Phil Mackie
Reporting from Cheltenham General Hospital

The first ambulance to arrive at Cheltenham General Hospital’s emergency department after I arrived was driven by a member of the armed forces.

A paramedic helped them offload a patient on a stretcher.

Unison have described the strike in Gloucestershire as solid, and say they expect nearly every driver due to work today to support industrial action.

At 11:00 the average wait for patients once they arrived inside was six hours, and 35 people were waiting.

At its sister hospital – the Gloucestershire Royal - the wait was a little longer and the department was busier, with 75 patients in the department.

The Gloucestershire Hospitals NHS Foundation Trust described the situation in both departments as fairly typical.

As we told you earlier, there's also been talks over the rail strikes, which have now finished for the day.

In Parliament Steve Montgomery has told MPs there are plans for more negotiations with the RMT and the Transport Salaried Staffs' Association (TSSA) unions tomorrow.

While he said he wouldn't air the details of those negotiations in public, he did say he accepts there are a number of challenges.

One MP notes comments from Mick Lynch who says strike action could last for at least another six months while Lynch goes further to say it could last up to two or three years.

Montgomery replied: "We want to get a resolution to these disputes as quickly as we can.

"This is hurting the industry, let's be clear about that.

"We are seeing customer confidence in this industry ebbing away."

Meanwhile Network Rail's chief negotiator Tim Shoveller was asked whether he has seen a difference between new Transport Secretary Mark Harper and Rail Minister Huw Merriman compared to the previous government when the strikes started last year.

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He answered: "The current secretary and rail minister have met with the unions, that previously didn't happen before.

"But, other than that I haven't seen any difference."

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Over in the House of Commons, the topic of the NHS, strikes and the government's role have (unsurprisingly) dominated proceedings at the first Prime Minister's Questions of 2023.

Here's a quick summary of some key exchanges between Prime Minister Rishi Sunak and Labour leader Keir Starmer:

• In his first question, Starmer suggested there had been no NHS strikes in the 13 years of the last labour government
• In response, Sunak said the government has been clear that it wants to have a "constructive dialogue" with unions and the government had followed the recommendations of the independent pay bodies
• Starmer continued to pursue the health service, point out waiting times for getting help ranging from GPs appointments to cancer treatment and asking when these would come down
• Sunak defended his government's record and said much of these problems are down to issues built up during the Coronavirus pandemic
• There were also some testy exchanges over the government's plans to introduce a minimum service level law, which would require a certain level of service during strikes in industries like healthcare
• Starmer accused Sunak of "sacking the nurses", while the PM said the Labour leader's opposition to the idea showed he was "on the side of his union paymasters"

Nick Johnson
reporting from Enfield, north London

Outside North Middlesex Hospital where there is no visible evidence of industrial action by London Ambulance Service workers.

There is no picket line, emergency vehicles are coming and going from the ambulance bay and there is a steady stream of patients in and out of A&E.

I’ve spoken to one ambulance driver pulling out of the bay who said he was not striking today “for personal reasons”

But it's a different story half-a-mile down the road at Edmonton Ambulance Station.

Just after 11:00 ambulances pulled in, the shutters came up, and ambulance workers came out waving flags.

Julie Cunnane is an ambulance worker and union rep. She’s striking today and says colleagues will only settle for an income “closer to the inflation figure”.

She also sought to reassure the public and said if anyone is critically ill, ambulances will be deployed directly from the picket line.

Latest figures show only 48.9% of the most seriously ill people to arrive at A&E were seen within the four-hour target.

Jenny Kumah
Reporting from Plymouth

There’s around six ambulances here at the region’s biggest hospital in Plymouth. Many have military personnel in the driving seat.

There have been days when there have been dozens waiting to handover. But today things seem relatively normal and the NHS have said they have put measures in place to mitigate the impact of the strike.

I spoke to Alan Butler whose mother had a stroke this morning.

The ambulance arrived in 20 minutes. He told me that he "understands why ambulance staff are striking" and that he was pleased his 74 year old mother was able to get the service she needs.

Susan Gerdes was dropped off by a relative to A&E after being sent there from a minor injury unit. She told me she "fully supports the strike” and that "the government should listen to what the staff need".

The South West has some of the worst ambulance response times in the country. So far today A&E times are around two hours with 70 patients in the department.

