Picket lines are being set up at dozens of hospitals and thousands of NHS appointments and operations have been cancelled, with the health service running a bank holiday-style service in many areas.
The Royal College of Nursing (RCN) has said it will still staff chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care.
Some areas of mental health and learning disability and autism services are also exempt from the strike, while trusts have been told they can request staffing for specific clinical needs.
When it comes to adult A&E and urgent care, nurses will work Christmas Day-style rotas.
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Saffron Cordery, interim chief executive of NHS Providers, said agency NHS trusts were “pulling out all the stops” to lessen the impact on patients.
She said: “But it’s inevitable that some operations or appointments will have to be rescheduled, and trusts are pulling out all the stops to minimise disruption.
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“The cold snap has ramped up demand that was already at or close to record levels, but on strike day NHS trusts will do everything they can to ensure that essential services are properly staffed and patient safety, always the number one priority, is safeguarded.”
RCN chief executive Pat Cullen has accused Health Secretary Steve Barclay of “belligerence” after he refused to discuss the issue of pay – because the government has already accepted recommendations made by the NHS Pay Review Body (PRB) to give below inflation pay rises of around 4%.
This would have seen them get a pay rise of around £1,400.
The RCN has been calling for a pay rise at 5% above inflation, though it has indicated it would accept a lower offer.
When it submitted the 5% figure to the independent pay review body in March, inflation was running at 7.5%.
But inflation has since soared, with RPI standing at 14.2% in September.
‘A tragic first’
Meanwhile, in Scotland, RCN members are being consulted on a revised pay offer from the Scottish government.
Ms Cullen said: “Nurses are not relishing this, we are acting with a very heavy heart.
“It has been a difficult decision taken by hundreds of thousands who begin to remove their labour in a bid to be heard, recognised and valued.
“It is a tragic first for nursing, the RCN and the NHS.
“Nursing staff on picket lines is a sign of failure on the part of governments.
“My plea to patients is to know that this strike is for you too – it’s about waiting lists, treatments that are cancelled year round and the very future of the NHS.”
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Royal College of Nursing leader Pat Cullen says the government’s ‘turned its back’ on nurses
The RCN has also raised the issue of huge staff vacancies in the NHS, with 47,000 nurse roles empty in England alone. And it has warned strike action may need to continue into January if the government does not re-negotiate on pay.
The health secretary said nurses were “incredibly dedicated to their job” and that it was “deeply regrettable some union members are going ahead with strike action”.
Mr Barclay added: “My number one priority is to keep patients safe – I’ve been working across government and with medics outside the public sector to ensure safe staffing levels – but I do remain concerned about the risk that strikes pose to patients.
“Nevertheless, the NHS is open and patients should continue to seek urgent medical care – and attend appointments – unless they’ve been contacted by the NHS.”
He said paying nurses more “would mean taking money away from frontline services at a time when we are tackling record waiting lists as a result of the pandemic.”
But pressure is mounting on the government to find a compromise on pay, with former Conservative Party chairman Sir Jake Berry saying it “is going to have to improve its offer”.
“We need to find a way as a government, and the union does too, to get to that centre point, that point of agreement straight away,” he told Talk TV.
During the strike, nurses will man picket lines at major NHS hospitals, including Guy’s and St Thomas NHS Foundation Trust in London, Addenbrookes Hospital in Cambridge and University Hospitals Birmingham NHS Foundation Trust.
Several trusts have already given details of cancelled outpatient appointments and planned treatments.
The Western Trust in Northern Ireland said it had “regrettably taken the decision to cancel some non-emergency services”, with 587 outpatient appointments postponed across Altnagelvin Hospital, Omagh Primary Care and Treatment Centre and South West Acute Hospital.
The trust said there would also be reduced staffing in community nursing services including rapid response nursing, district nursing, community respiratory nursing and continence services.
In Wales, the Welsh government said non-urgent or routine appointments are likely to be postponed.
On Wednesday, the head of NHS Employers said “real concerns” remain about the level of cover nurses will provide for cancer patients during the strike.
In a letter to NHS leaders, Danny Mortimer said some aspects of talks with the RCN had been disappointing and warned that “unless the government indicates a willingness to negotiate on pay-related matters, further strike dates will be announced by the RCN for January 2023 and beyond”.
A second RCN nurse strike is set for 20 December, while thousands of ambulance workers will go on strike on 21 December.
The RCN has urged agency workers not to cover for striking staff.
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.
There is also industrial action planned in a whole number of UK spheres, including paramedics,postal workers, Border Force agents, firefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.
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.
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.
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.”
On Monday, temperatures are expected to be more in line with the seasonal norm, at about 7C to 8C.
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.
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.
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.
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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.
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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.
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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.