hello and welcome. thousands ofjunior doctors in england have begun a four—day strike that's likely to mean the cancellation of hundreds of thousands of appointments and operations. nhs england has warned of unprecedented disruption, although staff will be available for emergencies. the action is part of an ongoing dispute about pay. the british medical association is demanding a 35% pay rise, which it says makes up for 15 years of below—inflation increases. the government says that is unaffordable and that the strike

will risk patient safety. it's three and a half hours since the action began. let's go around the country and join our reporters on the picket lines. first, to our correspondent sanchia berg, who's outside the university college london hospital. we hospital. can see those pictures behind you, we can see those pictures behind you, junior doctors on the picket line, tell us what they are saying to you. line, tell us what they are saying to ou. ~ . , ., line, tell us what they are saying to ou. . , , to you. what they are saying is they are resolute- _ to you. what they are saying is they are resolute. they _ to you. what they are saying is they are resolute. they want _ to you. what they are saying is they are resolute. they want the - are resolute. they want the government to come, sit down and negotiate with them. they are saying they are prepared to strike, to continue to strike and saying they want a restitution of what effectively they say a pay cut over the last ten years. they have been singing, they have had a lot of support from drivers going past. inside, we understand from the hospital, that emergency and urgent care is being provided for people who need it. the hospital have told us they are working with the junior doctors to ensure that is provided and that they are able to

demonstrate. they have said they have contacted people whose appointments have been cancelled and they apologised and say they will reschedule as soon as possible. but of course it is too early here and everywhere else to tell what impact this strike is really going to have on the nhs longer term. what this strike is really going to have on the nhs longer term. what advice is there to patients _ on the nhs longer term. what advice is there to patients who _ on the nhs longer term. what advice is there to patients who were - is there to patients who were supposed to have appointments today there at that hospital? have they all are told?— there at that hospital? have they all are told? . , ., , ., all are told? there are people who are auoin all are told? there are people who are going in- _ all are told? there are people who are going in. some _ all are told? there are people who are going in. some appointmentsl all are told? there are people who i are going in. some appointments are continuing. those whose appointments have been cancelled have been contacted. ucla told as. i understand that was the approach to be taken right across the nhs. so as i say, emergency and urgent care services are still being provided but other scheduled operations and appointments have been cancelled and will be rescheduled, as the hospital says. will be rescheduled, as the hospital sa s. . ~' will be rescheduled, as the hospital sa s. ., ~ . ., �* says. 0k, thank you. sanchia berg in london. let's go now to catherine

burns, who's outside the leicester royal infirmary. we can see those on the picket line behind you. what are those who are demonstrating today who are out on strike saying to you? i am struggling _ strike saying to you? i am struggling to _ strike saying to you? i am struggling to hear - strike saying to you? i am struggling to hear what i strike saying to you? i am | struggling to hear what you strike saying to you? i am - struggling to hear what you are saying because they are singing. you can see, they are out and they are singing. they are very are resolute in what they are saying. we have had lots of this today. this is all about pay, their 35% pay raise. i am joined by some of the doctors now. ben has been a junior doctor less than a yearand ben has been a junior doctor less than a year and is thinking about leaving the nhs. talk to me about why that is?— why that is? essentially, what it is is at the moment, _ why that is? essentially, what it is is at the moment, every _ why that is? essentially, what it is is at the moment, every single - why that is? essentially, what it is i is at the moment, every single time we go _ is at the moment, every single time we go into_ is at the moment, every single time we go into work, you have people are sick, _ we go into work, you have people are sick, you _ we go into work, you have people are sick, you have staffing which is only— sick, you have staffing which is onlyiust — sick, you have staffing which is onlyjust covering what it needs to come _ onlyjust covering what it needs to come in _ onlyjust covering what it needs to come in the first place, without including — come in the first place, without including sickness, and i don't feel i am including sickness, and i don't feel i am able — including sickness, and i don't feel i am able to— including sickness, and i don't feel i am able to do my best work. i don't _ i am able to do my best work. i don't feel— i am able to do my best work. i don't feel i'm able to manage with the stresses and strains that are

