In the UK's capital, strike action is due to start at 12:00 GMT. The chief executive of London Ambulance Service said ahead of the strikes that it would be a "really difficult day" - despite being confident that Londoners with life-threatening conditions would get the care they needed

Daniel Elkeles told the BBC that his team had been "working incredibly hard to ensure that we can have a response to the sickest patients who phone 999".

Elkeles explained how the service will operate during the day:

• There will be 200 ambulances available for the capital, compared to the usual 400 plus 50 cars
• Most of those 200 ambulances will be staffed by a member of the military, "with a clinician that may or not be a paramedic"
• Voluntary staff and some private ambulances will be involved
• There will be the usual number of call handlers, although they won't automatically dispatch a vehicle as usual; instead, a team of physicians will ring patients back to see if they can "find a response for those patients which isn't an ambulance"
• If the above plan proves insufficient, Elkeles says "our staff from picket lines will go and respond"

Image source, PA Media

Today's ambulance strike only involves staff in England and Wales.

In Scotland, two major health unions - Unison and Unite - previously called off ambulance strike action following pay talks.

The union GMB voted to reject a pay deal from the Scottish government - but it is not striking today in the country because it still deciding on next steps, and says it hopes strike action will not be necessary.

Northern Ireland's ambulance service, external already held a 24-hour strike on 12 December.

Away from today's strike, members of the Royal College of Nursing (RCN) in Scotland have rejected the latest pay offer from the NHS.

In the consultative ballot, 82% of members who voted rejected a deal which would have seen the average salary rise by 7.5%.

RCN Scotland says it will continue planning for industrial action and will announce strike dates early next year.

Meanwhile, members of the union representing midwives in Scotland have also rejected the latest NHS pay offer.

The Royal College of Midwives (RCM) said 65% of members voted against it. The union will now consider next steps including possible industrial action.

Amid today's strike action, expectant mothers close to their due date have been advised to make alternative plans for getting to the hospital.

However, London North West University Healthcare NHS Trust have reassured patients that maternity teams are available for people as normal during today's industrial action.

"Call us if you’re worried about you or your baby. Don’t put it off," it added.

Image source, PA Media

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

• Ambulance workers, including paramedics and call handlers, have begun striking in England and Wales over a pay dispute
• Health Secretary Steve Barclay said unions have refused to work with the government at a national level on how staff cover emergency calls during strike action
• His comments prompted anger from ambulance unions - Unison called it "utter nonsense"
• NHS England medical director Prof Stephen Powis advised the public not to get so drunk that they need to visit A&E, due to the pressures on hospitals during the strikes
• The NHS has said people should call 999 in life-threatening emergencies, and use 111 online otherwise
• Around 750 armed forces staff are being drafted in to cover walkouts in England
• Some striking staff are being called away from picket lines to deal with emergencies
• Hospitals are advising pregnant women who are very close to their due date to make alternative plans for getting to the hospital, should they need to

Tomos Morgan
BBC News in Cardiff

The picket line outside Cardiff’s ambulance HQ in the north-east of the city is far less dramatic than what I saw during yesterday’s nurses' strike. At times, there have been only three or four ambulance workers taking part - and there a several reasons why.

Firstly, it seems several of those on strike have been called out to deal with “red alert” emergencies.

The agreement was that staff taking part in industrial action would go back to work if required to deal with these the most serious calls (a threat to life or limb) - and that seems to have been the case this morning.

Only four of the 11 banks of ambulances are currently occupied with vehicles.

Secondly, where as yesterday nurses on strike worked in a variety of different department, from research to palliative care to health visiting, ambulance staff deal with only the most urgent medical emergencies - so as per the agreement above, they are and will be called back to work more easily if required.

Thirdly, it is only one union taking part in industrial action in Wales - the GMB union. Their members make up only around a quarter of the Welsh workforce.

Lastly, the practicalities.

The HQ is not on a main road, so it is not as visible and not getting the same amount of reaction from the public. And of course, no doubt the weather is playing it’s part - it’s pouring here at the moment.

We've heard today from ambulance staff on the picket line - but we’ve been contacted by a paramedic in the Midlands who isn’t taking part in strike action.

They tell us that they didn’t get to vote in the ballot period, but would have voted against strike action.

“I won’t strike,” they explain. “I took part in strike action in 1989 and I have bad memories of how that left me financially.

“I worked for six months and was paid via a national strike fund and then when we went back to work, the ambulance service fined us, so we were on half pay for six months.

“I just about managed to avoid having to walk away from our mortgage.”

Despite the bad memories, they understand why industrial action is being taken. “I am regularly being sent to 999 calls that are 20-hours old, I went on one call that was 36-hours old!

“This government is systematically destroying the NHS and harming patients on a daily basis, we are breaking our hearts every day because of the dreadful service we are currently providing our patients, it is so demoralising, and it is affecting the morale of the staff - but the impact on our patients, your friends and relatives is life threatening.”

Tracey Higgins
Journalist, BBC WM in Dudley

About 20 members of the GMB union were on a picket line in Dudley on Wednesday morning.

