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The Guardian - UK
The Guardian - UK
Politics
Mark Tran , Haroon Siddique and David Batty

Junior doctors strike: Jeremy Corbyn joins protest march - as it happened

Junior doctors: ‘None of us want to strike’

Evening summary

  • Jeremy Corbyn has thrown his support behind striking junior doctors with a speech to hundreds of protesters in Whitehall. He said: “The government has an opportunity to settle this, they should get on and do so.” He was joined by the shadow chancellor, John McDonnell, who said the health secretary, Jeremy Hunt, would eventually have to back down on his threat to impose a new contract.
  • Hundreds of striking doctors were joined by teachers and other protesters as they marched on Whitehall.
  • David Cameron has given his backing to Jeremy Hunt’s handling of the dispute with junior doctors. He told ITV News: “There is a good contract on the table with a 13.5% increase in basic pay – 75% of doctors will be better off with this contract. It’s the wrong thing to do to go ahead with this strike, and particularly to go ahead with the withdrawal of emergency care – that is not right.” William Hill is offering odds of 11-10 that Hunt will be out before the end of the year.
  • Hunt insisted he has no intention of backing down, saying his post as health secretary is likely to be his last big job in politics, and history will judge him on his ability to deliver a seven-day NHS. The health secretary said “the one thing that would keep me awake [at night] is if I didn’t do the right thing to help make the NHS one of the safest, highest quality health services in the world.”
  • Strikers from hospitals around the country said very few junior doctors had crossed the picket lines. At Manchester Royal Infirmary, doctors said they knew of no junior doctors who had showed up for work. A registrar at Hammersmith hospital in London reported the same.
  • Public support for junior doctors remains high despite their unprecedented action. A new Ipsos Mori poll for BBC News shows 57% of adults in England support the strike, but support for this round of stoppages is slightly lower than for previous strikes when emergency care was not affected.
  • The chair of the BMA’s junior doctors committee, Johann Malawana, described today’s walkout as “the saddest day in NHS history”. He said it was “entirely avoidable”, accusing Hunt for being unwilling to negotiate. Mark Porter, chair of the BMA council, urged Hunt to put patient care before political dogma for the sake of patients and the future of the NHS.

Vanessa Redgrave has taken to the stage to address the protesters.

This photo gives some sense of the scale of the protest with thousands reportedly now gathered in Whitehall.

Caroline Lucas, the Green party MP for Brighton, has also addressed the striking doctors, pledging to continue her fight against the commercialisation of the NHS.

Updated

Jeremy Corbyn told the crowds gathered in Westminster: “The government has an opportunity to settle this, they should get on and do so.”

John McDonnell, the shadow chancellor, said the health secretary would eventually have to back down amid sustained pressure from junior doctors.

Updated

Hundreds of protesters are now gathered outside Jeremy Hunt’s office at the Department of Health.

Updated

Jeremy Corbyn has demanded that Jeremy Hunt comes out of hiding, according to a Daily Mirror reporter at the scene.

Aspinall also reports that protesters outside the Department of Health are singing “where are you Jeremy?”

Updated

My colleague Ben Quinn is at the doctors’ strike march near parliament, where the number of protesters fill Westminster Bridge. The Labour leader, Jeremy Corbyn, and the shadow chancellor, John McDonnell, led the crowd on the walk from St Thomas’ Hospital to the Department of Health, joined by teachers marching in solidarity. Corbyn is expected to speak to the rally.

Ben has also spotted this protester’s banner, which alludes to David Cameron’s tax arrangements.

Updated

Senior hospital doctors have taken to Twitter throughout the day to express support for their junior colleagues, posting pictures showing how they are stepping in to provide cover.

Oliver Warren, a consultant colorectal surgeon at the Chelsea and Westminster hospital NHS foundation trust, made several posts throughout the day to make the point that the strike was not leaving patients without care.

He later posted: “Update from frontline – all going well! 3 consultant ward round, all pts [patients] seen – morale high. Off to ED to review a pt.”

He added: “Huge amounts of patient support – every single one.”

Dr Philip Lee, a consultant in acute medicine and elderly care, pledged his support for striking colleagues as he headed to work to provide cover. He tweeted: “On my way in to work, actually looking forward to being med reg for the day!”

Simon Fairweather, a striking junior emergency doctor, tweeted a photo of supportive senior colleagues.

Across England, hospitals appear to have coped well, with low waiting times across A&E departments and no urgent calls for doctors to return from the picket lines, according to the Press Association.

Other NHS staff took to social media to explain how they had worked longer hours in a show of support for the strike.

Updated

As many junior doctors have taken to the picket line, GPs have had to bear the strain and see extra patients needing medical attention.

One GP in Bromley, who spoke to the Guardian under condition of anonymity, said each doctor in his practice had taken on six extra appointments to cope with demand on strike days, and that all had been filled. Although, it is fair to say that some of those people probably should not have been going to A&E in the first place.

He said:

We’re dealing with a lot of minor injuries that people would normally go to A&E for. This morning I had a sprained ankle which I wouldn’t normally see.

In advance of the strike, the local CCG asked practices in Bromley to increase capacity to provide appointments across the area.

The GP added:

It hasn’t been that bad. I was expecting it to be a lot worse. Our patients are getting used to strikes. We’ve added capacity, but it hasn’t been horrendous.

Junior doctors, some on an open-top bus, and supporters from other professions are gathering for a march to the Department of Health.

Updated

While a large majority of the NHS workforce in England is supportive of an all-out strike, there is a minority of healthcare workers who do not agree with it.

Will Denby, a GP registrar in Hampshire, told the Guardian:

The strike is now wholly unfortunate, regrettable and damaging. I would like to hope that all parties wish it had never come to this - no one will come out of it well.

I don’t support withholding emergency care. I don’t think it directly causes harm, or affects safety, but it affects our relationship with the people we serve.

Our profession has to have trust with the society we serve at its heart, and while I agree there is a longer term view in all-out striking, for me a line is crossed. I would support continued striking, but not over acute and emergency care.

The highest participation rate by junior doctors in today’s action seems to have been at the Barts Health trust in London, which is also the NHS’s biggest trust.

