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NHS nurses are striking today in a dispute with the government over pay and patient safety.

Members of the Royal College of Nursing (RCN) will take industrial action on 15 December and 20 December across England, Wales and Northern Ireland for the first time in the union’s 106-year history.

Strikes by ambulance staff and some NHS workers in Scotland were called off after members of two unions voted to accept the Scottish government’s most recent pay deal.

Share your NHS experience – how are the strikes affecting you?

What services will still be provided?

The RCN has provided a list of areas which will be “exempt from the strike action”.

These are chemotherapy, dialysis, paediatric A&E, critical care units such as intensive care and high dependency, and neonatal and paediatric intensive care.

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Other services outside of these “may be reduced” to a Christmas Day or night-duty level.

Following concerns by chief nurses about patient safety, the RCN has confirmed cancer patients will get emergency and clinically urgent surgery on strike days.

Emergency cancer services will be protected – including for those with specific needs due to chemotherapy.

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Protections have also been agreed for mental health and learning disability and autism services as part of an emergency response.

NHS community teams will provide palliative care and clinically urgent interventions, such as insulin – while in-patient areas will see night-duty staffing.

The head of the NHS Confederation said trade unions are committed to maintaining emergency and critical care services, and he was “reasonably confident that we won’t see severe patient harm”.

Matthew Taylor, who speaks for healthcare systems in England, Wales and Northern Ireland, added patients can expect a bank holiday-level of service in hospitals during the industrial action.

What if you need to go to A&E?

“Front-door” urgent care assessment and admission units – including A&E – will see Christmas Day-level staffing.

The NHS says emergency care will continue to be available across the country, and it is “really important” people come forward as normal in an “emergency or in life-threatening cases”.

Paediatric A&E is exempt from the strikes.

Read more:
Health secretary ‘refuses to negotiate on pay’
Nurses ‘working equivalent of one day a week for nothing’

Strikes in the UK – which sectors are affected?

Anyone needing urgent care should use NHS111 online or dial 111 to be assessed, the NHS says.

But if someone is seriously ill or injured and their life is at risk, emergency care should be sought in the normal way by calling 999 or attending A&E.

What if you have a hospital appointment scheduled?

Patients are being advised to attend as planned – unless the NHS provider has contacted them to reschedule.

Even if the hospital trust is affected by strikes, people should attend appointments unless instructed otherwise.

Patients will have been contacted by letter or phone call and offered a new date if their appointment needs to be rescheduled.

Will GP services be available?

Yes – GP services will be running as normal. People should attend their scheduled appointments.

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Govt ‘turns back on nurses’

What services will be directly hit?

There is expected to be widespread disruption to planned care, such as non-emergency operations and outpatient appointments.

Thousands of appointments and operations will need to be rescheduled as they are unlikely to be carried out on the day of action.

Up to 100,000 nurses are estimated to be joining the strike action, which will last for 12 hours on each day.

What other issues have been raised over patient care?

Dame Ruth May, chief nursing officer for England, and her counterparts in Scotland, Wales and Northern Ireland, have written to the RCN general secretary Pat Cullen regarding a series of concerns about safety.

They said chemotherapy is being rescheduled from the strike days at some hospitals – despite the union agreeing it would be exempt nationally.

But an RCN spokesperson said there will be derogation for emergency cancer services, adding: “Cancer patients will get emergency and clinically urgent surgery, it is not in doubt.”

Where will the strikes take place?

Not every hospital in the country will be affected by the strike action – but here is a list of those where strikes are scheduled:

England

East Midlands:
• Kettering General Hospital NHS Foundation Trust
• NHS Nottingham and Nottinghamshire ICB
• Northamptonshire Healthcare NHS Foundation Trust
• Nottingham University Hospitals NHS Trust
• Nottinghamshire Healthcare NHS Foundation Trust

Eastern:
• Cambridge University Hospital NHS Foundation Trust
• Cambridgeshire and Peterborough NHS Foundation Trust
• Cambridgeshire Community Services NHS Trust
• Hertfordshire Community NHS Trust
• NHS Hertfordshire and West Essex ICB
• Royal Papworth Hospital NHS Foundation Trust