put upon — the stresses and strains that are put upon me in the nhs as it is at the moment. put upon me in the nhs as it is at the moment-— put upon me in the nhs as it is at the moment. ., , ., ., ., ., the moment. you said you have had to take time off — the moment. you said you have had to take time off because _ the moment. you said you have had to take time off because of— the moment. you said you have had to take time off because of stress - the moment. you said you have had to take time off because of stress and - take time off because of stress and burn—out. do you mind talking about that? burn-out. do you mind talking about that? , , ., , ., burn-out. do you mind talking about that? , , . , ., ., , that? essentially what it was, durin: that? essentially what it was, during my _ that? essentially what it was, during my last _ that? essentially what it was, during my last rotation, - that? essentially what it was, during my last rotation, i - that? essentially what it was, during my last rotation, i wasj during my last rotation, i was having — during my last rotation, i was having moments at work where i was getting _ having moments at work where i was getting panic attacks because each day, i— getting panic attacks because each day, iwas — getting panic attacks because each day, i wasjust getting panic attacks because each day, i was just completely exhausted and then— day, i was just completely exhausted and then i_ day, i was just completely exhausted and then i was being lumbered with so much _ and then i was being lumbered with so much responsibility. seeing as i've so much responsibility. seeing as we only— so much responsibility. seeing as i've onlyjust left med school eight months _ i've onlyjust left med school eight months ago, i felt i wasn't able to cope _ months ago, i felt i wasn't able to cope and — months ago, i felt i wasn't able to cope and it — months ago, i felt i wasn't able to cope. and it did get to a point where — cope. and it did get to a point where my— cope. and it did get to a point where my partner, she did the best thing _ where my partner, she did the best thing for— where my partner, she did the best thing for me, which was she said you need _ thing for me, which was she said you need to— thing for me, which was she said you need to take — thing for me, which was she said you need to take some time off. i'm so thankful— need to take some time off. i'm so thankful to— need to take some time off. i'm so thankful to have for saying that because — thankful to have for saying that because i— thankful to have for saying that because i don't think i'd be able to because i don't think i'd be able to he in _ because i don't think i'd be able to he in work— because i don't think i'd be able to be in work for the last few months if that— be in work for the last few months if that hadn't been the case. you are riaht if that hadn't been the case. you are right at _ if that hadn't been the case. you are right at the _ if that hadn't been the case. gm. are right at the start of your career. do you think this is something you will stick with, are you going to stay in the nhs? i hope so because when _ you going to stay in the nhs? i hope so because when this _ you going to stay in the nhs? i hope so because when this job _ you going to stay in the nhs? i hope so because when this job is - you going to stay in the nhs? i hope so because when this job is good, i so because when thisjob is good, it's fantastic. it's a privilege to

serve — it's fantastic. it's a privilege to serve patients and their families and make — serve patients and their families and make people better, really. but it is so_ and make people better, really. but it is so frustrating and so difficult _ it is so frustrating and so difficult when the job is just made impossible by the system you are working _ impossible by the system you are working on. sol impossible by the system you are working on. so i hope i can be here again— working on. so i hope i can be here again in_ working on. so i hope i can be here again in five — working on. so i hope i can be here again in five years but i don't know if i again in five years but i don't know if i can— again in five years but i don't know if i can say— again in five years but i don't know if i can say that with any certainty. if i can say that with any certainty-— if i can say that with any certain . . ~' �* �* if i can say that with any certain . ., ,, �* �* ., certainty. thank you, ben. i'm going tot and certainty. thank you, ben. i'm going to try and grab _ certainty. thank you, ben. i'm going to try and grab marsha _ certainty. thank you, ben. i'm going to try and grab marsha now. - certainty. thank you, ben. i'm going to try and grab marsha now. so - certainty. thank you, ben. i'm going to try and grab marsha now. so how| to try and grab marsha now. so how easy was this decision to go out on strike for you? it easy was this decision to go out on strike for you?— strike for you? it was a really difficult decision _ strike for you? it was a really difficult decision for - strike for you? it was a really difficult decision for me - strike for you? it was a really i difficult decision for me because strike for you? it was a really - difficult decision for me because i am a _ difficult decision for me because i am a doctor _ difficult decision for me because i am a doctor i_ difficult decision for me because i am a doctor. i want _ difficult decision for me because i am a doctor. i want to— difficult decision for me because i am a doctor. i want to be - difficult decision for me because i am a doctor. i want to be there . difficult decision for me because ii am a doctor. i want to be there for my patients — am a doctor. i want to be there for my patients and _ am a doctor. i want to be there for my patients and i_ am a doctor. i want to be there for my patients and i want _ am a doctor. i want to be there for my patients and i want to - am a doctor. i want to be there for my patients and i want to be - am a doctor. i want to be there for| my patients and i want to be giving them _ my patients and i want to be giving them the _ my patients and i want to be giving them the care _ my patients and i want to be giving them the care they— my patients and i want to be giving them the care they need _ my patients and i want to be giving them the care they need and - my patients and i want to be giving . them the care they need and deserve but the _ them the care they need and deserve but the problem _ them the care they need and deserve but the problem is, _ them the care they need and deserve but the problem is, we _ them the care they need and deserve but the problem is, we just— them the care they need and deserve but the problem is, we just can't- them the care they need and deserve but the problem is, we just can't do. but the problem is, we just can't do that _ but the problem is, we just can't do that this— but the problem is, we just can't do that. this whole _ but the problem is, we just can't do that. this whole system _ but the problem is, we just can't do that. this whole system is- but the problem is, we just can't do that. this whole system is broken. that. this whole system is broken and it— that. this whole system is broken and it has— that. this whole system is broken and it has broken— that. this whole system is broken and it has broken us— that. this whole system is broken and it has broken us as _ that. this whole system is broken and it has broken us as well. - that. this whole system is broken and it has broken us as well. thei and it has broken us as well. the amount— and it has broken us as well. the amount of— and it has broken us as well. the amount of us— and it has broken us as well. the amount of us who _ and it has broken us as well. the amount of us who have - and it has broken us as well. the amount of us who have had - and it has broken us as well. the amount of us who have had to i and it has broken us as well. the . amount of us who have had to take time _ amount of us who have had to take time offm — amount of us who have had to take time offm i— amount of us who have had to take time off... i graduated _ amount of us who have had to take time off... i graduated in— amount of us who have had to take time off... i graduated in 2019 - amount of us who have had to take time off... i graduated in 2019just| time off... i graduated in 2019just before _ time off... i graduated in 2019just before covid — time off... i graduated in 2019just before covid and _ time off... i graduated in 2019just before covid and since _ time off... i graduated in 2019just before covid and since then, - time off... i graduated in 2019just before covid and since then, i- time off... i graduated in 2019just| before covid and since then, i know at least _ before covid and since then, i know at least two — before covid and since then, i know at least two people _ before covid and since then, i know at least two people from _ before covid and since then, i know at least two people from my - at least two people from my graduating _ at least two people from my graduating class _ at least two people from my graduating class who - at least two people from my graduating class who have . at least two people from my - graduating class who have committed suicide _ graduating class who have committed suicide and _ graduating class who have committed suicide and i— graduating class who have committed suicide and i know— graduating class who have committed suicide and i know so—

