Image source, REUTERS/Maja Smiejkowska

Dame Julie Moore, the former chief executive of University Hospitals Birmingham NHS Foundation Trust, says she would be worrying more than ever if she was still in charge.

Earlier, she told the BBC the NHS is in "a very serious state" and says "it's not a sudden thing - it's been years in the making".

Moore says the only way the dispute between unions and the government will be resolved is through discussion, and adds that "this stand-off does nobody any good".

It's the first time she's known strike action of this magnitude, she says.

Here are some more of your thoughts on the nurses' strike. You can get involved by emailing haveyoursay@bbc.co.uk, external

Image source, REUTERS/Henry Nicholls/File Photo

Downing Street says Prime Minister Rishi Sunak has not held Cobra meetings about NHS strikes or met the unions.

Instead, according to Downing Street, today's cabinet meeting focused on plans for the King's Coronation next May - and disputes with strikers weren't on the agenda.

The government's approach is "to accept the recommendations of the independent pay review bodies," the prime minister's official spokesman said.

Earlier, the head of the RCN, Pat Cullen, called on the PM to hold discussions with her personally.

But the spokesman said the government "doesn't think it would be right" to add a "political element" with the PM's direct involvement.

Jamie Coulson
Reporting from Leeds General Infirmary

There are more than a hundred nurses standing outside the Leeds General Infirmary on another brilliant blue sky day.

This is the second time in just five days these nurses have walked away from the patients they care for and about.

Every time a car beeps a horn they cheer and wave placards, including some homemade ones saying things like “some cuts don’t heal” and “safe staffing saves lives”.

Many of the nurses are deeply torn about going on strike but say this is about protecting the workforce and patients.

The government say the pay offer is fair but those here don’t see it that way.

The weather for this second strike is warmer than the first but this dispute shows no sign on thawing.

Image source, EPA

The health service is likely to be hit by major disruption as ambulance workers, including paramedics, control room workers and technicians walk out in England and Wales tomorrow.

Ahead of the strikes, the NHS has issued some advice to the public:

• Use NHS services "appropriately" - this includes 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 strike action

The two sides in the nurses dispute do not seem close to an agreement.

The Royal College of Nursing (RCN) wants a 19% pay rise, but the government says it will not open pay negotiations because it has already accepted the recommendations of an independent pay review.

Nurses and other NHS staff in England and Wales have been given a pay increase of 4.75%, with the lowest-paid nurses guaranteed a rise of at least £1,400.

The RCN says pay increases that are below inflation, which is currently running at 10.7%, make it hard to recruit and retain nurses in the NHS.

Unions in several of the current disputes emphasise that strikes are not just about pay.

They argue that changes to working conditions can be just as important.

There is a significant gap between between employers and unions in several of the big disputes.

Image source, .

Image source, James Manning/PA Wire

If you're just joining us or need a recap, here's the latest on today's nurses' strikes and tomorrow's planned ambulance worker walkout.

• Health leaders "cannot guarantee patient safety tomorrow", the NHS Confederation chief has warned Prime Minister Rishi Sunak

• Tens of thousands of ambulance workers, including paramedics and call handlers, are set to strike in England and Wales on Wednesday over pay
• Around 750 armed forces staff are being drafted in to cover the walkouts
• Health Minister Will Quince has urged people to avoid contact sports and other "risky activities" tomorrow

• Meanwhile, nurses in England, Wales and Northern Ireland have been striking today for the second time in as many weeks
• Prime Minister Rishi Sunak has insisted he won't back down against striking workers amid calls to reopen talks on nurses' pay
• Nurses' union boss Pat Cullen earlier told the PM to "stop hiding behind the media" and urged him to discuss pay with nurses

Ambulance services are warning of "unprecedented pressures" ahead of tomorrow's industrial action, with people urged to avoid risky behaviour in the coming days.

GP Dr Sarah Jarvis says ambulances will need to be prioritised for the most life threatening conditions "where getting treatment en-route to the hospital could save a life".

Speaking to BBC News, she cited conditions requiring the most urgent care to include: the symptoms of a heart attack or stroke, heavy bleeding, a seizure and possible anaphylaxis - the most life-threatening kind of allergic reaction.

