Norfolk junior doctors onto day two of the longest NHS strike in history
Some hospitals in England have called on junior doctors to return to work
A number of hospitals have called on striking junior doctors to return to work due to patient safety concerns, during the longest walkout in NHS history.
This comes as junior doctors across Norfolk, and England, are on to their second day of a six-day walkout.
Some services across the country say they're facing "significant demand", with two hospitals declaring critical incidents, and others reporting significant waits in A&E departments.
One hospital warned patients they may need to wait "up to 11 hours".
A number of hospitals have submitted so-called derogation requests, calling on doctors to return to work.
It is understood that just over 20 requests have been made by hospitals, but some may have submitted more than one request.
The British Medical Association (BMA) said that the derogation process was being "undermined" by the health service, with a number of the requests being submitted well in advance of the strike and a number of hospitals not illustrating what steps they have taken to mitigate the need for junior doctors to work.
All but one of the requests have been rejected, and the final one is being considered by the union.
The BMA said such requests should come as a "last resort" and only be used in "unexpected and extreme circumstances unrelated to industrial action".
"Astonishing"
In a letter to NHS boss Amanda Pritchard, BMA chairman of council Professor Philip Banfield said: "It is, therefore, astonishing that during this current round of industrial action, NHS England and some Trusts have refused to evidence any efforts to source alternative staffing or demonstrate rearrangements or cancellation of less urgent work."
He added: "We are increasingly drawing the conclusion that NHS England's change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action.
"The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the minimum service level regulations."
An NHS spokesperson said: "The NHS has a robust process in place for seeking derogations from the BMA to prioritise the safety of our patients and this has involved providing strong evidence where the most challenged systems need support."
What's happening in our hospitals?
- Queen Alexandra Hospital in Portsmouth said its A&E department was "full" as it declared a critical incident.
- A critical incident was declared by NHS Nottingham and Nottinghamshire Integrated Care Board due to "significant pressures on services".
- Bolton NHS Foundation Trust said it was facing "extreme pressure" with waiting times in A&E of "up to 11 hours".
- Warwick Hospital warned that it is under "extreme heightened pressure" while Airedale Hospital said its emergency department is "exceptionally busy".
- Health officials in Wigan said emergency services were "very busy" and that doctors were seeing "a lot of minor illnesses that could have been treated elsewhere such as a GP surgery or pharmacy".
- Leeds Teaching Hospitals warned that its hospitals are "under significant pressure".
- Health officials in East Sussex, South Tees, Gateshead, Greater Manchester, Berkshire, Rotherham and The Princess Alexandra Hospital in Harlow, Essex, have also reported being "busy".
Despite this, NHS officials say that people should still seek care when they need it.
"Challenging"
Professor Sir Stephen Powis, national medical director for the NHS in England, said the strike coincides with "one of the busiest and most challenging weeks of the year" as the NHS grapples with increased pressure from winter viruses and a rise in people coming forward who delayed seeking help over the holidays.
Sir Stephen said: "As the longest strike in the history of the NHS begins during one of the busiest and most challenging weeks of the year - the health service is experiencing the winter pressures of flu and Covid, combined with the huge disruption of industrial action.
"We know hospitals are already experiencing significant demand, with other NHS services also under immense pressure, and although staff are doing the very best for patients with extensive preparations in place, there is no denying the NHS has started the year in a very difficult position.
"This latest round of strike action will not only have an impact on this week but will have an ongoing effect on the weeks and months ahead as we struggle to recover services and cope with heavy demand.
"Our message for patients remains the same, continue to come forward for care using 999 and A&E in life-threatening emergencies and 111 online for everything else."
"Prioritising emergency care"
Dr Vin Diwakar, medical director for transformation at NHS England, told the PA news agency that officials had spent weeks doing "intensive preparation" for the strike.
"We have been prioritising emergency care as we have done during previous industrial action," he said.
"So we have emphasised to the public that if they have got a life-threatening illness they should continue to call 999, if they are worried that they are unwell but it is not an emergency then to use 111 online or 111 or to make an appointment with your GP or use your community pharmacy.
"It's likely that the impact is not just going to be for the current period of industrial action, it is going to go on for several weeks afterwards."
He said that the impact could go on for weeks due to lost doctor time, booking in rescheduled appointments and consultants catching up on their normal workload, which they were unable to do while covering for striking colleagues.
What does the Health Secretary say?
Health and Social Care Secretary Victoria Atkins said: "January is typically the busiest time of the year for the NHS and these strikes will have a serious impact on patients across the country.
"I urge the BMA junior doctors committee to call off their strikes and come back to the negotiating table so we can find a fair and reasonable solution to end the strikes once and for all."
Dr Vivek Trivedi, co-chairman of the BMA's junior doctors committee, told the PA news agency: "I hope they (the Government) come back to the table now, but from all of the signals they are sending it won't be until our strike action finishes. And I hope at that point we can come to a resolution."
Chief executive of conciliation service Acas, Susan Clews, said: "Acas remains in contact with all parties to the junior doctors' dispute.
"They are aware of the value that third-party assistance can bring, and that we have a team of experts who are well prepared and ready to help with the dispute."
Appointment cancellations
Of the 1,219,422 acute inpatient and outpatient appointment cancellations since the current period of strikes began, more than three-quarters (77%) have been on days where junior doctors have taken industrial action either by themselves or with other groups.
The BMA said junior doctors' pay has been cut by more than a quarter since 2008.
Last summer, the Government gave junior doctors in England an average rise of 8.8%, but medics said the increase was not enough and ramped up strike efforts.
Late last year the Government and junior doctors entered talks, but after five weeks of negotiations they broke down and more strikes were called.
Junior doctors from the Hospital Consultants and Specialists Association union will join colleagues on picket lines.
Consultants and speciality and associate specialist (SAS) doctors have agreed on a deal with the Government, which is being put to members.