graduating class who have committed suicide and i know so many— graduating class who have committed suicide and i know so many who - graduating class who have committed suicide and i know so many who have| suicide and i know so many who have less medicine, — suicide and i know so many who have less medicine, including _ suicide and i know so many who have less medicine, including friends - suicide and i know so many who have less medicine, including friends of. less medicine, including friends of mine, _ less medicine, including friends of mine, because _ less medicine, including friends of mine, because they— less medicine, including friends of mine, because they cannot - less medicine, including friends of mine, because they cannot carry. less medicine, including friends ofi mine, because they cannot carry on like this _ mine, because they cannot carry on like this they— mine, because they cannot carry on like this. they treat _ mine, because they cannot carry on like this. they treat us _ mine, because they cannot carry on like this. they treat us like - mine, because they cannot carry on like this. they treat us like we - mine, because they cannot carry on like this. they treat us like we are i like this. they treat us like we are expendable — like this. they treat us like we are expendable-_ like this. they treat us like we are exendable. ~ ., ., ,, ., expendable. what do you think about the 3596 -a expendable. what do you think about the 3596 pay increase _ expendable. what do you think about the 3596 pay increase demand, - expendable. what do you think about the 3596 pay increase demand, do - expendable. what do you think about| the 3596 pay increase demand, do you the 35% pay increase demand, do you think you will get that? i can the 3596 pay increase demand, do you think you will get that?— think you will get that? i can only ho -e think you will get that? i can only hepe because _ think you will get that? i can only hope because since _ think you will get that? i can only hope because since 2008, - think you will get that? i can only hope because since 2008, our. think you will get that? i can only i hope because since 2008, ourjobs have got— hope because since 2008, ourjobs have got harder _ hope because since 2008, ourjobs have got harder. there _ hope because since 2008, ourjobs have got harder. there are - hope because since 2008, ourjobs have got harder. there are more i have got harder. there are more complex— have got harder. there are more complex patients, _ have got harder. there are more complex patients, people - have got harder. there are more complex patients, people are i have got harder. there are more i complex patients, people are living longer _ complex patients, people are living longer we — complex patients, people are living longer we are _ complex patients, people are living longer. we are victims _ complex patients, people are living longer. we are victims of— complex patients, people are living longer. we are victims of our- complex patients, people are living longer. we are victims of our own i longer. we are victims of our own success— longer. we are victims of our own success in— longer. we are victims of our own success in some _ longer. we are victims of our own success in some ways. _ longer. we are victims of our own success in some ways. we - longer. we are victims of our own success in some ways. we are - longer. we are victims of our own . success in some ways. we are doing more _ success in some ways. we are doing more work. — success in some ways. we are doing more work. paying _ success in some ways. we are doing more work. paying for— success in some ways. we are doing more work, paying for our— success in some ways. we are doing more work, paying for our exams i success in some ways. we are doing i more work, paying for our exams and fees _ more work, paying for our exams and fees so— more work, paying for our exams and fees so at— more work, paying for our exams and fees so at the — more work, paying for our exams and fees. so at the end _ more work, paying for our exams and fees. so at the end of _ more work, paying for our exams and fees. so at the end of the _ more work, paying for our exams and fees. so at the end of the month, - more work, paying for our exams and fees. so at the end of the month, we| fees. so at the end of the month, we don't _ fees. so at the end of the month, we don't have _ fees. so at the end of the month, we don't have much— fees. so at the end of the month, we don't have much left— fees. so at the end of the month, we don't have much left after— fees. so at the end of the month, we don't have much left after we - fees. so at the end of the month, we don't have much left after we have i don't have much left after we have paid for— don't have much left after we have paid for all— don't have much left after we have paid for all of— don't have much left after we have paid for all of that. _ don't have much left after we have paid for all of that.— paid for all of that. thank you very much. i paid for all of that. thank you very much- i will— paid for all of that. thank you very much. i will grab— paid for all of that. thank you very much. i will grab the _ paid for all of that. thank you very much. i will grab the leader - paid for all of that. thank you very much. i will grab the leader of - paid for all of that. thank you very much. i will grab the leader of the j much. i will grab the leader of the singing now, tal is that you said you are considering leaving the nhs, why is that? i you are considering leaving the nhs, wh is that? ., you are considering leaving the nhs, why is that?— why is that? i love my “ob and i love the nhs * why is that? i love my “ob and i love the nhs and _ why is that? i love my job and i love the nhs and what - why is that? i love my job and i love the nhs and what it - why is that? i love my job and i | love the nhs and what it stands why is that? i love my job and i - love the nhs and what it stands for. the nhs _ love the nhs and what it stands for. the nhs used to be delivering high quality— the nhs used to be delivering high quality care funded by the taxpayer, whereas _ quality care funded by the taxpayer, whereas currently, we are delivering substandard care, funded by the

