A young paramedic on a picket line in Cardiff has told the BBC a number of his younger friends have decided not to strike today.

He did not want to give his name, but said some of them were asking: “What’s the point [in striking] if we’re going to have to respond to urgent calls?"

Unions have agreed striking workers can leave picket lines to respond to the most serious, life-threatening calls if necessary.

The paramedic turned up to the strike in his civilian clothing for the same reason - if he was in paramedic uniform he said he’d feel pressured to respond to calls.

Many patients saw their surgeries and appointments cancelled due to a separate strike by nurses yesterday - and one of them has told us she has had no choice but to go to A&E today.

Irina Velichinskaya travelled to Ealing Hospital's A&E department. She'd been experiencing knee pain and was notified yesterday that her scheduled appointment - which was due to take place at 13:00 today - had been cancelled because of the nurses' strike.

She says she woke up today in pain and came to A&E, but was worried she'd be affected by the strike by ambulance workers. However, she says A&E was the quietest she’s ever seen.

"It was quiet compared to previous times when I was here before, when I was waiting five or six hours for an emergency consultation or to see a doctor," she says.

Velichinskaya says she thinks "a lot of people are really struggling to get here".

Reality Check

Unison general secretary Christina McAnea was asked by the BBC on Monday about research from the Health Foundation charity, external that suggested ambulance workers had received an 8% pay rise between 2011 and 2021, after adjusting for cost-of-living changes.

"I dispute these figures," the union chief said. "I find it extremely unlikely that for most of them they would actually have seen a pay rise."

Her view is supported by the health think tank the Nuffield Trust, which released research this week, external suggesting that while ambulance staff had done better than most NHS workers, their pay had only just returned to its 2010 level, after adjusting for the cost of living.

It suggested the difference might be based on whether the figures included support staff.

Thousands of relatively low-paid ambulance staff were reclassified as support staff in 2019, meaning the data for the remaining ambulance workers showed a jump in average pay.

Also, the Health Foundation's figures only went up to March 2021, and the high rate of inflation since then means that ambulance staff are now likely to have seen a real-terms fall in their average basic pay.

Another difference is that the Health Foundation was using figures for basic pay, while the Nuffield Trust used figures for total pay. That's significant because ambulance workers, on average, make more than a quarter of their money from extra payments such as for overtime and other shift-work payments.

Reality Check

The latest figures from NHS Digital, external for April 2021 to March 2022 show that the average earnings per person for ambulance staff were £46,643 - of which £13,854 were extra payments for things like shift work and overtime.

Workers classed as support staff - such as ambulance technicians and non-emergency ambulance drivers - had an average pay of £29,139 over that period, of which £7,842 were extra payments on top of basic salaries.

An unusually large proportion of pay for ambulance staff comes from those extra payments.

Image source, Dave Skinner

Dave Skinner is an emergency medical technician with the London Ambulance Service. He voted to strike.

“The situation in London currently is as bad as it was during Covid, but we have none of the additional Covid measures to help us cope," he explains.

"Patients are dying waiting for us because there’s physically nobody to send. Our trucks are breaking down. We don’t have enough staff."

Despite the walkout, Skinner suggests top-priority callouts may receive quicker responses today. He says on normal days, ambulance teams get stuck queuing at hospitals or answering "non-emergency community issues that should be handled by GPs, mental health services or carers".

Of his experienced co-workers who are leaving this line of work for better pay and conditions elsewhere, he says: "I don’t blame my colleagues for going."

He says one issue is that those paramedics are being replaced by more junior staff - who are well-trained but may lack the "knowledge, skills and experience" of medics who've left.

Have you been affected by today's ambulance strike or yesterday's nurses's strike? Have you been trying to trying to get to hospital or access care?

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Health Secretary Steve Barclay wrote this morning that unions were making a conscious choice to "inflict harm on patients" by going on strike. This afternoon, he stayed silent when asked about those same unions.

Barclay was approached by reporters as he left a meeting of the government's emergency committee, Cobra. He said ministers had been "working on the contingency measures" for today's ambulance strike - and the focus was "patient safety".

He was then asked why he was "attacking the unions" - but didn't respond.

Barclay earlier told the BBC that unions had "refused" to work with the government on national agreements to cover category-two 999 calls - such as strokes and major burns - which are a step below the most serious category-one calls.

"That makes it very difficult for NHS colleagues to plan the contingency measures" such as working with the military, he said.

Unions expressed shock at Barclay's earlier comments, having made some local arrangements to cover category-two calls. Unison chief Christina McAnea called them "utter nonsense"- while Unite's Sharon Graham said they were a "blatant lie".

Nick Eardley
Chief political correspondent

Over the last few days, some at Westminster had been hoping a way out of this dispute could be found.

Perhaps the government could find a ladder to climb down, offering unions a compromise?

Based on today’s war of words, that seems a more distant prospect.

The health secretary has accused unions of making a conscious choice to inflict harm on patients.

Unite’s boss has just accused him of a blatant lie and suggested he should stand down.

Unison’s chief has said any deaths would be the fault of the government.

