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Senior health leaders have raised concerns about the care of cancer patients during the impending nurses’ strikes – including warnings that some chemotherapy appointments are being rescheduled.

In a letter seen by Sky News political editor Beth Rigby, the head of cancer care for NHS England, Dame Cally Palmer, called on Royal College of Nursing (RCN) union boss Pat Cullen to protect “life-saving” and “urgent” cancer surgery from walkouts, which begin on Thursday.

In another letter obtained by the Times, chief nursing officer for England, Dame Ruth May, says chemotherapy appointments are being rescheduled, and asked for assurances about the care of dying patients during the strikes in England, Wales and Northern Ireland on 15 and 20 December.

Chief Nursing Officer for England, Dame Ruth May
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Chief nursing officer for England, Dame Ruth May

Dame Cally said she was “extremely concerned about the absence of national derogation for urgent cancer surgery”.

A derogation is an exemption, either of an individual or a whole service, from taking part in strike action.

She went on: “I understand how enormously difficult these issues are for all concerned, but our common aim is to ensure we do not cause harm to people undergoing vital cancer treatment to achieve cure or extension of life.

“It’s important there is a clear and consistent decision on urgent cancer in line with the national derogation for chemotherapy and critical care.”

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The RCN insists there will be a derogation for emergency cancer services, as well as for mental health and learning disability and autism services, and said the public was behind its action.

“The public backs our campaign and knows that patients need a strong nursing workforce, but at the moment there are record losses jeopardising safe care,” the union said.

Dame Cally said the strikes were likely to lead to cancelled operations for cancer patients in P1 and P2 categories.

In her letter, she explained P1 surgery “is life-saving, and time critical, and must be maintained”, while P2 is “urgent cancer surgery which has an optimal time window”.

She said rescheduling procedures “is likely to lead to delayed operations and poorer outcomes” and many of these patients will move into the P1 category, requiring life-saving procedures as a result of re-scheduling.

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

The RCN, however, insisted cancer patients would get emergency and clinically urgent surgery, and in its response to the letter assured that was “not in doubt”.

A spokesperson for the union added: “This is a politically-motivated smear from a government that is failing cancer patients.”

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In their correspondence, the chief nursing officer for England, and her counterparts in Scotland, Wales and Northern Ireland, wrote to Ms Cullen raising a series of concerns about patient safety.

“Many chief nurses/directors of nursing are, of course, RCN members themselves and some have expressed feelings of having been let down by the RCN,” they wrote.

The chief nursing officers said chemotherapy is being rescheduled from the strike days at some hospitals despite the union agreeing it would be exempt nationally.

They wrote that “there are examples of some trusts being asked to submit derogation forms for chemotherapy and organisations now preparing to reschedule chemotherapy from 15th and 20th December”.

The chief nurses also asked for assurances that community nursing services providing “end of life care and good pain and symptom relief” continue in order to “alleviate unnecessary distress” for palliative patients and their families.

The RCN said on Tuesday it had agreed further exemptions to the strike action, including emergency cancer services and “front-door” urgent care assessment and admission units for paediatric-only A&E departments.

“This letter is already out of date, as we have met senior clinicians today and agreed key points. The safety of patients is everybody’s top concern,” the union’s spokesperson said.

The heated letters exchange came at a time when a new report shows the NHS is treating fewer patients than it was pre-pandemic despite more funding and staff – suggesting a long-term COVID impact on the health service’s performance.

The Institute for Fiscal Studies has said the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments and 11% fewer elective and maternity admissions in the latest month of data than it did in the same period in 2019, according to the IFS.

Health Secretary Steve Barclay in Westminster, London, ahead of his meeting with Pat Cullen, the head of the Royal College of Nurses (RCN), as he tries to avert strike action. Nurses have voted to strike in the majority of NHS employers in a row over pay, the first UK-wide strike action in its 106-year history. Picture date: Thursday November 10, 2022.
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Health Secretary Steve Barclay

Why did talks break down?

Talks between the unions and the government to try to avert strike action broke down on Monday, after Health Secretary Steve Barclay was accused of refusing to negotiate on pay.

The union is demanding a pay rise of 5% above the RPI rate of inflation, which was 14.2% in October, but Ms Cullen has hinted that she could compromise if the government negotiates on pay.

Ministers have repeatedly insisted they can’t afford to give inflation-busting pay rises and say they have accepted the independent pay review body’s recommendation of a £1,400 rise.

Meanwhile, 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.

The strikes come at a time of planned industrial action in a whole number of UK spheres, including healthcare – with paramedics also planning to walkout – postal workers, Border Force agents, firefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.

