this is bbc news. the headlines: ambulance workers go on strike today in a dispute over pay, as union leaders criticise the prime ministerfor not being willing to negotiate every time the health secretary speaks, i've got my head in my hands. i have never seen such an abdication of leadership that i have from rishi sunak and the health secretary. members of the royal college of nursing in scotland reject the latest pay offer from the nhs. a man has admitted to the murder of a woman and three children, as well as the rape of one of the murdered children. ukraine's president volodomyr zelensky is on his way to washington today in his first overseas trip since war broke out. it's early closing time for thousands of pubs this winter, hit by rising energy bills and staff shortages.

good afternoon. tens of thousands of ambulance workers, including paramedics and call handlers, are on strike in england and wales, as part of their dispute over pay and conditions. health officials warn patient safety is at risk, while the unions say ambulance crews will respond, to life threatening emergencies. the industrial action began at midnight across wales, the west midlands and the north of england. then, from six o'clock this morning, it extended to the east midlands and the south. the east of england and the isle of wight are unaffected. and within the last hour, ambulance workers and paramedics in londonjoined picket lines. with the very latest, here's our health correspondent, jim reed. what do we want?

fair pay! when do we want it? now! paramedics early this morning on the picket line coventry. staff said the dispute is about pay and also patient safety. you can spend four, five hours in the back of an ambulance sometimes waiting to go into the hospital. often we can hear over the radio there is a cardiac arrest and people we cannot get to. i have worked here 11 years and never seen this before. it is really stressful. as a result people have chosen other employment to go to. _ we are losing staff. ambulances were still leaving to go to the most life—threatening emergencies. most category one calls will be responded to, as may some category two calls like strokes and serious burns. other urgent problems like a woman in late stage labour or an elderly person falling on their home

might not be answered or delayed. the government accuses unions to make a conscious decision to inflict harm on patients. the three unions have refused to work with us at a national level only having local arrangements in terms of coverage of life—threatening and emergency calls. there is further uncertainty on the day because some of the emergency calls, whether they respond or not will be decided on the day in the call centres by members. unions acted furiously to suggestions they are deliberately causing harm. every time the health secretary speaks my head is in my hands. i have never seen such an abdication of leadership. we have negotiated locally all of the cover. the important thing to say is that this government has walked away from the negotiating table. this strike did not need to happen.

600 troops had been trained to step in and drive ambulances, although they are not allowed to treat patients or use blue lights. in brighton the military could be seen, alongside paramedics bringing patients into hospital. this strike at a time when ambulance services are already under intense pressure. in gloucester this week long queues of vehicles were stuck inside to outside hospital because there was no inside to unload patients. —— stuck outside hospital. this strike could not be happening at a worse time because of the pressure is the nhs faces. that is why yesterday, in a letter to the prime minister and again today we are appealing to both sides to try to find a way of both coming to the table and avoiding further industrial action. ambulance staff in northern ireland also went on strike last week while in scotland

a new pay offer has just been rejected by one union but a strike has not yet been called. strike action here in liverpool and across most of the rest of england and wales will continue through the day. with no breakthrough in talks and signs the dispute is getting more heated, expect further disruption next week and perhaps into the new year. let's talk to our correspondent, frances read, who is in ealing, west london, for us. what is the impact there? the impact here is onlyjust _ what is the impact there? the impact here is onlyjust starting _ what is the impact there? the impact here is onlyjust starting to _ what is the impact there? the impact here is onlyjust starting to be - here is onlyjust starting to be known because the strike started at about midday and will go on until midnight tonight. there aren't perhaps as many flashing blue lights and wailing sirens as we would normally see here. some people say amd is a bit like a ghost town. there were queues earlier on. we

have also seen a small but steady trickle of ambulances outside the hospital through the course of today. it's unclear if they are just transfer ambulances. the army have been driving some of the more critical ambulances across london at the london ambulance service had already declared what they called a business continuity incident even before the strikes were called because of the winter pressures so of course that just because of the winter pressures so of course thatjust adds to it. this afternoon i have seen a lady being brought in to the hospital by paramedics. they were as reassuring as ever and continuing to do their job very professionally. i also spoke to another lady who had brought her mother here today. she had recently had a knee replacement surgery and they suspect it has become infected and she had become quite poorly. she ran iii and they told the family to bring the mother here to be seen. of course that