The trust says that just 11.6% of the 1,000 or so junior doctors who were meant to be at work today showed up, which means that the other 88.4% stayed away. Barts runs four hospitals in the east of the capital: the Royal London, Barts itself, Newham general and Whipps Cross. Those figures are for today’s turnout at all four places.

Across London, slightly more junior doctors – 26% – turned up for work at the Royal Free hospital trust’s three hospitals.

We currently have 480 doctors on duty across the trust today, 72 of whom are junior doctors. If industrial action were not taking place we would expect to have 557 doctors on duty across the trust, 278 of whom would have been junior doctors.

So that’s 72 of 278 who did cross picketlines – just over one in four.

Updated

Kunal Babla, a doctor in Lewisham hospital’s neo-natal department, said accusations of “greedy” juniors looking after themselves were misplaced. He said:

If we privatise what do you think is going to happen to my salary? We all stand to gain from a privatised service and we are telling you not to do it.

On the industrial action, he said:

You’ve got to have hope otherwise it’s pointless. If you can’t see an end to it you may as well not try. We are making lots of noise and everyone’s hearing, but the people who have an opportunity to put an end to it aren’t listening.

In the same email in which NHS England said 78% of doctors did not show up for work today (see previous update), it gives figures for the previous industrial action on 6 to 8 April, when emergency cover was provided.

At the time of the previous walkout it said that 46% of junior doctors had reported for duty on the day shift but it could not say how many of those were rostered on to emergency care and so not expected to join the action.

However, it now says that it has calculated that approximately 88% were on strike on 6 to 8 April. It seems strange that they have only managed to calculate and/or release this figure now. A cynic might suggest that they are trying to show that appetite for the industrial action has declined among BMA members.

Dr Anne Rainsberry, national incident director for NHS England, said:

The NHS exists to help the sick and people in need and we’d like to sincerely apologise to the more than a hundred thousand people facing disruption during this strike alone, as well as the thousands more affected over the last few months.

This is an unprecedented situation and staff across the NHS have made herculean efforts to ensure continued safe services for patients, which is always our top priority. However the escalation of this action does bring heightened risk and we are continuing to vigilantly monitor the picture across the whole of the country.

The NHS is open for business but in some places may be under specific pressure. We ask the public to use it wisely in this very challenging time as some services may change and some may be busier than usual.

Updated

78% of junior doctors did not work today

NHS England says the earliest available data “indicates that 78% (21,608) of junior doctors who were expected to be working have not reported for duty today – this includes other forms of absence, such as sickness, not just industrial action”.

Updated

Helen, who works in paediatrics, is based at the Royal London hospital doing all her on-call and weekend shifts there, but during days she’s working at the Wellington Way community centre, also in east London.

She has worked overseas but came back to the UK as this is where she trained. She said morale was much better when she was working in New Zealand, as was the attitude to flexibility in training. Just this week she has had 15 email offers of work from New Zealand and would consider going back, she said.

The thing I feel guilty about is we’ve been quiet for too long and we’ve been stretched and stretched and stretched and kept saying yes. But If I keep accepting substandard funding then I’m complicit in the system too.

She explained that at the Royal London – with four paediatric wards and 80 beds – on a day shift there are usually seven registrars, 11 senior house officers and usually one on-call consultant in. Meanwhile other paediatric consultants are working in the hospital but in operating theatres, clinics and ward rounds.

She said:

The consultants in paediatrics just came down a while ago and gave support. A consultant said it had been so quiet he saw [only] three patients.

They have been extremely supportive but it’s a short-term measure and for a two-day stretch, but it can’t continue.

Updated

Denis Campbell points us to a blog by the widely-respected NHS commentator Roy Lilley, who slates both sides in the junior doctors’ dispute. First he tackles Jeremy Hunt and his determined campaign to turn the health service in England into a truly seven-day service – which he calls a “world-class cock-up”. Lilley says:

For the NHS to become a truly seven day service would have been a world-first achievement. So far, making it happen has been a world-class cock-up. Instead of inspiring the NHS to show the world what good looks like, we have provoked the back-bone of the workforce to stand outside hospitals watching ambulances arrive.

It is because the 7-day ‘thing’ is a work in progress that the DH, whoever the secretary of state may be, cannot give in to the unions. To concede to the BMA is to become a soft touch for the rest of the groups that are likely to rail against inevitable changes to their working practices. The government cannot give in. They cannot have their election pledge blocked by a trade union. The junior doctors have never been the enemy. Their union is…

Then, moving on to the British Medical Association, he is just as excoriating.

The BMA find themselves in a similar bind. Recent elections to the BMA council have moved them to the left; they are no friend of this government. This is not about gaps in a rota or a premium for weekend working. This is about the cost of losing a strike.

In the same way the [NHS hospital] trusts are the bystanders in this row; picking up the pieces, making the best of too few staff, too high locum costs and too little money, so the junior doctors, their career and reputations will be the collateral damage in a battle the BMA have been quite happy to see them fight.

The BMA? Stuck with a plan A that hasn’t worked and a plan B that means more strikes and disruption. You can’t dignify it with the word strategy.


Updated

Rachel Sinton, a junior doctor on the picket line outside Royal Liverpool University hospital spoke to Frances Perraudin. She said:

I know so many people who are talking about leaving. They’re demoralised, it just becomes a point where it’s not worth it and we love our jobs.

The TUC is being urged to organise a national day of action in support of the junior doctors, reports the Press Association.

The executive of the Public and Commercial Services (PCS) union called for the idea to be discussed at a meeting of the TUC general council on Wednesday.

PCS general secretary Mark Serwotka said:

It is increasingly clear that the Government is deliberately stoking the dispute for political reasons, and that the BMA’s brave response continues to be necessary in defence of patient safety.

The junior doctors’ determined action enjoys wide public support and deserves the fullest possible support and solidarity from the trade union movement.

Damien Gayle is now at Lewisham hospital where hail and snow have forced most of the junior doctors indoors. Jonah Dearlove, a second year trainee in the ear, nose and throat department, explained his opposition to the new contract. At the moment his basic salary is £28,000, which he makes up in unsociable hours payments.

