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Senior health leaders have raised concerns about the care of cancer patients during the impending nurses’ strikes – including warnings that some chemotherapy appointments are being rescheduled.

In a letter seen by Sky News political editor Beth Rigby, the head of cancer care for NHS England, Dame Cally Palmer, called on Royal College of Nursing (RCN) union boss Pat Cullen to protect “life-saving” and “urgent” cancer surgery from walkouts, which begin on Thursday.

In another letter obtained by the Times, chief nursing officer for England, Dame Ruth May, says chemotherapy appointments are being rescheduled, and asked for assurances about the care of dying patients during the strikes in England, Wales and Northern Ireland on 15 and 20 December.

Chief Nursing Officer for England, Dame Ruth May
Image:
Chief nursing officer for England, Dame Ruth May

Dame Cally said she was “extremely concerned about the absence of national derogation for urgent cancer surgery”.

A derogation is an exemption, either of an individual or a whole service, from taking part in strike action.

She went on: “I understand how enormously difficult these issues are for all concerned, but our common aim is to ensure we do not cause harm to people undergoing vital cancer treatment to achieve cure or extension of life.

“It’s important there is a clear and consistent decision on urgent cancer in line with the national derogation for chemotherapy and critical care.”

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The RCN insists there will be a derogation for emergency cancer services, as well as for mental health and learning disability and autism services, and said the public was behind its action.

“The public backs our campaign and knows that patients need a strong nursing workforce, but at the moment there are record losses jeopardising safe care,” the union said.

Dame Cally said the strikes were likely to lead to cancelled operations for cancer patients in P1 and P2 categories.

In her letter, she explained P1 surgery “is life-saving, and time critical, and must be maintained”, while P2 is “urgent cancer surgery which has an optimal time window”.

She said rescheduling procedures “is likely to lead to delayed operations and poorer outcomes” and many of these patients will move into the P1 category, requiring life-saving procedures as a result of re-scheduling.

Read more:
Strikes every day before Christmas – which sectors are affected and why

The RCN, however, insisted cancer patients would get emergency and clinically urgent surgery, and in its response to the letter assured that was “not in doubt”.

A spokesperson for the union added: “This is a politically-motivated smear from a government that is failing cancer patients.”

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In their correspondence, the chief nursing officer for England, and her counterparts in Scotland, Wales and Northern Ireland, wrote to Ms Cullen raising a series of concerns about patient safety.

“Many chief nurses/directors of nursing are, of course, RCN members themselves and some have expressed feelings of having been let down by the RCN,” they wrote.

The chief nursing officers said chemotherapy is being rescheduled from the strike days at some hospitals despite the union agreeing it would be exempt nationally.

They wrote that “there are examples of some trusts being asked to submit derogation forms for chemotherapy and organisations now preparing to reschedule chemotherapy from 15th and 20th December”.

The chief nurses also asked for assurances that community nursing services providing “end of life care and good pain and symptom relief” continue in order to “alleviate unnecessary distress” for palliative patients and their families.

The RCN said on Tuesday it had agreed further exemptions to the strike action, including emergency cancer services and “front-door” urgent care assessment and admission units for paediatric-only A&E departments.

“This letter is already out of date, as we have met senior clinicians today and agreed key points. The safety of patients is everybody’s top concern,” the union’s spokesperson said.

The heated letters exchange came at a time when a new report shows the NHS is treating fewer patients than it was pre-pandemic despite more funding and staff – suggesting a long-term COVID impact on the health service’s performance.

The Institute for Fiscal Studies has said the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments and 11% fewer elective and maternity admissions in the latest month of data than it did in the same period in 2019, according to the IFS.

Health Secretary Steve Barclay in Westminster, London, ahead of his meeting with Pat Cullen, the head of the Royal College of Nurses (RCN), as he tries to avert strike action. Nurses have voted to strike in the majority of NHS employers in a row over pay, the first UK-wide strike action in its 106-year history. Picture date: Thursday November 10, 2022.
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Health Secretary Steve Barclay

Why did talks break down?

Talks between the unions and the government to try to avert strike action broke down on Monday, after Health Secretary Steve Barclay was accused of refusing to negotiate on pay.

The union is demanding a pay rise of 5% above the RPI rate of inflation, which was 14.2% in October, but Ms Cullen has hinted that she could compromise if the government negotiates on pay.

Ministers have repeatedly insisted they can’t afford to give inflation-busting pay rises and say they have accepted the independent pay review body’s recommendation of a £1,400 rise.

