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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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Eight men arrested after attempted murder of couple in their 60s in Newcastle

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Eight men arrested after attempted murder of couple in their 60s in Newcastle

Eight men have been arrested in connection with the attempted murder of a couple in Newcastle, police have said.

A man and a woman in their 60s were found with serious injuries inside a property in Durham Street in the city’s Elswick area at around 6.45pm on Friday.

The woman sustained serious head injuries and remains in hospital in a critical condition, while the man is in a stable condition.

A man in his 30s was initially arrested on suspicion of attempted murder, Northumbria Police said on Saturday, before announcing seven further arrests on Sunday. All eight men remain in custody.

Five of the men – two in their 20s, two in their 30s, and one in his 40s – have been arrested on suspicion of attempted murder.

A man in his 50s has been arrested on suspicion of conspiracy to murder, while two other men – one in his 40s and one in his 60s – have been arrested on suspicion of assisting an offender.

Detective Chief Inspector Mark Atherton, the senior investigating officer in the case, said: “Eight suspects are now in custody being questioned, and I would like to reassure our communities extensive inquiries into this serious incident have already been carried out.”

Police are urging anyone with information to come forward and have issued an appeal for people who saw a red Renault Twingo car, which was allegedly stolen.

The vehicle is believed to have been parked in the West End of Newcastle between 6.30pm and 8pm on Friday before being found in the Longbenton area on Saturday morning.

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“We would like to thank everyone who has already come forward and as part of our investigation we are keen to hear from anyone who may have seen the Renault Twingo,” DCI Atherton said.

“Any information – no matter how insignificant it may seem – could prove vital to establishing exactly what happened that evening.”

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David Cameron reveals he has been treated for prostate cancer

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David Cameron reveals he has been treated for prostate cancer

Former prime minister Lord Cameron has revealed he has been treated for prostate cancer.

The former Tory leader, who was PM from 2010 until 2016, and foreign secretary from November 2023 until last year’s general election, went public in an interview with The Times.

The 59-year-old joins Olympic cycling champion Sir Chris Hoy, ex-Sky News presenter Dermot Murnaghan and another former PM, Rishi Sunak, in campaigning for better diagnosis and treatment.

He has now had the all clear and is cancer-free.

Lord Cameron went to the GP for a prostate-specific antigen (PSA) test – which looks for proteins associated with prostate cancer – after his wife Samantha urged him to make an appointment. His result showed his numbers were worryingly high.

Recalling the moment when, after a follow-up biopsy, he was told he had cancer, Lord Cameron said: “You always dread hearing those words.

“And then literally as they’re coming out of the doctor’s mouth you’re thinking, ‘Oh, no, he’s going to say it. He’s going to say it. Oh God, he said it’. Then came the next decision. Do you get treatment? Or do you watch and wait?”

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Lord Cameron with his wife Samantha in May. Pic: PA
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Lord Cameron with his wife Samantha in May. Pic: PA

Lord Cameron said his older brother Alexander died of pancreatic cancer at the same age he is now. “It focuses the mind,” he said. “I decided quite quickly. I wanted to move ahead and that’s what I did.”

The former prime minister opted to have focal therapy, a treatment which delivers electric pulses via needles to destroy the cancerous cells.

He was given a post-treatment MRI scan around the time the US struck a nuclear plant in Iran last year. “It was the same week as Donald Trump was talking about the bomb damage assessment… I got my own bomb damage assessment,” he quipped.

Explaining why he has shared his diagnosis, Lord Cameron said: “I’ve got a platform. This is something we’ve really got to think about, talk about, and if necessary, act on.

“I want to, as it were, come out. I want to add my name to the long list of people calling for a targeted screening programme.”

What is prostate cancer?

Prostate cancer is the most common cancer affecting men.

Around 55,000 men are diagnosed with the disease in the UK every year.

It usually develops slowly over many years.

Cancer cells begin to grow in the prostate, the small gland found just below the bladder.

What are the symptoms?

Symptoms do not usually appear until the prostate is large enough to affect the urethra, which is the tube carrying urine from the bladder.

The most common ones are needing to urinate more often and straining to pee.

Men may also feel as though their bladder has not fully emptied.

These symptoms are common and do not always mean somebody has cancer, but they should be checked out by a GP.