Remember, if there is to be a compromise, all of these people will have to hammer it out. This ramping up of the rhetoric is not going to help.

There are some ways the government could look to compromise on pay. Unions have suggested they’d be open to a bonus payment. The government has suggested it could look at a better offer next year.

But at the moment, the blame game is as heated as it has been.

Image source, Reuters

If you're just joining us or need a catch-up, here's a rundown of what's been happening today:

• Ambulance workers are striking in England and Wales over a pay dispute, with about 750 armed forces helping run services during the walkouts
• The NHS has told people to call 999 in life-threatening emergencies, and use 111 online otherwise
• Pregnant women who are very close to their due date are being advised to make alternative plans for getting to the hospital, should they need to - the London North West University NHS Trust separately assured expectant mothers they can still call its maternity unit
• Away from today's action, nurses in Scotland who are members of the RCN union have rejected their latest pay offer from the NHS and are planned strikes for early next year
• Paramedics have been telling the BBC they are striking because of the pressures on the service and in their own lives - though one who isn't striking told the BBC that misuse of the ambulance service is having a major impact on staff
• Demand for ambulances has reduced in some areas of the country, such as south-west England where the Unison union says calls are down by a third, suggesting people are following the advice to only call in an emergency
• Earlier, Health Secretary Steve Barclay accused ambulance unions of taking a conscious decision to inflict harm on patients

• His comments prompted anger from Unite's Sharon Graham, who said this was a "blatant lie" and an "embarrassment for him and the government"

Nick Eardley
Chief political correspondent

Image source, PA Media

A union leader has accused the health secretary of telling a "blatant lie"- and suggested he should no longer be in his job.

Stephen Barclay accused ambulance unions of taking a conscious decision to inflict harm on patients.

Sharon Graham from Unite said the government did not understand how the issues were dealt with.

In a statement she said: "To say that ambulance unions have taken a conscious choice to inflict harm on patients is a blatant lie. The unions have negotiated critical cover, including 999 calls, at a local level with hosts of NHS Trusts. That is how it is done.

"Stephen Barclay obviously doesn't understand how these issues are dealt with in the NHS. That is an embarrassment for him and the government. He has now lost all credibility. Clearly he isn't the man for the job... He's well past his sell by date."

She added: "Where is Rishi Sunak? He is, as usual, absent without leave. It is time we got some adults in the room. The prime minister should step up to the plate and meet the unions to negotiate a new deal.

"We'll meet him on Christmas Day if needs be. In all my 25 years negotiating deals I have never seen such an abdication of leadership as that of the current posted-missing PM and the out of touch hapless health secretary."

Jamie Coulson
Health correspondent, BBC Look North

There are around 20 ambulance workers on this picket line in Wakefield, some in full uniform in case they are called away to deal with a life-threatening emergency.

Here they are predominantly GMB union members on a 24-hour walkout, but at other stations Unison members are also on strike for 12 hours.

There is a mixture of anger and frustration among those I’ve spoken to today, with many saying the strike is a last resort but also their only option.

Wearing a blanket over her uniform, paramedic Abigail Rowley believes strike action is her only choice. She has been a paramedic for 18 months.

“I think it’s important that we are all together and supporting the NHS. We need to come together as one because it’s underfunded and we’re not going to patients.

"We’re stuck in the back of ambulances for hours on end and we just need to sort something out.”

Moments after we spoke to Abigail she had to throw off her blanket and climb into an ambulance to respond to a Category 1 life threatening call.

Image source, PA Media

Ambulance staff on strike in south-east England have been told by the employer not to talk to the media during today's industrial action, an official from the GMB union says.

Speaking at a picket line in Walton-on-Thames, Surrey, Stuart Fegan says "it's only right and proper" that GMB members should be able to explain to the public their reasons for striking.

He explains that members "obviously... don't want to be here in the first place".

But they've been been "put off" speaking to reporters by South East Coast Ambulance Service (Secamb), he tells the PA news agency.

A paramedic who voted to strike has been telling us what it’s like to go to work at the moment. Stephen Raven has been a paramedic for eight years. Here’s what he had to say about the strike action:

“We’re being asked to do more and more for less and less. The operational demand is so high, there are no intervals between jobs. We regularly miss breaks.

"I’m scheduled to work a 12-hour shift but I do 14 hours minimum and there is no opportunity to leave this vehicle unless I’m with a patient. And I'm often too tired to deal with my family when I get home.

“Every year, the government has ignored the pay boards until they had no choice but to accept them, so in the last two years they kept saying ‘think about your patients’ - but they haven't thought about them for the last 10 years.

“I attended to a man this week who had waited 18 hours for an ambulance and his question to me was ‘Are you on strike?' and my response was: ’No, the system’s broken’."

“A lot of people will say that we get paid overtime for finishing late and we do, but I would like to go home and see my wife. It’s not about the money - it's about a desirable lifestyle.”

Image source, PA Media

The demand for ambulances is reportedly lower in some areas today today, as people appear to be following advice to only call in an emergency.

