Jamie Coulson
Reporting from Leeds General Infirmary

Julie Parkinson has been a nurse for 37 years and works in trauma and related services at Leeds Teaching Hospitals.

“We need support to help our patients and care for them properly," she says.

"It’s not about us, it’s about patients and it’s about the state of our NHS. It’s a war zone out there and we need support. Support us please,” she adds.

Michelle Roberts
Health editor, BBC News online

Over the last few days, there have been strong words spoken on both sides of the row about NHS nurses' pay and no hint of a resolution.

Nurses are adamant that, with rising inflation, they deserve a fairer deal than the average 4% proposed by the independent pay review body and offered by the government.

The cabinet minister in charge of contingency planning for strikes, Oliver Dowden, has said the offer made is reasonable and that it would be"irresponsible to allow public sector pay and inflation to get out of control".

The strike today is similar to that last Thursday. Staff are providing "life preserving" and some urgent care, but routine services are likely to be disrupted.

Nurses have already threatened to stage a fresh wave of strikes in the New Year on an even larger scale if ministers fail to respond in the 48 hours following today's action.

Reality Check

Health minister Will Quince defended the government’s refusal to open negotiations on nurses’ pay, on BBC Breakfast this morning.

He said: “What we are not willing to do is to open negotiations about pay and that’s because we have an independent pay review body. That body makes recommendations every year and the government has accepted those recommendations in full”.

It's true the government accepted the NHS pay review body’s recommendations in July of £1,400 pay rise for all staff - worth about 4%, on average, for nurses. These recommendations are not legally binding and the government can reject them, as it did in 2014.

Also, the government set constraints that the body has to consider when making pay recommendations. They include:

• the NHS budget which has been set for the next three years
• the government's inflation target

Read more here

Some 63% of members of the general public are in support of nurses going on strike due to pay disputes, a survey carried out by Savanta suggests.

Data collected between 9 and 11 December suggests public support for nursers, postal workers and railway workers going on strike decreased in comparison to the period between 28 and 30 October - though for nurses it is only one percent lower, after a dip in November.

Image source, .

We have been contacted by Kat, a patient who had an appointment cancelled at Addenbrookes Hospital on 15 December due to industrial action. She is in “full support” of the nurses’ striking.

She says: “The government is failing in their duty to support our NHS, which has unfortunately resulted in others needing to take drastic action. There is a healthcare staffing crisis in our country, and this will not improve until nurses are paid fair wages. They are the heroes who are fighting today so we still have an NHS tomorrow.

“Obviously a cancelled appointment does affect me but it is important to think long term and to make sure we have an NHS with adequate staffing for years to come.

“The government keeps referring to the pay review body and the recommendation they made as their reason for not talking but that was months ago, and inflation and the cost of living have gone up since then.

“To use that as an excuse to not meet is not great, I think the least they could do is meet and discuss pay.”

Laura Foster
BBC Health correspondent

Some ambulance workers are spending so long queueing outside hospitals that they’re clocking off shifts and returning the next day to the same patients they’d left the night before.

The National Secretary of the GMB Union, Rachel Harrison, earlier told MPs that the situation is leading to frustration, burnout and low mental health among staff.

“They feel they are being physically prevented from carrying out their jobs because of this handover delay.”

“They have friends and family members screaming at them as if it’s their fault.”

A strike by ambulance workers in England and Wales is due to start at midnight tonight.

Michelle Roberts
Health editor

Image source, Shutterstock

Tens of thousands of ambulance workers, including paramedics and call handlers, are set to strike in England and Wales on Wednesday over pay.

The impact upon services will vary by region, but extensive disruption is expected.

What if I need to call 999?

If in need, do call. There will still be staff answering emergency calls and sending out some ambulances.

All Category 1 calls - classed as the most life-threatening situations, such as cardiac arrest - will be responded to by an ambulance.

However, conditions which are serious but not judged to be immediately life-threatening - which could include some people who may be having a stroke - might not be immediately attended to by emergency teams.

Some ambulance trusts have agreed exemptions with unions for specific incidents within this category - known as Category 2 calls.

What about my GP or NHS 111?

Do still use these services for assistance. GPs and 111 call handlers are not striking, but bear in mind they are likely to be busy.

How is the NHS preparing to protect patients?

