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Hospital leaders have expressed serious concerns about how they will maintain patient safety as the health service enters “unchartered territory” during “unprecedented” strike action next week.

Junior doctors who are training in England will stage their longest walkout so far between 11 and 15 April.

The 96-hour strike is likely to be the most disruptive in the history of the health service due to the length of the action and the fact doctors have chosen to stage it directly after a long bank holiday weekend.

The bank holiday traditionally causes disruption to the NHS even without the prospect of strike action.

The walkout also coincides with the Easter school holidays, which means many consultant staff who provided cover during the first round of strikes will be unable to do so again due to pre-planned holidays and childcare commitments.

NHS Providers, which represents NHS trusts, said the timing of the strike and its duration present a “range of challenges over and above the disruption seen from the industrial action in recent months”.

It said that during the strike, the NHS will focus resources on emergency treatment, critical care, maternity, neonatal care and trauma.

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But even in these areas, there are “real concerns of a raised risk to safety”, NHS Providers said.

The strikes could lead to delays for some patients starting treatment – for instance, if a new cancer patient needed to start weekly rounds of chemotherapy, the start of their treatment may be delayed until after the strike action to ensure continuity.

Last month’s 72-hour walkout led to about 175,000 hospital appointments and operations being postponed.

Hospital leaders have raised concerns with NHS Providers about the impact of the strike.

“This is less about what planned routine work gets pulled down and everything about maintenance of safety in emergency departments, acute medicine and surgery,” one hospital trust chief executive said.

“Concerned doesn’t begin to describe it.”

Another said: “I am not confident this time that we can maintain patient safety as we will not be able to provide the cover.”

“Many of the consultants who stepped up to do nights last time are not available or are more reluctant this time,” a third said.

While another added: “Those with families almost certainly won’t as [they] can’t rearrange out of school holidays.”

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Sir Julian Hartley, chief executive of NHS Providers, said: “It’s clear from our extensive dialogue with trust leaders that we are in uncharted territory.

“Yet again we are seeing colleagues pull out all the stops to minimise disruption and ensure patient safety. But the challenges here are unprecedented.”

Dr Latifa Patel, workforce lead for the British Medical Association, said: “No one understands better than us, the doctors who care for them, that patients are getting a substandard experience 365 days a year from an overstretched and understaffed NHS.

“In this brutal work environment, patient care is at risk every day due to chronic staff shortages and years of underinvestment in equipment and services.

“Junior doctors have no desire to strike, they been pushed into this action by long-term government inaction and now want to bring this dispute to an end as quickly as possible.

“We hope the health secretary will come to the table immediately with a meaningful pay offer so doctors can avoid more strike action and instead return to doing what they want to be doing: caring for their patients.”

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Why are doctors quitting the NHS?

A department of health and social care spokesperson said: “Four days of strikes by junior doctors will risk patient safety and cause further disruption and postponed treatment.

“The BMA’s demand for a 35% pay rise is totally unreasonable and unaffordable.

“We urge them to come to the table with a realistic approach so we can find a way forward, as we have done with other health unions, which balances fairly rewarding junior doctors for their hard work with meeting the prime minister’s ambition to halve inflation.

“We are working with NHS England to put in place contingency plans to protect patient safety.

“The NHS will prioritise resources to protect emergency treatment, critical care, maternity and neonatal care, and trauma.”

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Man suffers cardiac arrest onboard boat trying to reach UK

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Man suffers cardiac arrest onboard boat trying to reach UK

A man has died after suffering cardiac arrest onboard a boat attempting to reach the UK.

The vessel turned back towards Equihen beach on the French coast yesterday morning.

A nurse tried to resuscitate the man but was unsuccessful.

Pic: PA
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Pic: PA

French authorities have now launched an investigation into the circumstances.

A spokesperson for Doctors Without Borders, also known as MSF, has criticised authorities on both sides of the Channel.

Jacob Burns said: “Yet again we have a tragedy in the Channel, that is the consequence of the deadly, costly and ineffective security policies implemented by the UK and France.”

