PA reports that Unison members set up the official picket line outside the London Ambulance Service HQ in Waterloo, London, just ahead of the walkout, which starts at midday.

Members are waving flags and horns are honking in support as they drive past the picket line, which is flanked by a large group of reporters.

The group has hung up banners reading “Support the ambulance workers” and “Unison ambulance workers, together we rise”.

The Guardian’s defence editor Dan Sabbagh has the detail on the role of the armed forces in the ambulance workers’ strike today:

Six hundred armed forces personnel, dressed in military uniform, will be paired with paramedics across England to cover for striking ambulance workers on Wednesday.

Officials said the military, from all three services, will not be involved in medical care - but are on hand to drive ambulances and the pairing is intended to allow them to free up paramedics so they can treat patients in response to emergency calls.

The troops will be able to turn on an ambulance’s blue light if they are driving the vehicle. But, defence sources said that unlike fully trained ambulance staff, they will have to fully respect the rules of the road - meaning “they are not allowed to run red traffic lights” if they are driving the vehicle, whatever the nature of the medical emergency.

A further 150 military will help with logistics on Wednesday, the Ministry of Defence said, while the extra drivers will be deployed within the following NHS organisations: the London Ambulance Service, North West Ambulance Service, South East Coast Ambulance Service, Yorkshire Ambulance Service and North East Ambulance Service. 

The Guardian’s Steven Morris has been out speaking to striking ambulance staff in Wales. He reports:

Striking ambulance staff on the picket line outside their base in Pontprennau, Cardiff, described their agony at making the decision to strike but said they felt they had no choice.

John Harris, 53, an advanced emergency medical technician who has been in the service for 21 years, said:

 

I have massively wrestled with my conscience to do this. To withdraw our service from the public is a huge challenge for any one of us. But at the moment we’re not able to provide a proper service.

When you have patients waiting on the floor for 26, 28, 30 hours, that is not a service. We shouldn’t have patients dying in front of A&E because we can’t get them through the front door.

The day before yesterday I went to a patient with a fractured hip after a fall who had been waiting 28 hours by the time we got to him. That’s absolutely wrong.

We’re haemorrhaging staff at an alarming rate, experienced staff. When an ambulance technician on band four can earn more in Tesco than he can on an ambulance, working shifts, making life or death decisions that is not a sustainable future.

Our burnout rate is through the roof. More and more staff physically can’t do the job. Not just frontline staff but control room staff who have relentless amounts of calls come in and are constantly having to tell people: ‘I’m sorry, you’re going to have to wait another four hours, eight hours.

We should be paid more but it is also about saving the NHS because we are beyond breaking point. The NHS is collapsing around our ears and it is unsafe for patients. People need to support us to help save the NHS.

People are looking for out. I’m actively looking for something else. I came into this job to be here until 60. It was my dream job. I still love the job, I love to pull my uniform on but it’s not sustainable.

Ian James, an emergency medical technician who has worked for the ambulance service for 30 years and is on strike for the first time, said: 

It was a very difficult decision but we’ve had 10 years of deterioration, of seeing massive reductions. We are the poor relations in the NHS and in the emergency services.

Dominic Hardware, 34, who has spent three years as an emergency medical technician, said:

I felt there was nothing else I could do but go on strike. We’re not responding to emergencies, not assisting the general public, not able to do the job properly.

He said a typical shift was helping between one and three patients because of delays at A&E and around twice a month a whole 12 hour shift could be spent outside a hospital. 

PA has an interview with Harry Maskers, a 34 year-old former Royal Marine who now works as an emergency medical technician for the Welsh ambulance service, who said he earns less as a paramedic than he did when he worked in a call centre aged 20.

He said: 

Believe me I experience a lot more trauma in this job.

Doing a job not for the money is all well and good but it doesn’t pay your mortgage, and it doesn’t put food on your kid’s table.

I’m a single dad but I’m fortunate, I have a strong support network and family around me. But I know people a lot worse off who are having to use food banks.

One day you’re saving someone’s life or holding someone’s hands because their son has committed suicide upstairs. The next day you’re going into a food bank because you can’t feed yourself. It’s beyond a joke now and something needs to change.

