Hospital bosses "cannot guarantee patient safety" during tomorrow's ambulance strike and there is "deep worry", says the NHS Confederation
Tens of thousands of workers are set to strike in England and Wales over pay, with military personnel asked to support services
The latest talks between the government and unions ended with both sides voicing disappointment - and the health secretary calling union pay demands "unaffordable"
Five ambulance trusts have declared critical incidents ahead of the planned action, citing high demand and difficulty handing patients over to hospitals
Tomorrow's action comes a day after a second walkout by nurses in England, Wales and Northern Ireland
The Royal College of Nursing wants a 19% pay rise and says below-inflation increases are compromising care by making it hard to attract and retain nurses
The prime minister has insisted he will not back down against striking workers, including nurses, urging them to consider whether strikes are "really necessary"
Thank you for joining our live coverage of the industrial action taking place in the health sector across England, Northern Ireland and Wales.
Today's writers were Jack Burgess, Ruchira Sharma, Malu Cursino, Sam Hancock and Marita Moloney.
Our editors were Sarah Fowler, Samuel Horti, Heather Sharp, James FitzGerald and Dulcie Lee.
You can read more here:
Image source, PA MediaPM Rishi Sunak was asked about the NHS strikes in front of the Commons' liaison committee this afternoon
We'll shortly be closing our live coverage of today's nurses' strike and tomorrow's planned action by ambulance workers. Here's a recap of the main developments:
Michelle Roberts
Health editor, BBC News online
Nurses have been on the picket line today in protest over pay, and tomorrow ambulance staff across most of England and Wales will do the same.
Not all union members are striking or voted for the industrial action.
But it is looking likely that NHS staff will be asked to stage more strikes in the coming weeks and months.
The Royal College of Nursing has already set an ultimatum - unless the government starts talking about a pay deal, there could be a fresh round of industrial action in January.
The clock is ticking for ministers to respond within 48 hours of today’s nursing strike ending.
The message to them from the RCN - let’s get this wrapped up by Christmas.
General Secretary Pat Cullen says she will negotiate "at any point to stop nursing staff and patients going into the new year facing such uncertainty."
Prime Minister Rishi Sunak has insisted he will not budge.
Wales' health minister has urged people not to "add extra pressure" on the ambulance service ahead of planned strike action tomorrow.
Eluned Morgan warned the public in a statement to "consider carefully what activities you take part in tomorrow and on the 28th".
"There's no doubt the two days of industrial action, following hard on the heels of action by nurses which have caused a delay in treatment for thousands of patients in Wales, are going to cause huge pressure on ambulance services," she wrote. "It's important to call 999 if in you are in immediate danger, but we must all consider very carefully how we use ambulance services on these days."
It comes after Westminster health minister Will Quince suggested people should avoid contact sport and unnecessary car journeys ahead of the strike, earlier today.
Nurses in all but one Welsh health board took part in strike action today - you can read more here.
We've got more details of how London's ambulance provision will look tomorrow - following a conversation between the city's ambulance chief and our health editor Hugh Pym.
Earlier we told you Daniel Elkeles was expecting a "really difficult day" despite being confident that Londoners with life-threatening conditions would get the care they needed.
Giving more information, Elkeles says there will be a "very different operating model tomorrow".
Victoria Bourne
Reporting from central London
Protesters have spilled out onto Whitehall in central London as they sing chants of “claps don’t pay the bills” and “overworked and underpaid”.
It’s certainly a lively atmosphere on a dreary day outside Downing Street.
One of the organisers of today’s solidarity march, Alia Butt, is an NHS psychologist based in east London.
She’s a member of the group NHS Staff Voices and tells me that the situation facing nurses and other health workers is “scandalous”, with some having to turn to food banks and others facing the prospect of homelessness.
“It’s heart-breaking hearing nurses having to leave the NHS to work in supermarkets," she says. "They don’t find that they are being treated well because of the lack of resources.”
Here are some more of your thoughts on the nurses' strike. You can get involved by emailing haveyoursay@bbc.co.uk, external
Quote MessageNurses were the ones right on the front line in the pandemic and are now on the front line in the fight to save health care free at the point of delivery. For those who think the NHS is unaffordable and there is a better model of care, most healthcare systems around the world are struggling at present including the lauded French and German health services. We have an aging and sicker population and need a debate about what we are prepared to spend as a country.
David Somerfield
Quote MessageAs much as I have sympathy for the nurses who are underpaid, the proper route through this is via the pay review body. You can't agree to a pay review body and then disagree with what they decide. It is rightly nothing to do with the government, so go back and request a new look through that body.