For more minor injuries, like a fall, she said it's preferable for people to try to get to a hospital by themselves or with the help of a friend or family member rather than by ambulance.

This would apply in the case of an elderly person suffering a fractured wrist after a fall at home, for example. However, it will be more difficult to transport someone who has injured their hip, she added.

Jarvis also urged people to avoid drinking alcohol "for their own safety" to ensure they don't end up in A&E.

A bit more now from Matthew Taylor, head of the NHS Confederation, who has written to Prime Minister Rishi Sunak today warning that many NHS leaders say they "cannot guarantee patient safety" during tomorrow's ambulance strike.

Speaking to BBC Radio 4's World at One programme he said: "If the government is not willing to negotiate on pay, then it looks as though negotiations will not take place."

And, he adds, "if negotiations do not take place, then industrial action will take place" and if tomorrow's strikes go ahead "there will be risk, there will be harm to patients".

Taylor, a former Labour adviser, said it's "our responsibility" to make this "absolutely clear to the public, to the politicians and to the trade unions".

The NHS Confederation is a membership body representing health service organisations across the NHS.

Here are some more of your thoughts on the nurses' strike. You can get involved by emailing haveyoursay@bbc.co.uk, external

Lastly, Kevin McKeon writes in and says he's waiting for a knee replacement. Nurses and ambulance workers striking may delay his operation - but he's "quite content" for that to happen, he says.

"Nurses are highlighting the truth about the state of our health service. Good on them."

Image source, Victoria Jones/PA Wire

Ambulance workers are set to strike in England and Wales tomorrow, with tens of thousands of people - including paramedics and call handlers - striking over pay.

• The impact upon services will vary by region, but extensive disruption is expected.
• Around 750 armed forces staff are being drafted in to help cover the walkouts in England and Wales.
• Category 1 calls classed as the most life-threatening situations, such as cardiac arrest, will be responded to by an ambulance, but some category 2 and 3 - those not judged to be immediately life-threatening - might not be immediately attended to by emergency teams.
• The NHS is asking people to use services wisely during industrial action and take steps to help ensure care is available to patients who need it most.

Read more here.

Rachel Harrison, national secretary of the GMB trade union, has been speaking to the BBC ahead of tomorrow's ambulance strike action.

Despite concerns about ambulance services tomorrow, Harrison says it is important to keep in mind that people in some areas are not able to get ambulances today - on a non-strike day - which she says is due to staff shortages and poor working conditions.

Harrison has called on the government to put an offer on the table that she can take back to GMB union members.

She says: "If we were offered 7.5%, we would take that back to our members. We are a member-led union and we will consult members on any offer that is made. It will be them that decide whether it is a sufficient offer or not."

"What we've asked for is something that recognises a decade of lost earnings, that recognises the cost of living pressures that our members are facing.

"And most of all, what we're asking for, is for them to genuinely listen to our concerns with regards to retention of this workforce."

Harrison was asked whether GMB would call off the strike if Health Secretary Stephen Barclay made a 7.5% pay rise offer today.

She replied: "We would suspend some action so that we could fully consult our members on that offer."

Howard Johnson and Hamzah Abbas
BBC News in London

Though the mood has largely been supportive outside of St Mary’s hospital for today's nurses' strike, patients have undoubtedly been impacted by the action.

Takieddine Belhoua, his arm in a sling, told the BBC that he had broken his hand in the bath on Sunday.

He had waited a whole day in hospital yesterday only to be told that his operation wouldn't happen and that he'd have to come back at the weekend due to strike action.

While he was waiting in hospital, a nurse gave him some water as he had struggled to eat and drink, and he will continue to struggle until he has had treatment, he says.

The health secretary says he is "happy to talk" with trade unions.

However, on the issue of NHS pay, Steve Barclay says the government "has accepted in full" the recommendation of the pay review body.

Speaking to the media, Barclay calls on the unions to "act responsibly" during tomorrow's ambulance strike.

"I think all of us should be focused on patient safety... and I urge the trade unions to do likewise," he says.