I’ve made the difficult decision to come into work to strike in civilian clothes. I won’t be responding to critical calls, like many of my colleagues who are doing the same.

All the calls we respond to on a day-to-day basis are critical anyway, so personally I feel that if you come in and do the derogations nothing really changes.

Every shift feels like a strike because most of the time we’re not responding to calls.

We didn’t join to do that and it’s so demoralising for us, and most importantly, regardless of what we’re feeling, there’s a patient on the back of the ambulance who potentially has waited up to 30 hours or more for us to come.

Then they will have to wait an insane amount of hours outside hospital, only to be let in and have to wait x amount of hours to see a doctor or a nurse because they’re also chronically understaffed and stressed.

The back of an ambulance is no place to toilet someone, to wash someone, to comfort someone in distress.

I feel like unless I take action this pattern will continue. 

A paramedic based in Nottinghamshire has said patients’ lives have been at risk “longer than these strikes were even considered”.

Tom, 33, who did not want to provide his last name, has been a paramedic with East Midlands ambulance service for five years and said he would be striking if he was on duty.

He told PA: 

I’ve attended elderly patients who have been on the floor with broken hips for over 20 hours. They’ve been waiting that long that their limbs have started to become necrotic (dying tissue), resulting in major surgery to remove said limbs.

In 14 hours I saw and attended one patient of my own and did not have a break … And there were, at one point, 11 ambulances stuck at (the) hospital unable to be freed back onto the road.

The conditions we work in on a regular basis don’t enable us to do the job we want to do to its full capacity and is putting patients’ lives at risk long before strikes were even considered…. We regularly go 12, 13, 14, 15, 16 hours without a break or even so much as a brew or any warm food, or food at all, due to these delays.

The ambulance service striking is one that has very little bearing on the grand scheme of things but hopefully has a big influence on highlighting the already failing NHS we so desperately need to treasure and invest in. 

The Guardian’s Scotland editor, Severin Carrell, has the latest on a proposed pay deal for midwives in Scotland:

Midwives in Scotland could take strike action after members of the Royal College of Midwives “resoundingly” rejected a revised pay offer from ministers in Edinburgh.

The RCM said 65% of its members voted against accepting the pay offer, since it did not significantly improve the take home pay of most members.

The RCM’s board will now decide whether to take industrial action, which was suspended last month after ministers upgraded their pay offer, in an effort to force the Scottish government to revise the offer again.

The Royal College of Nurses in Scotland is due to announce within hours whether its members have accepted the revised offer. It too suspended strikes in Scottish hospitals to allow its members to consider the upgraded offer.

Earlier this month, Unison and Unite called off strike action after members accepted the revised offer, which gave the lowest-paid staff up to £2,751, up by 11.24%, with most staff paid £2,205, up 7.5%, and a new minimum hourly rate of £11.09. The highest paid saw their wages rise by around 2%.

Jaki Lambert, RCM director for Scotland, said: “Our members have spoken loud and clear – the latest pay offer by the Scottish government is simply not good enough. It goes nowhere near addressing the rising cost of living and would see many midwives actually worse off in real terms.”

Related: Health unions call off strike action in Scotland after new pay offer 

Here’s an update from the Guardian’s Scotland editor Severin Carrell on the pay offer for Scottish nurses:

Scottish nurses have overwhelmingly rejected a “best and final” pay offer from Scottish ministers and are threatening to stage national strike action unless a fresh, better offer is tabled.

The Royal College of Nursing in Scotland said 82% of its members who voted had declined the offer. It said they would now start preparing for strike action in Scottish hospitals, announcing the dates for strikes early in the new year.

The Scottish NHS now faces a wave of strikes in hospitals, community services and amongst ambulance crews.

Earlier on Wednesday the Royal College of Midwives in Scotland said its members had also rejected the upgraded offer, by 65%, and would now consider how and when it will take industrial action. The GMB Scotland, which also covers parademics, announced on 15 December its members had refused to accept the deal.