“At the moment I can diary card, where we record all of our hours, we go through the BMA and if it’s not in compliance with our terms and conditions then they may have to make a payout to the doctors because they classified them under the wrong pay scale.

That’s a disincentive for the hospitals to set out rotas that are unsustainable … That stops us from being made to work unsafe hours, and that’s going away.”

According to Dearlove, under the new contracts, instead of having to pay doctors who are being overworked, the hospital would have to pay another fine – to itself.

He went on: “One of the reasons why the contract is being changed is potentially a consequence of the fall-out at Hitchinbrooke (Cambridgeshire), which was taken over by a private company and was given back because they couldn’t run it profitably.

“If they change the doctors contract that will be a chance for them to change all the contracts to bring them in line with this model – the nurses, the support staff, the radiographers. They will be able to cheaply move everyone into working at the weekend, low cost and with no safeguards to prevent the hospital – or ultimately the private provider – from imposing unsafe hours.

“NHS budgets are shrinking in real terms and so in order to get the best value for money the hospital, or private provider, is going to want to staff the rotas in a minimal way. If you don’t have any safeguards on working hours there is nothing to prevent one employer from staffing things in such a way that you are well over your [contracted] working hours. That will leave us with tired doctors who are going to make mistakes and put patients at risk.”

Updated

This junior doctor wants the health secretary to know the impact working weekends has had on her love life.

Some figures from the Royal Bournemouth and Christchurch hospitals trust.

Of the 125 junior doctors who were expected in today, 46 worked. The figure was more like 50% last strike.

The BMA calculates that today and tomorrow about 100 surgical appointments and some 700 outpatient/follow-up appointments will have been lost. That’s not to say they were cancelled at the last moment – they were simply not planned in when they would have been normally.

Basil Fozard, medical director at the trust, said safety of patients had not been compromised. “The key element is that there is solidarity among the consultants and other grades who are supportive of the junior doctors.” He said that A&E, the acute medical unit and most theatres were working normally.

Fozard would not say if he supported the strike but two of his children have taken part in the dispute – and he said he had spoken to them today – which suggests relations are amicable and he may have sympathy.

Updated

Scotland’s first minister Nicola Sturgeon has written to David Cameron urging the government to return to the negotiating table with junior doctors’ leaders.

Senior hospital doctors’ union the Hospital Consultants and Specialists Association (HCSA) says there is “growing frustration” among senior clinicians at the government’s failure to act to defuse the dispute.

Professor Ross Welch, president of the TUC-affiliated HCSA, said:

Consultants and specialists will be stepping into the breach today to ensure that excellent patient care continues across our NHS for those most in need.

Senior hospital doctors have for weeks been working with trusts to ensure that the most vital services, including cancer care, are provided.

However, they do so with a sense of growing frustration with a government that refuses to lift the threat of planned imposition of the new contract for doctors in training.

The HCSA has always backed in principle the idea of seven-day services, but not at any cost.

There is no shortcut to a safe seven-day service, and widespread concerns over the impact of the current proposals on recruitment, retention and the health and wellbeing of the next generations of hospital consultants must not be ignored.

Updated

The weather has thinned the ranks of picketers at Lewisham hospital.

Aisha Gani at St Thomas’ hospital near Westminster.

Updated

A junior doctor tells Frances Perraudin she feels completely undermined.

Members of the Communications Workers Union have shown up in support of striking junior doctors at Bournemouth Royal hospital.

Updated

Junior doctors from King’s College hospital, south London, plan to depart from their pickets in an open-top bus this afternoon to tour nearby communities, speaking with local people and trying to get their message across.

They will pick up teachers and nurses before heading on to join colleagues at St Thomas’. A big march is due to depart at 5pm from the pickets at the riverside hospital over into Westminster and on to the Department of Health.

The doctors said:

We’ve got a vintage open-top bus and the plan is to mobilise doctors into our local community, who have been very supportive, to get our side of the story across. This idea that it’s about Saturday pay is not the case. We are trying to push through that spin and get the arguments out. We’ve got loads of leaflets and banners and we’ll make it a bit more visual.

The NUT (teachers union) are going to get on board, some of the nurses are going to come, and then we are going to end up at St Thomas’ for 5pm, for the big march.

Updated

At South London and Maudsley NHS foundation trust 40 trainees have attended work duties today out of a total of 246* (approximately one in six of the junior doctor workforce), according to Tony Rao, consultant psychiatrist at the trust and chair of the BMA’s local negotiating committee.

He said:

Having over 80% of junior doctors taking part in industrial action is a sad reflection of the strength of feeling about imposition of the junior contract.

*this figure was amended as the initial figure was incorrect.

Updated

I was wondering if we would see any Prince tributes...

Tom Gilberthorpe, a senior trainee psychiatrist at the Maudsley, says he is worried that the imposition of the new contract will particularly affect doctors working in mental health.

For me, as a psychiatric trainee, we are on call and out-of-hours work takes place from home – we are called into hospital. But obviously we are on call for periods of 24 hours often and we can be called at any time throughout that period. Given that we are not based in the hospital, the government sees an opportunity in the new contract to target our pay.

The other major impact on psychiatrists in some respects is that there are many who opt to do less than full-time training. That means I work 80% – I have a day at home to look after my daughter. The new contract will disproportionately affect those trainees that are on less than full-time contracts, and the majority of those are women who take time off for maternity.

One of the overriding issues that’s led to an impasse is the unsociable hours pay, which for people who have family is something we want to protect. We want to protect our weekends and be fairly remunerated for the time we work unsociable hours.

Jeremy Hunt seems to have focused a lot of his spin on the notion that the BMA and junior doctors are striking purely because of a small point about the Saturday and neglects to address the issue of whether or not the proposed contract and seven-day NHS services are indeed safe and sustainable. He’s made his conclusions in the absence of modelling or piloting the contract, or any robust evidence to suggest that seven-day services, as he proposes, will have any impact on mortality or patient outcomes.

Updated

Pun of the day and a cute animal picture to boot.