Hospitals have already been asked to free up any beds they can by discharging those patients who can safely leave.

Is the army stepping in?

Troops from the Army, Navy and RAF will be deployed to alleviate the consequences of strike action.

Some 600 members of the armed forces are due to take on ambulance driving roles and 150 personnel will provide logistical support.

Read more here.

Image source, Reuters

Rishi Sunak has insisted he will not back down against striking workers, including nurses who are staging industrial action today.

The prime minister is facing calls to reopen talks on nurses' pay and deal with the growing wave of strikes across the public services.

But Sunak told The Mail, external he would rather accept widespread disruption than increase workers' pay, which he says would fuel inflation.

"I'm going to do what I think is right for the long-term interests of the country - combating inflation," he said.

Sunak said unions should instead focus on future pay negotiations adding: "We do need to think about what's the right approach for next year."

Nurses' union boss Pat Cullen earlier told the PM to "stop hiding behind the media", telling him to "get into a room and discuss the nurses pay claim" to resolve the crisis before Christmas.

Read the full story here.

Here is a selection of your thoughts on the nurses' strike. You can get involved by emailing haveyoursay@bbc.co.uk, external.

Helen Butler writes in to call this a "do or die moment for the NHS" - an organisation she says is "crucial to the foundations of equality, respect and humanity in this country".

"Either the government invests in its staff and infrastructure, or it doesn't. Dogma, delay or indecision now will harm patient care for years to come," she says.

Others are more critical of striking nurses.

Patrick says he's been waiting a while for a hospital appointment. He says if striking workers get their way and wages go up, businesses will put up their prices.

"It is just creating a viscous circle. The government has already got to pay back billions that it borrowed to cover Covid costs, which is has to pay back. How many more handouts does the government have to pay?"

Dev Biddlecom says the main problem is that the current NHS model is unworkable, and that the nurses and their unions "must be realistic" when it comes to pay.

"The pay review panel has made recommendations on their pay so it should be accepted. The government is right to stand firm on pay increases at this time."

The Royal College of Nursing's general secretary says her union and the government need to sit down and have talks.

"There's no quick fix to this, I get that," says Pat Cullen, "but at the end of the day we need to sit down and we need to have discussions".

Speaking from a picket line in Gateshead, Cullen says Prime Minister Rishi Sunak needs to "stop hiding behind the media" and needs to get into a room and discuss the nurses pay claim.

The 78 year-old mother of Matthew, from Ilkley, had a fall and had to wait 11 hours for an ambulance, and died of sepsis from an infection two days later.

He tells 5 Live he's in "two minds" about the industrial action, as he believes “it is absolutely [paramedics] right to strike, where they feel that the situation has got to a point where the only thing they can do to express their dissatisfaction is to strike".

“But then on the other hand of course you worry that there are going to be people who will directly suffer and maybe even lose their lives because of those strikes,” he says.

“Seeing someone that you love in a situation where she was so helpless and I felt so helpless, all I could do was ring he emergency services every few hours and ‘say what is happening’."

Today's nursing strike is primarily about pay: the Royal College of Nursing is calling for a pay increase of 5% above the RPI inflation rate, which would mean a pay rise of more than 19%. The government says this is unaffordable.

The graphic below breaks down exactly how much nurses get paid in England - you can see the minimum and maximum pay for new nurses, experienced nurses, specialist nurses, and consultant nurses.

The average pay for a nurse is about £37,000.

Hamzah Abbas
BBC News in London

Image source, .

Approximately 50 nurses have gathered on the picket lines outside St Mary's Hospital in London.

A number of them are holding signs that say "honk if you support fair pay for nursing", which have been greeted with supportive honks from members of the public and ambulance drivers going by.

Nurses have also been chanting "no nurses, no NHS" and: "What do we want? Patient safety. When do we want it? Now!"

They have spoken to us about the lack of staffing, too - there are empty beds but not enough staff to care for patients.

Health chiefs and unions are being questioned by a group of MPs in Westminster over the impact of NHS strikes.

Professor Julian Redhead, national clinical director for urgent and emergency care at NHS England, says "demand and flow" is the main problem facing the health service at the moment.

Prof Redhead says demand on our emergency services is "up to phenomenal degrees" and there's also an increase in flu, Covid admissions and the fallout from the cold snap.