Pic: PA
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Pic: PA

Later on Saturday, a lifeboat carried migrants who have made the voyage into the Port of Dover.

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Photographs showed them huddled under blankets and orange life jackets on board.

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Protesters clash over asylum hotels

Provisional statistics from the Home Office suggest almost 24,000 people have arrived on small boats in the UK so far this year.

Towns and cities across the UK have seen protests in recent days, primarily outside hotels believed to be housing asylum seekers.

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Women’s Euros final: The Lionesses face Spain tonight – and they’re seeking revenge

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Women's Euros final: The Lionesses face Spain tonight - and they're seeking revenge

Here the Lionesses are again. Another final. Another showdown with Spain.

All of a sudden, what was once so anticipated and longed for can start to seem expected rather than extraordinary.

What happened to the great underachievers of world football? They are now consistently among the final two going for glory.

England wins
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At Euro 2022, the Lionesses ended England’s 56-year wait for a major trophy by beating Germany 2-1 after extra time. Pic: Reuters

No one is taking that for granted.

Especially not Leah Williamson, with the chance to retain the European Championship trophy lifted three years ago at Wembley.

“The opportunity of tomorrow and what’s on offer is the best thing in football,” the England captain said. “I think we don’t necessarily carry the weight of it and how much it means to people, but we’re aware of it because it means the same to us.”

So often they were only watching other nations making finals.

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England’s first was the men winning the 1966 World Cup.

England v Spain: All you need to know

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Lionesses ‘know what win would mean to nation’

Then, with the rebirth of women’s football after bans and neglect, it was the Lionesses’ turn to make it to the finals – in 1984 and 2009.

And the Three Lions had to wait until 2021 to make it to a final, losing to Italy on penalties at Wembley.

It kickstarted an incredible run of five successive years of finals for England senior teams – with another men’s Euros final defeat in 2024.

The Lionesses have led the way, bringing football home by defeating Germany in the Euro 2022 final at Wembley.

They just missed out on going one better when reaching a first Women’s World Cup final a year later.

Soccer Football - FIFA Women's World Cup Australia and New Zealand 2023 - Final - Spain v England - Stadium Australia, Sydney, Australia - August 20, 2023 England manager Sarina Wiegman reacts REUTERS/Carl Recine
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England manager Sarina Wiegman reacts to defeat against Spain at the Women’s World Cup final in 2023. Pic: Reuters

Soccer Football - FIFA Women's World Cup Australia and New Zealand 2023 - Final - Spain v England - Stadium Australia, Sydney, Australia - August 20, 2023 England's Lauren James looks dejected after losing the world cup final REUTERS/Amanda Perobelli
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Lauren James looks dejected after their World Cup defeat, but is confirmed fit for Sunday’s revenge match against Spain. Pic: Reuters

Now, in Basel, comes the chance for revenge against Spain – even though no one in the England camp is saying that, publicly at least, in Switzerland.

Especially knowing how challenging a task it is coming up again against Aitana Bonmati and Alexia Putella – the recent winners of football’s biggest individual honours.

England fans celebrate after England beat Italy at Women's Euro 2025. Pic: Reuters
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England fans celebrating after England beat Italy to reach the finals. Pic: Reuters

Soccer Football - FIFA Women’s World Cup Australia and New Zealand 2023 - Final - Fans in Manchester watch Spain v England - Piccadilly Gardens, Manchester, Britain - August 20, 2023 England fans watch the match Action Images via Reuters/Jason Cairnduff
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Given England’s history against Spain, it could be a nerve-wracking time for England fans. File pic: Action Images/Reuters

But this is Spain’s first Euros final.

And there is some fear from the world champions at England’s grit and resolve to produce comebacks late in the quarter-finals and semi-finals – with 19-year-old Michelle Agyemang’s goals integral to the fightbacks.

England celebrate after defeating Italy in the Women's Euro 2025 semi-final. Pic: Reuters
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England celebrate their semi-final win against Italy to reach the finals. Pic: Reuters

Michelle Agyemang celebrates scoring her side's opening goal.
Pic: AP
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Michelle Agyemang has propelled England to the Euro 2025 final with two vital goals. Pic: AP

Spain captain Irene Paredes reflected yesterday on how the Lionesses can flip a result late on.

