The number of people phoning 999 appears to have dropped in parts of England as thousands of ambulance staff and paramedics strike until midnight.
The West Midlands Ambulance Trust thanked people for heeding their advice to only call in an emergency as ambulance trusts reported receiving fewer calls.
The drop in calls comes as health leaders have urged people to still phone for an ambulance if they are in a life-threatening emergency.
It is feared some people in desperate need of help will not phone 999 during the strike action.
Hundreds of members of the army, navy and RAF have been drafted in to cover as paramedics, technicians, control room workers and other staff in England are on strike.
All Category 1 calls (the most life-threatening, such as cardiac arrest) are being responded to during the walkouts, while some ambulance trusts have agreed exemptions with unions for specific incidents within Category 2 (serious conditions, such as stroke or chest pain).
Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), said: “There may be a number of reasons why 999 calls are dropping – hesitancy may be a key factor during the industrial action.
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“We want to reassure patients and the public that if they need emergency care, A&Es remain open.”
The Welsh Ambulance Service has said demand is “manageable” but any “influx of calls would put significant pressure on our service”.
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Members of the armed forces are not due to be sent on critical emergency callouts or to carry out clinical tasks.
Meanwhile, the East Midlands Ambulance Service said it was too early to say how the service was coping.
Up to half of its more than 4,000 workforce were GMB members who were striking.
South Central Ambulance Service said its main impact from strikes was patient transport services in Sussex and Surrey, rather than urgent and emergency care services.
The London Ambulance Service declined to comment on how services were running.
Thursday and Friday ‘expected to be busy’
Meanwhile, a chief executive of a large northern teaching trust told the Health Service Journal (HSJ) it had “so far not (been) as bad as I’d feared in terms of hospital pressures – in fact, (emergency departments) are less pressured than usual.
“We haven’t seen cars/taxis with patients arriving in large numbers but the problem is that much of the risk is not currently visible to us given people will be at home.
“We therefore expect very busy days on Thursday and Friday.”
It comes as the Royal Albert Edward Infirmary in Wigan declared a critical incident and said it was full after facing “unprecedented pressures” in its A&E department.
The strike action has taken place as there is a bitter war of words between unions and Health Secretary Steve Barclay who has said he will not back down on pay.
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‘I cannot express how bad it is’ – paramedic
Health secretary accused of ‘blatant lie’
Mr Barclay said the Unite, Unison and GMB unions had “refused” to work with the government at the national level to set out plans for dealing with the strikes.
But the unions said all those agreements had been made locally and were in place.
From a picket line in Longford, Coventry, Unite general secretary Sharon Graham accused Mr Barclay of a “blatant lie” for saying ambulance unions had taken a “conscious decision” to inflict harm on patients.
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Health sec criticises timing of ambulance strike
Meanwhile, a paramedic in Nottinghamshire said patients’ lives have been at risk for a long time due to issues in the NHS.
Tom, 33, from the East Midlands Ambulance Service, said: “I’ve attended elderly patients who have been on the floor with broken hips for over 20 hours.
“They’ve been waiting that long that their limbs have started to become necrotic (dying tissue), resulting in major surgery to remove said limbs.”
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Sky’s Jason Farrell looks at the impact of ambulance staff walkouts on patients and those who care for them.
‘Don’t get blind drunk’
A former Royal Marine who is among striking health workers described it as “demoralising” to spend entire shifts waiting outside hospitals with patients stuck in the back of ambulances as he demanded “something needs to change”.
Harry Maskers from Cardiff, who works for the Welsh Ambulance Service, said that while he was unable to strike during his military career, he was taking the opportunity to do so now, with “the kicker” being the government’s refusal to discuss the issue of pay.
Mr Barclay had earlier urged the public to “use their common sense in terms of what activities they do” while ambulance workers are on strike, while the medical director of NHS England Professor Sir Stephen Powis urged people not to get “blind drunk”.
The walkout by ambulance staff and paramedics comes as nurses in Scotland overwhelmingly rejected the latest pay offer from the Scottish government, in a move which could see members of the Royal College of Nursing (RCN) take strike action for the first time ever.