dwindling goodwill of the people who work for _ dwindling goodwill of the people who work for it. we go to work everyday and you _ work for it. we go to work everyday and you feel— work for it. we go to work everyday and you feel like you are failing your— and you feel like you are failing your patients, like you are not giving — your patients, like you are not giving them their standard of care they deserve and you aspire to deliver— they deserve and you aspire to deliver and then you go home demoralised and realise you are struggling to pay your bills because you are _ struggling to pay your bills because you are earning £14 an hour. it is not sustainable, it is not fair and it is not— not sustainable, it is not fair and it is not good for patients.- it is not good for patients. thank ou ve it is not good for patients. thank you very much- _ it is not good for patients. thank you very much. there _ it is not good for patients. thank you very much. there you - it is not good for patients. thank you very much. there you go, i it is not good for patients. thank. you very much. there you go, that it is not good for patients. thank- you very much. there you go, that is the situation in leicester. this is just one of the picket lines up and down the country today.— just one of the picket lines up and down the country today. and now tojim reed, our health reporter who's in the bbc newsroom. i think it's worth starting talking about exactly who junior doctors are. if you want to become a doctor in the uk, you have to do between 4-8 in the uk, you have to do between 4—8 years of training at a medical school. it is after going to medical school. it is after going to medical school that you will become a junior doctor, for anotherfour school that you will become a junior doctor, for another four to eight years. so it can involve people with a fair chunk of experience. about 75,000 doctors across england will

be considered junior doctors, about half the doctors in a hospital and a quarter of those in gp surgeries. so how much dojunior quarter of those in gp surgeries. so how much do junior doctors earn? let's look at this. these are the different pay scales, because there is such a wide variety and experience, there is a wide variety, a big change, big gap in the pay scales. in the first year as a junior doctor come your basic salary will be roughly £30,000. by the fifth year, it is up to 60,000 years. then these light coloured blue boxes show amounts for things like un—social hours, working at weekends, overtime, like un—social hours, working at weekends, over time, and that would lift salary in the first year to roughly 40,000 on average. the argument the bma, the british medical association, makes it is these pay scales have fallen quite dramatically behind inflation, the cost of living, over the last 15 years or so and that is why they are asking for a 35% rise in wages to make up for what they say is a gap

in, because of inflation, in the cost of living, in the real wages doctors get. as a result of this, thatis doctors get. as a result of this, that is why you are seeing 47,000 members, roughly two thirds of junior doctors are members of the british medical association, 47,000 doctors expected to go on strike in england this week. how then could patients be affected by this four day strike? let's have a look. nhs trusts expect there to be between 250000 and 350,000 appointments and operations cancelled. the biggest impact is likely to be in these pre—booked appointments and that is because in emergency care, what hospitals generally try to do is to move over more experienced consultant doctors to cover for the junior doctors who are striking. as a result, the kind of senior doctors that would normally be responsible for cancer scans, that would normally be responsible for cancerscans, hip that would normally be responsible for cancer scans, hip operations, outpatient appointments, other

consultations, won't be able to do those, which is where you see this big gap in operations that might be delayed or cancelled this week. elsewhere in the uk, so we have been talking a lot about england today. this strike is england's only bet other parts of the uk are affected. in scotland, junior doctors there are being asked for their opinion on whether to take industrial action. that ballot will close on the 5th of may. in wales, the welsh government has made a commitment to pay restoration, to restore paid to that 2008 level. doctors in wales would like to see a further commitment and have not ruled out strike action. in northern ireland, doctors there say they are also watching the situation closely, complicated in northern ireland by at the moment there is no functioning executive. so today, this week, this strike is very much england only but other parts of the uk could very well be affected in the future. back to you. as far as negotiations are concerned, they don't appear to be

any. both sides firmly entrenched and blaming one another? that any. both sides firmly entrenched and blaming one another?- and blaming one another? that is riuht. and blaming one another? that is right- junior _ and blaming one another? that is right. junior doctors _ and blaming one another? that is right. junior doctors say - and blaming one another? that is right. junior doctors say that - and blaming one another? that is right. junior doctors say that they j right. junior doctors say that they are asking for a 35% pay increase. the government has described that as unaffordable. it essentially makes the argument that unless junior doctors accept or drop that 35% demand, then they will not start full pay negotiations. the bma say it is up to the government to put a reasonable offer on the table to start those talks. at the moment, although there have been discussions, they have not been any firm negotiations over pay, at least anything that could see these strikes called off. we have four days of strikes this week. we could very well see extra strikes, more industrial action announced in the coming weeks and months. speculation in the press today that this industrial dispute could run all the way through to the next general election in 2024.— election in 2024. for now, jim, thank yom _ now to rob sissons at queens