But she was also discussing how their World Cup win was tarnished by the on-pitch kiss that led to former Spanish federation president Luis Rubiales being convicted of a sexual assault on striker Jenni Hermoso.

It sparked a wider clamour in Spain for improved rights and respect for women.

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Spain’s players struggle for respect

“Since then [2023] we took big steps forward,” Paredes said.

“I think this idea is disappearing from society. I still believe we have to continue opening doors… we’re a reference for boys and girls in society, but we still have things to do.”

It is a reminder that while tonight is about collecting silverware, both England and Spain know that emerging as champions can drive further growth in women’s football back home.

Amid it all, they’ll try to savour just what reaching a final means and how rare they are – until recently for English and Spanish women.

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Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated

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Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated

A woman who thought she was being injected with Botox was left unable to swallow and doctors thought she had suffered a stroke – after she contracted a life-threatening illness from a potentially illegal product.

Nicola Fairley is one of dozens of people who have developed botulism linked to unlicensed anti-wrinkle injections.

She had the procedure done with her regular beautician after winning a Facebook competition for three areas of “Botox”.

Nicola Fairley
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Nicola Fairley

“Within two or three hours my forehead and the sides of my eyes had started to freeze,” Nicola says.

“At first I thought ‘amazing’, that’s what I wanted – then it just carried on.”

Nicola was eventually sent to A&E in Durham, where she met several other patients who all had similar symptoms.

Doctors were stumped. “They thought I’d had a stroke,” she says.

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“We all had problems with our eyes, some of us with our breathing. I couldn’t swallow – they put me on nil by mouth because they were worried I would choke in the waiting room.”

Nicola Fairley
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Doctors were worried Nicola could choke after she was injected with a suspected illegal product

It turns out all of the patients had recently had anti-wrinkle injections containing botulinum toxin.

Health officials believe they were imported, illegal products.

Botulism – the disease they caused – is so rare many doctors never see it in their entire careers.

It can cause symptoms including slurred speech and breathing problems, and can be deadly.

The disease is so unusual, and so many cases were coming in, that doctors exhausted their stocks of anti-toxin and had to ask hospitals as far away as London to get more.

Botulism

The UK Health Security Agency has so far confirmed 38 cases of botulism linked to cosmetic toxin injections, but Sky News has been told of several more.

The outbreak began in the North East but cases have now been seen in the East of England and East Midlands as well.

There are only a handful of legal botulinum toxin products in the UK – of which Botox is one.

But cosmetic treatments are largely unregulated, with anyone allowed to inject products like fillers and toxins without any medical training.

Cheap, illegal products imported from overseas are easily available.

Steven Land
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Dr Steven Land

‘It’s the Wild West’

Dr Steven Land runs Novellus Aesthetics clinic in Newcastle upon Tyne. He worked for decades as an emergency medicine doctor before moving into aesthetics.

He says he has been warning health officials of an outbreak for years.

“It’s the Wild West,” Dr Land told Sky News.

“Because anyone can do this, there is a lack of knowledge around what is legal, what’s not legal, what is okay to be injected.

“These illegal toxins could have 50 units, 5,000 units or rat poison – there could be anything in there.”

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Botulism

Dr Land showed us messages that he says he gets on a weekly basis, from sellers trying to push him cheap, unlicensed products.

They advertise “limited time offers” and cheap bundles on toxins imported from overseas. He calls them “drug dealers”.

“They are preying on the lack of knowledge among non-medical practitioners,” he says.

Consultations on how to regulate the aesthetics industry have been ongoing for years – but so far, no changes have been introduced.

The UK government now says it does plan to regulate certain procedures, but it’s not said how it will do this, or when.

“What will it take?” Nicola says. “One of the women we were with did almost die – she had to be resuscitated.”

Nicola’s beautician has stopped responding to her messages, so she says she still has no idea what the product was “or how much of it is in me”.

She doesn’t know how long her symptoms will last, but just hopes she will eventually recover.

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