Julie Lamberth, the board chair of RCN Scotland, said: 

It was the right thing to ask our members whether to accept or reject this offer. It directly affects their lives and each eligible member needed to be given the chance to have their say. And the result could not be clearer – we have forcefully rejected what the Scottish government said is its ‘best and final’ offer.

Make no mistake - we do not want to go on strike. Years of being undervalued and understaffed have left us feeling we have been left with no option because enough is enough. The ball is in the Scottish government’s court if strike action is going to be avoided. 

Stuart Fegan, of the GMB, said the South East Coast ambulance service (Secamb) had warned striking workers not to talk to the media on picket lines about the industrial action.

Speaking to the PA news agency from Walton fire station in Walton-on-Thames, Surrey, he said:

 

Many of our members do not feel they are able to do that partly because they’ve been put off by Secamb themselves, but obviously they don’t want to be here in the first place.

It’s wrong in the sense that everyone knows there was a strike planned for this day, that has to be notified to Secamb in advance.

Obviously it’s the members, the people that work for Secamb, that actually decided to take that action, so I think it’s only right and proper that they should be able to explain those reasons to the public.

PA has approached Secamb for comment. 

A small picket line has formed at the Ashford Make Ready Centre in Kent as South East Coast ambulance service ambulance workers strike over pay and conditions.

One senior health adviser for the local 111 service, who did not want to be named, said: 

We’re under increased pressure but there were twice as many calls waiting on Sunday, a non strike day, as there have been today.

From a staff point of view, the pressure is constantly on – it never used to be like this, it’s because of a lack of staff.

An ambulance worker on the picket line who also did not want to be named said: 

We’re making sure staff in the NHS get a fair day’s pay for a fair day’s work.

It’s so busy, it’s excruciating and it’s not fair on the patients.

We’re busy now because of Strep A, 111 is inundated and the people that are suffering are the patients.

Almost all of the ambulance trusts in England are so disrupted that patients may risk harm.

PA reports that the majority have declared so-called critical incidents, with many trusts stating that they were facing huge pressure before strikes began on Wednesday.

Thousands of ambulance workers and paramedics are involved in industrial action in a dispute over pay and conditions.

A critical incident is defined by the NHS as “any localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe requiring special measures and support from other agencies, to restore normal operating functions”.

Declaring a critical incident on Monday, East of England ambulance service said NHS services in that region were under “huge pressure as a consequence of 999 call volumes and hospital handover delays”.

The service said declaring a critical incident would allow it to “ensure our resources are focused on patients with the greatest need, as well as allow us to access wider support from our health and care partners”.

Yorkshire ambulance service said it had declared its incident on Tuesday as a result of “significant demand pressures impacting on its ability to respond safely to patients”.

South Central ambulance service said on Tuesday it was under “extreme pressure which escalated over the weekend and has continued into this week”.

It said the industrial action planned this month “may add further pressure”.

There are 10 individual NHS ambulance trusts in England. Critical incidents have been declared at:

A London ambulance service spokesperson said it declared a “business continuity incident” due to the “high demand across our 999 and 111 services”.

They added:

 

In recent days, we have been taking up to 7,000 999 calls every day compared to a pre-pandemic busy day of 5,500 calls.

We are doing everything we can to prioritise our sickest and most severely injured patients and would like to remind the public that if they need urgent medical advice that does not require an emergency ambulance to go to NHS111 online or call 111 for advice and support.

Neither East Midlands nor West Midlands ambulance services had declared critical incidents by 10am on Wednesday. 

In one Welsh ambulance service depot, all striking members have had to be called away from the picket line on emergency calls, the GMB union’s South West and Wales representative claims.

Nathan Holman tweeted a video of himself alone at Pentwyn service station in Cardiff just before 8am on Wednesday – less than an hour into the day-long walkout. 

I’m standing here on the picket line outside Pentwyn ambulance station. Unfortunately, all the members have had to go because, as you can see behind me, there’s only one vehicle left, they’ve all jumped on a vehicle and responded to emergency calls. So, just shows we’re still responding to the public.