family was able to do that by car. not everybody is able to do that of course. but the london ambulance service share has suggested that people should do that if it's not an immediate life—threatening emergency, that we can bring people to amd by car. the london ambulance service have today said they are able to see about 50% of people they would normally be able to collect and go to a face—to—face call. that bill means that 1000 people across london today who would normally get an ambulance will not be getting one today. an ambulance will not be getting one toda . . , an ambulance will not be getting one toda . ., , ., ~ an ambulance will not be getting one toda . ., ., ~ ., an ambulance will not be getting one toda. ., ~ ., ., , today. there was talk about taxis bein: today. there was talk about taxis being made _ today. there was talk about taxis being made available, _ today. there was talk about taxis being made available, did - today. there was talk about taxis being made available, did that i today. there was talk about taxis i being made available, did that come to fruition? we being made available, did that come to fruition? ~ ., ., , , . to fruition? we are not sure yet. we will seak to fruition? we are not sure yet. we will speak to — to fruition? we are not sure yet. we will speak to the _ to fruition? we are not sure yet. we will speak to the london ambulance | will speak to the london ambulance service about that later but that was certainly part of the plan. that is not unusual by the way. we have done that in the past. in order to taxi people to hospital if needed.

it's not completely out of the ordinary. but we are unclear at this moment how many of those are being used and whether it is working at all and indeed if it is the case that people are tending to stay away from a&e today, which is certainly what we have seen so far at the moment, then that might reduce the need for that. dr angela baron is a lecturer in hr and organisational behaviour at the university of sussex. it's good to be with you but are disappointing we are still talking about the strikes. haw disappointing we are still talking about the strikes.— disappointing we are still talking about the strikes. how unusual is it that we are — about the strikes. how unusual is it that we are seeing _ about the strikes. how unusual is it that we are seeing ambulance - about the strikes. how unusual is it that we are seeing ambulance staff| that we are seeing ambulance staff going out on strike like this? bier? going out on strike like this? very unusual. going out on strike like this? very unusual- very _ going out on strike like this? very unusual. very unusual _ going out on strike like this? - unusual. very unusual that we are seeing first line workers in the nhs, the nurses of the ambulance

drivers resorting to strike action. i think that is indicative. it's kind of a perfect storm. remember, this is notjust about money. of course money is important and they have seen a deterioration in their real wages. have seen a deterioration in their realwages. but have seen a deterioration in their real wages. but this is about patient care. it's about worrying that staffing levels are undermining patient safety. i do find it disappointing that we are seeing comments from government trying to pick these people against the patients. these people are not striking to impact patients. they really do want much of the strike is about they desire to have better staffing levels and better staff morale. speaking as someone who has worked in this area for a long time, i can tell you that if you do have good staff morale and if you are looking after people and you have high levels of well—being amongst your staff, there is a direct

correlation with their performance. and in the nhs that means patient survival rates. you and in the nhs that means patient survival rates.— survival rates. you mentioned atient survival rates. you mentioned patient safety _ survival rates. you mentioned patient safety but _ survival rates. you mentioned patient safety but surely - survival rates. you mentioned patient safety but surely thisl survival rates. you mentioned i patient safety but surely this will have the opposite effect on patient safety today. yes have the opposite effect on patient safety today-— safety today. yes in the short term and of course _ safety today. yes in the short term and of course there _ safety today. yes in the short term and of course there is _ safety today. yes in the short term and of course there is no _ safety today. yes in the short term and of course there is no point i safety today. yes in the short term and of course there is no point in i and of course there is no point in resorting to strike action if nobody is going to notice so the very nature of strikes is to demonstrate the value of those workers. to try to get across the message that it's not being reflected in how we are being treated and how we are being paid. so yes of course but i think with this group of people in particular and as your correspondent pointed out, they have not stopped giving life—saving treatment so if