Unite members added to the same picket line a bit later, bumping it up to about 30 picketers.

Unite local rep Jason Kirkham said it wasn’t just ambulance crews taking part in today’s strike, but also control room staff, call handlers and fleet mechanics.

“This is about conditions, this is about recruitment, this is about retention,” he said.

“At the moment our crews are probably spending about 80% of their time stuck outside hospitals. Instead of doing six, seven, eight, nine, 10 patients a day, they may only be doing one or two.

“There’s many examples of patients who have sadly passed away because of the delay of an ambulance getting to them.”

The CEO of the Stroke Association has said she is "extremely worried" about the impact of ambulance strikes on stroke patients.

Strokes are category two calls, considered an emergency, rather than life threatening.

That means an ambulance won't automatically be sent - although some ambulance trusts have agreed deals with unions to respond to these calls.

Speaking to Radio 4's The World Tonight on Tuesday evening, Juliet Bouverie said: “We are worried lives could be put at risk. Some may miss out on the treatment window and therefore may live with lifelong disabilities that could have been avoided.

“So it’s both our concerns about increased mortality, but also increased disability associated with stroke that the strikes could exacerbate.”

When asked if minutes make a difference when it comes to care for strokes, she said: “Every minute that a stroke goes untreated, 1.9 million neurons in the brain die.

"That’s why it’s absolutely essential that stroke patients get to hospital within that vital window, which is generally four to six hours from a suspected stroke."

She urged people to act on the symptoms of stroke and call 999.

Michelle Roberts
Health editor, BBC News online

There have been repeated warnings from those that work in emergency services that the system is struggling day to day.

Doctors and paramedics told the BBC back in May that long waits for ambulances across the UK were having a dangerous impact on patient safety.

There are national targets for how quickly ambulance crews should get to patients.

For life-threatening conditions, such as a cardiac arrest, the target is seven minutes or less. During today's strike, trusts say all of these category one emergency calls will be responded to.

But they cannot guarantee it for the next tier down - category two calls, for things like a person having a stroke or someone with a major burn.

The target response time for these emergencies is 18 minutes, but that target has not been met in England for a while - even before winter pressures began to bite.

5 Live’s Nicky Campbell show has been hearing from people about how the ambulance strike has affected them today.

Margret in Orpington, who is 77 years old, slipped and fell this morning.

“In the past I have called an ambulance,” she says, “but this morning I called my carers and they were here within minutes".

"We have to recognise our carers today because they don’t have the luxury of going on strike,” she says.

“I’m not saying paramedics aren’t amazing, and when I’ve gotten into the hospital the nurses couldn’t have been nicer, but they’ve got the luxury of striking.”

Margret says her carers are there for her when it matters: “They’ve already said if you can’t get back into bed tonight you ring our office and we will come and get you back into bed."

The NHS has issued guidance to the public amid strikes today held by ambulance workers, including paramedics and call handlers, in England and Wales:

• Use NHS services "appropriately" - they advise using 111 online as the first port of call for health needs and only using 999 if it is a life-threatening emergency
• Patients with non life-threatening conditions will have to wait longer than usual for an ambulance and may be asked to make their own way to hospital - although it is important that they get medical advice from 111 or 999 before doing so
• The public are asked to take "sensible steps" to keep themselves and others safe during the disruption, such as drinking responsibly or checking up on a vulnerable family member or neighbour
• The NHS says it will contact anyone whose medical appointment has to be rescheduled due to strikes. Anyone who has not been contacted is asked to attend appointments as planned
• People are reminded that general practice, community pharmacies, and dentistry are not impacted by the strikes

Image source, .

The head of the Unite union has accused the Prime Minister Rishi Sunak of the worst "abdication of leadership" she has seen in 25 years.

Sharon Graham told BBC Radio 4's Today programme: "This lies squarely at the door of the government."

Graham said there had been discussions for weeks about minimising the impact in emergency cases.

"We don't want patients to suffer in any way, shape or form," she said.

But she added on pay: "I've never seen an abdication of leadership like it in 25 years of negotiating".

She told the PM she would be willing to negotiate on Christmas Day if necessary and an agreement could produce "the greatest Christmas present for the entire country".

Sunak has insisted he will not back down against striking workers. He told MPs yesterday that the best way to help workers would be to reduce inflation.

We're revisiting earlier comments from Health Secretary Steve Barclay, in which he said trade unions "haven't been willing" to work with the government on national contingency planning during strike periods.

Unison general secretary Christina McAnea says she is “genuinely shocked” by Barclay's comments.

She tells LBC radio it is “utter nonsense” and a “complete and utter lie” to suggest unions made it almost impossible for the government to make contingency plans during the strikes.

“I think they’re covering up for the fact that he waited until the day before the strike to even ask us about contingency planning,” she says - referring to a meeting between Barclay and unions yesterday.

She says it “had been laid out to him in no uncertain terms all the work that has been getting done for the past few weeks to make sure there were safe contingency plans in place”.

