Thanks for following our coverage of today's strike by ambulance workers - you can read more about today's walkout here:

• NHS braced for more walkouts as ambulance staff strike

• Three paramedics tell BBC News what it is like to work in the strike-hit profession at the moment
• And if you'd like to find out what is happening in your area with A&E, ambulances and hospital waiting lists, enter your postcode into our tool here.

Today's writers were Adam Durbin, Thomas Mackintosh, Chris Giles, Alex Binley and George Wright.

The editors were Rob Corp, Jamie Whitehead and Heather Sharp.

Image source, Reuters

We'll be pausing our live coverage of the ambulance strike soon - but before we go here's a recap of today's main developments:

• Around 20,000 ambulance workers, including paramedics, emergency call handlers and technicians are holding strike action in England and Wales
• The walkout over pay and staffing varies between regions, but is due to end by midnight
• NHS England is advising patients to call 999 for life-threatening emergencies but to use 111, GPs and pharmacies for everything else
• Many taking part in today’s action have told us about regular hours-long waits outside hospitals to hand over patients

• Health Secretary Steve Barclay says the strikes are "extremely regrettable" but acknowledges the NHS is under "very severe pressure"
• NHS Providers' interim chief executive Saffron Cordery says she expects pressure on the service to "mount" during the day
• Despite the strike action, some workers are leaving picket lines to help with urgent 999 calls
• Fourteen health unions, representing more than a million NHS staff, say they won’t submit evidence to the NHS pay review body for the 2023-24 pay award "while the current industrial disputes remain unresolved"
• The unions, which represent ambulance staff, nurses, porters, healthcare assistants, physiotherapists and other NHS workers in England, have made clear they will not discuss next year until their demands for this year are met

Image source, Getty Images

Labour has accused the government of being in denial over the state of the NHS.

Shadow Health Secretary Wes Streeting said the NHS is "going through the biggest crisis in its history" and urged ministers to "listen to some of the stories behind the numbers".

"This winter has shown just how high a price patients are paying," he said at Labour's Opposition Day debate.

"I know they like three word slogans, but is the latest Conservative slogan on the NHS really 'crisis, what crisis?"'

Health Secretary Steve Barclay has described strikes in the NHS as "extremely regrettable" and acknowledged the service is under "very severe pressure" over a rise in winter illnesses like flu.

Prime Minister Rishi Sunak has included cutting NHS waiting lists in the five promises he made at the start of 2023.

At today's Prime Minister's Questions he said he was "passionately committed" to protecting the NHS "with more funding, more doctors and nurses, and a clear plan to cut the waiting lists".

But the government says the pay rises staff are requesting are "unaffordable".

More NHS strikes look likelypublished at 16:49 Greenwich Mean Time 11 January 2023

16:49 GMT 11 January 2023

Nick Triggle
Health correspondent

Image source, Reuters

The NHS is braced for more strikes by staff after health unions pulled out of the independent pay review process.

The announcement by 14 health unions that they would no longer work with the NHS Pay Review Body came during today's walkout by ambulance crews in England and Wales.

The unions had been due to make a submission about the 2023-24 pay award, but said they would not do this given the on-going dispute about this year, upping the pressure on ministers.

One of the unions, the Chartered Institute of Physiotherapy, also announced it would be taking its first strike action of winter later this month, while sources at the GMB said fresh ambulance strikes are likely to be announced next week.

Unions have made clear that they will not discuss next year until their demands are met this year.

NHS staff were given an average rise of 4.75% this year - with everyone guaranteed at least £1,400.

This was in line with the recommendations of the independent pay review process. But unions believe the process took too long - by the time the pay award was made six months after their submission, inflation had risen sharply.

A Department of Health and Social Care spokesman defended the pay review system, pointing out it considers a range of evidence from trade unions, the NHS and government.

He said the health secretary wanted to have an "honest conversation" with unions about what was affordable.

Victoria Bourne
Reporting from Bristol

Lizzie Archer, who has been a paramedic for 12 years, told me she is on the picket line in Bristol today because she was frustrated about not being able to do her job

"I’m hoping they will listen to us. Pay is not our only reason for being here, it is about patient safety. We don’t want to have to do this, it is heartbreaking", she said.