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‘Where am I going to go with the kids?’ Mum-of-three left homeless after reporting threats to police

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'Where am I going to go with the kids?' Mum-of-three left homeless after reporting threats to police

As mother-of-three Danielle pushes two prams down the street in south London, her only thought is where will they all sleep tonight?

The 21-year-old, whose children are all under the age of five, had a council house in Southwark but had to move out because she faced threats of violence.

“I didn’t know that going to the police would end up with me being homeless,” she says.

Heartbroken and panicking, with nowhere else to go, Danielle is in a park with her three children – two daughters, aged one and four, and her two-year-old son.

“I’m so sorry, I wish this could all be better,” she tells them. Her eldest clutches a plastic toy and asks when they are going home.

“We don’t have a home anymore,” Danielle replies. She can’t hide the truth from her any longer.

Treated image for Farrell homeless piece

Danielle, who has long dark hair and is wearing a puffer jacket, is pacing, her mobile phone pressed to her ear, making a series of desperate phone calls, pleading for help.

“Where am I going to go with the kids,” she asks a housing officer. “I have nowhere to go.”

At this point it’s around 3pm and council offices will soon be closing. As her phone dies, Danielle, now sitting on a bench, her eldest daughter comforting her siblings in their buggies, breaks down in tears.

Her story exemplifies a national housing crisis where currently more than 150,000 children in England are living in temporary accommodation.

It is hard to imagine someone more vulnerable; a 21-year-old, at risk of violence, a care leaver herself, mother-of-three. If she’s fallen through the net, then who is it catching?

Treated image for Farrell homeless piece

Initially, Southwark council paid for her to have temporary accommodation elsewhere.

But things changed when police informed them it was too dangerous for her to come back to the borough.

“To sit there and tell a four-year-old little girl we can’t go home because we don’t have a home, that’s very upsetting as a mum because I brought her into this world to love her, protect her, to give her a home, and me being a mum telling her I can’t do that right now, it breaks my heart, but I know it’s not my fault,” she tells Sky News.

“Last Tuesday, I got a call to say they could no longer fund my accommodation because the police said it’s no longer safe to return back to Southwark, so they don’t owe me a duty of care.”

The council emailed her a letter which implied she was being made homeless for her own protection. The letter instructed her to present herself to another “local authority homeless person unit to seek rehousing outside of Southwark,” it said. “This is on the grounds of personal protection for you and your children.”

Treated image for Farrell homeless piece

The letter, dated 30 September, explained her current accommodation would terminate on 9 October.

But, when Danielle approached another council, they wanted more details from Southwark. In the meantime, her landlord said Southwark had stopped paying, so he evicted her and changed the locks.

“We are just going around in a loop and in the meantime me and my children are homeless, and nobody seems to care,” she told us when we found her on 10 October.

“They are not protecting me or my children, they’ve put us at an even more high risk, but they don’t seem to acknowledge that.”

As we sit on the park bench together, a Southwark housing officer calls confirming that, despite her being on the streets, they would not extend the temporary accommodation. The person on the phone says it was a management decision.

Treated image for Farrell homeless piece

At this point, we call Southwark’s press office and get a very different tone and a sense that the situation isn’t acceptable.

After an anxious wait, by late afternoon Danielle is told she can return to her temporary accommodation.

But while Danielle was on the streets, she took her child for a routine vaccination and was flagged with children’s social services, which adds to her worries.

“I know I am a good mum,” she says. “A doctor might have thought my nails were dirty or I didn’t look like a normal person, but she has to understand, I had nowhere to go that day.

“I had no keys, nowhere to live. I was living out of a black bag in my grandad’s shed. So, what do you expect?”

Treated image for Farrell homeless piece

In a statement, councillor Sarah King from Southwark told us: “This has been a very distressing situation for Danielle and her children, and I hope that she is at least relieved to be in safe accommodation now. We will be working to resolve her housing situation permanently and continue to support her until that happens.”

The council she was applying to told us they believed the issue was now being dealt with by Southwark.

Read more:
Number of children in temporary accommodation hits record high
Temporary housing spending for homeless people soars in London

Housing lawyer Simeon Wilmore told Sky he’s come across this kind of thing “many times” and believes both councils have behaved badly.

“Southwark should have been in contact with the receiving party or receiving local authority and it should be more managed and structured, and she should be at the centre of the decision making,” he said.

“If they have reason to believe she may be eligible for priority needs then the duty of care kicks in. They must accommodate.”

Danielle

The problem is councils have run out of homes. In Southwark alone 17,700 people are on the borough’s waiting list, nearly treble the figure over five years ago.