Brad came out of St Thomas’ hospital, in central London, and asked the doctors for a badge to show his support for them. “Can I have one for my baby as well?” he asked.

Originally from the United States, where he says it costs upwards of $20,000 (around £14,000) to have a baby, he said:

I am proud to be supporting the junior doctors. I am becoming a father, my baby is due tomorrow and my wife is inside [the hospital].

I just think you’re talking about one of the most vital services in the country and I don’t think people become doctors for money or greed. The hours they work already, politicians wouldn’t want to do themselves. They [doctors] have gone through years and years of schooling and everyone in society deserves respect and if you don’t give good conditions and working conditions it undermines the service they do.

He said he wanted his baby to have consistency of care growing up and a safe and secure place for the baby to be treated.

Another man came out of the hospital and approached doctors. He took a sticker and said:

I’d like to register my support. I had a heart attack five days ago. You saved my life. It’s not about the money it’s what they do. And you should chuck Jeremy Hunt in the fucking river.”

He shook their hands and crossed the road. Taxis continue to beep their support, but one jogger shouted “shame on you”.

A consultant came out and handed his colleagues cups of tea and said he was supporting them.

Updated

Junior doctor Don Lindop told Frances Perraudin that this “is one of the biggest issues the NHS has faced in the last 40 to 50 years”.

Lunchtime summary

  • David Cameron has given his backing to Jeremy Hunt’s handling of the dispute with junior doctors. He told ITV News: “There is a good contract on the table with a 13.5% increase in basic pay – 75% of doctors will be better off with this contract. It’s the wrong thing to do to go ahead with this strike, and particularly to go ahead with the withdrawal of emergency care – that is not right.” William Hill is offering odds of 11-10 that Hunt will be out before the end of the year.
  • Hunt insisted he has no intention of backing down, saying his post as health secretary is likely to be his last big job in politics, and history will judge him on his ability to deliver a seven-day NHS. The health secretary said “the one thing that would keep me awake [at night] is if I didn’t do the right thing to help make the NHS one of the safest, highest quality health services in the world.”
  • Strikers from hospitals around the country said very few junior doctors had crossed the picket lines. At Manchester Royal Infirmary, doctors said they knew of no junior doctors who had showed up for work. A registrar at Hammersmith hospital in London reported the same.
  • Public support for junior doctors remains high despite their unprecedented action. A new Ipsos Mori poll for BBC News shows 57% of adults in England support the strike, but support for this round of stoppages is slightly lower than for previous strikes when emergency care was not affected.
  • The chair of the BMA’s junior doctors committee, Johann Malawana, described today’s walkout as “the saddest day in NHS history”. He said it was “entirely avoidable”, accusing Hunt for being unwilling to negotiate. Mark Porter, chair of the BMA council, urged Hunt to put patient care before political dogma for the sake of patients and the future of the NHS.

Updated

David Cameron is being kept updated on the junior doctors strike, according to his official spokeswoman, who said there had been a series of contingency planning meetings.

She questioned the motivations of the doctors and compared their position with other public sector workers.

You look at the impact on patients today and the concerns on risk, people are asking: ‘Is this an appropriate and proportionate response?’

On some of the issues at the heart of this, on Saturday pay, junior doctors earn more than ambulance workers, nurses, healthcare assistants, and others in the public sector like police officers and firemen, who also work on a Saturday. It is important that people understand the contract is on average going to lead to an increase in basic pay of 13.5%.

She said the health secretary had written to the chair of the board of the BMA.

We would like to work with them on this and move forward. We’ve had three years of talks, there have been numerous concessions, we have done all we could to avoid these strikes.

Updated

Dr Tony Rao, consultant psychiatrist at South London and Maudsley NHS foundation trust, says that 230 consultants and 20 middle grade doctors are reporting for work to cover junior doctors who are taking industrial action today.

He said:

Our trust has provided a safe and carefully planned system in each of its four boroughs to ensure that there is sufficient emergency cover to meet the extra demand.

Rao said that he had not managed to obtain figures for how many junior doctors had shown up for work.

National Voices, a coalition of more than 140 health and social care charities, has offered to mediate in the contract dispute.

In a blog on the coalition’s website, chief executive Jeremy Taylor writes:

Why have talks not resumed? There is some evidence that neither side actually wants a resolution and that for different reasons, they are spoiling for a fight. Let us hope this is not the case. A perhaps more plausible explanation has to do with psychology. The dispute is now a classic stand-off in which neither side can back down without losing face ...

This is classic territory for mediation by an independent and trusted third party. It could for example be the charities and patient organisations under the umbrella of National Voices. We would be very happy to provide the neutral space for talks to resume, and to help find a suitable mediator. All of this would of course have to be out of the glare of publicity. Either party need only pick up the phone to us to start the ball rolling. Some might think this naïve. I am happy to be accused of naivety if the alternative is a continuing game of chicken between the government and the BMA for which patients pay the price.

The waiting room in the A&E department at Manchester Royal Infirmary has rarely been so quiet, according to seasoned staff, reports Helen Pidd.

A video display on Tuesday morning said that the wait was one hour maximum, with anyone requiring immediate care guaranteed on-the-spot treatment. There were just two people in the usually busy waiting room at 10am. Waits of well over four hours are common, especially on Friday and Saturday nights, say junior doctors.

Outside, one paramedic said it would be a good day to get ill in Manchester, with casualty staffed entirely by consultants. “It’s always like this on strike days: for once, they’re over-staffed rather than under-staffed, and with the best qualified doctors in the hospital,” said the ambulance worker.

On Oxford Road, around 50 doctors waved placards in what medics said was their biggest picket yet. All said they knew of no junior doctors who had crossed the picket line. Attending his second picket was Rudy the cocker spaniel, who was sporting a tabard saying: “Dogs 4 Evidence Based Contracts.”

His owners, Max Clayton-Smith, 30, a trainee anaesthetist, and Annalie Clark, 29, training to be a psychiatrist, said they feared that the new contract would jeopardise patient safety.

