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Hospitals should free up beds by safely discharging patients in advance of “extensive disruption” caused by industrial action by ambulance crews, health chiefs have said.

They warned of “a very challenging period” when ambulance crews in England and Wales are due to walk out for two days on 21 and 28 December in a dispute over pay.

It follows Thursday’s one-day strike by nurses in England, Wales and Northern Ireland.

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In a joint letter with national medical director Professor Sir Stephen Powis and chief nursing officer Dame Ruth May to NHS trusts and integrated care boards, Sir David Sloman, NHS England’s chief operating officer, said measures should also be put in place to ensure ambulance patient handovers are kept to no more than 15 minutes.

NHS data shows ambulance handover delays at hospitals in England have hit a new high, with one in six patients last week waiting more than a hour to be passed to A&E teams.

Just over one in three had to wait at least 30 minutes. The numbers are higher than at any point in recent winters.

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

NHS Providers’ interim chief executive Saffron Cordery said “Trust and system leaders are being asked by NHS England to focus on reducing handover delays and maximising capacity in urgent and emergency care.

“But given the scale of operational pressures on providers now including very high bed occupancy levels, rising flu admissions, ongoing COVID-19 pressures, record staff absences and increasing A&E attendances, this will be incredibly difficult to implement.

“We understand why ambulance staff have voted for industrial action but it’s vital that the government and unions talk urgently to find a way to prevent this and further strikes from happening.”

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The first nurses’ strike in a century

Meanwhile, Pat Cullen, the general secretary of the Royal College of Nursing (RCN), has said Health Secretary Steve Barclay’s “macho” negotiating style is hampering efforts to resolve the nurses’ pay dispute.

She said that when she met Mr Barclay in the House of Commons on Monday, it had been “very confrontational” with him refusing to discuss pay.

“I see a macho culture in this government,” she said.

“He needs to get to a place where he’s inspired with the value of care and treatment. He doesn’t value that because it’s a 90% female profession.”

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‘We hugely value nurses,’ says Steve Barclay

Following Thursday’s strike, RCN members are due to walk out again on Tuesday.

Ms Cullen urged Prime Minister Rishi Sunak to step in before the dispute “engulfs” the NHS, warning there would be a further “escalation” of the nurses’ action in January involving longer stoppages and more organisations.

On a visit to Belfast on Friday, Mr Sunak insisted that while “the door is always open to talks” the government was determined to stick to the recommendations of the independent pay review body.

“We want to be fair, reasonable and constructive, that’s why we accepted the recommendations of an independent pay body about what fair pay would be,” he said.

Read More:
Nurses call biggest ever strike a ‘turning point’ as No 10 says ‘no plans’ to up offer on pay

‘We are exhausted and deflated’ – nurses’ stories from picket lines across the country

The NHS pay review body has recommended below-inflation pay rises of around 4% for nurses and the government is refusing to negotiate with unions who want a higher offer because it has accepted this recommendation.

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The nurses’ strikes explained

It has emerged that nearly 16,000 appointments, procedures and surgeries were rescheduled in England – 54,000 less than the government suggested – due to Thursday’s strike.

The figures were published after Health minister Maria Caulfield said around 70,000 appointments would be lost due to the industrial action.

But, according to provisional NHS data reported by trusts where the RCN strike took place, 2,452 inpatient and day case elective procedures and 13,327 outpatient appointments were rescheduled, coming to 15,779 in total.

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Across England, 9,999 staff were absent from work due to the strike, according to figures on the NHS England website.

The highest numbers were seen in the South West where striking staff came to 2,372, with 2,023 in the Midlands and the next highest, 1,714 in the North East and Yorkshire.

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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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