medical centre, in nottingham. tell us what is going on there. the mood here — tell us what is going on there. the mood here is _ tell us what is going on there. he mood here is very tell us what is going on there. tie: mood here is very defiant. tell us what is going on there. “ii9: mood here is very defiant. what people have been telling me here is they can't see any end to this dispute, with both sides seemingly far apart. what they want to see is this 35% pay restoration. the mood on the picket line, defined here. we have the mascot of the picket line, which is zelda, the corgi who is keeping everyone entertained on the picket line. the atmosphere here is jovial but inside the hospital, well, the responsibility of looking after patients with many of the doctors missing rests heavily on the shoulders of managers, who say it is harder than last time. a short time ago, i spoke to the medical director of nottingham university hospitals, who gave advice to patients to contact 111 if they were not sure where to go but he also said that this is proving to be a very

difficult strike to staff. the four days after the four—day bank _ the four days after the four—day bank holiday is an additional challenge to us. it has been quite difficult _ challenge to us. it has been quite difficult to — challenge to us. it has been quite difficult to organise the rotors that we — difficult to organise the rotors that we have cover now across the organisation and our primary response _ organisation and our primary response and it is to keep people safe~ _ response and it is to keep people safe~ so — response and it is to keep people safe. so we have consultants working throughout _ safe. so we have consultants working throughout the emergency department and all— throughout the emergency department and all the wards. let's bring in ryan, from the british medical association, the union rep here. what would you say to people watching this at home, some of whom might not have had their pay restored to levels that it was in 2008 and might have some sympathy for the government's line that this request is big, it's perhaps unreasonable and unrealistic in the eyes of the government at least? i in the eyes of the government at least? ., in the eyes of the government at least? ~' ., ~' in the eyes of the government at least? ,, ., ~' ., least? i think i would like to tell them that it _ least? i think i would like to tell them that it sounds _ least? i think i would like to tell them that it sounds a _ least? i think i would like to tell them that it sounds a really - least? i think i would like to tell them that it sounds a really big | them that it sounds a really big number, — them that it sounds a really big number, 35% sounds a huge number but it reflects— number, 35% sounds a huge number but it reflects how much of our pay we have _ it reflects how much of our pay we have lost — it reflects how much of our pay we have lost. we have lost a quarter of

eight _ have lost. we have lost a quarter of eight to _ have lost. we have lost a quarter of eight to put — have lost. we have lost a quarter of eight. to put it into context, it would — eight. to put it into context, it would mean lifting a first year doctor's — would mean lifting a first year doctor's pay from £14 to £90 an hour, _ doctor's pay from £14 to £90 an hour, which — doctor's pay from £14 to £90 an hour, which doesn't seem an unreasonable ask to me. and hour, which doesn't seem an unreasonable ask to me. and fran is from croatia- — unreasonable ask to me. and fran is from croatia. you _ unreasonable ask to me. and fran is from croatia. you are _ unreasonable ask to me. and fran is from croatia. you are in _ unreasonable ask to me. and fran is from croatia. you are in your- unreasonable ask to me. and fran is from croatia. you are in your first i from croatia. you are in yourfirst year of practising on the wards in the uk. you are telling me, in croatia it is 7 euros and now you are getting. here you are getting £14 roughly an hour. lots more money but you still don't think it is enough? but you still don't think it is enou~h? �* , but you still don't think it is enough?— but you still don't think it is enou~h? , ,, , enough? because the responsibility and the amount _ enough? because the responsibility and the amount of— enough? because the responsibility and the amount of work— enough? because the responsibility and the amount of work we - enough? because the responsibility and the amount of work we are - enough? because the responsibility. and the amount of work we are doing on the _ and the amount of work we are doing on the wards— and the amount of work we are doing on the wards for— and the amount of work we are doing on the wards for patients _ and the amount of work we are doing on the wards for patients is - and the amount of work we are doing on the wards for patients is quite - on the wards for patients is quite huge _ on the wards for patients is quite huge the — on the wards for patients is quite huge. the pressure _ on the wards for patients is quite huge. the pressure we _ on the wards for patients is quite huge. the pressure we are - on the wards for patients is quite huge. the pressure we are on, . on the wards for patients is quite i huge. the pressure we are on, it's ridiculous— huge. the pressure we are on, it's ridiculous that _ huge. the pressure we are on, it's ridiculous that the _ huge. the pressure we are on, it's ridiculous that the nhs _ huge. the pressure we are on, it's ridiculous that the nhs doesn't . ridiculous that the nhs doesn't recognise — ridiculous that the nhs doesn't recognise the _ ridiculous that the nhs doesn't recognise the importance - ridiculous that the nhs doesn't recognise the importance of. ridiculous that the nhs doesn't . recognise the importance of work that the _ recognise the importance of work that the juniors— recognise the importance of work that the juniors are _ recognise the importance of work that the juniors are doing - recognise the importance of work that the juniors are doing all- that the juniors are doing all around — that the juniors are doing all around the _ that the juniors are doing all around the country. - that the juniors are doing all around the country. i- that the juniors are doing all around the country. i think. that the juniors are doing all. around the country. i think we should — around the country. i think we should correct— around the country. i think we should correct this. _ around the country. i think we should correct this. it - around the country. i think we should correct this. it is- around the country. i think we should correct this. it is a - around the country. i think we should correct this. it is a bad| should correct this. it is a bad message _ should correct this. it is a bad message from _ should correct this. it is a bad message from the _ should correct this. it is a bad message from the nhs. - should correct this. it is a bad message from the nhs. me i should correct this. it is a bad message from the nhs. we have heard from hospital— message from the nhs. we have heard from hospital managers _ message from the nhs. we have heard from hospital managers that _ message from the nhs. we have heard from hospital managers that they - from hospital managers that they cannot guarantee patient safety. is this really responsible, coming out on strike? it this really responsible, coming out on strike? , , , ,