there are emergencies, they have been stories of nursing coming off the picket line to go on treat people because there was an emergency happening. these are the kinds of people that will do that. but the fact remains, it's a bad day to get ill. but the fact remains, it's a bad day to net ill. �* , .,, ., but the fact remains, it's a bad day to et ill. �* , ., , to get ill. and people have been advised not _ to get ill. and people have been advised not to _ to get ill. and people have been advised not to take _ to get ill. and people have been advised not to take risks - to get ill. and people have been advised not to take risks and i to get ill. and people have been i advised not to take risks and avoid anything that might mean they will need an embolus. even if we resolved theissue need an embolus. even if we resolved the issue of pay for these people on strike today, if it's about staffing levels, that is not going to be fixed quickly. when you think about how many staff vacancies there are across the nhs in general, that's not going to be fixed even if everyone is sitting up and taking notice of the strike today. what needs to happen to solve that? firstly, we could stem the exodus from the nhs. that would be a good start. to try to hold onto the skilled people that we have already

got. and value them more. every time somebody leaves and they are leaving because it's a stressfuljob and they can earn just as much money in a much less stressful situation, thatis a much less stressful situation, that is a loss of expertise, the investment in all of the training thatis investment in all of the training that is going to those people. that would be the first step, to try to hold on to people we have got. the second step is to look again at how we train. nurses, the bursaries have been taken away from the nursing profession. they go into the profession. they go into the profession with a pretty substantial student loan to pay back. maybe that should be revisited to some extent. and i think it is about making it a more attractive profession. backing up

more attractive profession. backing up those gestures we made a few years ago in the pandemic when everybody was out clapping and saying how important these people were, we need to back that up and show that we really meant that by looking at their working conditions and trying to be proactive about that. but this dispute has been a long time in the making and it's going to take an awfully long time to address those issues. to stop demonising these workers and start negotiating with them, that would be a pretty good start. it negotiating with them, that would be a pretty good start-— a pretty good start. it depends who ou listen a pretty good start. it depends who you listen to _ a pretty good start. it depends who you listen to because _ a pretty good start. it depends who you listen to because the _ a pretty good start. it depends who i you listen to because the government say they don't feel the talks are happening because of the other side. i think you have a season ticket with us! thank you very much. nurses in scotland have rejected the latest pay offer from the nhs. the royal college of nursing in scotland �*overwhelmingly�* rejected the scottish government's offer by 82% in a consultative ballot.

rcn scotland says it will continue planning for industrial action and will announce strike dates early next year. 0ur correspondent, lisa summers, is in edinburgh and explained what the dispute is over. the deal here in scotland would have seen health care workers given an average of 7.5% pay increase and it was billed as the best and whole of the uk and the fact that such a high proportion of members have rejected it will be a real blow to the scottish government and the first minister because she personally intervened, meeting this needed to see if there was anything that could be done to get the deal over the line. but it leaves a complicated picture in scotland because of the unions including unison have already accepted the deal and others like the gmb who represent the majority of amble workers have turned it down. so there is a willingness to get back round the table on all sides but it's quite hard to see where the negotiations will go so well strikes are not guaranteed here in scotland in the new year, they

are certainly getting a lot closer. a man has admitted murdering a pregnant woman, herson and daughter and her daughter's friend, in derbyshire last year. damien bendall had pleaded guilty to manslaughter, but changed his plea in the last few hours. 0ur corresponent, phil mackie, is at derby crown court. remind us of the background to this. this was a september 2021 in the town of kilmartin north derbyshire on the outskirts of sheffield. terry harris and her two children, son john and daughter lacey as well as lacey's friend, were murdered by damien bendall at their house. the run up to that involved some fairly gruesome details which rather traumatic the members of the family had to sit through and here in court this morning. we also learned a lot more about the man who has now admitted those murders, damien

bendall. a man with a string of previous convictions. he was a heavy drug user, cannabis and cocaine. he was in an abusive relationship with terry harris hui was expecting a child with. he had been for instance selling her positions —— possessions to fuel her —— a drug habit. 0ne selling her positions —— possessions to fuel her —— a drug habit. one of the most heartbreaking things we saw was some phone footage from lacey and connie who was staving over for the sleepover shed text messages with friends and family and at 9:30pm that night damien bendall killed them all with a hammer. some of the teachers are so horrific to repeat here. after he had killed them he tookjohn's xbox at sheffield to exchange for more drugs which he took on the next morning he dialled 999 and told the operator