Ian White
Quote MessageThe incompetence and wastage of NHS management means there is less money for nurses and ambulance drivers. The NHS needs a fundamental restructuring in order to deliver a better service. It is no longer fit for purpose.
Tony Woolford
Let's take a look at some of the images from England and Wales of today's nurses' strike:
Image source, Getty ImagesNursing staff from North Tyneside General Hospital reacted to support from passing motorists
Image source, Getty ImagesNurses on the picket line outside the Walton Centre, a neurology hospital in Liverpool
Image source, Getty ImagesProtesters turned out at Heath Hospital in Cardiff, Wales
Image source, Getty ImagesNurses and supporters gathered outside University College Hospital before marching to Downing Street
Image source, Getty ImagesNurses and supporters marched towards Downing Street after a day of strike action
Reality Check
The head of the nursing union the Royal College of Nursing (RCN) Pat Cullen earlier said she would "set out very clearly what has happened to [nurses'] pay over this last decade” when it comes to negotiating with the government.
Health think tank the Nuffield Trust has looked at, external what has happened to pay in the NHS between 2010-11 and 2021-22, and found that for nurses and health visitors it had fallen about 6% after adjusting for the cost of living.
It expects that in the current year that will become a 10% fall, because of rapidly rising prices.
The government says it accepted the recommendations of the NHS Pay Review Body and that nurses in England had a 3% pay rise last year while other pay in the public sector was frozen.
The average pay for a nurse is about £37,000. You can read more about nurses’ pay here.
Image source, ReutersTalks have wrapped up between Health Secretary Steve Barclay and union representatives from Unison, Unite, GMB and AACE - but with seemingly little progress made.
Onay Kasab, Unite's national lead officer, says the meeting was "entirely pointless" and the health secretary "refused to discuss pay".
"How he hopes to get movement and resolve the dispute without discussing the key issue is mystifying," he says.
Christina McAnea from Unison also says there was "no movement" and she's "very disappointed" the strike will go ahead.
She says Barclay was "sympathetic to ambulance and other health workers but has no room for manoeuvre apparently, so I don't know where we go with this".
But the health secretary says "ultimately union demands are unaffordable during these challenging times".
He says it's "disappointing" some union members are going ahead with further strike action, adding: "My door remains open to further talks."
Ione Wells
Political correspondent
Given that strikes are dominating the political agenda right now, the exchange on this topic in Parliament just now was remarkably un-notable.
The prime minister stuck to the lines we have heard repeatedly from the government, saying:
Sunak does not sound like a man about to change his insistence that he will not back down against striking workers.
But while this line of questioning was relatively calm, the mood outside was not.
NHS chiefs have raised concerns for patient safety during tomorrow's ambulance strike.
Michelle Roberts
Health editor, BBC News online
Several ambulance trusts have declared "critical incidents" today due to pressure on services.
It means health bosses are concerned that they cannot provide priority care in the usual way.
That can be for a number of reasons - having a very high number of calls, for example.
It's a formal way to flag that they are temporarily struggling with demand.
Hospital trusts can declare critical incidents too.
Local and sometimes national teams can then help to ease the pressure.
Busy hospitals are already preparing for tomorrow's ambulance strike - they have been advised to free up beds by discharging any patients that they safely can.
Hamzah Abbas
BBC News
Some of the strikers outside St Mary’s Hospital in London are wearing tinsel and getting into the festive spirit.
They’ve delivered a few renditions of Last Christmas by Wham!, with the lyrics changed to reflect their reasons for striking.
For those of you wondering, this is how it goes: “Last Christmas I worked all day, but the very next day I was burnt away, this year, to save us from tears, we’re striking for better pay.”
Members of the public have also just delivered chocolates and coffee to those on the picket line.
Rob Sissons
East Midlands health correspondent
Picket lines formed today at Nottingham's two main hospitals, a day after the Nottingham University Hospitals NHS Trust went into the highest state of alert due to A&E pressures.
The Royal College of Nursing (RCN) says it is working with hospitals in the area to ensure staffing does not fall below minimum safe standards agreed with management.
The trust says on day one of the walkout, some RCN members were called back in and agreed to boost staffing in an area of concern.
Nurse Sunil Glen, 33, who is striking outside Queen's Medical Centre, says the action is not just about pay. "There are not enough nurses on the wards - it is affecting patient safety."
Holly Mee, 35, a nurse at Nottingham City Hospital's burns unit, says her area has adequate staffing but others are short - and she fears strikes won't be resolved soon.
"I think it is going to drag on they are already digging their heels in... they don't feel it is worth paying us as much as we are entitled to."
The critical incident status in Nottingham is unlikely to ease until Thursday at the very earliest. Tomorrow, ambulance workers are also set to go on strike.