Lizzie explained there was a recent emergency call which had stayed with her, where a woman was waiting on the floor for 16 hours because she couldn’t get an ambulance.

She adds that when they were able to help, it was "evident she had had a stroke" and the amount of time the woman was waiting "leaves you out of the window for treatment".

Pressure on services may increase in coming hours and dayspublished at 16:36 Greenwich Mean Time 11 January 2023

16:36 GMT 11 January 2023

Nick Triggle
Health correspondent

Judging disruption of an NHS strike on the day it happens is very difficult.

By all accounts, demand for the ambulance service has been down - as it was on the strike on 21 December when services reported calls were one-third below normal.

It is also true that many ambulance staff continue to work. The GMB said three-quarters of staff were working even in services hit by the strike to ensure life-and-limb cover was provided as they are legally required to do.

NHS Providers, which represents health managers, has said the pressure will mount as the day progresses - the last of the walkouts does not end until 23:59GMT.

What is also true is that it can be very hard - even when you get the figures on calls - to judge the impact of the disruption. If people have delayed seeking care it is possible they will present in the coming days with their condition worsened as a result.

Image source, Shutterstock

Clare Lissaman
Reporting from Telford

A paramedic in Shropshire has said she is striking because she fears for patient safety, adding staff do not feel valued.

Katie Nelson said the situation was "incredibly demoralising" with most shifts being spent queuing outside hospitals because of pressures and delays.

"Now we are not able to help the people who really need our help and that's not what we want to do," she said.

Katie, who spoke to the BBC from a picket line outside Donnington Ambulance Station in Telford said the situation was getting "worse and worse".

"I think morale is at an all-time low to be honest with you. We are coming to work and we know that we're going to be queueing outside a hospital all day," she said.

Health workers' pay dispute looks set to drag onpublished at 16:13 Greenwich Mean Time 11 January 2023

16:13 GMT 11 January 2023

Hugh Pym
Health Editor

So where does this dispute go from here?

There’s no news of further talks, but on a strike day both sides tend to fall back on previously stated positions.

Health unions have welcomed the fact that Health and Social Care Secretary Steve Barclay was ready to talk about pay for health staff in England at the meeting on Monday. But while ideas about one-off payments or backdated pay rises from April were raised they weren’t discussed.

The sticking point is still over whether more money can be found for a higher pay increase this year. There is no indication yet that Downing Street and the Treasury are ready to provide that extra funding.

But there’s the possibility of more talks later this week or early next with one source saying Monday had at least seen the start of a process - albeit one which might drag on for a while.

Rob Sissons
Reporting from Nottingham

Striking ambulance crews in Nottingham say they are embarrassed and the strain on service means some patients face big delays.

Those on the picket line outside one of the East Midland's most important ambulance bases, the Beechdale Ambulance Station, stress the dispute is about much more than pay.

Ambulance technician Lance Allen says 999 callers are generally so pleased when help arrives, but that the crews just want to get their quicker.

“It is never nice to find someone on the floor, or someone in pain who has been there for such a long period of time. Every single person I work with will always turn round and say they're really sorry for these delays," he tells me.

At at a board meeting this week, the East Midlands Ambulance Service revealed it had record handover delays in December, after hospitals delaying accepting patients meant more were stuck in the back of ambulances.

The trust lost almost 28,000 hours to delays in December, equivalent to the loss of 74 of the staff's 12-hour shifts each day.

It says the record delays are down to difficulties with the flow of patients through the NHS and social care system.

Meanwhile, a report for the trust said patients are coming to harm "as a direct result of the delays, adding that "the number of serious incidents is likely to rise".

During the last strike day call volumes to the service were down 30 per cent - and the trust is hoping for a similar trend today.

Erica Witherington
Reporting from Barnsley Hospital

There’s been a steady trickle of people coming into Barnsley A&E, many pleasantly surprised by how quickly they’ve been seen.

One mother, sent with her little girl because their GP was “full up”, was in and out within a couple of hours. Another patient told me she’d had a ten hour wait here two weeks ago, but today had waited just an hour and a half.

Outside on her break, A&E nurse Bethany Sharn says the lack of ambulances has made for an unusually quiet day. Although five are currently parked outside, she says it would normally be 15 or 16 - with some waiting as long as eight hours for a hospital cubicle to become free.