File pic: AP
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File pic: AP

Lord Cameron is backing a call by the charity Prostate Cancer Research for the introduction of screening for men at high risk of the disease.

“I don’t particularly like discussing my personal intimate health issues, but I feel I ought to,” he continued. “Let’s be honest. Men are not very good at talking about their health. We tend to put things off.

“We’re embarrassed to talk about something like the prostate, because it’s so intricately connected with sexual health and everything else. I sort of thought, well, this has happened to you, and you should lend your voice to it.

“I would feel bad if I didn’t come forward and say that I’ve had this experience. I had a scan. It helped me discover something that was wrong. It gave me the chance to deal with it.”

Approximately 12,000 men in the UK die from prostate cancer every year, making it the country’s biggest male cancer.

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An ongoing trial is looking at how healthcare professionals could use PSA tests with other assessments to improve screening.

Lord Cameron’s interview comes ahead of a meeting on Thursday, which could see the National Screening Committee give the green light for the first NHS screening programme for prostate cancer.

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Upcoming budget will be big – and Starmer has some serious convincing to do as he fights for survival

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Upcoming budget will be big - and Starmer has some serious convincing to do as he fights for survival

Wednesday’s budget is going to big.

It will be big in terms of tax rises, big in terms of setting the course of the economy and public services, and big in terms of political jeopardy for this government.

The chancellor has a lot different groups to try to assuage and a lot at stake.

“There are lots of difference audiences to this budget,” says one senior Labour figure. “The markets will be watching, the public on the cost of living, the party on child poverty and business will want to like the direction in which we are travelling – from what I’ve seen so far, it’s a pretty good package.”

The three core principles underpinning the chancellor’s decisions will be to cut NHS waiting lists, cut national debt and cut the cost of living. There will be no return to austerity and no more increases in government borrowing.

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What flows from that is more investment in the NHS, already the big winner in the 2024 Budget, and tax rises to keep funding public services and help plug gaps in the government’s finances.

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Some of these gaps are beyond Rachel Reeves’ control, such as the decision by the independent fiscal watchdog (the Office for Budget Responsibility) to downgrade the UK’s productivity forecasts – leaving the chancellor with a £20bn gap in the public finances – or the effect of Donald Trump’s tariffs on the global economy.

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Will PM keep his word on taxes?

Others are self-inflicted, with the chancellor having to find about £7bn to plug her reversals on winter fuel allowance and welfare cuts.

By not pulling the borrowing lever, she hopes to send a message to the markets about stability, and that should help keep down inflation and borrowing costs low, which in turn helps with the cost of living, because inflation and interest rates feed into what we pay for food, for energy, rent and mortgage costs.

That’s what the government is trying to do, but what about the reality when this budget hits?

This is going to be another big Labour budget, where people will be taxed more and the government will spend more.

Only a year ago the chancellor raised a whopping £40bn in taxes and said she wasn’t coming back for more. Now she’s looking to raise more than £30bn.

That the prime minister refused to recommit to his manifesto promise not to raise income tax, VAT or national insurance on working at the G20 in South Africa days ahead of the budget is instructive: this week we could see the government announce manifesto-breaking tax rises that will leave millions paying more.

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Starmer’s G20 visit overshadowed by Ukraine and budget

Freeze to income thresholds expected

The biggest tax lever, raising income tax rates, was going to be pulled but has now been put back in neutral after the official forecasts came in slightly better than expected, and Downing Street thought again about being the first government in 50 years to raise the income tax rate.

On the one hand, this measure would have been a very clean and clear way of raising £20bn of tax. On the other, there was a view from some in government that the PM and his chancellor would never recover from such a clear breach of trust, with a fair few MPs comparing it to the tuition fees U-turn that torpedoed Nick Clegg’s Lib Dems in the 2015 General Election.

Instead, the biggest revenue in the budget will be another two-year freeze on income tax thresholds until 2030.

This is the very thing that Reeves promised she would not do at the last budget in 2024 because “freezing the thresholds will hurt working people” and “take more money out of their payslips”. This week those words will come back to haunt the chancellor.

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Will this budget help lower your energy bills?

Two-child cap big headline grabber

There will also be more spending and the biggest headline grabber will be the decision to lift the two-child benefit cap.

This was something the PM refused to commit to in the Labour manifesto, because it was one of the things he said he couldn’t afford to do if he wanted to keep taxes low for working people.

