NHS bosses today begged Britons to ‘drink sensibly’ over Christmas so the health service doesn’t capitulate.
On the eve of the biggest ambulance walk-out since the 1980s, health minister Will Quince urged the public not to do anything ‘risky’ and avoid driving if their journeys are unnecessary.
Mr Quince also insisted it was ‘really important’ people don’t call for an ambulance unless their condition is ‘life-threatening’, urging Britons with other illnesses to use NHS 111.
Heart attack victims face being made to make their own way to hospital tomorrow, with soldiers drafted in to help cover 999 calls.
Meanwhile, the NHS pleaded with the public to behave sensibly to avoid piling even more pressure on ailing A&E units, which are already being battered.
Graphic shows: The average response times for Category 1, 2, 3 and 4 calls to ambulance services across England (left), and the average response time for each call (red) compared to the target response time (blue) across all services (right)
Graphic shows: The average time it takes for ambulance services across England to pick up 999 calls
Military personnel from the Household Division take part in ambulance driver training at Wellington Barracks in London, as they prepare to provide cover for ambulance workers on December 21 and 28
Elizabeth Jane Davies, 93, suffered a hip fracture in a fall at her residential care home in Llanbedrog, Llyn Peninsula
Sir Stephen Powis (left), NHS England’s medical director, said: ‘There is no doubt that the NHS is facing extreme pressure. Health minister Will Quince (right) today urged Britons not to do anything ‘risky’ tomorrow because of the disruption caused by strikes
Sir Stephen Powis, NHS England’s medical director, said: ‘There is no doubt that the NHS is facing extreme pressure.
‘Industrial action will add to the already record demand we are seeing on urgent and emergency care, and so it is really important that the public play their part by using services wisely.
‘This means continuing to call 999 for life-threatening emergencies – if it is not life-threatening you may have to wait longer than usual for an ambulance.
‘And using 111 online for other health needs where you will receive clinical advice on the best next steps to take.’
He added: ‘But people can also help by taking sensible steps to keep themselves and others safe during this period and not ending up in A&E – whether that is drinking responsibly or checking up on a family member of neighbour who may be particularly vulnerable to make sure they are ok.’
NEWCASTLE: Royal College of Nursing (RCN) General Secretary Pat Cullen, centre, joins members of the RCN on the picket line outside the Royal Victoria Infirmary in Newcastle today
BIRMINGHAM: Members of the RCN take to the picket line outside the Queen Elizabeth Hospital in Birmingham this morning
Military personnel from the Household Division take part in ambulance driver training at Wellington Barracks in London today
A Household Division troop prepares to provide cover for ambulance workers on December 21 and 28 when members of the Unison, GMB and Unite unions take industrial action over pay
Hours earlier, Mr Quince said: ‘Where people are planning any risky activity, I would strongly encourage them not to do so.’
Mr Quince, who reports into the Health Secretary Steve Barclay, did not specify what constituted ‘risky’ behaviour. No10 also refused to list examples.
However, Mr Quince later revealed in an interview with BBC Radio 5 Live that such activities would include running on icy roads and playing contact sports.
Mr Quince told anyone with chest pains on Wednesday to call 999, despite the strike action by ambulance workers.
‘If you have chest pains, then phone 999. If it is not life-threatening, then it’s really important that people call NHS 111 or NHS 111 online,’ he told BBC Radio 4’s Today programme.
Asked whether people should avoid driving their cars because of the strikes, he told BBC Radio 5: ‘If there are unnecessary journeys I would say don’t, no.
‘But I’m not going to say people shouldn’t drive but people should take care.’
The stark warning comes on the day thousands of nurses take to picket lines across the country in an ongoing dispute over pay.
Action could rumble on for six months, the union organising the chaos has warned.
Rishi Sunak has warned striking workers he will hold out against their ‘unreasonable’ pay demands for months if necessary.
Ambulance workers including paramedics, control room workers and technicians will join the growing wave of NHS strikes tomorrow.
Health chiefs say the action, co-ordinated by three separate unions, represents the most serious threat to date.
In some instances, unions have agreed to allow staff to attend only life-threatening incidents where a person’s heart has stopped or they are not breathing. These are known as category one calls and should be responded to within seven minutes, on average.
Others claim it will be down to individual members to decide if they wish to offer a more comprehensive service.
It raises the prospect that some heart attack and stroke patients may not be picked up. Such calls are classified as category two, and should be responded to within 18 minutes, on average.
The action means more people than expected will be forced to make their own way to hospital in an emergency and makes it more likely that they will die or be left with serious disabilities, experts fear.
Talks between ministers, GMB, Unison and Unite and NHS ambulance services are ongoing, however.
Around 600 members of the Army, Navy and RAF from across the country have been drafted in to help during the walkouts.
Some never driven the medically equipped vehicles before.
Troops received last-minute training today. Some have had to take time off to assist.
The ambulance strike will affect emergency services across England and Wales on two days
A senior officer overseeing training at Wellington Barracks in London acknowledged the demands would be new to some personnel but said troops were ‘confident’ and had ‘a huge amount of initiative’.
Lieutenant Colonel James Shaw, Brigade Major of the Household Division, said: ‘I think there’ll be a few nerves going out tomorrow – it’s a really important task and I think we’re incredibly proud.
‘And obviously being military, you just want to do the best you can possibly do on this sort of thing, so I’m sure there will be a few nerves.’
Personnel covering for striking ambulance workers on Wednesday will not be allowed to break red lights or turn on blue lights when driving.
