AAs dawn broke, it became clear what was at stake in the biggest ambulance strike since 1990. As paramedics from Gateshead to Cardiff welcomed the messages of support from passing drivers, a boss of an ambulance trust asked people to dial 999 only after they found themselves wondered, “Do I feel like I’m dying?”
Professor Sir Stephen Powis, the medical director of NHS England, briefed radio listeners over breakfast on Wednesday how clinicians should weigh up whether to send ambulances to people with stroke.
Meanwhile, Steve Barclay, the health minister, claimed: “Ambulance unions have made a conscious choice to harm patients,” a statement that set the tone for a day of bitter rhetoric between unions and government over wages and staff.
Union leaders countered that Barclay was “insulting” healthcare workers, who were anguished by taking strike action, and ignored the reality that “patients are being harmed every day” by the state of the health department.
24-hour strikes started in several parts of England and Wales from Tuesday, alongside 12-hour strikes in other regions. Unison, Unite and the GMB unions agreed to attend Category 1 calls – the most life-threatening cases – while some ambulance trusts agreed exceptions for specific incidents within Category 2 calls – such as strokes.
Half of London’s ambulances were out of service, even as 600 uniformed troops were paired with paramedics to make up for absences.
Some picket lines were quickly depleted as strikers were called away to answer life-threatening calls, but seven out of 10 ambulance services in England reported critical incidents – meaning a service “is no longer able to deliver critical services, patients may have been injured or the area is not safe”.
Calls fell as the public heeded advice to hesitate before calling, raising concerns that people who needed urgent help might not get it and that Thursday could see a rise of 999 calls. An ambulance driver said on Twitter: “we DO go to jobs, but to the jobs we should go. Those who need us the most! We’ve been moving into jobs that don’t require an ambulance for far too long.”
In Wales, Jason Killens, the director of the ambulance service, said the fall in calls caused fewer delays outside emergency departments. “There are no obvious cases of serious injury or death,” he said.
Across the picket lines, paramedics argued that the delays in treatment caused by the strike were little different from those caused by routine NHS blockades. Wage was a major factor in the strikes – unions want more than the average 4.75% raise – but health care conditions were often more glaring.
“For Barclay and the government to talk about patient welfare is just pretty sickening,” said GMB general secretary Gary Smith, addressing strikers in County Durham, where no one said they wanted to take part in industrial action.
At a picket line in Walton-on-Thames in Surrey, strikers held signs reading “1 in 3 paramedics see deaths from delays” as a Royal Mail van stopped and handed out pork pies.
“Out-of-hospital wait times are so long that we are actually doing less work than ever before because we are stuck with one patient for five, six, seven, 10, 12 hours while people wait helplessly in the community,” said Ben Clark, a paramedic. at the South West Ambulance Service.
Employees assured themselves that the public was behind them. According to a December 16-19 YouGov poll, 63% of people support union action by paramedics. It is the second highest level of support for all working class groups involved in this winter’s wave of industrial unrest, after nurses; 31% were against strikes by ambulances compared to 49% against strikes by RMT railway workers.
On a GMB picket line outside an ambulance base in Pontprennau, Cardiff, John Harris, 53, said: “I have struggled enormously with my conscience to do this. It is a huge challenge for each of us to withdraw our service to the public. But at the moment we are not able to provide a good service.
“If you have patients waiting on the floor for 26, 28, 30 hours, that’s not a service,” said the former Royal Marine. “We shouldn’t be letting patients die in the emergency room because we can’t get them through the front door. The day before yesterday I went to see a patient with a broken hip after a fall who had waited 28 hours for us to get to him. That is absolutely wrong.”
As the strikes began, government and union positions only seemed to harden amid warnings from Unison’s general secretary, Christina McAnea, that without negotiations, members could escalate the strikes into the new year.
Barclay again said pay negotiations would not take place and insisted on the supremacy of the independent pay review body. He told Sky News: “We’re investing in the NHS, we’re investing in social care, and I don’t want to divert money from those essential services aimed at patients.”
He also claimed that unions refused to cooperate with the government on a national level about how staff would answer emergency calls during strike action.
McAnea told the picket line in London’s Waterloo that this was “disgraceful … fear mongering”. She said Barclay “knows full well that for the past two or three weeks we’ve been negotiating where our members are taking strike action to build contingency plans.”
“If anyone is responsible for things that are happening, it is that government in Westminster that has steadfastly refused to talk to us about anything to do with payments,” she said.
Meanwhile, Sharon Graham, the head of the Unite union, accused the prime minister, Rishi Sunak, of the worst “abandonment of leadership” she had seen in 25 years.
Glimpses of compromise came from Steve Brine, the Conservative chairman of the health and social care selection committee, who urged ministers to stand firm and offer no more money than recommended by the wage-monitoring body. But he suggested next year’s wage review process could be accelerated. “Ministers must not trample this process in any way and they will not,” he said.
At 12:00 about a dozen striking Unison members arrived at Gateshead ambulance station in Low Fell for a 12-hour strike by paramedics, emergency and ambulance technicians.
“We have ambulances lined up at hospitals for eight, nine hours,” says Brian Dodds, a paramedic for 30 years. “It’s not the fault of the staff. It’s not the hospitals fault. It comes down to the government’s neglect of health care over the last 12 years. Everything is cut. Beds are gone. We can’t accommodate patients anywhere. There is no social care.”
It was distressing to those working on the front lines, he said. “It takes its toll. People can’t stand not being able to care for patients, that’s what we’re here for.”
Back in Cardiff, 34-year-old Harry Masks chose to strike in plain clothes and not respond to emergency calls. “All the calls we respond to on a daily basis are critical anyway, so personally I feel like if you come in and do the anomalies, nothing really changes,” he said. “Each service feels like a strike anyway, because we usually don’t respond to calls [but waiting outside hospitals to admit patients].”
He added: “I now earn less than when I was 20 and worked in a call center, and believe me, I experience a lot more trauma in this job. One day you save someone’s life or you hold someone’s hands because their son above committed suicide. The next day you go to a food bank because you can’t feed yourself. It’s more than a joke now and something has to change.”