But on Wednesday, the government will announce its spending £3bn-a-year to lift that cap. Labour MPs will like it, polling suggests the public will not.

What we are going to get on Wednesday is another big tax and spend Labour budget on top of the last.

For the Conservatives, it draws clear dividing lines to take Labour on. They will argue that this is the “same old Labour”, taxing more to spend more, and more with no cuts to public spending.

Having retreated on welfare savings in the summer, to then add more to the welfare bill by lifting the two-child cap is a gift for Labour’s opponents and they will hammer the party on the size of the benefits bill, where the cost of support people with long-term health conditions is set to rise from £65bn-a-year to a staggering £100bn by 2029-30.

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Why has chancellor U-turned on income tax rises?

Mansion tax on the cards

There is also a real risk of blow-up in this budget as the chancellor unveils a raft of revenue measures to find that £30bn.

There could be a mansion tax for those living in more expensive homes, a gambling tax, a tourism tax, a milkshake tax.

Ministers are fearful that one of these more modest revenue-raising measures becomes politically massive and blows up.

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This is what happened to George Osborne in 2012 when he announced plans to put 20% of VAT on hot food sold in bakeries and supermarkets. The plan quickly became an attack on the working man’s lunch from out-of-touch Tories and the “pasty tax” was ditched two months later.

And what about the voters? Big tax and spend budgets are the opposite of what Sir Keir Starmer promised the country when he was seeking election. His administration was not going to be another Labour tax and spend government but instead invest in infrastructure to turbocharge growth to help pay for better services and improve people’s everyday lives.

Seventeen months in, the government doesn’t seem to be doing things differently. A year ago, it embarked on the biggest tax-raising budget in a generation, and this week, it goes back on its word and lifts taxes for working people. It creates a big trust deficit.

Pic: PA
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Pic: PA

Government attempts to tell a better story

There are those in Labour who will read this and point to worse-than-expected government finances, global headwinds and the productivity downgrades as reasons for tax raising.

But it is true too that economists had argued in the run-up to the election that Labour’s position on not cutting spending or raising taxes was unsustainable when you looked at the public finances. Labour took a gamble by saying tax rises were not needed before the election and another one when the chancellor said last year she was not coming back for more.

After a year-and-a-half of governing, the country isn’t feeling better off, the cost of living isn’t easing, the economy isn’t firing, the small boats haven’t been stopped, and the junior doctors are again on strike.

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What tax rises could chancellor announce?

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Budget jargon explained

The PM told me at the G7 summit in Canada in June that one of his regrets of his first year wasn’t “we haven’t always told our story as well as we should”.

What you will hear this week is the government trying to better tell that story about what it has achieved to improve people’s lives – be that school breakfast clubs or extending free childcare, increasing the national living wage, giving millions of public sector workers above-inflation pay rises.

You will also hear more about the NHS, as the waiting lists for people in need of non-urgent care within 18 weeks remain stubbornly high. It stood at 7.6m in July 2024 and was at 7.4m at the end of September. The government will talk on Wednesday about how it intends to drive those waits down.

But there is another story from the last 18 months too: Labour said the last budget was a “once in a parliament” tax-raising moment, now it’s coming back for more. Labour said in the election it would protect working people and couldn’t afford to lift the two child-benefit cap, and this week could see both those promises broken.

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Can the Tories be blamed for the financial black hole?

Can PM convince his MPs?

Labour flip-flopped on winter fuel allowance and on benefit cuts, and is now raising your taxes.

Downing Street has been in a constant state of flux as the PM keeps changing his top team, the deputy prime minister had to resign for underpaying her tax, while the UK’s ambassador to the US, Peter Mandelson, was sacked over his ties to the Jeffrey Epstein, the late convicted paedophile. It doesn’t seem much like politics being done differently.

All of the above is why this budget is big. Because Wednesday is not just about the tax and spend measures, big as they may be. It is also about this government, this prime minister, this chancellor. Starmer said ahead of this budget that he was “optimistic” and “if we get this right, our country has a great future”.

But he has some serious convincing to do. Many of his own MPs and those millions of people who voted Labour in, have lost confidence in their ability to deliver, which is why the drumbeat of leadership change now bangs. Going into Wednesday, it’s difficult to imagine how this second tax-raising budget will lessen that noise around a leader and a Labour government that, at the moment, is fighting to survive.

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