Meanwhile, members of the Rail, Maritime and Transport union (RMT) began the first of two 48-hour strikes at Network Rail – and 14 train companies – on Tuesday which will last until Friday.

The strikes come at a time of planned industrial action in a whole number of UK spheres, including healthcare – with paramedics also planning to walkout – postal workers, Border Force agents, firefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.

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UK weather: Scottish hamlet reaches -18C in coldest January night in 15 years

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UK weather: Scottish hamlet reaches -18C in coldest January night in 15 years

Temperatures in a hamlet in northern Scotland fell to -18.7C (-1.66F) overnight – the UK’s coldest January night in 15 years, the Met Office has said.

Altnaharra, in the northern region of the Highlands, reached the lowest temperature while nearby Kinbrace reached -17.9C (-0.22F).

It is the coldest January overnight temperature since 2010, when temperatures dropped below -15C several times at locations across the UK, including -22.3C (-8.14F) on 8 January in Altnaharra.

Forecasters had previously said there was a very small probability it could reach -19C.

A Highland cow grazes in a snow-covered field near Shotts, North Lanarkshire. Temperatures will continue to fall over the coming days, with the mercury potentially reaching minus 20C in northern parts of the UK on Friday night. Weather warnings for ice are in place across the majority of Wales and Northern Ireland, as well as large parts of the east of England. Picture date: Friday January 10, 2025.
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A Highland cow grazing near Shotts, North Lanarkshire. Pic: PA

Met Office meteorologist Alex Deakin said: “Friday night into Saturday morning may well be the nadir of this current cold spell.”

Temperatures for large parts of the UK are set to fall again as the cold weather continues.

St Andrew's church, Kiln Pit in Durham Pic: PA
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St Andrew’s church at Kiln Pit in Durham. Pic: PA

Met Office meteorologist Zoe Hutin said: “We’ve still got tonight to come, and tomorrow (Saturday) night could also be chilly as well.

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“Temperatures for tomorrow night, it will be mainly eastern parts that see temperatures dropping widely below freezing, so East Anglia, the northeast of England, northern and eastern Scotland as well.

“So another chilly night to come on Saturday, but then as we go into Sunday and into Monday, then we can start to expect temperatures to recover somewhat.

“I won’t rule out the risk of seeing something around or just below freezing again on Sunday night into Monday, but it won’t be quite so dramatic as the temperatures that we’re going to experience as we go overnight tonight.”

Ugo Sassi from Cambridge skates on a frozen flooded field in Upware, Cambridgeshire. The Cambridgeshire Fens were the birthplace of British speed skating and require four nights of frost, with a temperature of -4 or colder and little or no thawing during the days in between, to make ice strong enough to skate on. Temperatures will continue to fall over the coming days, with the mercury potentially reaching minus 20C in northern parts of the UK on Friday night. Weather warnings for ice are in pla
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Skating on a frozen flooded field in Upware, Cambridgeshire. Pic: PA

On Monday, temperatures are expected to be more in line with the seasonal norm, at about 7C to 8C.

A family walk across Hothfield Common in frosty conditions near Ashford in Kent.
Pic: PA
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A family walk across Hothfield Common in frosty conditions near Ashford in Kent. Pic: PA

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The freezing conditions have led to travel disruption, with Manchester Airport closing both its runways on Thursday morning because of “significant levels of snow”. They were later reopened.

Transport for Wales closed some railway lines because of damage to tracks.

Hundreds of schools in Scotland and about 90 in Wales were shut on Thursday.

Meanwhile, staff and customers at a pub thought to be Britain’s highest were finally able to leave on Thursday after being snowed in.

The Tan Hill Inn in Richmond, North Yorkshire, is 1,732 feet (528m) above sea level.

Six staff and 23 visitors were stuck, the pub said on Facebook.

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Government contract ends for controversial asylum barge Bibby Stockholm

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Government contract ends for controversial asylum barge Bibby Stockholm

The government contract for the controversial asylum barge in Dorset has ended.

The last asylum seekers are believed to have left Bibby Stockholm at the end of November after Labour said it would have cost more than £20m to run in 2025.

Its closure this month was expected, and on Friday the management firm and the Home Office confirmed to Sky News the contract had now expired.

It’s currently unclear when Bibby Stockholm will leave Portland and what it will be used for next.

The Conservative government started using the vessel in August 2023.

It said putting nearly 500 men on board while they waited for an asylum decision was cheaper than paying for hotel rooms.

However, it was controversial from the start and sparked legal challenges and protests.

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August: 2023: Barge reminds migrant of Islamic State

Days after the first group boarded there was an outbreak of Legionella bacteria in the water system and it had to be evacuated for two months.