Image source, House of Commons/PA MediaLet's turn to Parliament for a moment, where Prime Minister Rishi Sunak is being grilled by MPs at the liaison committee.
Tory MP Steve Brine - who chairs the health select committee - asks Sunak how big a problem he considers the NHS strikes, and what he'll do about them.
Sunak says the independent NHS pay review body, which made the recent pay recommendations that are now being challenged, has long been listened to.
He also says the body will have seen projections for inflation at the time of making their suggestions.
Asked what he'll do if the body comes back next year and recommends more money for NHS staff, Sunak says the government has a commitment to the NHS. But he avoids being drawn on future pay disputes.
Image source, PA MediaMilitary personnel have been training to cover for striking ambulance workers in London tomorrow
Strike action tomorrow will make for a "really difficult day", says the chief executive of London Ambulance Service.
Daniel Elkeles adds that his team has been "working incredibly hard to ensure that we can have a response to the sickest patients who phone 999 tomorrow."
And, speaking to the BBC's health editor Hugh Pym, Elkeles says he's "confident" Londoners with life-threatening emergencies will still receive the care they need.
He cites a staffing agreement reached with the union - and plans for military officers to help out.
But the challenges arise because "we're already so very busy", he says.
Laura Foster
BBC health correspondent
Image source, REUTERS/Maja SmiejkowskaFor NHS leaders to write to the prime minister and say he needs to be prepared to negotiate pay feels like a big moment during these NHS strikes.
NHS Confederation and NHS Providers have largely not got involved with any of the discussions about pay and industrial action before.
But now here they are writing directly to the prime minister saying "we urge you to do all you can to bring about a compromise solution otherwise more members of the public will suffer unnecessarily".
The 4% pay rises that have been given in England and Wales, and are soon to be awarded in Northern Ireland, were recommended by an independent pay review body.
But they’re just guidelines – governments have the power to offer more money if they choose.
And it seems this last-minute intervention wasn’t enough to shift the agenda at this afternoon’s meeting between unions and the Health Secretary for England.
Ambulance staff are still set to begin striking from midnight tonight with significant disruption expected tomorrow.
Image source, PACEMAKERHundreds of hospital appointments have been cancelled as Northern Ireland's nurses stage a second day of strike action.
Last week, they joined colleagues in England and Wales in the first day of the planned two-day industrial action.
Emergency care will continue but other services have been impacted.
The Royal College of Nursing (RCN) has warned of further strikes in the new year, which Northern Ireland's most senior civil servant in the health service warns could have "catastrophic consequences".
Peter May, warns "safe patient care - already under severe stain - may be further undermined" by more strikes in 2023, amid "a winter of unprecedented challenges".
The walkouts have affected hundreds of patients across Northern Ireland. For example, in the Belfast Health Trust, 175 new outpatient appointments, 289 outpatient reviews and 26 inpatient day cases were cancelled.
Read more on the situation in Northern Ireland here.
Image source, PATwo more ambulance services - Yorkshire Ambulance Service and South Central Ambulance Service - have declared critical incidents, bringing the total to five.
Yorkshire Ambulance Service says that as of 13:00 GMT on 20 December, a critical incident has been declared due to "high levels of demand, significant delays for patients waiting for an ambulance and delays in handing over patients at hospitals".
Earlier, Mark Ainsworth, Director of Operations at South Central Ambulance Service NHS Foundation Trust (SCAS), said: “Last week was an extremely difficult week, which has only escalated over the course of the weekend and into this week, leading to us declaring a critical incident."
Calls to 999 are up 50% on this time last year, while 111 calls are up 75% over the same period, the service says.
It says it faces the additional challenges of "ambulances being unable to handover the care of their patients at some of our acute hospitals which prevents us getting crews back on the road to respond to other patients".
It said tomorrow's strike action "may add further pressure" but the impact is expected to be mainly on non-emergency patient transport.
A critical incident allows services to prioritise certain patients and cancel non-urgent demands on staff such as training.
Image source, PAThere'll be "nerves" among military personnel who are missing Christmas leave to drive ambulances during tomorrow's strike action, says a senior officer.
Lt Col James Shaw - who's overseeing training for the task at Wellington Barracks in London - tells the PA news agency that despite the anxieties, it's a "really important task".
He adds: "I think we're incredibly proud."
Asked how he feels about being drafted in during the holiday, Lt Cpl Connor Roberts says: "I'm absolutely fine."
Meanwhile, Sapper Terry Obeng observes that responding to incidents will be different to his normal work. He explains: "An injured civilian is not an injured soldier. An injured soldier knows he is going to get injured. A civilian doesn't know."