Michelle Roberts
Health editor, BBC News online

In an emergency, people should call 999 for life-saving care. Ambulance crews will be responding to the most clinically urgent cases.

All category one calls - the most critical, 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 but not immediately life-threatening conditions, such as stroke or chest pain.

Unless it is “life or limb”, an ambulance may not come or you may have to wait longer than usual for one. During a previous ambulance strike last month, hospitals advised pregnant women who are very close to their due date to make alternative plans for getting to the hospital, should they need to.

Call handlers - who are also striking today, but will still be working- will assess when and where ambulances should sent.

General practice staff, pharmacies, and dentists are not on strike and will run a normal service, although it may be busier than usual.

NHS 111 is also available to offer advice, external.

Image source, .

A paramedic for the West Midlands Ambulance Service said he has chosen not to strike over concerns for patient safety.

Daniel Duffield, 23, said ambulance service staff’s pay is “quite good” and has a “mixed view” on the strike action.

He told the BBC: “I’m not striking on grounds of patient safety and I think the pay is quite good, I don’t have an issue with pay. But I fully support those who choose to strike, people have got to do what is right for them.”

Staff have been working longer hours as the demand ambulance services across England are experiencing have resulted in more delays, Duffield said.

“I really think morale would improve within the ambulance service if the delays were not there and people could go home on time,” he added.

He said the longer hours have taken a mental and physical toll on him.

“It also affects my eating. If I’m getting home at 9 or 10 pm instead of 6 or 7 when I should finish, I’m not only not eating with my family, I may not feel like eating anything at all,” he said.

“There’s both a physical and mental effect with the stress, fatigue and pressure, the physical demand of the job. It does make you think ‘how long can I do this for?’.”

How did we get here?published at 09:11 Greenwich Mean Time 11 January 2023

09:11 GMT 11 January 2023

Nick Triggle
Health Correspondent

The walkout this winter by ambulance staff is the first time they have taken strike action since 2014.

Essentially the dispute is about pay, but here are the finer details.

Real-terms pay cuts: The pay rise on offer in England and Wales of 4.75% on average comes at a time when inflation, the rate that prices are rising, is more than double that. It also follows a decade in which staff have seen their pay in real terms - once inflation is taken into account - fall.

Generally low salaries: While the ambulance service provides life-saving treatment, the salaries are well below the national average for many. For example, 999 call handlers typically earn around £22,000 to £23,000 a year.

Recruitment woes: The squeeze on pay and mounting pressure has meant that services are struggling to fill vacancies - around one in 10 posts are vacant in some areas. Ambulances are struggling to respond to calls, it is taking two to three times longer than it should to reach emergency calls such as heart attacks and strokes.

Unions’ bottom line: They say the service is simply not safe - and until pay is improved that will not be resolved.

Image source, Getty Images

The NHS is facing extreme pressure as A&E wait times and ambulance delays are at their worst levels on record.

Unions are demanding a pay rise above inflation, but they are also protesting about being stuck in ambulances outside A&E departments for long periods, rather than attending to new emergencies.

More than 40% of crews were forced to wait at least half an hour to hand over patients in the week up to 1 January, data has shown.

Senior doctors have said the NHS is on a knife edge, with some A&Es in a "complete state of crisis".

Find out what is happening in your area with A&E, ambulances and hospital waiting lists by entering your postcode here.

People should use their "common sense" over what they do during the ambulance worker strikes in England and Wales, Health Secretary Steve Barclay has said.

Speaking on Times Radio earlier, he said: "People can see that today is going to be a very challenged day for the ambulance service."

Barclay added the focus will be on ensuring life-threatening incidents are dealt with and acknowledges "there will be strain on the rest of the system".

"So, we are just saying to people, use their common sense. Of course, if it is genuinely life threatening, then they should phone 999," he said.

Image source, PA Media

Health Minister Steve Barclay has been speaking for the government on the BBC's morning programmes and on Radio Four he is pressed on what exactly is being offered to ambulance workers.

Asked on the Today programme about whether the government is willing to make a reasonable offer for pay the unions want, Barclay does not answer directly but says the government must be looking at the pressure inflation has put the health service under in the context of any pay offer.

He adds he will not speculate in public over negotiations with the unions.

The question comes after Unison general secretary Christina McAnea told the programme earlier unions would "seriously consider" any offer from the government this year.

Questioned about whether pay rises would be linked to productivity increases, he says the government must look at these issues across departments and adds it is important to look at efficiency across the health service

Pressed on whether productivity is the worker's problem to solve, rather than a failing of the government, Barclay says no-one is suggesting NHS staff work harder and that problems with technology and administration are a key area of frustration to staff.

He also denies these issues are to do with the government not investing enough in the health service.

