Vital Q&A as 10,000 ambulance staff and 100,000 NHS nurses prepare to walk out over December 

More than 10,000 ambulance workers will walk out on December 21 and 28 at nine NHS trusts in England and Wales in the latest strike to hit the Christmas period, the GMB union has announced. 

The strike will see paramedics, emergency care assistants, call handlers and other staff walk out in the ongoing dispute over pay.

Unions Unite and Unison have also said their ambulance workers will walk out on December 21 as the NHS could be brought to a standstill in the days before Christmas.  

Nurses, porters, healthcare assistants, cleaners and other NHS workers at Liverpool Heart and Chest Hospital and Liverpool University Hospital will also take industrial action on the same day, Unison has announced.

One of the unions orchestrating the unprecedented action — the Royal College of Nursing — has already pledged action on December 15 and 20, which will see 100,000 nurses down tools. 

(File Photo) Ambulance workers will walk out on December 21 and 28 in the latest strike this Christmas

The Royal College of Nursing has already announced a strike on December 15 and 20 

This map shows the hospitals where the Royal College of Nursing will hold its first strikes over pay on Thursday 15 and Tuesday 20 December

The Royal College of Nursing is demanding a 19.2 per cent pay increase for its members and says devastating NHS strikes will go ahead unless ministers enter ‘formal pay negotiations’

Which ambulance services will be affected by the strike? 

More than 10,000 ambulance workers will strike in England and Wales on December 21 and 28. 

The GMB ambulance strike will affect: South West Ambulance Service, South East Coast Ambulance Service, North West Ambulance Service, South Central Ambulance Service, North East Ambulance Service, East Midlands Ambulance Service, West Midlands Ambulance Service, Welsh Ambulance Service and Yorkshire Ambulance Service. 

When should I call 999? 

The strike will affect non-life threatening calls only as unions and health bosses insist urgent care will not be affected by any of the strikes this Christmas.

However, the ambulance strike could mean that falls and minor accidents are not responded to by ambulance teams.

When should I call 111?

The NHS recommends calling 111 for general health guidance and advice on illness, and for urgent healthcare that is not life-threatening. 

More patients than usual may be directed to the 111 service as only life-threatening calls will be responded to by ambulance services affected by the strike. 

When will NHS nurses go on strike? 

Around 100,000 nurses are set to walk out in England and Wales on December 15 and 20 as unions seek a pay rise for workers above the level of inflation.

Will hospitals be affected by the nurses’ strike?

Nurses are required by law to maintain a minimum staffing level to keep patients safe.

Therefore, some nurses will be exempt from the strike to provide this minimum level of service.

The exact numbers remaining on the job will be negotiated locally between the RCN and each NHS Trust/Board.

What will the level of care be?

The RCN handbook says nursing provision during the strike should be equal to the skeleton staffing for Christmas Day, although the NHS says it has well-tested procedures to limit disruption.

Which nurses will remain in post?

Emergency nurses in A&E and intensive care will keep working, as will district nurses who help elderly people in the community. Other exemptions will be negotiated at a local level.

Rachel Harrison, GMB National Secretary, said of the ambulance worker strikes: ‘After twelve years of Conservative cuts to the service and their pay packets, NHS staff have had enough.

‘The last thing they want to do is take strike action, but the government has left them with no choice.

‘Steve Barclay needs to listen and engage with us about pay. If he can’t talk to us about this most basic workforce issue, what on earth is the Health Secretary for?

‘The Government could stop this strike in a heartbeat – but they need to wake up and start negotiating on pay.’

Unison is also set to ballot 10,000 hospital and ambulance staff at 10 NHS trust on strikes once again after a recent vote fell short of the legally-required threshold. 

The trusts being balloted include all the remaining ambulance services in England and Wales. 

Sara Gorton, Unison’s head of health, said: ‘The government will only have itself to blame if there are strikes in the NHS before Christmas.

‘Ambulance staff and their health colleagues don’t want to inconvenience anyone. But ministers are refusing to do the one thing that could prevent disruption – that’s start genuine talks about pay.

‘Wages are too low to stop health workers quitting the NHS. As more and more hand in their notice, there are fewer staff left to care for patients. The public knows that’s the reason behind lengthy waits at A&E, growing ambulance delays, postponed operations and cancelled clinics.

‘Threatened NHS strikes in Scotland were called off because ministers there understand higher wages and improved staffing levels go hand in hand. Unfortunately, the penny’s yet to drop for the Westminster government.’

Senior insiders last week warned that fears the NHS will suffer its worst ever winter are ‘fast becoming reality’. 

Bosses have promised hospital trusts will do all they can to mitigate risks to patients during walk-outs, which could rumble on until May.

But NHS England chief executive Amanda Pritchard has warned that some ops and diagnostic scans will inevitably have to be cancelled. 

Chemotherapy and kidney dialysis could also be postponed. Emergency care won’t be disrupted, bosses have insisted. Senior NHS sources still fear lives will be put at risk, however.