“The new contract will obviously cause problems with the recruitment and retention of staff in specialities which already have a significant out of hours burden, such as paediatrics, A&E and psychiatry,” said Clayton-Smith, who works at Chorley hospital in Lancashire, which recently had to shut down its emergency department because of staff shortages.

If you’re asking those doctors to do even more antisocial hours for less pay, even fewer trainees would choose those specialisms, he suggested. His fiancee, Clark, said the couple had already had serious discussions about one of them leaving medicine all together if they start a family: “It’s definitely affected us, as two doctors. If Saturday is just another normal working day, I don’t know how you are supposed to manage if you have children.”


Updated

No junior doctors have turned up for work at Hammersmith hospital today, this registrar claims.

Ben White, who resigned live on TV yesterday, joined the picket at Newham general hospital.

Updated

Junior doctors have been receiving messages of support – and donations – from around the world.

Updated

Strike is 'not right' – David Cameron

The prime minister has given his backing to Jeremy Hunt’s handling of the dispute with junior doctors.

He told ITV News:

There is a good contract on the table with a 13.5% increase in basic pay – 75% of doctors will be better off with this contract.

It’s the wrong thing to do to go ahead with this strike, and particularly to go ahead with the withdrawal of emergency care – that is not right.

Updated

Doctors on the picket line at Royal Oldham hospital have received a message of support – and some appropriately named chocolates to keep them going – from a local primary school.

Updated

This card from a former junior doctor who quit the profession in December – “Couldn’t take it anymore” – was sent to a picket line in central London.

Updated

Nusiba Taufik, a junior doctor in her first year of training, has been on the picket line outside the Royal Liverpool University hospital during all of the four previous strikes. Frances Perraudin has been talking to her.

“It’s taken us a while to get to this point and a lot of us were nervous about the fact that it was a full walk-out, but the consultants reassured us that everyone was going to be safe,” she said.

“The strike is only until 5pm, so I’m sure they can hold the reins until then. Obviously they are the most senior doctors in the hospital and they have the most clinical knowledge and management skills, so we were all reassured by that.”

Taufik says public support doesn’t seem to have waned at all in Liverpool since the first strike.

“There were warnings that it would if we went to a full walkout, but we’ve had loads of members of the public come and visit the picket,” she said. “People in Liverpool are obviously more politically inclined than other parts of the country, but even national opinion polls suggest most of the public still support the strike.”

Taufik said she was hoping up until the last minute that the strike would be called off.

“Yesterday when Hunt came out to do his speech we were all still in work waiting for an announcement, possibly to stop the strike,” she added. “We were all really hoping that it wouldn’t come to this … [Hunt] obviously realises that if we were to have a proper public debate he wouldn’t come out of it very well.”

Updated

William Hill is offering odds of 11-10 that Jeremy Hunt will cease to be in the job before the end of 2016.

“Mr Hunt is taking a firm line over the doctors’ strike which could ultimately cost him what he has already called his ‘last big job in politics’,” said the bookmaker’s spokesman, Graham Sharpe.

Updated

Alessio Perrone, at Newham hospital, in London, for the Guardian, has been speaking to Eva Tan, a junior doctor for care for the elderly. She said:

I’m a mother, a woman, and I work part-time. I’m already working long hours – often without the time to eat or go to the toilet – without a break. I would be affected greatly [by the new contract].

People must know that there are still more doctors in hospitals today than during bank holidays. We aren’t covered during annual leave, and hospitals are understaffed. There are more and more gaps in the rotas at Newham general hospital. It’s a big problem. I’ve worked in Germany as well, and there we were always covered.

If [Jeremy] Hunt wants to have a real seven-day NHS he should improve emergency care. This plan about elective care doesn’t make sense, it wouldn’t have an impact on it.

Junior doctor Eva Tan on the picket line outside Newham general hospital
Junior doctor Eva Tan on the picket line outside Newham general hospital Photograph: Alessio Perrone for the Guardian

Updated

Here is audio of the health secretary on BBC Radio 4’s Today programme. He said that health secretaries are never popular but “what history judges is did you take the tough and difficult decisions that enable the NHS to deliver high quality care for patients”.

Jeremy Hunt: a very bleak day for the NHS – audio

Some health professionals have responded to a Guardian callout for their views. Here’s a sample of what they said.

Medical HR manager, Lancashire

I think the British Medical Association (BMA) has muddled the dispute with a much broader issue regarding privatisation and funding. Having worked with junior doctors and their contracts for over 20 years, this contract reduces hours universally, provides better safeguards and for those who work the hardest, and offers significant pay increases. The dispute has also been mishandled by Jeremy Hunt, but the Department of Health is right to proceed with the terms, having made concessions along the way, not replicated by the BMA.

Ben Norris, junior doctor, general medicine, south England

I’m concerned that some of my colleagues joining the strike are doing so without having studied the proposed terms in detail. It’s extremely worrying how many junior doctors I’ve spoken to are either wrong or misinformed about basic aspects of a contract they purport to oppose. I’m also worried. How much further will this go? I cannot countenance an indefinite walkout.

District nurse, community, Derbyshire

Although I may not fully agree with the potential impact on patients (and nurses who will be bearing the weight), they are doing this on principle for the benefit of all NHS staff. If the precedent for reducing unsocial hours is set, it would be catastrophic for nurses – we would see a lot more leave the profession, or their jobs to become agency nurses.

Updated

JK Rowling has backed the striking junior doctors on Twitter:

Simran Singh, BMA union leader at Newham general hospital, told Alessio Perrone, at the hospital for the Guardian, that only two junior doctors have chosen to work there today.

Singh said:

As far as I’m aware, only two doctors out of over a hundred are choosing to work today.

Previous surveys found the strike would have 78% of support, and of the remaining 22% many were on annual leave or emergency cover. I would be enormously surprised if turnout is below 70-80%.

A consultant working in acute care, who did not wish her name or her hospital to be identified, told the Guardian’s Aisha Gani that six out of 16 junior doctors had showed up in the department where she was working:

In obstetrics and gynaecology, eight registrars should be here and we have three today. There should be six senior house officers and we have three. We should have two F1 who haven’t turned up. As a result we have seven consultants acting as the juniors and covering emergency work.