this really responsible, coming out onstrike? , ,, ,, on strike? it is responsible because basically better _ on strike? it is responsible because basically better working _ on strike? it is responsible because basically better working conditions | basically better working conditions the doctors — basically better working conditions the doctors means— basically better working conditions the doctors means a _ basically better working conditions the doctors means a better- basically better working conditions. the doctors means a better system, basically better working conditions i the doctors means a better system, a better— the doctors means a better system, a better situation, _ the doctors means a better system, a better situation, where _ the doctors means a better system, a better situation, where patients - the doctors means a better system, a better situation, where patients get i better situation, where patients get their own _ better situation, where patients get their own health— better situation, where patients get their own health care _ better situation, where patients get their own health care because - their own health care because happier— their own health care because happier workers— their own health care because happier workers means - their own health care because happier workers means a - their own health care because i happier workers means a happier system~ — happier workers means a happier system its— happier workers means a happier s stem. : :, happier workers means a happier s stem. : ., ., ., ., system. a final word from elliott. you are a year— system. a final word from elliott. you are a year one _ system. a final word from elliott. you are a year one doctor- system. a final word from elliott. you are a year one doctor as - system. a final word from elliott. you are a year one doctor as well| system. a final word from elliott. i you are a year one doctor as well in your first year of your career. £14 an hour roughly. what do you think to the money?— an hour roughly. what do you think to the money? what do i think to the mone ? i to the money? what do i think to the money? i mean. _ to the money? what do i think to the money? i mean, when _ to the money? what do i think to the money? i mean, when you _ to the money? what do i think to the money? i mean, when you do - to the money? what do i think to the money? i mean, when you do five i money? i mean, when you do five years— money? i mean, when you do five years of— money? i mean, when you do five years of really tough medical education and then you are coming in, education and then you are coming in. working — education and then you are coming in, working really long shifts, doing — in, working really long shifts, doing things we shouldn't really have _ doing things we shouldn't really have to — doing things we shouldn't really have to be doing, well above our pay grade, _ have to be doing, well above our pay grade, the _ have to be doing, well above our pay grade, the support we are getting because _ grade, the support we are getting because of staffing issues, especially at night, and we are also assessing _ especially at night, and we are also assessing patients when they come in the door— assessing patients when they come in the door and making decisions. for what _ the door and making decisions. for what we _ the door and making decisions. for what we are — the door and making decisions. for what we are getting paid, it probably isn't what we deserve. but there are probably isn't what we deserve. iei,ii there are higher wages probably isn't what we deserve. elf there are higher wages down the track, providing you do well in your

job and people say it is a job for life? it job and people say it is a “ob for life? . ., , job and people say it is a “ob for life? .., , , job and people say it is a “ob for life? , , ,., job and people say it is a “ob for life? , , ., life? it could be but you want --eole life? it could be but you want people to _ life? it could be but you want people to stay _ life? it could be but you want people to stay here. - life? it could be but you want people to stay here. the - life? it could be but you want. people to stay here. the amount life? it could be but you want - people to stay here. the amount of my colleagues who are planning to leave, _ my colleagues who are planning to leave, its — my colleagues who are planning to leave, its a — my colleagues who are planning to leave, its a lot and i don't know if it is sustainable.— it is sustainable. would you go to australia or— it is sustainable. would you go to australia or canada? _ it is sustainable. would you go to australia or canada? if _ it is sustainable. would you go to australia or canada? if pay - it is sustainable. would you go to australia or canada? if pay is - it is sustainable. would you go to australia or canada? if pay is not| australia or canada? if pay is not bein: australia or canada? if pay is not being properly _ australia or canada? if pay is not being properly restored - australia or canada? if pay is not being properly restored and - australia or canada? if pay is not being properly restored and the . australia or canada? if pay is not i being properly restored and the fact that the _ being properly restored and the fact that the cost of living crisis is increasing _ that the cost of living crisis is increasing and impending, maybe it is a consideration i would say so. thank— is a consideration i would say so. thank you — is a consideration i would say so. thank you all are very much for joining us. as you can see, some really strong opinions here and lots of the ping from motorists on the busy road, which they are taking as support here. fiifi busy road, which they are taking as sopport here-— earlier, dr layla mccay, policy director at nhs confederation, a membership organisation which speaks for healthcare systems in england, wales and northern ireland, told us more. the strikes are going to have really significant impacts. our members, our health leaders up and down the country, are telling us how concerned they are about the disruption

that this is going to cause, and the lack of capacity across the health service, which is going to mean that in order to focus on urgent and emergency care, many, many people across the country are hearing that their appointments or their operations are having to be postponed. so it's very fraught at the moment, as everybody tries to figure out how much capacity there is and what needs be done to maintain patient safety. yeah, bma has refused to exempt any services but says it has plans to protect patients, but are you worried, though, that people will die? well, at the moment everybody has been putting in hours and hours and hours of work to figure out what are the mitigations? what are the best ways to keep people safe? and that is what they're going to be doing throughout this strike period and beyond. so that — patient safety — is the primary consideration of health leaders and they'll be focusing on making sure they can do as much as possible, but certainly we have heard from members that they are worried.