“People call an ambulance when they really don’t need one. They think if they come in an ambulance they’ll get seen quicker, but it doesn’t work like that,” she says.

Waiting in his cab, a paramedic tells me why he’s chosen not to strike: “I don’t want it on my conscience. I’ve got elderly grandparents, and it’s people like them who’ll suffer today.”

At the same time, he says something has got to be done. “I’ve worked here seven years, and every year it’s worse. But there’s got to be another way to do it.”

Anne-Marie Tasker
Reporting from Lincoln

Around 20 ambulance workers and union staff manned the picket line outside Lincoln’s South Park ambulance station, in bright sunshine but braving a bitterly cold wind.

Twice, striking workers handed over their flags to rush to ambulances and respond to 999 calls.

A member of the public drove up to deliver dozens of drinks, sandwiches and pieces of fruit to striking workers, saying “they want to be looked after".

"I’ve been on a picket line myself and I know what it’s like. They’re fighting for their lives”.

Melissa Farrell, a paramedic for East Midlands Ambulance Service, said: “Sometimes, there are hundreds of jobs on the stack in the control room, we’re stuck in the backs of ambulances for hours on end, waiting for beds at the hospital, while genuine real emergencies are being shouted out and we’ve got no resources available to send to them."

Josh Pearson, a technician for East Midlands Ambulance Service, said his colleagues are “struggling and having to go to foodbanks, having to cut back, choosing between food and bills but I think the pay is a part of it”.

He added “I’m happy with my pay as a technician but it’s the patient care, it’s the knock-on effect to secure the future of ambulance service really, because the job at the moment isn’t appealing.”

Harry Low
BBC London News

Women giving birth at home might need to make their own way to hospital in case of emergency, NHS trusts in London are warning.

There are delays due to about 20,000 ambulance workers and emergency call-handlers walking out across England.

"There is no guarantee that an ambulance or paramedic will be able to come to your home today," Chelsea and Westminster Hospital said.

It's a similar message from Lewisham and Greenwich NHS trust: "We cannot guarantee a quick journey into hospital should you need it during an emergency for you and your baby," .

A decision not to come into hospital for those planning a home birth "may compromise the safety of you and your baby", it added

More than 400 people a week in England could be dying as a result of long delays to treatment in A&E departments, according to an expert who's looked at the data for BBC Radio 4's More or Less programme.

The President of the Royal College of Emergency Medicine suggested earlier in the month the crisis in urgent care could be causing 300-500 deaths a week.

Both NHS England and the government have said they don’t recognise those figures.

More or Less asked Stuart McDonald of LCP Health Analytics to look into the issue. He used available information on NHS waiting times and a study in the Emergency Medical Journal, external on the extra risk of dying as a result of long A&E waits.

While McDonald's calculation is not perfect, he estimates that 415 people are dying each week because of delays. He states that is a conservative figure - and it could be higher.

• You can listen to the episode on BBC Sounds here.

Phil Mackie
Midlands correspondent, BBC News

By 1pm, more ambulances had come and gone, although only one had been driven by military personnel.

The wait times had decreased both here and at its sister hospital - the Gloucestershire Royal - but the number of people waiting inside each emergency department had gone up. In Cheltenham the average time spent in the department was four hours, two hours fewer than earlier, and in Gloucester, it had also fallen - to five hours.

One elderly lady, sporting a black eye and a head bandage, told me she’d had a nasty fall in the gym earlier, and her daughter had brought her to hospital.

She was treated within a couple of hours and sent back home.

Bettina Nagy, pictured above, had also had a fall and hyperextended fingers on her right hand.

She’d been able to get herself to the emergency department, was bandaged up, given painkillers and sent home within an hour and a half.

Image source, ADAM VAUGHAN/EPA-EFE/REX/Shutterstock

Ambulance workers are "incandescent about the way the government is managing" strikes, the head of one of their main unions says.

Speaking on BBC Radio 5 Live Andy Prendergast, the national secretary of the GMB union, said 75% of ambulance staff are working, which he described as "unprecedented for a strike".

Asked whether Business Secretary Grant Shapps was right to assume “patchy emergency care” during the strikes, he replied “absolutely not”.

Prendergast said "our members have spent their lives dedicated to saving people’s lives" adding the current dispute was a "case where the public knows who’s right".