On average councils spend 1% of their budget on temporary accommodation, but research by Sky News has found 30 councils spend 10% or more, with several spending over 20% of their overall budgets on homelessness. This is council money going to private landlords.

Adam Hugg, head of housing at the Local Government Association, says the numbers of people needing support “are going through the roof” and the lack of available homes “creates a real challenge”.

He says there is a need for long-term investment to build more council houses as well as reform to housing benefit to make sure more people can be kept in their homes.

Danielle has few home comforts in her temporary flat, which has plain white walls and a TV on the floor. Her wish is for a place she can make her own and paint her daughter’s bedroom walls pink.

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She has Halloween decorations on a shelf, while in a corner of the living room there is a long box containing a Christmas tree. On top, there is a child’s yet-to-be-filled-out wish list for Father Christmas, while a pack of red and white baubles and a can of snow spray sit nearby.

“These are all my little Christmas bits I’m going to do with the kids when we eventually have a home,” Danielle says, but she still has no idea when that might be.

“They have told me I’m not going to be here for Christmas,” she says. “So, I don’t know where I’ll be. I just hope it’s not on the street.”

It seems the housing crisis has reached a point where even extreme vulnerability is no guarantee of help.

Councils want more secure longer-term government funding so they can build more homes, but with more children than ever living in temporary accommodation, this is a chronic national problem that will take more than one Christmas to solve.

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Sara Sharif: 10-year-old’s stepmother said girl’s father beat her up ‘like crazy’, according to WhatsApp messages read in court

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Sara Sharif: 10-year-old's stepmother said girl's father beat her up 'like crazy', according to WhatsApp messages read in court

Sara Sharif’s stepmother sent her sister some pictures of the 10-year-old looking bruised and miserable – and told her to “delete” them, a court has heard.

“Look what he’s doing,” Beinash Batool told Qandeela Saboohi, referring to the beatings Sara was allegedly getting from her father, Urfan Sharif.

“Delete the pictures.”

A series of WhatsApp messages exchanged between 2020 and 2023, in which Batool told her sister about the physical attacks Sharif was allegedly inflicting on his daughter, were read out to a jury at the Old Bailey.

Sara Sharif
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Sara Sharif

Batool repeatedly told her sister that Sharif was hitting Sara for being “naughty”, “rude and rebellious”, and because she had cut up his clothes, hidden keys and torn up documents.

Batool, 30, Urfan Sharif, 42, and Sara’s uncle, 29-year-old Faisal Malik, are accused of carrying out a campaign of abuse culminating in Sara’s murder on 8 August last year.

As early as February 2020, Batool described Sharif as going on a “rampage” after spilling hot tea, saying he was “possessed”.

Writing about 10 photographs of Sara, she wrote: “This is how bad he is beating her… I feel really sorry for her. He beat the crap out of her.”

On another occasion, Batool said Sharif “went ballistic” and “beat Sara up like crazy”. She expressed fears he could break an arm or leg.

In May 2021, Batool told Ms Saboohi: “Not great in our house, it’s all a bit manic. Urfan beat the crap out of Sara and my mind is all in bits. I really want to report him.

“Why the hell doesn’t Urfan learn – she’s covered in bruises, literally beaten black.”

Afterwards, Sharif sat “on his fat bum” and played the board game Ludo, she said.

She went on: “Why the hell I’m even letting him in the house. I’m sorry for Sara, poor girl cannot walk. She literally fainted in the kitchen in the morning. He made her do sit-ups all night.”

Asked what Sara had done, Batool said: “Because she hid the keys.”

By 2022, Batool said she was planning to get some “legal advice” but was advised by her sister to give it time and not to rush.

Urfan Sharif, Beinash Batool and Faisal Malik. Pics: Surrey Police
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Urfan Sharif, Beinash Batool and Faisal Malik. Pics: Surrey Police

In an update later that year, Batool said she was thinking about taking Sara out of school, saying: “I don’t want to but kinda don’t have a choice.

“I’m just fed up of her behaviour and Urfan’s. Sara’s body is literally bruised because Urfan beat her up. I cannot even cover it up.

“He beat Sara up yesterday and I can’t send her to school on Monday looking like that.

“She ripped Urfan’s documents in front of him and was being rude and rebellious.”

Referring to an image of Sara in a hijab, Batool wrote: “You haven’t even seen her body, it’s a whole lot worse.”

Days later, she said Sara’s school was worried about her and Sharif was “stressed” about it.

In an apparent reference to Sara’s injuries, she wrote: “Urfan told me to cover it up with makeup and she’s going to wear sunglasses.”

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Two months before Sara died, Batool referred to “Sara’s antics”, telling her sister: “Urfan beat the crap out of Sara… Yeah, he beat her up like crazy.