He adds that bed occupancy levels are higher now than most times of the year, and that they're running "at about 98% occupancy across our trusts".

Dr John Martin, president at the College of Paramedics, says waiting times are now longer than they were five years ago.

He says that over the last five years, demand has gone up 18% in England, with a 50% rise for category one calls.

"We are seeing a sicker population who are calling us more often," he adds.

Image source, EEAS

Away from the nurses strike, we've heard that the East of England Ambulance Service (EEAS) is declaring a critical incident following "huge pressure" from 999 calls and hospital handover delays.

The NHS service said: "We can ensure our resources are focused on patients, external with the greatest need, as well as allow us to access wider support from our health and care partners."

It said staff were working "incredibly hard in challenging circumstances" and responding to calls and incidents as quickly as possible.

The service covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk.

Ambulance staff across England and Wales are due to go on strike tomorrow - however, services in the east of England will be completely unaffected.

Maria McCann
BBC News NI

Nurses have taken to the picket line at Antrim Area Hospital in Northern Ireland for a second time in less than a week.

Denise Kelly is a front-line clinical nurse and says staffing shortages are affecting staff and patients every day.

"Nurses are going home demoralised, destabilised; they have a moral injury because they feel they are not able to give the care those patients deserve."

A number of Scottish nurses, who are not on strike in Scotland, travelled to Northern Ireland to join their colleagues in a show of solidarity this morning.

You can read more from Maria here.

Nick Eardley
Chief political correspondent

The health secretary will sit down with the unions representing ambulances later.

But there is little to no prospect of the meeting leading to a compromise that would see tomorrow’s strike cancelled.

My understanding is Stephen Barclay primarily wants to talk about what calls will be staffed as normal tomorrow.

Those decisions are being taken on a local basis and government insiders say that they have patchy information and fear it could risk patient safety.

On the big issue of pay, there is no sign of ministers budging.

The prime minister has told the Daily Mail he will keep making the same argument that the current offer is fair and reasonable.

So at the moment, the chances of any imminent breakthrough when it comes to health strikes in England are pretty low.

Image source, Jacob King/PA Wire

If you're just joining us, here's the latest on today's nursing strikes:

• Nurses across England, Wales and Northern Ireland are striking for the second time this month
• Life-preserving care will still be provided but routine services may be partially staffed
• The walkout follows a dispute with the government over pay
• The Royal College of Nursing (RCN) is calling for a pay increase of 5% above the RPI inflation rate, which would mean more than a 19% pay rise
• The government has called this "unaffordable" and Health Minister Will Quince says he's not willing to open pay negotiations because the recommendations of an independent pay review have already been accepted
• Quince has also urged people to avoid "risky activities" tomorrow when ambulance workers in England and Wales go on strike. Health Secretary Steve Barclay is meeting three unions representing paramedics later today to discuss which type of emergency calls will be exempt from strike action
• Health chiefs and unions are being questioned today by a group of MPs in Westminster over the impact of NHS strikes

A number of striking nurses have been speaking to the BBC from the picket line.

In Cardiff, one nurse says that staff shortages mean conditions are unsafe for patients, while a newly qualified nurse says working conditions are affecting her mental health.

Meanwhile, in Nottingham, Suneil, who is a nurse at the Queen's Medical Centre, says that the hospital went into "critical incident mode" and that people have been waiting 30-40 hours for a bed. He is expecting things to get worse, he says.

Suneil was working in A&E last night, he says. "It is pretty terrible, there's people waiting 30-40 hours for a bed without a proper hot meal, without being cleaned. It's a dire situation and it's only going to get worse, it's not going to get better."

Another nurse says staff might leave en masse for Europe, where pay is better.

Laura Foster
BBC Health correspondent

Nearly 1,700 appointments and operations have had to be postponed so far in Northern Ireland today because of the nurses strike, according to BBC analysis.

These are all non-urgent appointments because any service deemed to be life-preserving, such as A&E and chemotherapy, is protected during the strikes.

It looks like the worst hit area was outpatient appointments – where patients don’t need to stay overnight.

More than one trust said that where possible they were carrying out work online and over the phone.

This figure for Northern Ireland will most likely go up though, as the Southern Health and Social Care trust has yet to publish its data.

Anyone who has a pre-booked appointment is being told it will still be going ahead unless they’ve been contacted.