Around 1,500 ambulance staff in Wales are expected to take part in Wednesday’s industrial action. Crews are still required to respond to critical 999 calls but, despite this, the service is expected to be “significantly impacted”, according to the Welsh government. 

Stuart Fegan, of the GMB union, has called on Rishi Sunak to “listen to the public” and to some senior ministers in his own government.

Speaking at the Walton fire station picket line, he told the PA news agency: 

We are here to support our members striking (for the) first day of industrial action that we’ve seen in a generation of our ambulance service.

“It’s fair to say that none of our members want to be here this morning. They’re here because they feel they have to be based on the fact that the NHS is being run down in terms of the quality of care that’s provided to the public.

These people deserve a pay rise that meets the cost of living (crisis) that we’re currently experiencing. Get back around the table with the trade unions and settle this dispute.

Rachel Hall here taking over from Kevin Rawlinson – if there’s anything we’ve missed, or you have photos and observations to share from the picket lines, do drop me an email atThis email address is being protected from spambots. You need JavaScript enabled to view it.. 

Student paramedic Sam Catcliffe has said that one reason for the ambulance workers’ strike was the toll that long queues for ambulances takes on staff and patients.

The NHS worker, speaking at a picket line outside a West Midlands ambulance service site in Coventry, told PA: 

It’s getting worse and worse by the day.

It’s never nice going to someone who has been waiting five, six, seven or 10 hours for an ambulance.

We would like to get there as soon as we can ideally.

We needed to take action to get our voice and point across. Hopefully something gets resolved from it. 

GMB’s senior organiser for south London and Surrey, who joined the picket line in Walton-on-Thames, has said the public support for the strike is “absolutely overwhelming”. Stuart Fegan, 46, from Frimley, was speaking as horns honked in support in the background. 

I’ve been an official for the GMB for 25 years and I’ve never actually seen this level of public support for a group of striking workers. It just goes to show what high regard all our uniformed services are held in by the public.

We’ve got members of the public dropping off food for our striking members and you can hear the cars honking their horns as they drive past. We know from the polls that public support for this strike is overwhelming. 

GMB members at a picket line outside Walton fire station in Walton-on-Thames, in Surrey, are waving flags and holding signs reading “Save the NHS” and “1 in 3 paramedics seen deaths from delays”.

Vehicles have been honking their horns as they drive past, including a fire engine. A Royal Mail van also pulled up and handed the workers pork pies. Marks & Spencer have donated the group a basket full or food, while staff at the neighbouring fire station dropped off alcohol-free beers. 

The Unite union is prepared to meet the government for pay negotiations “any time, any place, anywhere”, Graham says. 

They need to discuss what they are doing in terms of the NHS for the long term. It needs more investment. They are the people at the helm. This is happening on their watch.

Pointing out that those on the picket line served the public throughout the pandemic, when many workers across key sectors had lost their lives, Graham adds: 

They went out when Covid was rife – nobody knew there was going to be a vaccine. Now that crisis is over, those exact same workers have been treated like dirt.

That is what happens in our society now. Every day, people go out and deal with a crisis, they do all the donkey work and then when they come back and they’ve dealt with it, they are the ones who have to pay for it. This economy is broken and it needs to be looked at very differently. 

So far, half of ambulance crews in Wales have worked normally. A quarter are on complete strike. The final quarter are responding only to red and some of the most serious amber 1 call-outs.

At first light at Pontprennau ambulance station in Cardiff, there were around 10 ambulances in the car park. By 9am, all but three had gone out on emergency calls.

But, speaking outside an ambulance station in Cardiff, the chief executive of the service in Wales Jason Killens warned patients with less serious conditions faced long delays – or no response at all. He also said that the dispute would cause knock-on effects tomorrow. 

The issue of pay is clearly a matter for government and not something I’m going to get into. In terms of workplace environment, it is difficult and has been for many months, particularly with pressure across health and social care leading to emergency handover delays. Often our people will only see one person a shift. That’s not what they joined for. Our staff are deeply frustrated.

He said it had been hard for staff to take the decision to strike: 

These are difficult choices for our clinicians and control room staff to make. Many are deeply conflicted about what to do. My message to them is that you must do what you believe to be right.

