Striking junior doctors' pay demand unreasonable - No 10

1. Junior doctors across England are striking for four days, demanding a 35% pay rise and better patient safety
2. The government says there will be no pay talks with the BMA union unless it abandons its 35% starting position
3. Health Secretary Steve Barclay says such a pay rise is unreasonable and the government needs to focus on getting inflation down
4. The BMA union says it wants "pay restoration" because junior doctors have had 15 years of below-inflation wage rises
5. The strike will cause "unparalleled disruption" which will take weeks to recover from, NHS England's medical director Prof Stephen Powis has warned
6. More than a quarter of a million appointments and operations could be cancelled, and some hospitals say up to half of planned treatment is affected

Thanks for joining us

Dulcie Lee

Live reporter

The junior doctors' strike might be continuing for another three days, but we're pausing our live page here.

• If you are just catching up, read our main story here
• Want to know why the doctors are on strike? Read this
• Find out how the strikes are affecting patients and doctors here

This page was edited by Rob Corp, James FitzGerald, John Hand and me.

Our writers were Emily McGarvey, Gem O'Reilly, Krystyna Gajda, Jennifer McKiernan, Andre Rhoden-Paul and Ece Goksedef, with Malu Cursino reporting from Trafalgar Square.

Thanks for joining us.

What's happened today?

PA Media

We're shortly going close our live coverage shortly - let's recap the day:

• Thousands of junior doctors are out on picket lines across England for the first day of a four-day strike in an ongoing row about pay and patient safety
• Junior doctors want a 35% pay rise, with the British Medical Association (BMA) arguing wages have not been increasing in line with inflation for 15 years
• But Health Secretary Steve Barclay says such a pay rise is unfair and unreasonable, although insists his door is open for talks
• Downing Street though say they won't hold talks until unions ditch the 35% figure and stop striking
• NHS bosses have warned the strike will cause "unparalleled disruption" and will take weeks to recover from
• This afternoon the BMA held a demonstration in Trafalgar Square, with thousands of junior doctors turning out to protest

.

'It's a vicious cycle of pay, conditions and poorer services'

Malu Cursino

BBC News

BBC

Stephanie Wentzel (left) and Jessica Gillard are junior doctors based in London

A little earlier I was down in Trafalgar Square, where I met Stephanie Wentzel and Jessica Gillard, who are both junior doctors in the NHS.

Stephanie told me there had been a "vicious cycle" of low pay leading to poor staff retention, “which then leads to poorer working conditions for people left behind and therefore a poorer service for patients”.

She said the same pattern is seen in nursing, and the cycle needs to be broken.

“No doctor wants to be on strike," Jessica tells me, but says: "We do not have the staff, we do not have the funding.”

When doctors try to make an understaffed rota work "they burn out", she adds.

Watch: Union pay demand not fair - minister

Health Secretary Steve Barclay earlier said he's ready to negotiate a "fair and reasonable" settlement with junior doctors, but a 35% pay rise was neither fair nor reasonable.

Catch up with what he had to say here:

Junior doctors' pay demand 'not fair' - health secretary

'I've been ashamed at patient care levels'

PA Media

Over at Southmead Hospital in Bristol, 28-year-old emergency medicine trainee Nima Maleki says he has been at times "ashamed" of the care patients are receiving due to a lack of resources.

Dr Maleki adds: "On a personal level, I worry about my own family if they have to see a healthcare professional, go to A&E, have a planned appointment.

"I worry for them and I think 'what if it takes too long? What if they have an accident and they're not seen in an appropriate amount of time?'

"What we're asking for is not a pay rise; we're asking for our pay to be restored back to what it was in 2008 to 2009.

It's the same job, but actually we're working so much harder while being paid in real terms a lot less."