Updated

Colin, a taxi driver from Liverpool, has joined the picket line outside the Royal Liverpool University hospital to show his support for the junior doctors, reports Frances Perraudin.

His eldest son, now 34, had a heart transplant aged 13 and another of his children has epilepsy. Colin says he owes the NHS everything.

“If I ever came into big money, I would give it to a hospital and buy them equipment,” he says. “If I gave money to the government, they’d just squander it. I don’t blame the junior doctors going on strike. I blame Mr Hunt... He’s got a horrible smirk on his face and Dennis Skinner at 84 years of age picked him up on that.”

“The more people support the doctors the better it will be for the patients,” he says. “They’re not in it for the money. It’s about patient safety. If you’re tired you can’t write. If I’m tired I can’t drive because people’s lives are at risk. It’s the same with junior doctors. It costs money to keep people alive, but at the end of the day that’s why working class people pay taxes and national insurance.”

Updated

Danielle Jeffreys, 27, is one of those quitting England when her core training ends in August. She’s taking up a post in Scotland. Many of her colleagues are off to Australia.

She said:

I feel quite burnt out, I feel very overworked at the moment and I need a change and this is a job that is something different. It’s not just working on the wards, it’s also doing a bit of research and also in Scotland they’re not imposing the contract.

Updated

At King’s College hospital, an activist with the Young Socialists is trying to drum up support for a march on the TUC to lobby for a general strike.

The 27-year-old, who declined to give his name, said: “Trade union leaders have the power to call the country to a halt and to ask other sectors of society – teachers, bus drivers – to come out in solidarity with the junior doctors. At the moment they have not done enough to support the junior doctors or defend the NHS, and most of society depend on the NHS.

Trade union leaders represent all of society, apart from the junior doctors. They can show more solidarity by calling a general strike. This could bring the government down and that’s the only way out. The junior doctors are fighting alone.”

Updated

Here are some images from the picket line at King’s College hospital, in south London:

Junior doctors putting up a poster at King’s College hospital, south London
Junior doctors putting up a poster at King’s College hospital, south London. Photograph: Damien Gayle/THE GUARDIAN
Messages of support for junior doctors strike at King’s College hospital, south London
Messages of support for junior doctors strike at King’s College hospital, south London. Photograph: Damien Gayle for the Guardian
Poster about seven-day working at King’s College hospital, south London
Poster about seven-day working at King’s College hospital, south London. Photograph: Damien Gayle for the Guardian
Posters at King’s College hospital, south London, picket line
Posters at King’s College hospital picket line in south London. Photograph: Damien Gayle for the Guardian
Posters outside King’s College hospital, south London
Posters outside King’s College hospital, south London. Photograph: Damien Gayle for the Guardian

Updated

The Guardian’s Healthcare Network has a gallery of illustrations of junior doctors striking.

Doctors tell me more strikers have turned out on the picket line this time than before, with some estimating numbers at 200. There has been much public support – passers-by have taken stickers, shaken the hands of doctors and and wished them luck. Cyclists rang their bells while motorists beeped their horns. Sara, who works in mental health, said her department suffers when cuts are announced and doesn’t automatically get the support it needs.

“I often think of patients who come to A&E in the middle of the night at crisis point and need the consistency of doctors and need the time. It’s not quick,” she said.

Updated

Here’s the latest message to Jeremy Hunt from the BMA council chair, Dr Mark Porter:

For the sake of patients, the long-term future of the NHS and future generations of junior doctors on whose expertise and commitment we all depend, we continue to urge the secretary of state to put patient care before political dogma.

Updated

Josh Gaon is a second year junior doctor who would be at work at the acute medical unit at the Royal Bournemouth hospital. His emotions? Shock, sadness but also insulted at how he feels the government is treating the junior doctors. He makes an interesting point about the government’s suggestion that junior doctors don’t have the skills to analyse things like contracts. He says sifting information, making judgments, is a huge part of their job.

Updated

Some of the more playful placards from the picket lines.

And this tweet

This is a nice image from Hammersmith hospital, in west London:

Jake Osborne, 45, who runs staff support groups for doctors and nurses, says staff are demoralised.

Standing on the picket line wearing a National Health Alliance placard, he said: “I get to hear how the staff are feeling about their jobs. People are definitely more disillusioned, more fed up – especially around not having enough recruitment, not having enough staff and having to bring in agency people. They cost twice as much, they don’t know the patients, they don’t know how to do things on the ward. That’s the thing which comes up the most. It’s just a complete lack of planning from the government.”

Updated

There has been much debate around the strength of participation in previous strikes with the NHS/Department of Health claiming that about 45% of junior doctors have showed up for work during previous walkouts.

However, those figures have been pretty meaningless as emergency care workers were not striking and no indication was given of how many of those who did work were rostered to emergency services.

This time, a clearer picture should be available, given that it is the first all-out walkout, including junior doctors working in emergency care.

Given that context, this is an interesting tweet from the chair of the BMA’s junior doctors committee:

Updated

We would like to hear from healthcare professionals about what they are doing on strike days. Junior doctors, how do you feel about an all-out strike? What are the consequences for patient care? We would also like to hear from others who are working on strike days – for example, consultants, nurses, healthcare assistants, GPs, porters and administration staff. How are you coping? How do you feel about junior doctors carrying out an all-out strike?

This Guardian video explains the reasons behind the dispute:

Why are junior doctors striking?

Updated

The BMA has been keen to stress that in the absence of junior doctors, more senior colleagues (consultants) will be covering emergency care.

This tweet shows consultants stepping in for their striking colleagues at St Mary’s hospital, in London.

Benedict Porter, 26, F1 general medicine at King’s College hospital, in Camberwell, south London, said that although he and his colleagues are labelled “juniors” many of them in fact fill senior roles (junior doctors is a catch-all for all doctors below consultant) and can be running the hospital overnight.

Fundamentally NHS services are already overstretched and we already provide emergency services seven days a week. What the government want to do is provide non-emergency services on the weekend like outpatient appointments and surgery for things that are not emergencies or life-threatening.