London:
• Great Ormond Street Hospital for Children NHS Foundation Trust
• Guys and St Thomas NHS Foundation Trust
• Imperial College Healthcare NHS Trust
• NHS North Central London ICB
• Royal Marsden NHS Foundation Trust

North West:
• Alder Hey Children’s NHS Foundation Trust
• Health Education England
• Liverpool Heart and Chest Hospital NHS Found Trust
• Liverpool University Hospitals NHS Foundation Trust
• Liverpool Women’s NHS Foundation Trust
• Mersey Care NHS Foundation Trust
• The Clatterbridge Cancer Centre NHS Found Trust
• The Walton Centre NHS Foundation Trust

Northern:
• Gateshead Health NHS Foundation Trust
• Northumbria Healthcare NHS Foundation Trust
• The Newcastle Upon Tyne Hospitals NHS Foundation Trust

South East:
• Oxford Health NHS Foundation Trust
• Oxford University Hospitals NHS Foundation Trust
• Royal Berkshire NHS Foundation Trust

South West:
• Devon Partnership NHS Trust
• Gloucestershire Health and Care NHS Foundation Trust
• Gloucestershire Hospitals NHS Foundation Trust
• Great Western Hospitals NHS Foundation Trust
• NHS Bath, North East Somerset, Swindon and Wiltshire ICB (BSW Together)
• NHS Devon ICB (One Devon)
• NHS Gloucestershire ICB (One Gloucestershire)
• North Bristol NHS Trust
• Royal Devon University Healthcare NHS Foundation Trust
• Royal United Hospitals Bath NHS Foundation Trust
• Torbay and South Devon NHS Foundation Trust
• University Hospitals Bristol and Weston NHS Foundation Trust
• University Hospitals Plymouth NHS Trust

West Midlands:
• Birmingham Women’s and Children’s NHS Foundation Trust
• Herefordshire and Worcestershire Health and Care NHS Trust
• NHS Birmingham and Solihull ICB (BSol ICB)
• The Royal Orthopaedic Hospital NHS Foundation Trust
• University Hospitals Birmingham NHS Foundation Trust
• Worcestershire Acute Hospitals NHS Trust

Yorkshire and the Humber:
• Bradford Teaching Hospitals NHS Foundation Trust
• Leeds Community Healthcare NHS Trust
• Yorkshire & Humber NHS England
• The Leeds Teaching Hospitals NHS Trust

Wales

• Cardiff and Vale University Health Board
• Powys Teaching Local Health Board
• Welsh Ambulance Services NHS Trust Headquarters
• Hywel Dda University Health Board
• Swansea Bay University Health Board
• Cwm Taf Morgannwg University Health Board
• Betsi Cadwaladr University Local Health Board
• Velindre NHS Trust
• Public Health Wales
• Health Education and Improvement Wales Health Authority
• NHS Wales Shared Services Partnership
• Digital Health and Care Wales

Northern Ireland

• Northern Ireland Practice and Education Council
• Southern Health and Social Care Trust
• Western Health and Social Care Trust
• Belfast Health and Social Care Trust
• Business Services Organisation
• Regulation & Quality Improvement Authority
• Northern Ireland Blood Transfusion Service
• Public Health Agency
• Northern Health and Social Care Trust
• South Eastern Health and Social Care Trust
• Northern Ireland Ambulance Service

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UK on ‘slippery slope’ to ‘death on demand’, Justice Secretary Shabana Mahmood warns ahead of assisted dying vote

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UK on 'slippery slope' to 'death on demand', Justice Secretary Shabana Mahmood warns ahead of assisted dying vote

The UK is on a “slippery slope towards death on demand”, according to the justice secretary ahead of a historic Commons vote on assisted dying.

In a letter to her constituents, Shabana Mahmood said she was “profoundly concerned” about the legislation.

“Sadly, recent scandals – such as Hillsborough, infected blood and the Post Office Horizon – have reminded us that the state and those acting on its behalf are not always benign,” she wrote.

“I have always held the view that, for this reason, the state should serve a clear role. It should protect and preserve life, not take it away.

“The state should never offer death as a service.”