Killens said the service had spoken to the military about getting support but said: 

The trade unions were clear they would not support staff working alongside someone from the MoD on this occasion.

Holman, a GMB officer who spent 25 years working as a paramedic, said: 

Taking industrial action is a big decision. We don’t want people injured but on a daily basis people are losing their lives because the NHS is not funded correctly. We’ve got to draw a line.

Medics do not want to strike, we do not want to be here. Ultimately the funding comes from Westminster. I think the Welsh government can do better but ultimately if they are not getting the funding from Westminster they would have to take the money from elsewhere. They need to stop protecting the fat cats and start protecting the people of this country. 

During a visit to an ambulance service hub in Longford, in Coventry, to meet with paramedics on the picket line, Unite’s general secretary Sharon Graham says of the government: 

What they need to do is to get this crisis over – get back around the negotiating table so we can do a deal, these people can go back to work, and we can begin to look at what is happening in our NHS.

People are leaving the NHS to go and work in Tesco and Amazon. There is something drastically wrong with that.

This government can make different choices. They can say that ‘actually, we choose to invest in the people in the NHS’. But they are looking at different choices, because they don’t want this to end. I think they want this crisis to be there.

Barclay denies escalating the dispute by accusing unions of making a “conscious choice” to “inflict harm” on patients. Asked on BBC Breakfast whether his language in the Daily Telegraph was “ramping up this current atmosphere”, he said:

No, it reflects the very different action we’ve seen from these trade unions – the GMB, Unite and Unison – compared to what we saw from the Royal College of Nursing (RCN), where we agreed national exemptions in terms of what would be covered by the RCN, whereas the three unions striking today have refused to work with us on a national level.

On Tuesday, MPs heard that unions and ambulance trusts in most parts of England and Wales have struck deals to ensure “life and limb cover” during the strike. Rachel Harrison, the national secretary of the GMB, told parliament’s health and social care select committee: 

Life and limb cover will be provided. The last thing that our members want to do is put patients in harm’s way … The government has to play their part, they have to come to the table and talk to us. Our members want a resolution to this.

The unions point out that Barclay has refused to engage substantively with their concerns, telling them he will not move from the real-terms pay cut he is offering. 

Following a similar line, the leader of the Unite union Sharon Graham tells LBC that, if the government is advising people not to run or play football in case they end up needing an ambulance, that advice should be provided “365 days a year”. 

There are 130,000 vacancies in the NHS, there’s 3,000 vacancies within the ambulance service.

It’s like, even in normal play, there (is) strike action happening anyway. We are in a crisis in the NHS. If we do not get around the table and start these negotiations and seriously look at how retain and recruit staff, we have got a very serious situation – not for one day, but for 365 days a year.

Asked whether she would consider coordinated industrial action, possibly with the RMT or other unions, Graham says: 

Well, obviously, it depends on whether we have the same members in the same industry. So of course, the point I’m making… these are political disputes, these disputes are industrial disputes about pay, and that’s very important. 

The health system is crumbling under the leadership of the Conservatives, with record ambulance delays even before an emblem of its decline, Unison’s general secretary Christina McAnea has said.

Asked on LBC radio how concerned listeners should be if they had a road accident, had a fall on a bike or fell off a ladder, she has said:

They should be as concerned today as they are every other day because those are exactly the kind of instances where it’s almost impossible to get an ambulance to go out because ambulances are so stretched.

McAnea says there are thousands of staff vacancies and “the NHS, the whole system, is basically crumbling under this government”.

She sys she’s “genuinely shocked” by what Barclay has said about her union’s members, adding that it has been “laid out to him in no uncertain terms all the work that has been getting done for the past few weeks to make sure there were safe contingency plans in place”.

McAnea says it is “utter nonsense” and a “complete and utter lie” to suggest unions have made it almost impossible for the government to make contingency plans. 

I think they’re covering up for the fact that he waited until the day before the strike to even ask us about contingency planning.

The union chief says it’s “entirely likely” strikes will go into the new year, adding that the government should “come clean” with the workforce that they could not provide a safe and reliable service owing to a lack of staff and poor planning. 