Earlier, we reported remarks from Health Minister Will Quince, who urged people to avoid "risky activities" tomorrow when ambulance workers in England and Wales go on strike.

He has since been asked to clarify what activities are deemed "risky", and when pressed on his comments he told BBC Radio 5 Live: "If there is activity that people are undertaking tomorrow, whether it's - for example - contact sport, they may want to review that."

Asked if people should go running, he said this was not "hugely risky", but added: "Would I go running tomorrow if it was still icy? No I wouldn't, because that would encompass additional risk."

Naomi Grimley
BBC News

The National Secretary of the GMB Union, Rachel Harrison, has told MPs that “life and limb cover” will be provided in tomorrow’s ambulance strike.

She said her union had entered into discussions “in good faith” on what kind of emergency care would be provided and said “the last thing that our members want to do is put patients in harm’s way”.

Speaking to the Health Select Committee earlier today, she confirmed that most local agreements had now been signed off with employers to agree exemptions to strike action. But she put the blame for the dispute firmly on the government saying her members were “prevented from delivering patient care” but that they wanted "a resolution to this”.

Harrison pointed to what was already happening outside hospitals: “People are dying waiting to be handed over at A&E departments: that is happening today. And that’s one of the very reasons that has driven us to this dispute.”

She called on ministers “to do their part” and come to the table, to do a deal on pay.

Image source, Reuters

At least three ambulance services have now declared critical incidents.

North East Ambulance Service, South East Coast Ambulance Service and the East of England Ambulance Service have all moved to the status as staff work to respond to calls.

It comes a day before thousands of paramedics, technicians, control room workers and other staff will walk out in England and Wales.

North East Ambulance Service said it declared a critical incident on Monday afternoon as a result of "significant delays for more than 200 patients waiting for an ambulance, together with a reduction in ambulance crew availability to respond because of delays in handing over patients at the region's hospitals".

Stephen Segasby, chief operating officer at the North East Ambulance Service, said the service is under "unprecedented pressure".

"Declaring a critical incident means we can focus our resources on those patients most in need and communicates the pressures we are under to our health system partners who can provide support," he said.

East of England Ambulance Service said it was "under huge pressure as a consequence of 999 call volumes and hospital handover delays".

Here's a bit more from the head of the NHS Confederation head's letter to PM Rishi Sunak:

"With less than 24 hours to go to the ambulance strike, there is now deep worry among NHS leaders about the level of harm and risk that could occur to patients tomorrow and beyond," NHS Confederation Chief Executive Matthew Taylor has said.

Taylor, a former Labour adviser, adds it's rare to hear "such strong and urgent expressions of concern" from those running our hospitals, ambulance services and other vital health services.

He urges the prime minister to resolve the dispute between the government and unions by doing all he can "to bring about a compromise solution" and avoid members of the public suffering unnecessarily.

Image source, Reuters

NHS Confederation chief executive Matthew Taylor has warned Prime Minister Rishi Sunak that patient safety will be at risk during tomorrow's ambulance strike.

In a letter sent to Sunak ahead of the strikes, Taylor says: "This is not something NHS leaders would ever say lightly, but many now tell us that they cannot guarantee patient safety tomorrow."

He continues: "On health grounds alone, it is clear we have entered dangerous territory."

He urges the prime minister to end the government's dispute with unions quickly.

The letter asks Sunak to "be prepared to negotiate on the substantive issue of pay awards".

Taylor also says the NHS Confederation, a membership body representing health service organisations across the NHS, will continue to ask trade unions to negotiate "in good faith".

Hugh Pym
BBC News Health Editor

Image source, Reuters

The meeting between Health Secretary Steve Barclay and leaders of three unions representing ambulance staff is due to begin at 1:30pm.

Barclay has said on several occasions his "door is always open”.

One of the leaders, Rachel Harrison of the GMB, says they have only been given 30 minutes to discuss emergency cover.

She told a committee of MPs this morning that, considering strikes were due to begin at midnight, this was a “bit late in the day”.

She said local agreements on strike cover had already been reached. She said it was unlikely there would be anything new said on pay so the strikes were set to go ahead.

Christina MacAnea of the Unison union told journalists it was “totally smoke and mirrors” by the government.