what he had done. we saw body one camera footage from the police officers arriving not taking him seriously initially and then going into the house and discovering the awful scene. all of them died from severe head injuries. we also heard from prosecutors this morning after he changed his pleas to guilty saying this was such a heinous crime and so dreadful that it warrants a whole life tariff. these are very rare but as we know there is a mandatory life sentence where people are convicted of murder but pleaded guilty to murder and often we talk about the use they might get whether it's 20 or 30 or even a0 and in this case the prosecutors say it warrants a whole life sentence. in mitigation his defence barrister said he accepted that is likely to be the case. we will know exactly what he gets in the next half an hour or so.

ukraine's president, volodymyr zelensky, is travelling to washington on his first trip abroad since the russian invasion in february. he'll address a joint session of congress and hold talks with president biden at the white house, where a new package of military aid will be announced. let's get the latest on the fighting. 0ur correspondent, hugo bachega, has more from kyiv. this is president zelensky yesterday in bakhmut, meeting troops engaged in some of the fiercest battles in this war. today he'll be in washington, his first foreign trip since russia invaded in february. it's a trip full of security risks and was only confirmed hours before it was due to start. here is the president at a train station in poland, ahead of his flight to washington. the us has been ukraine's most important ally in the war. it has committed tens of billions of dollars in aid and weapons, more than any other country. and there is more to come.

president biden will announce a package with military aid, including patriot missiles. this is a sophisticated air defence system ukrainians say they need to defend their country from air strikes. russia's campaign targeting critical infrastructure has left millions of people without electricity, heating and water. this, as temperatures plummet below freezing. ukraine says russia is using winter as a weapon, trying to break ukrainian morale. but people here say they are determined to resist. 300 days into the war, ukraine is warning against complacency, saying russia, despite military setbacks still poses a major threat. for president zelensky, this visit is an opportunity to speak to those criticising support for his country and make the case for even more help. in moscow, president vladimir putin said he would ensure the safety of people across russia, including in the

ukrainian regions he claims to have annexed. he said the main nato countries were using all their military power against russia. let's speak to our north america correspondent, anthony zurcher. what are you expecting to see during this visit? it is hugely symbolic. it is symbolic. we will see a meeting at the white house between president zelensky and president biden and then they will have a joint press conference in the late afternoon. then president zelensky will address a joint session of congress which is an honour bestowed on foreign leaders from winston churchill on. it is a high profile chance for the ukrainian president to speak to not only the policymakers in washington but to speak to the american public. all of

this comes as republicans are getting ready to take over the house of representatives. there are about 86 new member of congress coming in next year so this is a chance essentially to make his case to a bunch of new faces who are going to determine ukraine policy in the new year. ., ~' , , determine ukraine policy in the new year. ., ~ , , ., determine ukraine policy in the new year. ., ~ i, ., _ ., year. how likely is that policy to continue as _ year. how likely is that policy to continue as we _ year. how likely is that policy to continue as we have _ year. how likely is that policy to continue as we have seen i year. how likely is that policy to continue as we have seen it i year. how likely is that policy to | continue as we have seen it since last february? i continue as we have seen it since last february?— last february? i think there are indications _ last february? i think there are indications that _ last february? i think there are indications that support - last february? i think there are indications that support for i indications that support for continued aid to ukraine is eroding in the us. 0ver continued aid to ukraine is eroding in the us. over the past few months we have seen republican members of congress voting against it particularly when it is a stand—alone bill when they are voting on ukraine aid. if you look at public opinion polls about a third of americans now say they don't want to give any more aid to ukraine. that is sharply divided

along partisan lines. about half of republicans are saying they are done with supplying military and economic aid to ukraine. that is down from about 80% of republicans in march. so you are seeing a steady erosion particularly long pass of divides between republicans and democrats. thank you very much. shashankjoshi is defence editor at the economist. how significant is this visit for president zelensky at this particular time? enormously significant- _ particular time? enormously significant. it's _

