Up to 25,000 ambulance workers across England and Wales have gone on strike in a dispute with the Government over pay.
Paramedics, call handlers, drivers and technicians from the Unison and GMB unions are taking part in staggered strikes across a 24-hour period.
It comes as 14 health unions, representing more than a million NHS staff, said they will not submit evidence to the NHS pay review body for the next wage round “while the current industrial disputes remain unresolved”.
Instead, the unions, which represent ambulance staff, nurses, porters, healthcare assistants, physiotherapists and other NHS workers in England, called for direct pay talks with ministers.
NHS Providers has warned the NHS will be hit harder by Wednesday’s strike than one held in December as more staff, including call handlers, go on strike.
Saffron Cordery, NHS Providers’ interim chief executive, said on Wednesday lunchtime it was “too early” to determine what the impact would be but that she expected pressure to “mount” during the day.
Speaking to BBC Radio 4’s World At One programme, Ms Cordery said: “It is still emerging about the picture of what is going on.
“Of course there will be disruption today but once again we have seen on the ambulance strike day reduced demand for ambulance services.
“I think that it is fair to say that as the day goes on, the pressures will mount. That’s what we saw last time round with the industrial action.
“We know that there will be disruption but the scale of it is hard to see at the moment.”
Ms Cordery said the NHS was able to “step forward and manage” through industrial action, but that it was having a “knock-on effect” on “waiting lists (and) treating people that need it in a timely fashion”.
Unison has balloted around 15,000 of its members who are striking in London, Yorkshire, the North West, North East and South West.
More than 10,000 GMB ambulance workers are also walking out, with their ambulance services covering the South West, South East coast, North West, South central area, North East, East Midlands, West Midlands, Yorkshire and Wales.
NHS England has told patients to continue to call 999 for life-threatening emergencies but to use 111, GPs and pharmacies for non-urgent needs.
It said some people may be asked to make their own way to hospital, though it urged people to seek medical advice from 111 or 999 before doing so.
Speaking on Sky News, Health Secretary Steve Barclay was asked whether he agreed with comments by Business Secretary Grant Shapps that striking paramedics were being “reckless”.
Mr Barclay said: “If there are delays to ambulances, then it is concerning in terms of our ability to get that care.
“It is clearly a concern as to the impact it has on patient safety.”
Asked about pay talks to break the current deadlock, Mr Barclay said he does not “think it is right” to “retrospectively” go back to April when it comes to reviewing this year’s pay offer to NHS staff.
It comes amid reports he is considering backdating any 2023/24 pay rise, due to be finalised in the spring, to this month in order to boost the current year’s settlement offer.
Asked on BBC Radio 4’s Today programme if he is considering “reopening” the current year’s negotiations, Mr Barclay said: “The purpose of the meeting on Monday was to look at this coming year’s pay review body and the evidence going in.
“But, of course, it was an opportunity to listen to the trade unions in terms of their points on last year’s settlement.
“I don’t think it is right to go all the way back to April and retrospectively look at April when we’re already under way in terms of this year’s pay review body.
“But, of course, the unions made representations about that and what the Prime Minister said at the weekend is nothing is off the table.”
Mr Barclay also urged people to use their “common sense” regarding what activities they do during a strike.
Ambulance responses are split into categories, with category 1 being the most life-threatening such as cardiac arrest, while category 2 covers conditions such as stroke, heart attack and sepsis.
No blanket agreement has been reached on responding to category 2 calls, with unions and trusts agreeing locally which category 2 calls will receive a response during the strike.
Mr Barclay condemned unions for failing to agree national minimum safety levels during strikes – something that would be fixed by legislation presented to Parliament on Tuesday.
Unison’s head of health Sara Gorton told the PA news agency that unions have been wanting to talk with ministers for more than a decade about putting minimum legal staffing requirements in place, without success.
The Government’s new focus on the issue appears to be an attempt to vilify health workers and a “distraction from the job in hand”, she said as she stood on the picket line outside the London Ambulance Service (LAS) headquarters in Waterloo.
She said the situation within the NHS seems to be “worsening day by day” and the “ball is in the Government’s court” to fix it.
She added: “If we are going to get a resolution to the current dispute and the wider staffing crisis across the NHS, then what’s going to be needed is for the Government to commit to having those direct talks.”
Asked about pay, Jon Richards, assistant general secretary at Unison, said the Government tone had changed since Christmas.
“I think we’ve seen a chink of light, to be honest. That’s something we’re pleased about,” he told BBC Breakfast.
“The Government have started talking about pay, so, yes, we see some progress, but we haven’t had an offer – we haven’t had anything in writing yet and we need to have that before we can make progress.”
Meanwhile, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, told Times Radio there had been “a state of crisis” in the NHS for the last month and problems going back several years.
He called for perspective, adding: “Yes, (the strike) will be disruptive, and actually, in a way, what we’re more concerned about is not what happens on the day, but we know that it creates disruption in the following days.
“We talk about a rebound effect because there is a pent-up demand, all sorts of problems occur in the system later.”