Analysis: Justice secretary’s intervention is potentially embarrassing for the PM

On 29 November, MPs will be asked to consider whether to legalise assisted dying, through Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill.

Details of the legislation were published last week, including confirmation the medicine that will end a patient’s life will need to be self-administered and people must be terminally ill and expected to die within six months.

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Minister ‘leans’ to assisted dying bill

Ms Mahmood, however, said “predictions about life expectancy are often inaccurate”.

“Doctors can only predict a date of death, with any real certainty, in the final days of life,” she said. “The judgment as to who can and cannot be considered for assisted suicide will therefore be subjective and imprecise.”

Read more: Gordon Brown says assisted dying should not be legalised

Under the Labour MP’s proposals, two independent doctors must confirm a patient is eligible for assisted dying and a High Court judge must give their approval.

The bill will also include punishments of up to 14 years in prison for those who break the law, including coercing someone into ending their own life.

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Details of end of life bill released

Read more: Where does the cabinet stand on assisted dying?

However, Ms Mahmood said she was concerned the legislation could “pressure” some into ending their lives.

“It cannot be overstated what a profound shift in our culture assisted suicide will herald,” she wrote.

“In my view, the greatest risk of all is the pressure the elderly, vulnerable, sick or disabled may place upon themselves.”

Kim Leadbeater waits to present the Assisted Dying Bill. File pic: House of Commons/Reuters
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Kim Leadbeater waits to present the Assisted Dying Bill. File pic: House of Commons/Reuters

Labour MP Kim Leadbeater, who put forward the bill, said some of the points Ms Mahmood raised have been answered “in the the thorough drafting and presentation of the bill”.

“The strict eligibility criteria make it very clear that we are only talking about people who are already dying,” she said.

“That is why the bill is called the ‘Terminally Ill Adults (End of Life) Bill’; its scope cannot be changed and clearly does not include any other group of people.

“The bill would give dying people the autonomy, dignity and choice to shorten their death if they wish.”

In response to concerns Ms Mahmood raised about patients being coerced into choosing assisted death, Ms Leadbeater said she has consulted widely with doctors and judges.

“Those I have spoken to tell me that they are well equipped to ask the right questions to detect coercion and to ascertain a person’s genuine wishes. It is an integral part of their work,” she said.

In an increasingly fractious debate around the topic, multiple Labour MPs have voiced their concerns.

In a letter to ministers on 3 October, the Cabinet Secretary Simon Case confirmed “the prime minister has decided to set aside collective responsibility on the merits of this bill” and that the government would “therefore remain neutral on the passage of the bill and on the matter of assisted dying”.

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Justice secretary’s assisted dying intervention is explosive – and potentially embarrassing for PM

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Justice secretary's assisted dying intervention is explosive - and potentially embarrassing for PM

With six days to go before Friday’s historic Commons showdown on assisted dying, it’s the opponents who are turning up the heat.

The explosive attack on the bill by Shabana Mahmood follows the poignant and personal plea from Gordon Brown to MPs to reject the bill.

We knew the justice secretary is opposed to the bill. She has already made that clear. But her attack on it, in a letter to constituents, is brutal.

Read more: UK on ‘slippery slope’ to ‘death on demand’, warns justice secretary

She talks about a “slippery slope towards death on demand”. Savage. The state should “never offer death as a service”, she says. Chilling.

So much for Sir Keir Starmer attempting to cool the temperature in the row by urging cabinet ministers, whatever their view, to stop inflaming or attempting to influence the debate.

Ms Mahmood talks, as other opponents have, about pressure on the elderly, sick or disabled who feel they have “become too much of a burden to their family”.

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Details of end of life bill released

She hits out at a “lack of legal safeguards” in the bill and pressure on someone into ending their life “by those acting with malign intent”.

Malign intent? Hey! That’s quite an assertion from a secretary of state for justice and lord chancellor who’s been urged by the PM to tone down her language.

It’s claimed that Sir Keir ticked off Wes Streeting, the health secretary, after he publicly opposed the bill and launched an analysis of the costs of implementing it.

Read more: Where does the cabinet stand on assisted dying?