what would you say to people today who are seeking medical assistance? i would say that if you need medical assistance, you should still go and seek that assistance. if you have other options, so for example 111 or going to your gp or going to your pharmacist, you should really be aware of all the options that are available and act accordingly. but certainly, services will be there, everybody will be working as hard as they possibly can to deliver that care, but, yeah, continue following the national advice from nhs england. there's already a huge backlog in the nhs, isn't there, after covid? what impact are these strikes going to have on those already lengthy delays for many, many millions of people across the country? it is certainly the case that having to postpone hundreds of thousands of appointments is going to have an impact on the waiting lists, and that is incredibly frustrating for everyone involved — not least obviously patients themselves.

this is obviously hugely stressful whenever your operation or your appointment has to be postponed, but then, of course, it's very stressful too for health leaders, who are not only worrying about patients but also worrying about how they're going to maintain and reduce those waiting lists. and of course it's really stressful for staff, as well. nobody wants to see this sort of thing, so it is a very stressful time all round for everyone. so let's look at the bma, which is demanding a 35% pay increase forjunior doctors, which they say would bring their salaries to 2008 levels. the health secretary says this is completely unrealistic, there are no signs of talks at the moment, what's your view? my view, the view of the nhs confederation and the view of health leaders across the country is that it is not productive to sit here in a stalemate and it's certainly not sustainable. it is the case that the government

and the negotiators for the junior doctors need to get together and have genuine conversations. if they're not able to have those productive conversations that can come to a resolution by themselves, which currently seems to be the situation, then they need to start considering mediation, for example from acas. there are people across this country who are really, really keen to get this resolved and i think that this needs to be everybody�*s priority now, as we see the disruption that these strikes are causing. it's not good for patients, it's not good for staff. dr layla mccay from the nhs confederation there. we can bring you some reaction from the health and social care secretary, steve barclay, who said to the press association, it's extremely disappointing the bma has called strike action for four consecutive days. he says the walk—outs will risk patient safety and also been time to maximise disruption after

the easter break. he said i hope to begin formal pay negotiations with the bma last month and its demand for a 35% pay rise is unreasonable. it would result in some junior doctors are receiving a pay rise of over £20,000. he says if the bma is willing to move significantly from this position and cancel strikes, we can resume confidential talks and find a way forward, as we have done with other unions. he goes on to offer some advice saying, people should attend appointments unless told otherwise by the nhs, continue told otherwise by the nhs, continue to call 999 in life threatening emergency and use nhs111online services for nonurgent health needs. i'm joined now by dr claire mitchell. she's a british doctor, now an emergency consultant, who moved to queensland, australia, for work and decided to stay there. thank you forjoining us. why did you decide to move? i thank you forjoining us. why did you decide to move?— you decide to move? i moved to australia for _ you decide to move? i moved to australia for a _ you decide to move? i moved to australia for a year _ you decide to move? i moved to australia for a year plus - you decide to move? i moved to australia for a year plus 's -

you decide to move? i moved to| australia for a year plus 's career australia for a year plus �*s career break in to experience life and medicine in another country and i am now here eight years later. what medicine in another country and i am now here eight years later.— now here eight years later. what do ou make now here eight years later. what do you make of — now here eight years later. what do you make of these _ now here eight years later. what do you make of these strikes _ now here eight years later. what do you make of these strikes today? i now here eight years later. what do| you make of these strikes today? to be honest, watching it from this side of the world, it's devastating. my side of the world, it's devastating. my friends and colleagues in the uk, it's their last resort. they don't want to be off the wards or out of the emergency department and it is just such a shame that it has come to this. i think it is years of catch up and ultimately playing the long game to protect patients. you decided to stay there after being there one year. was pay a big factor in that decision?— in that decision? working conditions was definitely _ in that decision? working conditions was definitely a _ in that decision? working conditions was definitely a factor. _ in that decision? working conditions was definitely a factor. i _ in that decision? working conditions was definitely a factor. i think - in that decision? working conditions was definitely a factor. i think pay i was definitely a factor. i think pay is always a side issue but it's very wrapped up in the working conditions, which is ours and its pat’- conditions, which is ours and its pay. also here, there is a daft thing is better which allowed for better supervision and training. —— mcgregor staffing is better. we had access to study leave, exam leave, annual leave. we got married and we