In Pictures: Thousands of junior doctors walk out

Let's take a look at some photos from the first day of strike action:

Getty Images

Getty Images

Junior doctors in Manchester were also seen on the picket line

PA Media

A rally in support of junior doctors made its way from Trafalgar Square, down Whitehall and past the Houses of Parliament

Gareth Fuller /PA Wire

Other junior doctors outside the William Harvey Hospital in Ashford

PA Media

And of course, a dog was spotted too

Strikes inevitable after government's underfunding - Greens

More political reaction to bring you now, this time from the Green Party's co-leader Carla Denyer who says junior doctors are "absolutely right to call for their pay to be restored to pre-austerity levels".

"Years of government underfunding has pushed the NHS to breaking point and resulted in poor pay, thousands of unfilled vacancies, declining working conditions, overworked staff and stretched capacity," she says.

"Strike action by junior doctors and other health service workers is the inevitable consequence."

The Green Party says it is committed to a "properly funded NHS" which it says would increase investment by at least £6bn.

WATCH: Singing strikers on the picket lines

Some junior doctors have been singing their protest chants to popular tunes on picket lines in England.

Take a look:

Singing strikers on the junior doctors' picket lines

Searing pain and a trip to A&E: Being treated during the strikes

Callum May

BBC News

The sharp pain in my lower back this morning should have been enough of a warning. The pool of vomit I deposited at the side of the tube station platform convinced me that something wasn’t right. Sorry, fellow commuters (and readers).

As I staggered on towards Northwick Park Hospital I feared two things: that my condition wasn’t serious enough to warrant treatment in A&E; and that the doctors’ strike would mean a long wait for help.

Inside I waited around 10 minutes to be seen.

I was in such pain that I didn’t realise I was being treated by a physician associate - medics who work with GPs and in hospitals to assess and care for patients.

Rachel quickly and calmly explained my diagnosis - a kidney stone - and organised immediate intravenous painkillers, administered by a nurse. A doctor had signed off on the prescription and confirmed my diagnosis.

Scan results and a cup of NHS tea later, I was discharged after less than five hours.

The strike may have put the health service under pressure, but my experience shows it also relies on many professionals who are not doctors.

What the strikes are about - in 100 words

Junior doctors in England are on a four-day strike, demanding better patient safety and a 35% pay rise.

They say this would compensate them for 15 years of below-inflation wage increases.

The government says it's unrealistic, pointing to the deal nursing unions and others have recommended - a 5% pay rise and one-off payment of at least £1,655.

Only England's junior doctors are walking out as Wales, Scotland and Northern Ireland must strike their own deals.

The health secretary accused organisers of timing the strike - after Easter - to "maximise disruption".

A three-day walkout last month led to 175,000 treatments and appointments cancelled.

Spirits high as rally reaches Westminster

Malu Cursino

Reporting from Whitehall, central London

Watch: Festive mood at Trafalgar Square rally

That was an eventful afternoon.

BMA members have left Trafalgar Square and made their way past Downing Street and Whitehall.

BBC

Even dogs joined their owners while wearing scrubs

The hope for union members is to negotiate a better pay deal with the health secretary, whose absence was brought to the crowds attention many times during the rally.

Some members of the public were also keen to join, clap and make their support for striking doctors clear.

One couple stood next to me during the speeches were surprised when they heard junior doctors’ starting salary is £14 per hour.

Despite widespread frustration among striking doctors, spirits were high and placards could be seen dancing in the air as people bopped along to the music and cheered on those speaking before them.

EPA

'The government needs to sort this out’

Hamish Whiteley

Hamish Whiteley was due for a knee replacement operation on 14 April at Leicester General Hospital. But this has been rescheduled to 19 May, due to both the doctors' strike and because he’s recently had Covid.

Whiteley told BBC News he can only walk 200-300 yards at a time and is in pain.

He’s not able to do his usual trip to the allotment and hasn’t been able to see his grandchildren in case he catches a cold which would postpone the operation.

“The delay is just exasperating - it’s the uncertainty and the fact that you can't plan anything,” he told BBC News.

“I feel very strongly that it’s the government’s job to sort this strike out,” he added.

At the moment, Downing Street say there will be no pay talks with the BMA union unless it abandons its demand of a 35% pay rise and stops striking.

Why are there no strikes in Scotland, Wales and Northern Ireland?