They are not due to be sent on critical emergency callouts or carry out clinical tasks but ambulance trainers have told them they should be prepared to hand equipment to their clinical partner if asked.
Despite the help of the armed forces, health leaders said they cannot guarantee patient safety during the ‘very dangerous time’ during strikes.
NHS Confederation chief executive Matthew Taylor told BBC Radio 4’s World At One programme: ‘We never want to alarm people but we have reached the stage where our leaders feel it’s necessary to say they cannot guarantee patient safety, they cannot avoid risks as these strikes unfold.
‘We are particularly concerned about the ambulance workers’ strike tomorrow but we’re concerned about the possibility of further strikes.
‘We need to make clear that we’re entering into a very dangerous time and this is why we’re upping even more our call to the Government and to the trade unions to try to find a way of solving this dispute and helping us get through the winter.’
During questioning by MPs on the Commons Health Committee, ambulance leaders warned the service is already struggling under huge pressure and cannot hit response times, with paramedics stuck for hours outside hospitals waiting to hand over patients.
One 93-year-old woman was left lying on the floor ‘screaming in pain’ while waiting for an ambulance for 25 hours after a fall.
Elizabeth Davies was finally taken to Ysbyty Gwynedd, Bangor but then had to endure another 12-hour wait to be admitted to a ward.
Meanwhile, Mr Barclay is meeting unions this afternoon to discuss preparations for Wednesday’s strike but it is understood he will not discuss pay.
The Prime Minister Rishi Sunak’s official spokesman said: ‘He’s hoping for a constructive discussion ahead of these planned ambulance strikes.
Calendar shows the series of strikes set for the next two weeks and beyond
Britain’s strike hell continues into Christmas
‘He’s concerned that some union officials still haven’t confirmed what they will cover with regards to emergency calls with their talks with trusts so far.
‘We are conscious that the contingency plans we have can only do so much, so he will continue to urge them to honour their commitment to provide responses to life-threatening emergency calls.’
Rachel Harrison, a national secretary at the GMB trade union, told MPs that unless the Health Secretary is willing to talk about pay, ambulance strikes will go ahead.
She said: ‘Unless the Secretary of State is willing to talk to us about pay today, those strikes are set to go ahead.
‘Make us an offer on pay we can take back to our members.’
Asked what will happen if the Government does not move on pay, she said: ‘Our members will be the ones that will decide… We will continue to say to the Government, ‘our door is open to talk about pay’.
‘Our members will be the ones to decide on any pay offer that’s made and if no pay offer is forthcoming, we will continue to have that conversation next year as we head towards the next round of pay discussions as well.’
Regarding Wednesday’s strike, she said ‘life and limb’ cover will be provided.
Ambulance responses are split into categories, with category 1 being the most life-threatening such as cardiac arrest, while category 2 covers conditions like stroke, heart attack and sepsis.
Regarding exemptions for other categories, she said: ‘Most agreements have now been signed off and we’re doing our role in communicating to our members what they are and encouraging them to adhere to the exemptions that have been put in place.’
Ms Harrison said that cover will vary by service, but she added: ‘We will do everything within our power to ensure that communities are safe during this action. The Government has to play their part, they have to come to the table and talk to us.’
Conservative MP Lucy Allan told the committee 44,000 hours had been lost in a single month at West Midlands Ambulance Service, while ambulances waited outside hospitals to hand over patients to A&E.
Dr John Martin, president at College of Paramedics, said hospital handovers were ‘top of the list’ of issues.
Citing NHS England data published in December, he said: ‘There was 4,232 hours lost in one day outside of hospital. That equates to 176 ambulances.
‘That is our members who are really struggling because they can spend the whole of their shift outside a hospital waiting to hand over a patient.
‘Everybody is frustrated, including ED (emergency) doctors.
‘The frustration is they are worn out, they are tired, they want to get back to being good paramedics.’
Earlier, Dr Martin said that, over the last five years, demand for ambulances had gone up 18 per cent in England, with a sharp rise for category 1 calls, which include cardiac arrest and respiratory distress.
‘I looked back over the last five years nationally in England, it’s gone up by 18 per cent.
‘But more importantly it’s gone up much more significantly in the higher acute categories, so what we call category 1 is way, way higher than it was previously, above 50 per cent increase over the last five-year-period. So we’re seeing a sicker population who are calling us more often.’
He suggested patients in category 2 can wait so long for care that they are upgraded to a category 1 incident.
He said: ‘I don’t think safety is black and white. It’s not one or the other. Right now today we’re seeing long delays for patients. There are lots of patients waiting at the moment for an ambulance response.
‘On Wednesday, even with the derogations, that’s likely to be worse. But with this life and limb cover, paramedics up and down the country will absolutely want to keep patients safe.
‘I think the important bit to note though is that the Category 1 calls – the ones that come in at the time that look like they’re life and limb – they will get a response and the unions are working very hard on how that will occur.
‘It’s the group in category 2 and below who maybe don’t start off as life or limb, and this is what we’re seeing today and (likely on Wednesday), who will deteriorate over time and eventually they will become a life or limb emergency and obviously at that point they do fall into (Category 1).’
He added: ‘That’s happening today right now before we even get to industrial action on Wednesday.’
Daren Mochrie, chairman at Association of Ambulance Chief Executives, said he did not think the situation would improve in the coming months.
Quizzed by Conservative MP Lucy Allan, he told her: ‘I cannot see how in the next few weeks and months ahead the situation will improve.’
He added that retention of staff is a problem partly due to higher salaries outside the service.