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Health Secretary Steve Barclay says people should use
Meanwhile, National Highways workers will go on strike from Thursday until Christmas Day in the latest phase of industrial action by the biggest civil service union.
The strike involves members of the Public and Commercial Services union (PCS) working as on-road traffic officers and regional operating centre operatives, in London and southeast England.
It comes as planned strikes by railway cleaners in a dispute over pay have been called off.
More than 1,000 cleaners, who are members of the Rail, Maritime and Transport union, would have been involved.
He called emergency services but soon “water started seeping in”.
“I thought I’m going to have to get out, I’m going to have to smash a window,” Mr Randles said.
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He wound down his and his son’s windows, and climbed out before rescuing his son.
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‘Devastating’ flooding in Wales
“The water was chest high, I held him up as high as I could to keep him out of the water.”
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“It wasn’t raining so heavily, I’ve driven in much worse rain,” he added.
Mr Randles, a self-employed roofer who relies on the car for work, said he remained calm during the ordeal and was helped by the fact that Luca was asleep during the rescue.
Mr Randles’ partner Paige Newsome – who was not in the car at the time – said the incident was “really scary”.
“To think I could have actually lost them both – I don’t know how I would’ve lived,” she said.
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The road has been flooding for at least two decades, the couple said.
“What is it going to take for the council to sort it out? Does a fatal incident have to happen? It’s been going on for years,” Ms Newsome said.
The couple are worried about affording another car as well as Christmas celebrations.
But Mr Randles said: “I’m grateful that we got out safely and that we can spend his first birthday and Christmas as a family.”
Storm Bert has brought more than 80% of November’s average monthly rainfall in less than 48 hours to some parts, the Met Office said.
Around 300 flood warnings and alerts are in place in England, with another 100 in Wales and nine in Scotland, as heavy rain and thawing snow bring more disruption across the UK.
A major incident was declared by Rhondda Cynon Taf County Borough Council in South Wales after homes and cars were submerged in water.
‘It is devastating’
Gareth Davies, who owns a garage in Pontypridd, a town in Rhondda Cynon Taf, told Sky’s Dan Whitehead that flooding has put his small business “back to square one”.
As the River Taff burst its banks, the majority of the vehicles in Mr Davis’s garage were so damaged he says they will have to be written off.
“I am gutted,” he said, standing in his flooded garage, most of which is also covered in oil after a drum tipped over.
“How long is it going to take to sort out? I am going to lose money either way. I can’t work on people’s cars when I am trying to sort all of this out.
“It is devastating.”
Mr Davies said he has never had an issue with water coming into his garage until now.
Pointing to one car that had been hoisted into the air before water reached it, he said: “Lucky enough, I did come in this morning just to get that car up in the air.
“I don’t know what to say, I have been working flat out for two years to build this up and something like this happens, and it just squashes it all.
“This has put me back to square one.”
At least two to three hundred properties in South Wales have been affected by flooding, Councillor Andrew Morgan, leader of Rhondda Cynon Taf Borough Council, said on Sunday.
He said the affected buildings are a mixture of residential and commercial properties, after the weather turned out to be worse than what was forecast.
The Labour MP behind the assisted dying bill said she has “no doubts” about its safeguards after a minister warned it would lead to a “slippery slope” of “death on demand”.
In a strongly worded intervention ahead of Friday’s House of Commons vote, Ms Mahmood said the state should “never offer death as a service”.
She said she was “profoundly concerned” by the legislation, not just for religious reasons, which she has previously expressed, but because it could create a “slippery slope towards death on demand”.
Asked about the criticism, Ms Leadbeater said: “I have got a huge amount of respect for Shabana. She’s a very good colleague and a good friend.
“In terms of the concept of a slippery slope, the title of the bill is very, very clear.
“It is called the Terminally Ill Adults (End of Life) Bill. It cannot include anybody other than people who are terminally ill, with a number of months of their life left to live. It very clearly states that the bill will not cover anybody else other than people in that category.”
She wants people who are in immense pain to be given a choice to end their lives, and has included a provision in the legislation to make coercion a criminal offence.
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The matter will be debated for the first time in almost 10 years on Friday, with MPs given a free vote, meaning they can side with their conscience and not party lines.