Health is one of the issues dealt with by governments in the nations rather than the UK government at Westminster - so, while junior doctors in England are on strike, junior doctors in Wales, Northern Ireland and Scotland are not.

In Wales, that's because the Welsh Government is in talks with BMA Cymru over pay with the Welsh government, which is the first in the UK to make a commitment to the principle of "pay restoration" to the pre-austerity days of 2008.

In Northern Ireland, the Northern Irish Assembly is still suspended, so no pay negotiations with BMA Northern Ireland can take place.

And in Scotland, a ballot for 72 hours of strike action by BMA Scotland will close on 5 May, after the Scottish government offered a pay rise of 4.5%.

Watch: What to do if you're ill during the strike

The strike by junior doctors in England is scheduled to continue until Friday, but what should you do if you become seriously ill in the meantime? Gareth Roberts from Frimley Park NHS Trust in Surrey gives some advice on where to turn if you need medical help.

Junior doctors: Where to go if you are ill during strike days

How striking junior doctors affects wards

We've been hearing doctors say they have to cover for each other's job during the strike. What does that look like in practice?

A typical cancer ward might have one senior doctor and six junior doctors on a normal day, senior cancer doctor Dr Tom Roques says.

On a strike day, he says that might be three or four consultants instead.

"Most of our junior colleagues spend much of their time looking after the sickest patients in hospital," Dr Roques says, including making plans for patient treatment and discharge.

Consultants covering juniors also won't be able to carry out their normal duties in outpatient clinics, which means outpatient appointments are missed and patients will wait longer to start their urgent treatment.

'Here's my number, so call me, Barclay'

Malu Cursino

Reporting from Trafalgar Square

Reuters

We're now hearing speeches at the BMA rally in Trafalgar Square with plenty of interjections and responses from the noisy crowd.

Union officials are on a big stage speaking to what is now hundreds of junior doctors in Trafalgar Square.

"Full pay restoration," the crowd chants when there is a gap in speaking.

"What choice do you have other than to do what you are doing [striking]... Continue with this level of determination and unity and we will win this dispute," another speaker says to applause.

The mood is also light at times. Because the BMA says that it has yet to receive any pay offer from the government, we're now hearing a parody version of Carly Rae Jepsen hit Call Me Maybe - with BMA reps on the stage adapting the lyrics to implore Health Secretary Steve Barclay to call them.

"Here's our number, so call us, Barclay."

It's met with laughs as the crowd sings along.

'By pretty much every metric the NHS is crumbling'

Gem O'Reilly

Live reporter

Dr James Collins works in Eastbourne, East Sussex, as a registrar and says a lot of doctors are striking because of the lack of ability to provide patients with the care they need.

I interviewed James in March when the doctors were last on strike.

He said: "You have all these staffing problems and then that means that there aren't enough doctors on the ground.

"You can't give the patient care that you feel the nation and everyone, friends, family, everyone deserves."

'By pretty much every metric the NHS is crumbling'

The doctors are off their rocker - patient

Camilla Hill

Another critic of this week's strikes who is personally affected is research neuroscientist Dr Camilla Hill.

The 42-year-old was born with misaligned kneecaps - walking, kneeling, going downstairs and sleeping can all be painful for her.

Her operation has already been postponed once, and she expects it to be postponed again due to the strike action.

She told the BBC she understood if her procedure could not be done safely. But she did not agree with the pay demands of the junior doctors, saying they were “off their rocker”.

“Everyone is feeling the squeeze and there is a limited pot of money,” she said. “Their 35% pay demands are unfeasible and they have to realise they are unfeasible."

'Junior doctors are living in la-la land'

Paul Turnbull

Paul Turnbull, a 61-year-old occupational physician, is due for a procedure to have a 3D-printed prosthetic thigh bone implanted.

The operation has already been postponed twice - firstly due to a medical issue and then again because of last month’s doctors’ strike.

Explaining his objection to the strike, he tells us: “The welfare of patients is first and foremost.

“Junior doctors are living in la-la land if they think they are going to get a 35% pay rise, and I don’t believe they are badly paid compared to people in other professions and the general population.”