Ambulance workers are once again walking out in England on Wednesday in nationwide strike action.
Unison, the union behind the latest round of industrial action, is calling for a pay increase for workers. But it says this isn’t just about money – it’s also about making a stand to protect the crumbling NHS.
NHS England data from December showed A&E waits and ambulance response times have hit their worst levels on record across the UK.
Anecdotally, people are already sharing stories of long waits for ambulances, with some forced to order taxis or use public transport to get themselves to hospital. Recently, a woman told of how she had to strap her 89-year-old grandfather to a plank to get him to hospital in the back of a van after he broke his hip and shoulder. A 999 call handler told her no ambulances were available.
So, what do these strikes mean for a system that’s already stretched beyond its limits? Here’s what you need to know.
When and where are the strikes happening?
Emergency service workers who are members of Unison are walking out on Wednesday, January 11 and Monday, January 23. The action will impact services in London, Yorkshire, the North West, North East and South West.
Unison has said both strikes will last for 24 hours from midnight to midnight, and will involve all ambulance employees, not just 999 response crews.
Strikes jointly coordinated by GMB, Unison and Unite unions on December 21 impacted 10 of the 11 NHS trusts in England and Wales. A strike by members of the GMB union also took place at nine trusts on December 28.
The ambulance strikes are in addition to strikes by nurses, who are also taking action over pay, working conditions and longterm concerns about patient safety.
Will ambulances be available?
Some ambulances will be operating, but the strikes are expected to cause severe disruption.
It is expected that all category 1 calls – the most life-threatening, such as cardiac arrest – will be responded to. Some ambulance trusts have agreed exemptions with unions for specific incidents within so-called category 2, which covers serious conditions such as stroke or chest pain.
London Ambulance Service (LAS) chief executive Daniel Elkeles said an agreement had been reached to ensure no more than half of staff would strike at any one time to ensure serious calls. While LAS said it aims to respond “as normal” to strokes and heart attacks, the public were warned not to call for an ambulance unless it was “life and limb” emergency.
“It is still really, really busy in the NHS and hospitals are really, really full so I would just ask the public to be really helpful again tomorrow and only phone us if they have a life and limb-threatening emergency,” Mr Elkeles said.
“And if they have another urgent healthcare need please use 111 either on the phone or online.”
One hospital chief executive told the Guardian of the December strikes: “Most category one calls are supposed to be life-threatening so should be prioritised. But for category two and below it’s far less certain that people will get any kind of response, other than telephone advice.
“We are likely to see people with suspected strokes or heart attacks being asked to make their own way to hospital. A fit younger adult with a broken leg wouldn’t get an ambulance in these circumstances and it’s unlikely that an elderly person who has fallen at home would either.”
Health minister Will Quince’s comments that the public should stay safe and avoid “risky activities” that could pose a risk to health didn’t spark much faith in the system.
Why are ambulance workers striking?
The unions are calling for the government to improve pay for paramedics and other ambulance staff amid soaring inflation. But they say this is also about working conditions and protecting the NHS longterm.
Kristin Houlgate, a paramedic based in South West England, posted a Twitter thread in December explaining how “the entire system has collapsed”.
“We’re no longer practicing emergency medicine. We’re just desperately trying to put out fires and triage the sickest patients, but it’s just not enough,” she said.
“There are literally hundreds and hundreds of emergency calls in the stack with no resources to send. This is true up and down the country. People are dying waiting for ambulances as we queue outside ED’s [emergency departments], themselves in crisis and experiencing critical incidents.”
She explained that she’ll sometimes spend entire shifts queuing outside the hospital, trying to care for patients as best she can while her radio constantly receives more calls from patients they simply do not have the capacity to help.
As well as the impact on patients, Houlgate also shared the knock-on impacts on ambulance staff, who she says work long hours, often without a break and “no sustenance aside from a hastily snatched hospital biscuit and maybe a cup of water from the cooler”.
What does the government say?
Rishi Sunak has yet to budge over pay for ambulance staff, though No.10 has said the prime minister is willing to listen to nurses’ demands and indicated the government might consider a one-off payment to NHS workers to break the stalemate over strikes.
“The government is acting fairly and reasonably and will always continue to do so. I’m going to do what I think is right for the long-term interests of the country: combating inflation,” the prime minister said in December.
“The government is doing everything it can to be responsible and put in place contingency measures to support people, but ultimately I will continue to urge the unions to call off the strike because that’s what is causing disruption to people’s lives, that is what is having an impact on their health.”
But on Tuesday, business secretary Grant Shapps laid out a government plan to enforce minimum service levels during strikes, including for firefighters and railway workers, ambulance staff, nurses, and teachers.
If passed, the new bill would mean a certain number of employees would be required to work during a strike and could face the sack if they refused.
The aim was to protect “lives and livelihoods”, said Shapps, but unions have called the proposals “undemocratic, unworkable, and almost certainly illegal.” Even a Tory MP has criticised the bill as “shameful, shameful, shameful.”
“By all means fine the unions, make them agree to minimum service levels, but don’t sack individual NHS staff, teachers & workers!!!” tweeted Stephen McPartland, who served as security minister under Boris Johnson.
A government spokesperson said in December: “We want to ensure people are paid fairly, and we have been reasonable in our approach to agreeing to the independent pay review bodies’ recommendations for public sector pay rises.
“An inflation-matching pay increase of 11% for all public sector workers would cost £28bn, worsening debt and embedding inflation, which makes everyone poorer. That would be a cost to each household of just under £1,000.”