In December 2023, an Albanian asylum seeker, Leonard Farruku, died on board.

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A Home Office spokesperson said the government was determined to reform the asylum system to make it operate “swiftly, firmly and fairly”.

“This includes our accommodation sites, as we continue to identify a range of options to reduce the use of hotels,” the new statement added.

“We are already closing some hotels and will continue to engage with local authorities and key stakeholders as part of this process.”

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How is your local NHS coping under winter pressures?

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How is your local NHS coping under winter pressures?

Pressure on hospitals is particularly high this winter, with more than a dozen declaring critical incidents in recent days.

Hospitals struggle every winter with additional pressures due to the impact of cold weather, but the early arrival of flu this season and high volume of cases meant Christmas and New Year’s weeks were even busier than usual.

There are currently at least 20 hospitals that have declared critical incidents in England, although this is a fast-moving picture, and some trusts will go into critical incident for as little as half an hour.

The latest NHS winter situation reports give a more detailed look at the level of pressure experienced by individual trusts, including those with the worst ambulance handover delays and highest levels of flu patients.

Ambulance handover delays

When a patient arrives at a hospital in an ambulance, clinical guidelines suggest that it should take no longer than 15 minutes to transfer them into emergency care.

It is now common for handovers to regularly exceed this timeframe, however, when emergency departments are overcrowded and lack the capacity to keep up with new patient arrivals.

This is risky for patients because it delays their assessment and treatment by clinicians, and also reduces the availability of ambulances to respond to new incidents.

The trust with the longest delays was University Hospitals Plymouth, with an average handover time of three hours and 33 minutes over the week – two hours and 40 minutes longer than the average for England. It also recorded the longest average handover times for a single day, at five hours and 14 minutes on New Year’s Day.

Use the table below to search for local ambulance handover times:

On 7 January, University Hospitals Plymouth declared a critical incident at Derriford Hospital due to “significant and rising demand for hospital care”, though this has since been stood down.

The Shrewsbury and Telford Hospital Trust had an average ambulance handover time of three hours and 15 minutes, increasing by more than an hour from one hour and 51 minutes the week before.

In Royal Cornwall Hospitals NHS Trust, 83% of handovers took more than 30 minutes, the highest share among areas dealing with more than five ambulance arrivals per day.

This area also recently declared and then stood down a critical incident.

In total across England, 43 trusts out of 127 had average handover times of more than an hour, while nine areas had average handover times of more than two hours.

Flu

This winter’s flu wave arrived earlier than usual and has hit health services hard.

Over New Year’s week, there were 5,407 flu patients in hospitals in England on average each day, more than three times higher than during the same week last year and increasing by 20% from the week before.

The worst impacted trusts were Northumbria Healthcare and University Hospitals Birmingham, with 15% and 13% of all available beds occupied by flu patients respectively in the latest week.

Wirral University Teaching Hospital NHS Foundation Trust had among the biggest increase in flu patients from the previous week, more than doubling from 18 to 42 patients per day on average.

Use the table below to search for local flu hospitalisations:

There are some indications that flu activity may have now peaked, with national flu surveillance showing a decrease in positive flu tests in the latest week, though activity remains at high levels.

Bed occupancy

Current NHS guidance is that a maximum of 92% of hospital beds should be occupied to reduce negative risks associated with overfilled beds.

These risks include the impact on patient flow resulting from it being more difficult to find beds for patients, and negative impacts on performance and waiting times, as well as being linked to increased infection rates.

In the week to 5 January, 92.8% of 102,546 open hospital beds were available each day on average, not far off the recommended level.

However, bed occupancy was very high in some trusts, with more than 95% of beds occupied in 43 trusts on average over the week.

The trust with the highest rate of bed occupancy was Wye Valley NHS Trust, with 99.9% of 332 beds occupied on average throughout the week.

There was only one day when beds weren’t fully occupied, on 3 January, when two beds of 322 were available.

Use the table below to search for local bed occupancy:

Kettering General Hospital NHS Trust recorded bed occupancy of 98.5% over the week. This trust declared a critical incident on 8 January.

Part of the problem for bed availability is prolonged hospital stays – also known as bed-blocking.

This is often linked to pressures in other parts of the health and social care system, for example when patients can’t be discharged to appropriate social care providers even though they are ready to leave hospital.

Just under half of beds occupied by patients in English hospitals last week were occupied by long-stay patients who had been there for seven or more days.

In seven trusts, at least three in five beds were occupied by long-stay patients, while in Barking, Havering and Redbridge University Hospitals NHS Trust the figure was more than four in five beds.


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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