Will the justice secretary now receive a reprimand from the boss? It’s a bit late for that. Critics will also claim Sir Keir’s dithering over the bill is to blame for cabinet ministers freelancing.

Shabana Mahmood is the first elected Muslim woman to hold a cabinet post. Elected to the Commons in 2010, she was also one of the first Muslim women MPs.

She told her constituents in her letter that it’s not only for religious reasons that she’s “profoundly concerned” about the legislation, but also because of what it would mean for the role of the state.

But of course, she’s not the only senior politician with religious convictions to speak out strongly against Kim Leadbeater’s bill this weekend.

Gordon Brown. File pic: PA
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Gordon Brown. File pic: PA

Gordon Brown, son of the manse, who was strongly influenced by his father, a Church of Scotland minister, wrote about his opposition in a highly emotional article in The Guardian.

He spoke about the pain of losing his 10-day-old baby daughter Jennifer, born seven weeks prematurely and weighing just 2lb 4oz, in January 2002, after she suffered a brain haemorrhage on day four of her short life.

Read more: Gordon Brown says assisted dying should not be legalised

Mr Brown said that tragedy convinced him of the value and imperative of good end-of-life care, not the case for assisted dying. His powerful voice will strongly influence many Labour MPs.

And what of Kim Leadbeater? It’s looking increasingly as though she’s now being hung out to dry by the government, after initially being urged by the government to choose assisted dying after topping the private members bill ballot.

All of which will encourage Sir Keir’s critics to claim he looks weak. It is, or course, a private members bill and a free vote, which makes the outcome on Friday unpredictable.

But the dramatic interventions of the current lord chancellor and the former Labour prime minister are hugely significant, potentially decisive – and potentially embarrassing for a prime minister who appears to be losing control of the assisted dying debate.

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Max Verstappen wins Formula One world title for a fourth straight year

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Max Verstappen wins Formula One world title for a fourth straight year

Red Bull driver Max Verstappen has won the Formula One world title for a fourth straight year.

His victory was confirmed after finishing fifth at the Las Vegas Grand Prix. Mercedes’ George Russell won the race.

Max Verstappen celebrates his win. Pic: Reuters
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Pic: Reuters

The 27-year-old Dutchman becomes just the sixth driver in Formula One history to win four titles or more, after outscoring Lando Norris who took the chequered flag in only sixth.

Verstappen is now guaranteed the world crown with two races still remaining, with his domination cementing his name among Formula One’s greats.

“Oh my God man,” said an emotional Verstappen after securing the world title. “What a season. Four times. It was a little bit more difficult than last year.”

Lewis Hamilton raced back from 10th to second place to complete an impressive one-two finish for Mercedes. Carlos Sainz finished third for Ferrari, one place ahead of his team-mate Charles Leclerc.

Russell’s third victory was the most dominant of his career so far, crossing the line 7.3 seconds clear of Hamilton.

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Michael Schumacher and Lewis Hamilton have each won a record seven, with 1950s Argentine legend Juan-Manuel Fangio on five ahead of Alain Prost, Sebastian Vettel and now Verstappen on four.

Having won every Drivers’ Championship since claiming his first in the controversial end to the 2021 season when he beat Hamilton in deeply contentious circumstances, Verstappen now joins Hamilton, Fangio and Vettel in winning four titles consecutively.

Only Schumacher has achieved a run of five.

Red Bull's principal sponsor Christian Horner on the Las Vegas Strip Circuit. Pic: Reuters
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Red Bull’s principal sponsor Christian Horner on the Las Vegas Strip Circuit. Pic: Reuters

The team were hit by controversy earlier this season, with Red Bull’s principal sponsor, Christian Horner, facing allegations of controlling behaviour by a female staff member. Horner, who denied the accusations, was cleared, and a subsequent appeal was thrown out.

Horner congratulated Verstappen on the radio, telling him: “Max Verstappen you are a four-time world champion. That is a phenomenal, phenomenal achievement. You can be incredibly proud of yourself.”

Red Bull is on course to finish third in the constructors’ championship this year. This century only Hamilton in 2008 with McLaren, and Verstappen in 2021, have won the drivers’ title when their team did not win the constructors’ championship.

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