Unions have been discussing co-ordinating NHS strikes for weeks, saying action has to be ‘effective’ or it’s pointless.

Six — including the RCN, GMB, Unite and Unison — were dragged in for talks with the Health Secretary Steve Barclay last month.

No deal was struck during the behind-closed-doors discussions, however.

At the time, GMB, Unite and Unison — which represent up to 470,000 medics — had not announced the results of their ballot.

All three last week confirmed that members have voted to strike in the coming weeks.

Six unions — including the RCN, GMB, Unite and Unison — were dragged in for talks with the Health Secretary Steve Barclay (pictured) last month. No deal was struck during the behind-closed-doors discussions, however, with Mr Barclay so far refusing to cave into pay demands

Official figures show 7.1million people in England were in the queue for routine hospital treatment, such as hip and knee operations, by the end of September — the equivalent of one in eight people (red line). The figure includes more than 400,000 people who have been waiting, often in pain, for over one year (yellow bars)

Ambulance performance statistics for October show paramedics took longer to arrive to category one, two and three call outs since records began in 2017. Ambulances took an average of 1 hour, one minute and 19 seconds to respond to category two calls (red bars), such as burns, epilepsy and strokes. This is more than three times as long as the 18 minute target

A Freedom of Information request, submitted by the Liberal Democrats, revealed the postcode lottery patients face when calling 999. The figures cover the year to March 2022

Meanwhile, emergency care performance has deteriorated to fresh lows. More than 1,400 A&E attendees were forced to wait in more than 12 hours for care every day in October (yellow bars), while the lowest proportion ever recorded were seen within four hours — the NHS target (red line)

NHS data shows 539 people with influenza were taking up beds on November 27. The figure is 3.9-times higher than the peak logged across the entire season last winter, when a maximum of 138 flu patients were in hospital. This is despite winter pressures just starting to kick-off and cases expected to rise further

The Guardian reports bosses are now thrashing out plans to coordinate their action, with walk-out dates yet to be announced.

It could see hospitals operate a Christmas Day level of service. 

No10 is desperate for them to reconsider, however, amid fears that action across the health, transport and mail delivery sectors in the weeks ahead will cause more chaos than the infamous ‘winter of discontent’ in the 1970s.

Rishi Sunak’s spokesperson said: ‘We are concerned about the impact strikes by multiple unions will have on the people of this country as we head into the Christmas period.

‘We recognise that these are challenging economic times but public sector pay awards must be affordable for the taxpayer.’  

Mr Barclay has so far refused to cave into pay demands, which amount to up to 19.2 per cent for the RCN. 

If ministers agreed to the inflation-busting raise in order to avert more winter chaos, it would see the average nurse’s pay go from £35,600 to £42,400.

Ministers have insisted that their offer of four per cent, of £1,400, is enough.

Labour’s Shadow Health Secretary Wes Streeting last week admitted that his party also wouldn’t be able to meet the pay uplift demand. However, he said he would negotiate with the unions. 

One NHS official told The Guardian that the ambulance strikes would present ‘the biggest challenge’.

The disruption would hit the already crippled ambulance service and may make it impossible to respond quickly to emergencies. 

Demand on the service is also uncontrollable — unlike hospital care, where bosses are able to cancel elective care to ease some pressure. 

Britain’s last nationwide strike involving paramedics took place in the winter of 1989 to 1990, and the Government was forced to call upon the Army, police and volunteer drivers.

Armed Forces personnel could again drive ambulances under emergency plans to keep the service running.

No formal request for help has been made by the Department of Health and Social Care to the Ministry of Defence, however.

It comes after shock ambulance data released last week showed the dire state of the service.

Handover delays are at an all-time high, with more than 11,000 paramedic crews spending at least one hour waiting outside of hospitals before they could hand over their patient to emergency departments last week.

And one in three patients taken to hospital in an ambulance last week waited at least 30 minutes, instead of the 15-minute target, to be handed over to A&E. 

Meanwhile, patients with life-threatening illnesses or injuries are waiting up to one hour and 40 minutes, on average, for ambulances to arrive in the worst-hit part of England — more than five times longer than NHS targets. 

And one 85-year-old who fell and broke her hip was forced to wait 40 hours to be seen by hospital doctors after calling 999. 

The NHS blames the pressure on its record 133,000 vacancies in England and one in seven hospital beds last week being taken by patients fit for discharge due to the social care crisis.

Dr Adrian Boyle, Royal College of Emergency Medicine president, told BBC Radio 4’s Today programme: ‘Last week we recorded an excess mortality across all of the UK of about 900 extra people. 

‘There are lots of causes of this, but we think that problems with urgent and emergency care is probably contributing to about a quarter of this.’ 

Professor Sir Stephen Powis, NHS national medical director, said the figures show the NHS is facing ‘a perfect storm’.

‘We have already said we expect this to be the NHS’s most challenging winter yet,’ he said.

Rishi Sunak said he would meet the NHS ‘relatively soon’ to ensure plans to cut ambulance waits have a ‘real impact’.