Tomos Morgan
BBC News

Around 20 or so GMB union members have been on the picket line from around 0615 this morning just outside Newport, South Wales.

It feels a bit like deja vu - the same union went on strike before Christmas and nothing really has changed, bar a one-off pay offer by the Welsh government for health workers.

But all of those I spoke to here say “thank you, but that’s not going to be enough”. They, and other health care unions, want an increase in salaries, which means it seems unlikely tomorrow's talks with the Welsh government will avert further industrial action.

Wales' First Minister Mark Drakeford says he does not have the money to raise wages and that financial firepower must come from Westminster.

As we've been reporting, it's not just paramedics on strike today. Call handlers, emergency care assistants and ambulance dispatchers are also walking out.

One union official and ambulance worker, Dave Robb, has been speaking to us and says there are two issues that have led to the strikes: pay and patient safety.

He says that over the last 12 years there has been a constant reduction in funding for proper, adequate healthcare and the ambulance service in his area.

"First and foremost", he says, "we need to get around the table and discuss the issues we are raising."

Katherine Da Costa
Health reporter

Which and how many ambulance staff are on strike?

20,000 members of the two largest ambulance unions will be back on the picket lines in England and Wales this morning in the second walk out this winter over pay.

The GMB and Unison represent two-thirds of ambulance workers. A meeting between unions and the Health Secretary on Monday is said to have made some progress but nothing concrete enough for the strikes to be called off.

Today's strike affects all of Wales and most of England except the East region and the Isle of Wight. The length of the industrial action and start times vary but all trusts have agreed life and limb cover - that means all category one life-threatening calls will be attended.

But agreements on levels of cover for lower category calls are made locally so may differ around the country. Some patients may be asked to make their own way to A&E.

NHS England is urging patients to use NHS 111 online as the first port of call but call 999 in a life-threatening emergency.

Sharon Barbour
reporting from Gateshead

It's early, it's cold and it's dark but anger and determination have once again brought striking ambulance workers out to picket.

Ambulances are ready to go to life-threatening calls or "life and limb" where a threat exists to loss of life or limb - but other ambulance callers face a long wait.

Among them is Jayne Elliott - an experienced paramedic who is exhausted, angry and desperately hoping things will improve.

She says they are working under enormous pressure with staff shortages and long delays at packed A&Es in hospitals that can't take any more patients.

Colleagues are struggling to make ends meet and many are off sick - with stress, she tells me.

Image source, EPA

We've been hearing from Health Secretary Steve Barclay who says today's strikes are "extremely regrettable".

He points to the NHS being under "very severe pressure" which has seen a "seven-fold increase in flu admissions".

Barclay was asked on BBC Breakfast about a one-off hardship payment for workers but wouldn't give a direct answer when pressed on the issue by Jon Kay.

However, the health secretary says he has been in dialogue with other secretaries of state - including education and transport - as well as the prime minister about industrial disputes across other parts of the public sector.

Image source, Getty Images

Ambulance staff are making "difficult choices" around whether or not to go on strike, the chief executive of the Welsh Ambulance Service says.

Jason Killens tells BBC Radio Four's Today programme that while pay is the primary issue for most people taking industrial action, workplace conditions and patient safety are also significant concerns given the growing problems in emergency care.

"Of course they will be thinking about what has happened in the last few weeks in the choices that they make today," he says.

Killens says the Welsh Ambulance Service lost more than one-third of its emergency vehicles to delays in A&E handovers.

"When that happens, it means that ambulance isn't available to respond to a call in the community and sadly those patients end up waiting."

Killens emphasises exemptions are in place for those whose condition is immediately life threatening, like cardiac arrest, aren't breathing or are unconscious, as well as some calls for people with stroke or chest pain symptoms.

He adds this "life and limb cover" will be in place across Wales for the 24 hours of strike action.

Image source, Getty Images

One of the biggest unions representing ambulance workers says a "really good" one-off hardship payment or next year's pay rise being backdated would be considered.

Unison boss Christina McAnea tells BBC Radio Four's Today programme: "We're not ruling out anything, I'm a negotiator, that's what we do.

"If we got any kind of offer from the government we would seriously consider it, no matter what it was."

Ministers are looking at the option of a one off payment or bringing in next year's pay deal three months early.

They have not provided details yet and no further talks have been confirmed with unions.

Asked whether Unison was considering strikes to oppose the government's new minimum service plans, McAnea says no.

But she does say they would co-ordinate with other unions to oppose the bill, which would would require a baseline level of service from unions during strikes in certain industries like healthcare or railways.

"We'll certainly be looking at what we can do legally, and indeed in other ways, to influence the government to say this isn't the right action."

She says it was "quite appalling" that despite unions calling for safe staffing levels in the NHS, the only time the government would guarantee them was during strikes, noting the "utter chaos" in the health service

"To talk about bringing in minimum staffing levels is a total distraction, they're trying to distract from their inability to run the NHS."