He adds that as soon as the unions "got the government to the table making positive noises" that there may be a resolution to the dispute, they immediately moved to bring forward "completely needless and unnecessary legislation which simply curtails a fundamental human right” - a reference to the plans for minumum service levels in some industries during strikes.

Thomas Mackintosh
BBC News Live reporter

Image source, Reuters

I've been speaking to one ambulance worker in London - who didn't want to give their name - but felt compelled to explain why they are on strike.

They tell me: "I do at least three overtime shifts a month just to pay my bills - it is fine to organise but that shouldn't be the standard.

"There is a pressure on crews and I have definitely noticed a lot of people leaving, partially the burnout from Covid-19 didn't help.

"I also think the working conditions have become worse and worse and worse, and that the government depends on the goodwill of the staff going above and beyond and I think that is becoming an expectation.

"They are working harder than they should for not much money - that's the pressure point."

"I support the unions and anyone on strike. Everyone is suffering a similar problem, this is the result.

"It is not just one sector, it is lots of them because funding has decreased," the ambulance worker says.

NHS Providers is the membership organisation for acute, ambulance, community and mental health services and its chief executive has told the BBC it is "too early" to determine the impact of the strikes.

Speaking to Radio 4's The World At One, Saffron Cordery said: "It is still emerging about the picture of what is going on.

"Of course there will be disruption today but once again we have seen on ambulance strike day reduced demand for ambulance services.

"I think that it's fair to say that as the day goes on, the pressures will mount. That's what we saw last time round with the industrial action.

"We know that there will be disruption but the scale of it is hard to see at the moment."

She said the NHS was able to "step forward and manage" through industrial action, but that it was having a "knock-on effect" on "waiting lists (and) treating people that need it in a timely fashion".

Sharon Barbour
BBC Look North

Today's strike by North East Ambulance workers also includes call handlers and patient transport staff.

Kevin Haynes looks after patients. He's worked with the ambulance service for 16 years. He told me he how has seen the best of times, but these were the worst he has known.

Low pay was a major reason he was joining the picket line. He does as much overtime as he can to make enough to live on.

Kevin gets the bus into work, and recently noticed an advertisement for bus drivers. They were paying more than he earned driving patients.

His job involves taking cancer patients to treatment, he gets others to hospital for renal dialysis, and he drives those who are now needing end-of-life care to their home or to a hospice.

His head drops. He often gets to know these patients, and says listening to them on their last journey can be very sad.

Despite the strike, an agreement has been reached with the North East Ambulance Service that all of those vital services will also be protected today.

Thomas Mackintosh
BBC News Live reporter

Image source, Reuters

As we've been reporting, patients whose conditions are non life-threatening may not get an ambulance today.

National first aid and healthcare charity St John Ambulance will not be providing any additional support outside its planned and contracted activity during today's strikes.

However, medical director Dr Lynn Thomas has offered some first aid tips.

She says: "Simple first aid techniques like recognising a cardiac arrest and starting chest compressions, how to relieve choking and how to stop a bleed, are always important skills to learn and can make all the difference in an emergency.

"As well as making sure you have a first aid kit at home that is well equipped and ready for when accidents do happen."

Dr Thomas points to the charity's website, external for more advice and the St John YouTube channel , externalon how to use a defibrillator.

Erica Witherington
Reporting from Barnsley Hospital

Barnsley, South Yorkshire, is a town with a rich history when it comes to strikes.

But the paramedic unloading an elderly patient from his ambulance today is not in a union - he's "just not that type" - so he's on shift and answering this emergency call as usual.

He says it’s quiet in A&E today as "people seem to have got the message to stay away".

But the pressure he’s under at work is definitely worse than ever.

Four-hour waits outside Barnsley Hospital are frequent now – time spent waiting to hand over a patient which means he has to leave other calls for life-saving help unanswered. "It doesn't feel good," he tells me.

So what does he think of his colleagues out on the picket line today? "It's their right of course. But I don't think it will make any difference."

Nearby, a lady wheels her elderly father into A&E, his fractured wrist in a homemade bandage.

They wouldn’t have called an ambulance anyway she says, but she still has no sympathy for the strikers.

As a teacher, she tells me she’d never leave the pupils who need her like that, adding: “If you don’t like the pay, you can go and get a different job.”