They are also cutting out-of-hours pay so it means specialisms that require a lot of out of hours work are going to be penalised. People are not going to apply for those anymore. It’s going to have a really bad effect.

Updated

On Monday, junior doctors were alerted via the online junior doctors contract forum that the Guardian wanted to hear from someone who was not striking today, so that they could explain their thinking – even anonymously – for crossing a picketline.

Few people responded, which might indicate that participation in today’s walkout may be high. But one of those who did reply was Dr Amit Mukherjee, a trainee psychiatrist in London. He had this to say.

I am not participating in the strike tomorrow as I have taken emergency leave to look after my ill father in India.

Things are very different here. We as a family are using our savings to fund my dad’s chemotherapy. A while ago when dad was admitted, we had to pay for everything in hospital, including the price of gloves and syringes. My uncle in India died a few months ago and we had to pay for the ambulance to bring his body from hospital.

In my humble view, only those who are ready to accept the above types of situation should carry on as usual during the junior doctors strike. The rest should support the junior doctors in order to save the NHS before it is destroyed.

Updated

Dennis Skinner the senior Labour MP, aka the Beast of Bolsover, has put in an appearance at St Thomas’ hospital. While a doctor attached a BMA badge on his jacket, he said: “I’m here today because I support them (the doctors).”

He said doctors at the hospital helped when he had his heart and cancer operations: “They were there for my hour of need and now I’m here for them.”

Updated

Steven Morris at the Royal Bournemouth hospital says there is no sign yet of any patients turning against the junior doctors.

Phillip Macdonald, 59, stopped his powered wheelchair outside the main entrance to voice his support for the strike and shake hands with the medics.

“I want them to keep going until the government starts listening to them,” he said. “I don’t want doctors who are too tired to think to be caring for us. They deserve more than this government is giving them. Someone is going to die if they don’t start listening to the doctors. I’m completely behind them.”

Josephine Bintcliffe, 60, was arriving for a pre-assessment ahead of an operation. “I don’t care how long I have to wait today. These doctors are in the right. Jeremy Hunt is completely wrong.”

The hospital has put out a statement explaining how it will cope. It said: “The safety of our patients is our number one priority, so we will ensure our emergency services are covered at all times. However, to achieve this more planned operations/procedures and outpatient appointments will have to be cancelled than before. This builds upon the number of cancellations from the four previous strikes.”

Basil Fozard, medical director at the Royal Bournemouth and Christchurch hospitals trust, said: “We have to ensure that our patients in our emergency department and our inpatients receive high standards of care and that we maintain a safe service around the clock, so we are going to be redeploying staff from around the trust to ensure this. Unfortunately this will inevitably have a knock-on effect on appointments, and we apologise to all those affected.”


Updated

Picket numbers at King’s College hospital are picking up now. Some doctors have emerged dazed from night shifts, while bleary-eyed others have got up early to attend.

Jack Grenville, 32, a foundation year two doctor working in respiratory medicine, said he was on the picket “to demonstrate our staunch opposition to the government’s approach to the negotiations and the unsafe and unfair contract”.

He went on: “The government says the only issue remaining is Saturday pay, and that’s just not true. There are so many problems with this contract that I believe there should be a moratorium and we should go back to the drawing board. It’s unworkable – the government has consistently misappropriated statistics and lied in order to justify its position.

Updated

Aisha Gani is at St Thomas’ hospital, across the river Thames from the Houses of Parliament, where dozens of junior doctors in their scrubs, some with stethoscopes around their necks, held placards.

When the chimes of Big Ben rang out from across the river, doctors waved their banners for the waiting press, while vans beeped their support as they drove past.

Adrian Li, a junior doctor on core medical training who graduated four years ago, said: “Essentially this contract is not safe. In my department three junior doctors are covering 80 patients. All of those patients see one of us every day. At nights and on weekends one junior doctor covers. If Jeremy Hunt thinks two can cover the same number of patients, some of those patients will go a day without seeing a doctor at all. It’s impossible in the time we have. The service is already stretched unless more doctors are in. The maths doesn’t add up.”

Andrew, in child health, said: “I’m impressed by the plans in place and would be comfortable sending anyone in my family to a hospital today. I’m out for two reasons. I feel disillusioned, angry and hurt by what has been said in the media. I am absolutely shocked by what has been said by Jeremy Hunt and his team and by the concerted effort to mislead the public. I am disappointed an elected member of parliament can act unethically like this.”

Updated

Damien Gayle says junior doctors are still setting up their pickets outside King’s College hospital, London.

A marquee has been erected in front of the historic main entrance, banners are being lifted into place, megaphones stand ready and on the floor lies a pile of homemade placards. Prince blares put of a portable PA and passing drivers are beeping their horns in support.

James Hilton, 32, an intensive care doctor, said: “Obviously we’d rather not. I’d rather be at work doing the job that I love – but we’ve been left with no options.”

Updated

My colleague, France Perraudin, has been talking to a BMA official based in Hull who says junior doctors are enjoying support from their colleagues.

Dr Ellen McCourt, deputy chair of the BMA’s northern regional junior doctors committee, said junior doctors were now in the unusual situation of being quite used to industrial action.

“A year ago we wouldn’t have had the slightest idea what to do,” she said. McCourt, who works in Hull, said that all of the hospitals in her area had been able to staff their emergency rotas appropriately.

“We’ve not been made aware of any trusts being particularly obstructive or going out of their way to make things difficult. They all seem to have taken on board that they will have to postpone some elective work in order to prepare,” she said.

“While it’s not impossible that some trusts may not have postponed enough elective work, our juniors aren’t reporting back that there have been any difficulties. There are consultants and specialist grade doctors who are prepared to step up and provide cover because they appreciate the severity of the situation that we’ve found ourselves in.”

McCourt says junior doctors in her area are enjoying huge support from their colleagues.

“There are individuals who may not agree with everything we’re doing,” she said. “There are some people who don’t agree with industrial action at all, but the majority of consultants and specialists that we’ve spoken to are backing the junior doctors.

“They agree that we’ve been put in an impossible position and that we’ve tried everything else and that there are very few roads left for us to go down. It’s helpful for us to have that backing knowing that the senior doctors are very able and very confident and have got your back and are prepared to do your job in your absence and keep the patients safe.”