She say it's “entirely likely” strikes will continue into the new year, and says the government should “come clean” with the healthcare staff that they could not provide a safe and reliable service due to a lack of staff and poor planning.

Michelle Roberts
Health editor, BBC News online

Hospitals are advising pregnant women who are very close to their due date to make alternative plans for getting to the hospital, should they need to.

Due to the strike today, an ambulance may not be available.

The Hillingdon Hospitals NHS Foundation Trust, external, for example, says: "There is no guarantee that an ambulance or paramedic will come to your home to attend you in labour or in the event of an emergency.

"Please, therefore, make sure you have plans to get to hospital, for example by car or taxi.

"If you think you are in labour or have any concerns call our Maternity Triage Department immediately."

Sharon Barbour
BBC Look North

“Am I going to die? Do I feel like I am going to die?"

These are the questions the North East Ambulance Service wants patients to ask themselves before calling 999 today, as a number of their paramedics come off the road to join the picket line.

Chief operating officer Stephen Segasby says they will be prioritising patients where there is a risk of a loss of life, or limbs.

Category 1 calls - calls that are the most life-threatening - will get an ambulance.

Others - even emergencies - will be considered by a clinical team, and ambulances will only be dispatched if there is a threat to life or limb.

The military have been called in to help and they will drive less urgent ambulance transport, teamed with a paramedic.

But those callers face a long wait, and during the industrial action today, there may not be an ambulance at all to dispatch.

Patients who are seriously ill or injured, or whose lives are in danger, are being advised by the NHS to call 999. Call handlers will then assess whether an ambulance needs to be sent.

For all other healthcare needs, the NHS is advising people to contact NHS 111, external

Image source, BBC News

As tens of thousands of ambulance workers, including paramedics and call handlers, strike in England and Wales in a dispute over pay, we want to hear from you.

Whether you work for the ambulance service and are striking, or you are against industrial action being taken, please get in touch.

Perhaps you or a loved one have been unable to get an ambulance today - you can contact us in the following ways:

• Email haveyoursay@bbc.co.uk, external
• WhatsApp: +44 7756 165803
• Upload pictures or video
• Tweet: @BBC_HaveYourSay, external
• Please read our terms & conditions and privacy policy

In some cases, a selection of your comments and questions will be published, displaying your name and location as you provide it, unless you state otherwise. Your contact details will never be published.

Nick Eardley
Chief political correspondent

There is no sign at the moment that ministers will budge on pay.

There are some Conservative MPs who believe ministers will have to compromise eventually. They don’t think the Government can win a battle with NHS staff. Some have said so publicly, others believe the same privately.

But the health secretary has said he doesn’t want to be involved in annual pay negotiations - saying it would be a dangerous trap. Some of his colleagues argue it would damage the government’s authority if they backed down now, and that it would encourage other unions to strike for better pay.

Is there a way out?

I can see two options, though neither are a silver bullet.

One is a lump sum payment for NHS staff to deal with the cost of living. Unions are open to discussing this - but at the moment the government isn’t.

The other is next year’s pay deal. This is something figures in Government dangle as a potential olive branch. The problem here is that trust is low and there are no specifics on the table.

There is nervousness in Government about what will happen today. But for now the focus is on mitigating the impact; there will be another meeting of the emergency committee Cobra later today.

When asked by the BBC why he isn't open to having pay negotiations with trade unions, the Health Secretary, Steve Barclay, says the government has "accepted in full" the levels of NHS pay recommended by an independent pay review body.

He says that in past, broadcasters have criticised the government when it hasn't accepted the full recommendations.

Barclay says the government has also listened to paramedic concerns about handover delays in hospital A&Es, and says that's why £17.5bn of social care funding was announced in the autumn statement to deal with the issue.

He says in terms of pay, an independent pay review is a long-standing process that the Labour party has also supported.

"We have people who look at the affordability of the wider economy, to many people facing with cost of living pressures and balancing that with the need to invest in the NHS with consequences of the pandemic - that's why we've invested another £6.6bn in the NHS."

Health Secretary Stephen Barclay says the three unions striking today have "refused" to work with the government at the national level.

On BBC Breakfast, he says the unions' choice to only agree on local arrangements for dealing with the coverage of life threatening and emergency calls has led to "further uncertainty".

The public have been told to only call 999 for life-threatening situations. All category one calls - the most life-threatening such as cardiac arrest - will be responded to, while some ambulance trusts have agreed exemptions with unions for specific incidents within category two, which are serious conditions such as stroke or chest pain.

Trade unions "haven't been willing to work with us to agree national exemptions in terms of covering all of the category one, category two, life threatening and emergency calls", Barclay says.

"That makes it very difficult for NHS colleagues to plan the contingency measures - working with the military, working with community services, working with first responders - in terms of how we have contingency measures alongside the strikes."

Asked about pay, he says the government has accepted in full the recommendations of the NHS Pay Review Body - which said in July that NHS staff should receive a £1,400 increase - on top of the 3% pay rise given to workers last year.