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It's just gone midday, so here's a quick summary of the morning's developments for anyone in need of a catch-up:

• Around 20,000 ambulance workers, including emergency call handlers, are on strike today in England and Wales
• The NHS has urged people to use services "wisely" and only phone 999 in a life-threatening emergency
• Health Secretary Steve Barclay described the strikes as "extremely regrettable" and said people should use their "common sense" when it comes to what activities they do today
• Asked about the ongoing crisis in emergency care, Barclay acknowledged the NHS is under "very severe pressure" over a rise in winter illnesses like flu
• Paramedics and other ambulance staff from around the country have been sharing stories concerns about their experiences in recent weeks, with one describing emergency care as having already "effectively collapsed".
• The dispute is principally over the pay offer of 4.75% from last year being considered too low with the rising cost of living
• But many ambulance workers are also expressing concern about the crisis in emergency medicine and patient safety
• Unions are calling on the government to improve its offer to ambulance staff, suggesting any serious and reasonable proposal would be considered
• The government has previously said above-inflation pay rises for staff are "unaffordable" and that it is also is planning to introduce a law to maintain minimum services levels during future strikes
• Meanwhile, health unions representing over a million NHS staff have said they will not participate in upcoming pay review process while this year's disputes are unresolved
• We've also heard that NHS physiotherapists will strike later this month and in February

If you'd like to out what is happening in your area with A&E, ambulances and hospital waiting lists, you can enter your postcode into our tool here.

A moment ago we mentioned that physiotherapists have become the latest profession to announce strike action.

We have a bit more detail from the Chartered Society of Physiotherapy (CSP) who say over 4,200 members employed by 30 NHS trusts across England - will be called to strike on 26 January.

Then, a second day of strikes at an addittional 30 trusts will follow on 9 February as part of the ongoing dispute over pay and retention.

The CSP warns it will announce further dates – in England and Wales – if no improved offer is forthcoming from the respective governments.

Claire Sullivan says the strike action is an "absolute last resort".

"NHS staff not only deserve better pay but also desperately need it during this cost of living crisis," she says.

"This dispute will protect patient services both now and into the future, and it’s essential that the government comes up with an improved offer to avert further strikes and demonstrate they understand the scale of the problem."

Meanwhile, back at the Transport Select Committee in the Commons and Network Rail's chief negotiator Tim Shoveller and chair of the Rail Delivery Group Steve Montgomery have been taking MPs' questions.

Both start by saying they are optimistic deals will be reached to resolve all the disputes with the various rail unions.

"Discussions have moved at various paces," Montgomery said.

Another group of NHS workers have announced they are going to take strike action.

Physiotherapists will strike on 26 January and 9 February in a dispute over pay and staffing, the Chartered Society of Physiotherapy says.

Hugh Pym
Health Editor, reporting from London

The union Unison's head of health Sara Gorton was out on a picket line in London this morning.

She says there was a more positive atmosphere at talks with Health and Social Care Secretary Steve Barclay on Monday but adds it was regrettable in her view that it took industrial action to get ministers to talk about pay.

Dan Johnson
West of England correspondent

We are spending the day with Lewis Stoner, a paramedic from Devon who works at the Tiverton ambulance station.

He has been working in the ambulance service for the last ten years. Over breakfast in his kitchen before the school run he told me the strike is, for him, about more than just pay.

Lewis said "it is so hard at the moment in the services" and that he “wants his family to have an NHS in the future".

He told me that he is always hearing on the radio that "there is the highest priority call, but we have no-one to send" and that it feels like "the pressure just grows and grows and grows".

Lewis's wife Sarah told us that she has seen the stress he brings home after a shift and that he "used to be excited about the job".

She says that "we have to sit and talk and listen when the kids go to bed" and they can be "sat there talking for a few hours.”

He will be on the picket line from midday when his shift was supposed to start.

Lewis told us he understands it is likely he will be called into work if a Category 1 call comes in and he will go to help straight away.

Back at the House of Commons, where rail union bosses have been questioned by MPs about their dispute over pay and conditions.

RMT general secretary Mick Lynch concluded by saying there is a lot of support for the workers who have been on strike at various times in the last year.

"It's difficult to get support during industrial disputes," he says.

"But there is broad support for all the people that are involved."

Lynch tells MPs says he has been getting reports from picket lines all over the country which say they are well attended and the action being taken is "having the same effect as it did on day one".

Victoria Bourne
Reporting from Bristol Royal Infirmary

There has been a mixed picture from people I have spoken to outside the emergency department at Bristol Royal Infirmary.

One young mum said she had been worried about delays, but her daughter was seen by a doctor within 20 minutes of arriving last night.