She adds: “You need that reassurance, that someone is going to keep your patients safe, otherwise you would be very uncomfortable about taking this step.”

Updated

Nick Robinson’s last question is: “Are you part of the problem?” Hunt says health secretaries are never popular but as far as he’s concerned the question he poses himself is: “Did you take the tough decisions for the NHS to deliver better care? That’s what I’m absolutely determined to do.”

Updated

Jeremy Hunt rejects comparisons with miners' strike

Jeremy Hunt is on the Today programme, being questioned by Nick Robinson.

He denies that the government is itching for a fight, insisting that it has been trying hard for three years to find an agreement. As for comparisons to the miners’ strike, Hunt says he is not making such comparisons – as some ministers seem to be saying in background briefings. Given the government’s efforts to find a deal, Hunt says today’s action is not proportionate. The health secretary began by saying the government was trying to negotiate with the British Medical Association on a reasonable manifesto commitment for a seven-day contract. “It’s a very bleak day,” said Hunt.

Updated

What are the other papers saying about today’s stoppage? For the Telegraph, it is definitely a “miners’ moment”.

Who governs? That question, first posed by Sir Edward Heath in 1974, defined politics for the following decade, as successive governments struggled with trade unions whose ability to disrupt public services and strategic industries gave them clout to rival that of elected politicians. It was answered, decisively and to the benefit of the whole country, by Margaret Thatcher.

Sadly, that question has been raised once again by the British Medical Association and the all-out strike by junior doctors it has called. The union wants those doctors to withhold all care for patients today and tomorrow, even those needing emergency care. Its industrial action has already harmed patients: tens of thousands of planned operations have been cancelled, causing distress and pain. We can only pray that this is the worst harm caused by the BMA’s militancy.

Hugo Rifkind at the Times thinks the junior doctors are making a big mistake (paywall).

The longer strikes go on, the more routine operations are cancelled, the more — God forbid — patients die, then the more people, or at least, some people, will start to question their priorities. The government’s own callous intransigence will, of course, also be noted but that won’t make much difference because it already is.

Doctors have more to lose. The argument that junior doctors on bad contracts pose a greater risk to the public than no junior doctors at all is simply not politically tenable, even if it were true, which it isn’t either. Sympathy will ebb, and criticism will mount, and stricken young medical professionals will retaliate, and look dreadful doing so, because their training is not in public relations but in saving lives. Then older doctors will denounce them, as they are already starting to, and the cycle will continue, and it will ebb some more.

Heidi Alexander.
Heidi Alexander. Photograph: Alecsandra Raluca Dragoi for the Guardian

Heidi Alexander MP, Labour’s shadow health secretary, said:

“Nobody wanted to see this strike go ahead, least of all junior doctors. But Jeremy Hunt’s handling of this dispute has been utterly shambolic.

Even at the eleventh hour, Jeremy Hunt refused to back a cross-party proposal which could have helped to stop this week’s strike from going ahead. When he could have compromised and put patients first, he chose strikes.

We desperately need to find a resolution to this dispute. I urge Jeremy Hunt to think again, get back round the negotiating table and do what is right for patients.”

Updated

Ahead of today’s action, the Guardian spoke to patients. Here is a flavour of what they said.

Kate Stewart, a patient from Lincolnshire.

“I fully support the strike. The medics have made it clear that the strike could be called off by offering numerous olive branches, compromises or invitations to talk further; the reason it is going ahead is down to Hunt’s stubbornness. But in truth, I think we know that this is all part of a plan to dismantle our NHS, and there is nothing we can do to stop it. Nothing will persuade Hunt to agree to anything that will call off the strike, and I don’t get the impression that he feels any regret about this.”

Anonymous, 52, from Hartlepool.

My wife is due an endoscopy for possible bowel cancer this Wednesday. She’s scared enough as it is without worrying whether her appointment may either be delayed or cancelled at the last minute... Withdrawing medical aid to those in need breaks the Hippocratic oath that all doctors vow to do at the start of their career. Those participating in industrial action who have stated that they withdraw their services from saving lives are now playing at God. That is unforgivable. As soon as junior doctors chose to withdraw care and treatment they lost my sympathy.

The majority of the public support the junior doctors’ strike, but support for this round of action is slightly lower than for previous strikes when emergency care was not affected, according to a new Ipsos Mori poll for BBC News. The poll shows 57% of adults in England support the strike.

The findings also indicate that public support for the all-out strike, where no emergency care is being provided, is higher than was suggested when the same question was asked in January. While 57% support the current walkout, just 44% said they would still support the strikes if emergency care was not provided, when asked in January. Nearly one in five (18%) strongly oppose the full walkout. The survey was of 861 adults in England.

Anna Quigley, head of health research at Ipsos Mori, said: “We’re seeing today that support for the junior doctors is still prevalent among much of the public, even when emergency care is withheld. However, support is not as high as when we were polling for the strikes where emergency care was provided, as we suggested might happen in January. However, the erosion of public support has not been as stark as the January polling suggested, and the public still have some patience left for the junior doctors’ cause.”

Junior doctors protest outside Department of Health, London.
Junior doctors protest outside Department of Health, London. Photograph: Guy Bell/REX/Shutterstock

Updated

The NHS enters uncharted territory as junior doctors in England begin an all-out strike for the first time in its history. The stoppage begins at 8am and lasts until 5pm and there will be more of the same tomorrow. Unlike previous stoppages that began in January over a new contract the health secretary Jeremy Hunt wants to impose, junior doctors this time have refused to work in any area of medical care, including A&E and maternity services. Cover in those areas will be provided by senior consultants. Inevitably, the dispute has become more politicised and polarised with time, to the point where some senior ministers have described the confrontation as “a miners’ moment”, when Margaret Thatcher clashed with the National Union of Mineworkers in the early 1980s. We’ll be bringing you all the latest developments throughout the day with the help of colleagues around the country. Meanwhile, here is the Guardian’s coverage this morning.

Why are junior doctors striking?

Updated

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