particular time? enormously significant. it's the - particular time? enormously significant. it's the first i particular time? enormously i significant. it's the first foreign trip he's — significant. it's the first foreign trip he's done since the war began and not _ trip he's done since the war began and not only is that a sign of how confident— and not only is that a sign of how confident he feels, security and a physical— confident he feels, security and a physical sense, he is not worried about_ physical sense, he is not worried about assassination what is domestic political— about assassination what is domestic political circumstances, but i think it's also— political circumstances, but i think it's also a — political circumstances, but i think it's also a critical time in the campaign _ it's also a critical time in the campaign because this is winter in the fighting is entering a period of a lower_ the fighting is entering a period of a lower tempo you could say. russia has been _ a lower tempo you could say. russia has been on — a lower tempo you could say. russia has been on the retreat but it is massing — has been on the retreat but it is massing forces for another fight next _ massing forces for another fight next year~ — massing forces for another fight next year. ukraine is massing forces for a _ next year. ukraine is massing forces for a counteroffensive to take back all of _ for a counteroffensive to take back all of its _ for a counteroffensive to take back all of its territory. this is a kind of pivotal — all of its territory. this is a kind of pivotal phase of the campaign where _ of pivotal phase of the campaign where ukraine absolutely has to make a strong _ where ukraine absolutely has to make a strong case for additional weaponry and ammunition to facilitate that counteroffensive. this is — facilitate that counteroffensive. this is the first foreign trip since february this year, what does that say about how safe president zelensky feels? brute

say about how safe president zelensky feels?— say about how safe president zelens feels? ~ ., ., , zelensky feels? we have to remember i think that russia _ zelensky feels? we have to remember i think that russia sent _ zelensky feels? we have to remember i think that russia sent special - i think that russia sent special forces — i think that russia sent special forces and others to assassinate president — forces and others to assassinate president zelensky in the early weeks — president zelensky in the early weeks of— president zelensky in the early weeks of this campaign. they have still been _ weeks of this campaign. they have still been bombing site close to the centre _ still been bombing site close to the centre of— still been bombing site close to the centre of kyiv. he is very cautious about— centre of kyiv. he is very cautious about the — centre of kyiv. he is very cautious about the way he publishes images and videos about his precise location _ and videos about his precise location. so clearly there is still a concern — location. so clearly there is still a concern about his physical safety. but the _ a concern about his physical safety. but the fact — a concern about his physical safety. but the fact he is willing to leave the country and it's a pretty onerous _ the country and it's a pretty onerous trip to get out of ukraine given— onerous trip to get out of ukraine given the — onerous trip to get out of ukraine given the limited number of flights and the _ given the limited number of flights and the route through poland, but i think— and the route through poland, but i think it _ and the route through poland, but i think it speaks to a level of confidence and shows you how confident _ confidence and shows you how confident he is that he is no longer worried _ confident he is that he is no longer worried about russia being able to directly— worried about russia being able to directly subvert kyiv or his government in his absence which shows— government in his absence which shows you — government in his absence which shows you how limited russia's influences over those sorts of things — influences over those sorts of thins. ~ ., influences over those sorts of thins. . ., ., , influences over those sorts of thins. ~ ., ., , ., things. what does it tell you about his popularity _ things. what does it tell you about his popularity at — things. what does it tell you about his popularity at home, _ things. what does it tell you about his popularity at home, that i things. what does it tell you about his popularity at home, that he i his popularity at home, that he feels able to go on this trip? he is