It was a different story for the adults that I have spoke to though. One woman’s relative waited 10 hours before seeing a doctor, while another woman said she had spent eight hours and counting.

There was also a mixed picture in terms of support for today’s strike by ambulance workers.

Those I spoke to said they understood the reasons why they had taken industrial action, but they were worried about the impact it would have on those who needed emergency care.

The South Western Ambulance Service has warned people ambulances may only be able to respond today if there is “the most immediate risk to life.”

The service is responsible for some of the most remote places in England, with its cover stretching from Cornwall and the Isles of Scilly in the far South West to Gloucestershire and the Welsh border.

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Yesterday, Business Secretary Grant Shapps set out plans to enforce minimum service levels during strike action, including for ambulance staff, firefighters and railway workers.

Under the new bill, some employees would be required to work during a strike and could be sacked if they refuse.

Aslef general secretary Mick Lynch has been asked in the Transport Select Committee for his reaction to what Shapps introduced to Parliament yesterday.

"We will see what legal avenues we will take to challenge it," he said.

Lynch added that Shapps' new proposal "exacerbates" the current situation.

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More from the ongoing committee meeting in Parliament where RMT Union boss Mick Lynch has claimed to MPs that the Department for Transport (DfT) has a "Stalinist obsession about central control".

He says: "What we get from the DfT is provocations, provocations in language and also what is put into the documents.

"You can also see in the way they run the railway, when there is a Network Rail strike they shut Scotland and they shut large parts of Wales, and they choose to run the parts that connect to England, it's quite cynical in my view."

Lynch said leaders of devolved areas are "seething" with the transport services they get.

He adds: "The damage is being caused by the inconsistent and reckless policy of the people that are in control of railway."

Nick Triggle
Health Correspondent

On the day ambulance workers go on strike, the health unions have announced they are pulling out of the independent process to determine pay for next year.

The NHS Pay Review Body makes recommendations over wages – it was through this process that the government came up with the 4.75% award in England and subsequently Wales.

But the 14 health unions, representing more than one million ambulance staff, nurses, porters, healthcare assistants and physios, have decided they will not make a submission for 2023-24.

They argue the process is flawed as it takes too long and, pointing out it took six months last year by which time inflation had rocketed and the 4.75% recommendation was out of date.

Instead, they have called for direct negotiations with ministers about pay.

This can only be interpreted as a further deterioration in industrial relations as in Monday’s meeting ministers had been pushing unions to get involved in the process instead of disputing the 2022-23 award.

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While ambulance workers are on strike today, MPs are hearing about the ongoing dispute in the rail industry over pay, conditions and jobs. Members of the RMT and Aslef unions walked out last week bringing much of the network to a stand-still.

In the last hour, Aslef union leader Mick Whelan warned MPs the bitter strike on the railways is further away from being resolved than when it started last year.

The general secretary was asked by the Transport Select Committee to say how close, on a scale of one to 10, the situation was to a resolution.

"I think you can include zero," he replied.

"We're further away than when we started."

RMT general secretary Mick Lynch said: "We haven't got an agreement.

"Until we get an agreement we're not close to it."

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Health Secretary Steve Barclay has admitted to BBC Breakfast that the NHS is under "very severe pressure" and says the biggest concern among paramedics who've spoken to him isn't about pay.

He says their main frustration is about the long delays in handing over patients from ambulances to hospitals.

He adds the government has announced further investment for emergency departments, as well as looking into ways of targeting how to get patients who are fit to leave into social care.

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In Nottingham outside the Beechdale Ambulance Station half a dozen GMB union members were out on the picket line.

Vimal Mistry, an East Midlands Ambulance Service paramedic for seven years, says things have "just got worse" since the Covid pandemic.

"People can't get appointments anymore so they put off going to the doctor and when it gets worse they come to us," he says.

"Staff see all this and just get run down and with interest rates and fuel costs going up, people just can't afford the things they could do before.

"I'm now having to think about how much heating I have on in the house - I have it on for two hours a day now.

"I didn't think I'd be in a position where I'd be thinking about how much heating I am going to have on."

The average earnings for ambulance staff in England were £46,643, figures from NHS Digital, external for April 2021 to March 2022 show.

Of this, £13,854 came from extra payments for things like shift work and overtime.

Workers classed as support staff - such as ambulance technicians and non-emergency ambulance drivers - had average pay of £29,139, of which £7,842 came from extra payments.