No talks in the diary for todaypublished at 07:27 Greenwich Mean Time 11 January 2023

07:27 GMT 11 January 2023

Nick Eardley
Chief political correspondent

There is more optimism in pay talks, with ministers looking at options for a compromise.

But we don’t know enough at the moment to say with certainty whether that will avoid future strikes.

How much money would be involved? When would it happen? Would unions agree? All unanswered questions.

As things stand, there aren’t any further confirmed talks in the diary.

Ministers introduced minimum service legislation to Parliament yesterday. But it will be some time before that becomes law and could have any impact.

That legislation is causing tension with unions, who think it’s an attack on the right to strike.

There is also tension over which calls will be responded to today.

Striking workers will got to the most serious Category 1 999 calls. When it comes to Category 2, local arrangements are in place.

Some ministers have said that will lead to a postcode lottery. The business secretary has suggested unions are putting lives at risk.

Unions are angry at those accusations and say deals have been negotiated across England.

As we've been saying, 20,000 ambulance, paramedics and call handler staff have all walked out over an ongoing industrial dispute over pay and staffing.

The strike is affecting services across most areas of England and the Welsh Ambulance Service - with only the East of England and Isle of Wight Ambulance Service trusts unaffected. There are no strikes in Scotland and Northern Ireland.

Here's a quick look at the situation in north-east England.

Sharon Barbour is on a picket line in Gateshead and has been speaking to strikers.

They say a general decline of pay and conditions in the NHS is at the heart of why they are on strike adding the health service "needs investment and funding".

"We can't work like this anymore, the NHS is broken and the staff are broken," one worker explains.

If in need of emergency care, you should still call 999. There will still be staff answering emergency calls and sending out some ambulances.

All category one 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.

Instead, more clinicians are being brought in to answer 999 calls and judge the right response for individual patients.

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

Urgent problems that fit into category two will be responded to based on local agreements with the unions.

The NHS has issued guidance , externalto the public during today's strike by ambulance staff in England:

• Use NHS services "wisely" - 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
• The NHS says patients whose conditions are not life-threatening may not get an ambulance on strike days, as fewer vehicles will be on the roads and those with life-threatening needs will be prioritised
• The NHS 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
• The public is asked to play their part to look after themselves, loved ones and checking in on vulnerable family members and neighbours during strike action
• GP services will be running as normal on strike days and the public should continue to attend scheduled GP appointments

Emily McGarvey
BBC News Live reporter

Image source, Arron Glenwright-Cook

Arron Glenwright-Cook is a paramedic who will be on the picket line in Doncaster today.

He said he’s striking because the emergency care system has “effectively collapsed,” leaving paramedics unable to provide “safe and appropriate care”.

“The human suffering is significant and obvious – unless you’re in the back of that ambulance trying to get into A&E you don’t realise it’s happening,” he told the BBC.

He recalled sitting in a queue of ambulances outside hospital and hearing a dispatcher request immediate response to a life threatening emergency, but the nearest ambulance was 30 minutes away.

“We’re treating elderly patients, very frail patients with suspected fractures, in pain and unable to be moved into hospital – stretchers are not designed for eight hours at a time.”

He has four children and said losing a day’s pay to strike will make a “big difference” at the end on the month.

“Is that the kind of thing you want at the back of a paramedic’s mind when we’re providing end of life care to your grandmother, or resuscitating a loved one?

“Worrying about my gas and electric and how I’m going to buy food? I’ve given up faith that the government wants to fix this problem.”

Ambulance staff are staging action in many parts of England and all of Wales today in a dispute over pay and staffing.

The strikes, according to the union Unison, will involve all ambulance employees as opposed to just 999 response crews who took action in December.

Many of the services’ employees are likely to be exempted from the strike action under emergency cover plans, Unison said.

The co-ordinated walkout involves two main ambulance unions - Unison and GMB - and will affect non-life threatening calls.

Ambulance workers are also planning to strike on 23 January.

You can find out which ambulance services are on strike today and check whether you are affected by going to this page on the BBC News website.

Unions are calling for above-inflation pay rises for ambulance staff, but have not announced a figure.

Officials argue that any offer needs to be high enough to prevent a recruitment crisis.

In Scotland, two unions have accepted an improved pay offer of 7.5%.

The UK government says pay rises for ambulance workers and nurses were decided by independent pay review bodies.

Unison says the latest strikes are a direct result of the government’s “repeated refusal to negotiate improvements to NHS pay this year”.

The governments in England and Wales have given NHS staff an average rise of 4.75%.

Ambulance staff went on strike in England and Wales in December and Unison warned today’s action would be an escalation of that.