the most popular _ feels able to go on this trip? he is the most popular leader— feels able to go on this trip? he is the most popular leader in - feels able to go on this trip? he is the most popular leader in the world — the most popular leader in the world it's _ the most popular leader in the world. it's the function of being a wartime — world. it's the function of being a wartime leader who has survived against _ wartime leader who has survived against the odds. his approval rating — against the odds. his approval rating would make any world leader envious _ rating would make any world leader envious it — rating would make any world leader envious. it doesn't mean there are no little _ envious. it doesn't mean there are no little tension or problems. they are muted, — no little tension or problems. they are muted, they are not gone. for example. — are muted, they are not gone. for example. in— are muted, they are not gone. for example, in my publication the economist last week we published extensive — economist last week we published extensive interviews with president zelensky— extensive interviews with president zelensky and his top generals and we did pick— zelensky and his top generals and we did pick up— zelensky and his top generals and we did pick up on and reported signs of tension _ did pick up on and reported signs of tension between the presidential office _ tension between the presidential office and the army chief office. it doesn't _ office and the army chief office. it doesn't mean they're worried about a cool or— doesn't mean they're worried about a cool or worried about the military takeover— cool or worried about the military takeover of these kind of political military— takeover of these kind of political military tensions to existing wartime _ military tensions to existing wartime and they clearly are present in ukraine _ wartime and they clearly are present in ukraine as well. but i think it's very— in ukraine as well. but i think it's very clear— in ukraine as well. but i think it's very clear that he is not worried about _ very clear that he is not worried about political instability. he is confident in his political position.

as you _ confident in his political position. as you would expect given how well he has _ as you would expect given how well he has performed in the last ten months — members of the scottish parliament have restarted their debate on proposals, aimed at simplifying and speeding up the process which allows people to legally change their gender. msps are considering more than 150 amendments to the planned legislation, which the scottish government says will ensure dignity for trans people, but critics argue, is a threat to women and girls. our correspondent, lorna gordon, is at holyrood. is it fair to say this has been controversial? very strong opinions and this has been a controversial piece of legislation. it's also fair to say that both sides would agree that when it comes to the online world for debate has been extremely toxic. when it comes to the real world it has been very vocal. we have seen a

demonstration this afternoon outside parliament from a women's group opposing the legislation. they were shouting women won't be quiet. they have been other protests at previous points from some of the groups in favour of the legislation. what the scottish government wants to do is speed up and simplify the process that transgender people face when they want to change the agenda on they want to change the agenda on the birth certificate. at the moment a transgender person is to have a medical diagnosis and they have to live in their acquired genderfor two years. the scottish government wants to make it less administrative and make it easierfor people wants to make it less administrative and make it easier for people to go through this process. they also want to lower the age a person can apply to lower the age a person can apply to change the agenda from 18 to 16. some women's groups have concerns about this. joanna cherry earlier

onset she supports simplifying the process for transgender people but what she has concerns about is that this might give predatory men access to women only single six spaces. she and others campaigning against this legislation would like more safeguarding built into the legislation and they would like the process to be slowed down. while more of the safeguarding measures are built in. the scottish government says the rights of transgender people and women are not in conflict, that this is a small stigmatised group that needs more support. they have seen the biggest rebellion since the ms —— the snp took power in 2007. seven snp members voted against this legislation earlier in the process.

whilst the process has been delayed today because of a huge number of amendments, they have the numbers to pass this legislation but what is not yet clear is whether it will face opposition and challenge through the courts. now it's time for a look at the weather with helen. good afternoon. a little bit of wintry sunshine out and about, but equally we have got a fair amount of heavy and thundery showers running to the western isles and the highlands of scotland. fewer east of the grampians. one or two running across northern ireland to the north west of england. we are clearing the cloud slowly in the south. the best of the sunshine is further north. temperatures are a little lower than they have been this week. just a tad above the average. 0vernight, temperatures will fall away. still some showers around and we could get within a degree or so of freezing in local frost hollers. you can see quite a bit of cloud coming into the south and west as well with more rain and that is really on the cards for tomorrow. a lot more cloud creeps

in across much of england and wales. cloud covering the hills and outbreaks of rain and drizzle into parts of northern england. but it's northern england where we will see the brightest of the weather. just a few showers. not as many as today. temperatures a little bit lower. it will be milder than today where we have the rain further south. there is more online. hello, this is bbc news. the headlines... ambulance workers go on strike today in a dispute over pay, as union leaders criticise the prime ministerfor not being willing to negotiate. every time the health secretary speaks, i have got my head in my hands. i have never seen such an abdication of leadership as i have from rishi sunak and the health secretary. members of the royal college of nursing in scotland reject the latest pay offer from the nhs. a man has admitted to the murder of a woman and three children, as well as the rape of one

of the murdered children. ukraine's president volodomyr zelensky is on his way to washington