Tens of thousands of ambulance staff and other NHS workers have taken to picket lines across England and Wales in a bid to force through a better offer from the government on pay, as Rebecca Barry reports on the day so far
The disruption to the NHS caused by recent strikes is likely to carry on for several days, health leaders have warned.
People whose conditions might have worsened because they delayed seeking help were a particular concern, the membership organisation for NHS hospital, mental health, community and ambulance services said.
NHS Providers also warned about the knock-on impact to appointments which needed to be rescheduled and said they anticipated a return to “very high numbers” of emergency calls.
The number of people phoning 999 appeared to have dropped in some parts of England on Wednesday as thousands of ambulance staff and paramedics went on strike until midnight.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), said: "There may be a number of reasons why 999 calls are dropping – hesitancy may be a key factor during the industrial action.
"We want to reassure patients and the public that if they need emergency care, A&Es remain open."
Saffron Cordery, interim chief executive of NHS Providers, said: "Leaders across the NHS also know that as this week’s strike action draws to a close, the disruption is far from over.
“The fallout from strike action is likely to spill over into the coming days due to the knock-on impact across different parts of the health and care system, the need to reschedule elective and outpatient appointments, and the anticipation of a return to very high numbers of emergency calls.
“There is particular concern about patients who may have delayed seeking care – and whose conditions have deteriorated – now coming forward for treatment.”
Health leaders urged people to still call for an ambulance if they were experiencing a life-threatening emergency, amid fears that even those who needed help would not call.
Up to half of its more than 4,000 workforce were GMB members who were striking.
In spite of the strike, ambulance crews have been attending emergency calls and returning to their picket lines from the moment industrial action started on Wednesday, according to the GMB union.
Rachel Harrison, GMB Union Public Services National Secretary, told ITV News: "There are a lot of emergency calls that come into the services, and arrangements have been put in place with local employers to determine what gets covered.
"So as soon as we started this morning, before it even got daylight, we were seeing crews leaving picket lines to go and attend to patients in their communities."
Around 25,000 ambulance workers joined the picket line on the first of two days of strikes, as unions and the government remain locked in a bitter row over pay.
Ambulance crews have been attending emergency calls and returning to their picket lines from the moment industrial action started on Wednesday, according to Rachel Harrison
The length of time for which the industrial action will last for varies depending on each trust, but all walkouts will have concluded by midnight on Thursday.
NHS leaders have spoken of their "deep worry" and warned they cannot guarantee patient safety, as they urged the prime minister to step in.
The Royal College of Emergency Medicine (RCEM) said A&E departments were expecting some patients to turn up to hospital via cars rather than ambulances, and the medical director of NHS England urged people not to get "blind drunk".
Eight ambulance trusts are on their highest level of alert. They have declared critical incidents, which means they cannot provide usual critical services and patients may be harmed.
Scott Tyler, 28, an emergency medical technician who has been working for London Ambulance Service for more than four years, joined the picket line in Waterloo, central London.
Speaking, he said: “The reason we’re striking today is because we are overworked, underpaid and our job is only getting worse. Patients are going hours and hours without seeing an ambulance and it’s just unacceptable.
Asked how long the service has been under pressure, Mr Tyler said: “We haven’t had a break pretty much since the pandemic. The pandemic brought unprecedented pressure on our service that we did manage, but it was a lot of pressure. Now after the pandemic those calls rates are still as high and in the last, I would say, a week they are back to those levels again.
“The other day I believe there were over 7,000 calls and that is a lot. Usually if you get that, pre-pandemic that would have been New Year’s Eve, going into New Year’s when millions of people come to London. That’s what we’re experiencing almost on a daily basis.”
Elsewhere, Health Secretary Steve Barclay has refused to blame the government for any harm that comes to members of the public during the walkout.
Asked whether it would be the government or striking workers to blame for any harm resulting to patients, Mr Barclay refused to attribute any blame to Downing Street.
He said: "Well it’s the trade unions that have made a decision not to give a national undertaking to cover all of the emergency calls, to leave that to individual decisions with local trusts and with call handlers in terms of some of those emergency calls that will be responded."
"The government has put in place the contingency measures that it can."
During an interview with ITV News, the health secretary refused to blame the government for any harm that comes to members of the public as result of strikes by ambulance workers
He added that the strike action would cause "significant volatility" and impact "patient safety," after last ditch talks with the unions on Tuesday failed to avert the planned industrial action by paramedics, ambulance drivers, emergency care assistants, call handlers and other staff across England and Wales.
The government is refusing to budge on its stance on pay and maintains it will stick by independent pay review bodies' recommendations.
The NHS Confederation and NHS Providers, which collectively represent all NHS organisations, earlier wrote to the prime minister warning they were entering "dangerous territory" and urged him to end to the deadlock.
"With less than 24 hours to go until the ambulance strike, there is deep worry among NHS leaders about the level of harm and risk that could occur to patients tomorrow and beyond," they said.
The Unison general secretary told ITV News she was 'astonished' by the health secretary's accusation that workers have made a 'conscious choice to inflict harm on patients'
However, appearing before the Commons Liaison Committee, Rishi Sunak was adamant that the government could not accede to inflationary pay claims which would simply stoke soaring prices.
Tensions flared further when Mr Barclay wrote in the Daily Telegraph: "We now know that the NHS contingency plans will not cover all 999 calls.
"Ambulance unions have made a conscious choice to inflict harm on patients."
Union leaders insisted there would still be cover for the most serious calls through a series of local agreements.
All Category One calls - the most life-threatening such as cardiac arrest - will still be responded to along with the most serious category 2 calls which covers serious conditions, such as stroke or chest pain.
Unite general secretary Sharon Graham said claims many serious calls would receive no response were "misleading" and "at worst deliberately scaremongering" by ministers.
Meanwhile, nurses in England, Wales and Northern Ireland - who held a second 12-hour stoppage on Tuesday in support of their pay claim - said they would be announcing further strike dates on Friday unless ministers come forward with new proposals.
In a bid to plug staffing gaps during the walk outs, around 600 armed forces personnel have been deployed to cover for striking ambulance staff, providing support for paramedics, although their role will be strictly limited.
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