About 40 ambulance service staff gathered before dawn to form a picket line outside West Midlands Ambulance Services’ hub in Longford, Coventry. Standing behind a banner reading “Our NHS is under siege”, the workers stressed they were ready to leave the line to respond to emergency callouts when needed.

As passing ambulances sounded their horns in support of the strike action, the Unite union’s representative Steve Thompson said the walkout was about trying to retain and improve services, as well as pay. 

This is about telling them that we are not going to allow it (a deterioration in services) to happen. We are not going to roll over. We want the government to actually wake up and realise that this situation is serious. Unfortunately we are where we are because of political will. 

The health secretary Steve Barclay is “insulting” ambulance workers, the GMB union’s national secretary Rachel Harrison says.

Barclay has accused trade unions of making a “conscious decision” to “inflict harm” on patients in England and Wales by striking (see: 7.33am). Harrison has told the BBC: 

It’s really insulting that the secretary of state has said that. They have not taken the decision to take strike action lightly. They feel they have been forced into this position because year after year the government has failed to listen to them.

Barclay has repeatedly defended his comments this morning.

Asked if there would be harm to patients as a result of the walkout, Harrison said: 

The sad reality is that patients are being harmed every single day, and that’s when we’re not on strike. The Association of Ambulance Chief Executives themselves report that the increasing number of handover delays and waiting times is leading to harm to patients and deaths.

So, that’s happening when we’re not on strike. It’s issues like that which have forced our members into this position.

Powis is also warning people not to get “blind drunk” and risk ending up in an overstretched hospital during the ambulance strike. 

It’s the season of parties, pre-Christmas, so do enjoy yourself. But, obviously, don’t get so drunk that you end up with an unnecessary visit to A&E. That’s good advice at the best of times and certainly today, when we know that services are stretched.

Certainly, today is not the best of days to end up being in an A&E department if you don’t need to be there. If you’ve got yourself blind drunk that doesn’t sound like fun to me.

The ambulance strikes will create a “very difficult day” for the health service, the national medical director of NHS England warns. Prof Sir Stephen Powis has told BBC Radio 4’s Today programme:

 

Today is obviously going to be a very difficult day with the health service. But we’ve been working very closely with the unions to ensure that emergency services for life-threatening conditions are maintained, and that will include stroke and heart attacks.

There are increased clinicians in call centres to ensure that the right response goes out to the right incident.

He said strokes fall into the higher end of category two cases, so clinicians will determine what response is needed and he advised people to dial 999 “as usual” if you have a life-threatening condition. 

Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, said the emergency system has been under “immense pressure” for the last three years, including “the worst we’ve ever seen it” in the last year when it comes to delays handing over patients to A&E. He has told Times Radio: 

Trying to work out the effect of industrial action compared to a system which is already not doing what we want it to do is going to be difficult.

He said A&E departments were expecting people to turn up in different ways during the ambulance strike, adding: 

We’re expecting people with strokes and heart attacks to turn up at the front door. Now, because of the delays this has already been happening quite a lot anyway.

It is the best alternative to calling an ambulance – if you think you can get to hospital in a way that appears safe and efficient, with somebody giving you a lift, that might be a more appropriate thing to do.

He added that “hospitals are full to bursting” and some people would be waiting a long time in A&E. The UK had the “least number of beds of almost any European country” and this was coupled with problems discharging people into social care, he said. 

Asked why he refuses to talk to unions about pay, Barclay claims he does not want to “divert money” from services for patients. Pressed about repeated pleas from union leaders for a conversation to try and resolve the dispute, he tells Sky News: 

We have a process in terms of pay, an independent process, and we’ve accepted the recommendations of that in full.

We’re investing in the NHS, we’re investing in social care, and I don’t want to divert money from those essential services focused on patients to overturn what has been an independent process which has looked at what is affordable to the economy, what is affordable to your viewers at a time of cost-of-living pressure, but also recognising the system is under very severe pressure and we need to get that extra investment into the NHS and into social care.

