Junior doctors across England have launched a four-day strike in a worsening dispute over pay which threatens huge disruption to the NHS.
An estimated 350,000 appointments, including operations, will be cancelled as a result of the walkout by members of the British Medical Association (BMA).
Doctors mounted picket lines outside hospitals from 7am on Tuesday until Saturday morning in the longest stoppage of the wave of unrest, which has seen nurses, ambulance crews and other health workers take action since last year.
Managers have said patient care is “on a knife edge” because of the strike, while NHS Confederation chief executive Matthew Taylor said the number of appointments cancelled, previously suggested to be 250,000, was likely to rise by another 100,000.
The strikes centre around a pay row between the BMA and Government, with the union claiming junior doctors in England have seen a 26 per cent real-terms pay cut since 2008/09 because pay rises have been below inflation.
The union has asked for a full pay restoration that the Government said would amount to a 35 per cent pay rise – which ministers have said is unaffordable.
BMA officials said the pay issue is making it harder to recruit and retain junior doctors, with members previously walking out for three days in March.
National medical director of NHS England Professor Sir Stephen Powis said on Sunday the strikes will put “immense pressures” on staff and services.
Powis said he expects the number of operations and procedures having to be rescheduled “will be considerably more than the 175,000”.
He told BBC Radio 4’s Today programme: “When we had the last period of industrial action a few weeks ago, that was three days, we saw over 175,000 operations and procedures having to be rescheduled. We won’t get the exact number this week until the strike is over but our expectation is that we will see considerably more than that.”
He added: “I think it will be considerably more than the 175,000 – it’s four days this time, not three days, and of course it comes after the Easter holidays and a lot of staff are on leave this week.”
NHS England said staff will be asked to prioritise emergency and urgent care over some routine appointments and procedures to ensure safe care for those in life-threatening situations.
The health body said appointments and operations will only be cancelled “where unavoidable” and patients will be offered alternative dates as soon as possible.
Health and Social Care Secretary Steve Barclay said: “It is extremely disappointing the BMA has called strike action for four consecutive days.
“Not only will the walkouts risk patient safety, but they have also been timed to maximise disruption after the Easter break.
“I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35 per cent pay rise is unreasonable – it would result in some junior doctors receiving a pay rise of over £20,000.
“If the BMA is willing to move significantly from this position and cancel strikes we can resume confidential talks and find a way forward, as we have done with other unions.
“People should attend appointments unless told otherwise by the NHS, continue to call 999 in a life-threatening emergency and use NHS 111 online services for non-urgent health needs.”
The BMA has previously said it was willing to enter talks with Mr Barclay and suspend strikes if members were presented with a “credible” pay offer “to resolve 15 years of pay erosion”.
Mr Taylor, head of the NHS Confederation which is a membership organisation that represents healthcare bodies in the UK, said the likely impact of the strike is “heartbreaking” and called on both sides to end their “battle of rhetoric”.
He said there is “no question” this strike will be more disruptive than the 72-hour walkouts by NHS staff last month, which led to 175,000 cancelled appointments.
Speaking about pay negotiations which would avoid the action, Mr Taylor told BBC Breakfast on Monday: “It’s depressing that there seems to be no movement at all from the two sides of this dispute over the last few days.
“We should consider asking the Government and the trade unions to call in Acas, the conciliation service, to provide some basis for negotiations, because if anything the positions seem to have hardened over the last couple of days.”
Shadow health secretary Wes Streeting said: “The junior doctors’ strike this week will cause huge disruption to patient care.
“Where is the Prime Minister and why hasn’t he tried to stop it?
“Rishi Sunak says he ‘wouldn’t want to get in the middle of’ NHS pay disputes.
“Patients are crying out for leadership, but instead they are getting weakness.”
BMA junior doctor committee co-chairman Dr Vivek Trivedi said: “We were knocking on the Health Secretary’s door, asking to meet with him to negotiate a settlement to this dispute, long before the current strike got underway.
“We have been in a formal dispute since October. He refused to respond and meet us until we had a strike ballot result. He has had months to put a credible offer on the table and avert industrial action, so for him to say, ‘It’s disappointing,’ is at best disingenuous.
“We have always maintained our aim is for full pay restoration – to reverse the more than 26% real-terms pay cuts Mr Barclay’s Government have imposed on us over the past 15 years, putting starting salaries up by just £5 per hour to £19.
“We have always maintained we are willing to negotiate on how to achieve pay restoration, so for Mr Barclay to suggest we had any preconditions is yet again disingenuous.
“The reality is that the Health Secretary has had every opportunity to bring an end to the dispute. His decision to refuse to table a credible offer – indeed he has not tabled a single offer so far – means that this action is solely due to this Government’s repeated inaction.
“We would still be willing to suspend strike action this week if the Secretary of State makes a credible offer that can be the basis of negotiation.”
The co-chairman of the BMA junior doctors’ committee has said the 35% pay rise the union has asked for is “not a tall ask”.
Dr Vivek Trivedi told BBC Breakfast: “This uplift that we’re asking for is only to reverse the pay cuts that we’ve had, doctors have had more than a 26% real-terms pay cut over the last 15 years.
“All we’re asking is for a doctor who’s paid £14 an hour to be paid £19 an hour, so it’s not a tall ask.”
Dr Trivedi added that the 96-hour walkout by junior doctors could be stopped if Health Secretary Steve Barclay would approach negotiations with a “credible offer”.
“We’ve offered multiple dates to Mr Barclay to try and meet and he’s only met us twice, he didn’t have a mandate to negotiate once, and didn’t even give us an offer the second time,” he said.