Demand in south-west England is down by a third, says Unison - a union representing ambulance workers.

There had been huge demand for the service yesterday - with more than 700 callers waiting for ambulances at one point. A critical incident was declared.

Elsewhere, a West Midlands Ambulance Service spokesman says his team has also experienced fewer calls than normal.

He says the service is "grateful to the public for heeding the advice we issued yesterday".

As we've been reporting, tens of thousands of ambulance workers - including paramedics and call handlers - are on strike in England and Wales over a pay dispute.

Health think tank the Nuffield Trust says paramedics in England earn on average £46,643 per year. Their starting salary in England and Wales is £27,055.

Each employee is paid according to where they sit on a pay scale. Some are on band five, and others are on band six.

Our graphic below shows how their pay range compares with those of other NHS workers. As you can see, paramedics are somewhere in the middle.

Health Secretary Steve Barclay stressed yesterday that union pay demands were "unaffordable".

Image source, .

According to the Nuffield Trust's report, external, working experiences for paramedics have been a "long-standing concern".

It says their higher average earnings are largely driven by shift pattern and overtime work payments - of which ambulance staff receive the highest levels in the NHS.

The latest NHS figures, external for April 2021 to March 2022 show that of the average earnings for ambulance staff (£46,643), some £13,854 of these were extra payments for things like shift work and overtime.

One in 10 paramedics left their job in the 12 months running up to June 2022, the report found, and a quarter of those surveyed said they would leave their roles once they could find another job.

Just yesterday, GMB union chief Rachel Harrison told the Health and Social Care Select Committee ambulance workers were experiencing the highest level of sickness out of NHS staff due to "terrible" working conditions.

Laura Foster
Health correspondent

Ambulance staff in England and Wales are striking today in a row over pay.

Unions say the day-to-day pressures and restraints members face are leading to burnout and poor mental health, and mean that workers are choosing to leave the ambulance service.

So what's a typical day like for an ambulance crew in the UK right now?

Recent analysis by the BBC showed that more than 11,000 ambulances were spending longer than an hour stuck in queues outside hospital every week.

BBC News joined two members of South Central Ambulance service on shift in Milton Keynes to see the issues.

Sharon Barbour
BBC Look North

Joining one of the first picket lines of the ambulance strike in Newcastle this morning took some "soul searching" for paramedic Jamie Frend.

The action for him is about improving pay and conditions - especially for more junior staff, and colleagues who he says are turning to foodbanks.

Jamie's ambulance station is in Hexham, Northumberland, and he says the work is relentless, with non-stop 999 calls and long waits at A&E.

He says he's waited with a patient for six and a half hours, his colleagues have waited double that.

Throughout the strike, life-threatening 999 calls will get a response, other emergency calls in the North East will be considered by a clinical team.

But if a call comes and someone's life is in danger, paramedics will leave the picket line to try and save them, before coming back to hold up their signs - calling for better pay for the work they do.

Our colleagues at BBC Radio 5 Live have been hearing listeners' opinions about strikes by NHS workers, as ambulance staff stage a walkout today.

Adam in St Albans says he’s “totally behind” the strikers, since they're "the best of human-beings”. His message to NHS staff: “You shouldn’t just take whatever and carry on, you’re too good for that.”

He recalls when his two-year-old daughter Sadie was admitted to hospital after choking. She was given round-the-clock care for two days before she sadly died. "I’m still in awe of everybody that was involved with Sadie,” Adam says.

Image source, .

Mark in Rotherham says health workers shouldn't be "demonised", but believes the strikes are a "dereliction of duty".

He adds: “We’re living in a country that is sadly losing its moral compass... it’s supposed to be a vocation and a calling." He reckons NHS staff "won’t get the public behind [them]" with walkouts.

Tim in Sheffield backs the walkouts, though. He says that's "the least I can do", as he owes "everything" to the health service.

He cites a worrying moment when his baby girl was born: “The doctors weren’t sure whether my daughter and her mother would come out of the operating table, [but] they both did."

Chris in Swindon believes that "medical professionals should take what’s on offer at this moment" regarding salary offers, adding: “I haven’t had a pay increase for ten years. We’re all struggling."

He adds: “We talk about the NHS being in a dreadful mess at the moment. Will a pay rise improve that situation? I don’t think it will.”

BBC reporters are out and about across England and Wales today, finding out the impact of the ambulance workers' strike on services.

East Midlands correspondent Jo Black has been outside Northampton General Hospital this morning, and says she saw little to no activity outside the emergency department - with no ambulances arriving.

Workers at the East Midlands Ambulance Service - who are members of the GMB union - are walking out until midnight tonight, and are only responding to life-threatening calls.

We’ve been contacted by a paramedic with more than 20 years’ experience who says they won't be striking today because "not enough ballot papers were received in time” in their area.

“I went on strike in the last action we took, but we all left the picket line without question when dispatch phoned us, because we care.”

The paramedic, who asked to remain anonymous, says people “misusing the service” is putting more pressure on ambulance staff.

“The public also have to take responsibility for themselves," they say.