Despite Barclays claim that he is abiding by an independent review process, it’s important to note that some doubt the extent of their independence, noting that their members are appointed by ministers and are told to take account of the government’s priorities.

Specifically, Barclay has asked them to work within the budget that has already been set. And, while there are doubts that public sector pay awards would be inflationary, ministers insist they are and ask the bodies to take that into account.

Moreover, their recommendations are only that – and there is precedent for ministers overruling them when they want to. In 2014, the then health secretary Jeremy Hunt refused to implement the 1% recommended nominal pay rise – itself a real-terms pay cut. 

Barclay is also doubling-down on offering media pressure as a justification for not overruling the recommendations on NHS pay to offer more. He has told BBC Breakfast the government has accepted the recommendations “in full”, adding:

Indeed, when in the past the government hasn’t always accepted in full the recommendations, on programmes like this, ministers have been criticised for not doing so.

He accepted ministers do not have to accept the recommendations of the pay review bodies. He was told on BBC Radio 4’s Today programme of various examples of the government taking different approaches, including on health pay. 

When we don’t accept in full the recommendations we’re criticised for doing so. On this occasion, we have accepted them in full. 

Speaking to BBC Radio 4’s Today programme, Barclay is doubling down on his refusal to negotiate on pay and told staff struggling now that they should “look forward” to next year’s pay process. 

We’re already three quarters of the way through this year. So, what you’d be saying is, go all the way back retrospectively to April to unpick what has been an independent decision by the pay review body.

But we’re already now under way in terms of next year’s pay review process, the remit letters have gone out.

Obviously that body will then consider the changes in inflation, the other issues that have been raised, all as part of the normal process of looking at next year’s pay, so we should look forward.

Last week, as nurses went on strike, the former chair of the NHS pay review body Jerry Cope said the pay recommendation was out of date. He told BBC Radio 4’s Today programme: 

It took place in February and the world was a rather different place in February and therefore I think some of the evidence they considered was probably out of date by the time it was published. Because the process is very slow, the decision is a bit lagged.

Cope also said this factor offered a possible solution to the government. 

I think [ministers] should ask the pay review body to reconsider what they did last year, and not reopen last year, because I think it’s too late to do that, but actually say I want you to do a very quick turnaround for this year’s recommendations and I want you to take account on anything you might have missed last time round.

He said that could open the way to a higher offer, in a way that “respects the integrity of the pay review body” – although he also accepted that the pay review might decide not to change its recommendation. 

In Wales, emergency ambulance crews are responding to red calls (immediately life-threatening) and “selected” amber 1 calls (urgent but not immediately life-threatening) for conditions including chest pains, stroke, gynaecology emergencies and for serious road accidents. Other Amber 1 calls may be responded to after a remote clinical assessment.

A quarter of Welsh ambulance staff are members of the GMB and the trust said it expected the strike to have a “significant impact” on its ability to respond to 999 calls.

The trust is also worried there is a risk individual staff will elect not to respond even to the most serious of calls and there could also be sympathetic action from staff that are not members of the union. The military are not being brought in to drive ambulances in Wales.

The Welsh health minister, Eluned Morgan, called on people to stock up on first aid kit supplies and limit activities that could cause injuries. 

Ambulances will only be able to respond to the most urgent calls on strike days. Please don’t add extra pressure on services. It’s important to call 999 if you are in immediate danger, but we must all consider very carefully how we use ambulance services on these [strike] days.

She said everyone could help relieve the pressure by stocking up on prescription medications and over the counter remedies for common ailments to reduce the risk of falling ill on strike days and taking extra care during the cold weather to avoid slips, trips and falls, and accidents on the road. 

Some decisions about what will be covered during strikes by ambulance workers will be taken on the day, the health secretary, Steve Barclay, has said, as he acknowledges he has prepared no national contingency plan for the industrial action. He has told Sky News: 

The difficulty with putting contingency measures in place is given the uncertainty as to what exactly is and is not being covered, and the fact that those decisions in some cases will be taken on the day.

Thousands of ambulance workers in England and Wales are beginning a 24-hour strike action over real-terms salary cuts, describing last-minute talks with the government as “pointless” because the health secretary, Steve Barclay, refused to even discuss pay.