“Her oxygen level dropped really low, she’s finding it hard to stay awake.”

Asked if Sharif had hit her on the head, Batool said: “Nah, but she’s breathing really rapidly.”

The day before Sara died, Ms Saboohi tried to make contact but Batool told her she was “not in the mood to speak”.

Two days later, the defendants were captured on CCTV as they prepared to board a flight to Pakistan from Heathrow Airport.

That CCTV has now been shown to the jury.

On 10 August last year, police found Sara’s body in a bunkbed after Sharif called from Pakistan to say he had beaten her up “too much” for “being naughty”.

William Emlyn Jones KC, the prosecutor, has previously told jurors it was disputed whether messages Batool sent to two of her sisters were accurate or gave a full picture.

All three defendants, formerly of Hammond Road in Woking in Berkshire, have denied murder and causing or allowing the death of a child between 16 December 2022 and 9 August 2023.

The trial continues.

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Budget: Hostile market response as chancellor suffers Halloween nightmare

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Budget: Hostile market response as chancellor suffers Halloween nightmare

First things first: don’t panic.

What you need to know is this. The budget has not gone down well in financial markets. Indeed, it’s gone down about as badly as any budget in recent years, save for Liz Truss’s mini-budget.

The pound is weaker. Government bond yields (essentially, the interest rate the exchequer pays on its debt) have gone up.

That’s precisely the opposite market reaction to the one chancellors like to see after they commend their fiscal statements to the house.

In hindsight, perhaps we shouldn’t be surprised.

After all, the new government just committed itself to considerably more borrowing than its predecessors – about £140bn more borrowing in the coming years. And that money has to be borrowed from someone – namely, financial markets.

But those financial markets are now reassessing how keen they are to lend to the UK.

More on Budget 2024

The upshot is that the pound has fallen quite sharply (the biggest two-day fall in trade-weighted sterling in 18 months) and gilt yields – the interest rate paid by the government – have risen quite sharply.

This was all beginning to crystallise shortly after the budget speech, with yields beginning to rise and the pound beginning to weaken, the moment investors and economists got their hands on the budget documentation.

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Chancellor challenged over gilt yield spike

But the falls in the pound and the rises in the bond yields accelerated today.

This is not, to be absolutely clear, the kind of response any chancellor wants to see after a budget – let alone their first budget in office.

Indeed, I can’t remember another budget which saw as hostile a market response as this one in many years – save for one.

That exception is, of course, the Liz Truss/Kwasi Kwarteng mini-budget of 2022. And here is where you’ll find the silver lining for Keir Starmer and Rachel Reeves.

The rises in gilt yields and falls in sterling in recent hours and days are still far shy of what took place in the run up and aftermath of the mini-budget. This does not yet feel like a crisis moment for UK markets.

But nor is it anything like good news for the government. In fact, it’s pretty awful. Because higher borrowing rates for UK debt mean it (well, us) will end up paying considerably more to service our debt in the coming years.

Rachel Reeves and Chief Secretary to the Treasury Darren Jones prepare to leave 11 Downing Street
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Rachel Reeves leaving 11 Downing Street before the budget. Pic: PA

And that debt is about to balloon dramatically because of the plans laid down by the chancellor this week.

And this is where things get particularly sticky for Ms Reeves.

In that budget documentation, the Office for Budget Responsibility said the chancellor could afford to see those gilt yields rise by about 1.3 percentage points, but then when they exceeded this level, the so-called “headroom” she had against her fiscal rules would evaporate.

Read more:
Chancellor defends £40bn tax rises
Hefty tax and spending plans a huge gamble – analysis

In other words, she’d break those rules – which, recall, are considerably less strict than the ones she inherited from Jeremy Hunt.

Which raises the question: where are those gilt yields right now? How close are they to the danger zone where the chancellor ends up breaking her rules?

Short answer: worryingly close. Because, right now, the yield on five-year government debt (which is the maturity the OBR focuses on most) is more than halfway towards that danger zone – only 56 basis points away from hitting the point where debt interest costs eat up any leeway the chancellor has to avoid breaking her rules.

Now, we are not in crisis territory yet. Nor can every move in currencies and bonds be attributed to this budget.

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Markets are volatile right now. There’s lots going on: a US election next week and a Bank of England decision on interest rates next week.

The chancellor could get lucky. Gilt yields could settle in the coming days. But, right now, the UK, with its high level of public and private debt, with its new government which has just pledged to borrow many billions more in the coming years, is being closely scrutinised by the “bond vigilantes”.

A Halloween nightmare for any chancellor.

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