around since the very beginning. has with them. it has been around since the very beginning.— the very beginning. has not been at eace the very beginning. has not been at peace process _ the very beginning. has not been at peace process for _ the very beginning. has not been at peace process for many _ the very beginning. has not been at peace process for many years - the very beginning. has not been at peace process for many years since | peace process for many years since this started with the attack by my son israel on october seven that's been very clear from your allies that there needs to be an angle that is a two state solution. what is that going to look like and one that i think will be acceptable to the palestinian people?— palestinian people? what are the ma'or palestinian people? what are the major problem — palestinian people? what are the major problem is _ palestinian people? what are the major problem is the _ palestinian people? what are the j major problem is the palestinians have had opportunities to establish state outside israel but they rejected it, 1937, and 19117 and 1967 and most recently, there are very forthcoming with what was procured by president clinton and the prime minister put on a proposal that would've given them or notch percent of the territory and i was also rejected. palestinians have to ask, why is it that not exist for a crossroads where there is opportunity for statehood that they rejected? is impossible that they have a problem with thejewish state more than they have for their own state? ~ . , more than they have for their own state? a , ., more than they have for their own state? a, , ., ., ., state? many would argue that prime minister benjamin _ state? many would argue that prime minister benjamin netanyahu - state? many would argue that prime minister benjamin netanyahu is - state? many would argue that prime minister benjamin netanyahu is not| minister benjamin netanyahu is not serious about the two state solution and has not pursued any others policies into the stocks you mentioned or took place under previous administrations many years ago. is that the reality that there is a new leadership needed in israel and among the palestinians that is interested in pursuing itjust peace interested in pursuing itjust peace in two state solution and perhaps benjamin netanyahu is not the person to do that shallow lettuce except the presumption that benjamin netanyahu is the problem for the of argument and netanyahu is the problem for the of arc umen- . , netanyahu is the problem for the of arc umen- ., , , netanyahu is the problem for the of aruumen- ., , , ., netanyahu is the problem for the of ar. umen: ., , , ., ., , argument and why is that the others not able to make _ argument and why is that the others not able to make peace? _ argument and why is that the others not able to make peace? success i argument and why is that the others not able to make peace? success of| not able to make peace? success of israeli prime ministers of trade to make peace with the palestinians and there was never possible. suddenly, this is that it's all because of benjamin netanyahu is a bridge too far perhaps. the palestinian leadership as you know is a leadership as you know is a leadership that is very stuck in an orderly of looking at things and others that are moderates but nearly 70 days after the terrible massacre, they have failed to condemn that massacre. they have failed to do so even the foreign ministry, it put out this ridiculous statement on official stationery that israel was responsible for the deaths of the music festival. there are severe questions and serious questions about their commitment to repeat reconciliation. the about their commitment to repeat reconciliation.— reconciliation. the us national security official _ reconciliation. the us national security official speaking - reconciliation. the us national security official speaking the l reconciliation. the us national - security official speaking the prime minister, reiterating this message is heard in the defence secretary the disk continued for several weeks, if not months, how concerned are you by increasing criticism by the us in recent days the israeli activities and its failure to protect civilian lives in gaza? to think they'll continue to support you for the weeks or months at the first see conflict going on for? this issue came up in our meetings today are the americans and our military people have shown to the united states the rigorous process you have in selecting targets and headed it is a rigorous process and only after the stitches or mad that it was decided that we can hit what the ordinance and we really do have such a process in place and the idea that israel is indiscriminately carpet bombing causes just not true. from the us, the uk, the prime minister said today that he is concerned and far too many innocent people lost their lives. are you willing to continue this conflict with the loss of life and civilians by saying your journal with the loss of life and civilians by saying yourjournal you can to protect people but increasing criticism from around the world, from your key allies, how much is that we are in the decision—making process for the government? that whites say it _ process for the government? that whites say it was _ process for the government? tngt whites say it was the united states and the united kingdom affects us and the united kingdom affects us and we share our concerns and the truth is on the strategy, we have no disagreement. we agree that israel must defend itself against hamas protect our people if we agree that hamas military machines be destroyed and we agree that hamas cannot stay in gaza, its recipe for further violence and war and we can disagree on tactics we can learn from each other but we share the same goal and pursuit of this campaign against hamas in their utmost to safeguard the civilian population and facilitate the interest of humanitarian support population it's not gaza civilians, it is the hamas military machine. fadi quran, a palestinian activist and campaign director with the global palestinian organisation avaaz argues that palestinians should have the ability to elect their representatives democratically before they can think of a future political solution. ijust got off i just got off the phone with a friend in gaza father of three beautiful children and he was crying because he could not find food for his kids to eat today and he is asking them to try to do anything to just get food for him and his family and it does is that we're living in and it does is that we're living in a parallel universe to be even talking about the future when there are people currently starving at what we need to be looking at is a cease—fire what happens after the cease—fire, first ave needs to be palestinians are allowed to have democratic elections for palestinians around the world to choose representative competent leadership that can move them towards the solution that leads to dignity for all that israel has been preventing palestinians from having elections for at least the last 17 years and blocking palestinians in jerusalem from the selections what he is not mentioned is that every piece that the israelis have offered to the palestinian people has been the peace between the master and slave, palestinians do not have full sovereignty and self—determination and do not have their own return and barely have access to their own holy sites as palestinians, we want a piece that is just a piece that provides liberty for all and when i went accept any peace process that's going to lead us into a situation where it's really domination of every aspect of our lives continues but before going down that path, which can be focusing on a cease—fire right now with the majority of the world as we have seen has called for and yet, it is still not being moved forward by the israeli government and british support. t israeli government and british su ort. . israeli government and british su--ort. ., ., israeli government and british suuort. ., ., ., support. i want to come back to the cease-fire and _ support. i want to come back to the cease-fire and israel— support. i want to come back to the cease-fire and israel is _ support. i want to come back to the cease-fire and israel is looking - support. i want to come back to the cease-fire and israel is looking the | cease—fire and israel is looking the six hostages held by hamas released and the issue of elections, the last elections in gaza, 2005 that is when hamas was elected an organisation that has a name for distraction and its neighb