Nevertheless, Barclay has used an article in this morning’s edition of the Daily Telegraph to place the blame on the trade unions, accusing them of making a “conscious decision” to “inflict harm” on patients.

We now know that the NHS contingency plans will not cover all 999 calls. Ambulance unions have made a conscious choice to inflict harm on patients.

Union leaders insisted there would still be cover for the most serious calls through a series of local agreements during the strike; the first of two planned industrial actions. Unite’s general secretary, Sharon Graham, said claims many serious calls would receive no response were “misleading” and “at worst deliberately scaremongering” by ministers.

Christina McAnea, the Unison general secretary, said that if there were any deaths during the strike it would “absolutely” be the fault of the government. “They have been totally irresponsible,” she told TalkTV. “It’s completely irresponsible of them to refuse to open any kind of discussions or negotiations with us.”

Earlier, the NHS Confederation and NHS Providers, which collectively represent all NHS organisations, wrote to the prime minister warning they were entering “dangerous territory” and urging him to end to the deadlock.

The members of the three trade unions taking action today – Unison, Unite and the GMB – have been offered nominal pay rises of £1,400 each. These are, in effect, pay cuts because the roughly 4% nominal increase for most staff is far below inflation.

In evidence to the Commons health select committee, the GMB’s national secretary, Rachel Harrison, suggested the government upping its offer to 7.5% would be enough for the union to put to its membership to test if it was enough to end the impasse.

And, as NHS bodies call on the government and unions to work constructively towards an agreement in patients’ interests, Barclay is doubling down on the comments he made in the Telegraph (see: 7.33am).

He was asked: “That’s not conciliatory language, that’s not going to bring the two sides together, that only going to harden the side against you, isn’t it?” The health secretary replied: 

Well, it’s just a reflection on the fact that trade unions have chosen this time for the strike.

Barclay said recent increases in calls to 111 and 999 as a result of flu, Covid and Strep A meant the system is currently under severe pressure.

Ambulance delays were already at their worst levels on record before the strikes, with paramedics and doctors having to work flat-out just to get patients into hospitals.

Many face long waits to be transferred or being told to make their own way to hospital, with the NHS blaming a lack of capacity caused by difficulties in discharging patients into the community or social care. 

In Scotland, the government has already offered 7.5% – a rate that still represents a real-terms pay cut, but that unions have hinted would at least be enough to put to their members.

Asked it he would do similar, Barclay claimed there were “misconceptions” about the deal, telling Sky News its cost is “much more significant” than the nominal 7.5%.

One of the big misconceptions about the deal in Scotland … it wasn’t simply 7.5%. If you add in all the other measures in terms of reducing hours, extra annual leave, changes to the way overtime is addressed, protected learning time, actually the cost of that is much more significant and, as I say, one of the trade unions has rejected that as well. 

Barclay has referred to media pressure, when asked why he would not overrule the pay body’s recommendation, as ministers have done in the past. He has told Sky News: 

When we have done that, you have been the first – I’m sure – to criticise us for not respecting the independence. The difference here is we have accepted those recommendations in full because we recognise the system coming out of the pandemic has been under pressure. 

Matthew Taylor, the chief executive of the NHS Confederation, which represents NHS organisations, told BBC Breakfast he wanted to “encourage our colleagues in the ambulance service in the trade unions to work as cooperatively as they can through today’s industrial action to try to minimise patient harm”. 

These strikes come on top of the fact that we are already in a very challenging situation.

In most parts of the country the ambulance service is well away from meeting its targets for responses to those kind of category 2 cases – so not absolutely urgently, life threatening, but still very important urgent and critical cases.

So, this strike could not be happening at a worse time because of the pressures the NHS faces.

He urged the government and unions to reach an agreement, saying: “We cannot afford to drift into a winter of industrial action.”

Unions have blamed the need to strike on the government’s refusal to even engage with them on pay, while ministers have insisted they will not budge from their offer of a real-terms pay cut and portrayed the action in response as a choice by the unions.