As a result, the government is meant to remain neutral, so the intervention of cabinet ministers has provoked some criticismfrom within party ranks.
Labour peer Charlie Falconer told Sky News Ms Mahmood’s remarks were “completely wrong” and suggested she was seeking to impose her religious beliefs on other people.
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8:51
Kevin Hollinrake says he will be in favour of the assisted dying bill
Asked about his comments, Ms Leadbeater said it was important to remain “respectful and compassionate throughout the debate” and “for the main part, that has been the case”.
She added: “The point about religion does come into this debate, we have to be honest about that. There are people who would never support a change in the law because of their religious beliefs.”
Ms Leadbeater went on to say she had “no doubts whatsoever” about the bill, which has also been objected by the likes of Health Secretary Wes Streeting and former Labour prime minister Gordon Brown.
Asked if she has ever worried about people who don’t want to die taking their own lives because of the legislation, Ms Leadbeater said: “No, I don’t have any doubts whatsoever. I wouldn’t have put the bill forward if I did.
“The safeguards in this bill will be the most robust in the world, and the layers and layers of safeguarding within the bill will make coercion a criminal offence.”
There is a lot at stake this week for Sophie Blake, a 52-year-old mother to a young adult, who was diagnosed with stage four cancer in May 2023.
As MPs vote on whether to change the law to allow assisted dying, Sophie tells Sky News of the day her life changed.
“One night I woke up and as I turned I felt a sensation of something in my breast actually move, and it was deep,” she says, speaking from her home in Brighton.
“Something fluidy, a very odd sensation. I woke up and made a doctor’s appointment.”
Sophie underwent an ultrasound followed by a biopsy before she was taken to a room in the clinic and offered water.
“They said, ‘a hundred percent, we believe you have breast cancer’.”
But it was the phone call with her mother that made it feel real.
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“My mum had been waiting at home. She phoned me and said ‘How is it darling?’ and I said ‘I’ve got breast cancer,’ and it was just that moment of having to say it out loud for the first time and that’s when that part of my life suddenly changed.”
Sophie says terminal cancers can leave patients dreading the thought of suffering at the end of their lives.
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“What I don’t want to be is in pain,” she says. “If I am facing an earlier death than I wanted then I want to be able to take control at the end.”
Assisted dying, she believes, gives her control: “It’s an insurance policy to have that there.”
Disability rights advocate Lucy Webster warns that for people like Sophie to have that choice, others could face pressure to die.
“All around the world, if you look at places where the bill has been introduced, they’ve been broadened and broadened and broadened,” she tells Sky News.
Lucy is referring to countries like Canada and Netherlands, where eligibility for assisted deaths have widened since laws allowing it were first passed.
Lucy, who is a wheelchair user and requires a lot of care, says society still sees disabled people as burdens which places them at particular risk.
“I don’t know a single disabled person who has not at some point had a stranger come up to us and say, ‘if I were you, I’d kill myself’,” she says.
The assisted dying bill, she says, reinforces the view that disabled lives aren’t worth living.
“I’ve definitely had doctors and healthcare professionals assume that my quality of life is inherently worse than other people’s. That’s a horrible assumption to be faced with when [for example] you’ve just gone to get antibiotics for a chest infection. There are some really deep-seated medical views on disability that are wrong.”
Under the plans, a person would need to be terminally ill and in the final six months of their life, and would have to take the fatal drugs themselves.
Among the safeguards are that two independent doctors must confirm a patient is eligible for assisted dying and that a High Court judge must give their approval. But the bill does not make clear if that is a rubber-stamping exercise or if judges will have to investigate cases including risks of coercion.
Julian Hughes, honorary professor at Bristol Medical School, says there’s a very big question about whether courts have the room to take on such a task.
“At the moment in the family division I understand there are 19 judges and they supply 19,000 hours of court hearing in a year, but you’d have to have an extra 34,000,” he explains.
“We shouldn’t fool ourselves and think that there wouldn’t be some families who would be interested in getting the inheritance rather than spending the inheritance on care for their elderly family members. We could quickly become a society in which suicide becomes normalised.”