were given five weeks off work to do that. it was valued as part of our nonprofessional lives and ultimately, i think having that wellness within your work culture means that your doctors are more rested. we felt valued when we were here. you then provide better care when you are at work and that improves the whole system and improves the whole system and improves patient safety. what improves the whole system and improves patient safety. what is that now you _ improves patient safety. what is that now you have _ improves patient safety. what is that now you have been - improves patient safety. what is that now you have been there i improves patient safety. what is - that now you have been there awhile and have worked in both systems, what would you put the difference is down to? the huge size of the nhs over here compared to what must be a small health care system in australia? it small health care system in australia?— small health care system in australia? , , , ., australia? it is probably part of it but we still _ australia? it is probably part of it but we still have _ australia? it is probably part of it but we still have very _ australia? it is probably part of it but we still have very busy - australia? it is probably part of it| but we still have very busy tertiary hospitals, busy district general hospitals. we still have huge issues with staffing in rural hospitals in particular. i think the difference is that there is a culture of valuing workforce. doctors are paid more, they are also, junior doctors have regulated ours. they are capped

at 80 hours a fortnight in some states, with any hours worked over that as over time. and they are regarded as highly skilled and highly professional trained people who are where they are having those higher salaries. who are where they are having those highersalaries. i who are where they are having those higher salaries. i think having purpose, being allowed to be good at yourjob purpose, being allowed to be good at your job at purpose, being allowed to be good at yourjob at work and having autonomy gives professionals the motivation to do theirjob really well. and then i think being able to pay the bills isjust an important then i think being able to pay the bills is just an important thing then i think being able to pay the bills isjust an important thing and i think the cost of living crisis in the uk is a big factor at the moment as well. idr the uk is a big factor at the moment as well. , . ~ . as well. dr claire mitchell, interesting _ as well. dr claire mitchell, interesting to _ as well. dr claire mitchell, interesting to get - as well. dr claire mitchell, interesting to get your - as well. dr claire mitchell, - interesting to get your thoughts from queensland, australia. thank you. and now to simonjones, who's outside the william harvey hospital in ashford, kent. this hospital is one of five run by the east kent hospitals trust. it is one of the largest trusts in the country, serving around 700,000 patients here in east kent. managers

here at the hospital say they understand the frustration for patients who have their appointments and operations cancelled today. the hospital bosses say they don't have any control over this. this is a dispute between the government and the british medical association representing junior doctors. it is a small picket line here. we can talk to one of the junior doctors out on strike today. how are you feeling? well, none of us were keen to strike but unfortunately this is the way things— but unfortunately this is the way things have come to.— but unfortunately this is the way things have come to. what would you normally be — things have come to. what would you normally be doing _ things have come to. what would you normally be doing on _ things have come to. what would you normally be doing on a _ things have come to. what would you normally be doing on a typical- things have come to. what would you normally be doing on a typical day i normally be doing on a typical day like today? i normally be doing on a typical day like toda ? :, , normally be doing on a typical day like toda ? ., , ., .., normally be doing on a typical day like toda ? .,, ., .. ., like today? i was on call over the weekend. _ like today? i was on call over the weekend. so _ like today? i was on call over the weekend, so i'm _ like today? i was on call over the weekend, so i'm not— like today? i was on call over the weekend, so i'm not supposed i like today? i was on call over the | weekend, so i'm not supposed to like today? i was on call over the i weekend, so i'm not supposed to be in work— weekend, so i'm not supposed to be in work today. normally, we would be taking _ in work today. normally, we would be taking care _ in work today. normally, we would be taking care of a very overcrowded hospital. — taking care of a very overcrowded hospital, where basically for the past six — hospital, where basically for the past six months or so we have had to bed patients — past six months or so we have had to bed patients and corridors. so this is the _ bed patients and corridors. so this is the level— bed patients and corridors. so this is the level of pressure we have

been _ is the level of pressure we have been under all this time. is taking strike action _ been under all this time. is taking strike action not _ been under all this time. is taking strike action not going _ been under all this time. is taking strike action not going to - been under all this time. is taking strike action not going to put - been under all this time. is taking | strike action not going to put more pressure on the system? fin strike action not going to put more pressure on the system?— pressure on the system? on those rounds, pressure on the system? on those grounds. no _ pressure on the system? on those grounds. no nhs _ pressure on the system? on those grounds, no nhs worker— pressure on the system? on those grounds, no nhs worker should i pressure on the system? on those i grounds, no nhs worker should ever take any— grounds, no nhs worker should ever take any kind of political action. i mean. _ take any kind of political action. i mean. this— take any kind of political action. i mean, this would be a very convenient way for the government to -et convenient way for the government to get us _ convenient way for the government to get us to— convenient way for the government to get us tojust convenient way for the government to get us to just do even convenient way for the government to get us tojust do even more work convenient way for the government to get us to just do even more work for free _ get us to 'ust do even more work for free. �* , ., get us to 'ust do even more work for free. �* ,. get us to 'ust do even more work for free. �* ., ., get us to 'ust do even more work for free. �* y., ., ., ., ., free. but your pay demand, a lot of --eole free. but your pay demand, a lot of people saying _ free. but your pay demand, a lot of people saying it _ free. but your pay demand, a lot of people saying it is _ free. but your pay demand, a lot of people saying it is completely - people saying it is completely unrealistic, 35%. it people saying it is completely unrealistic, 3596.— unrealistic, 3596. it is only unrealistic _ unrealistic, 3596. it is only unrealistic within - unrealistic, 3596. it is only unrealistic within the - unrealistic, 3596. it is only i unrealistic within the bounds unrealistic, 3596. it is only - unrealistic within the bounds of what _ unrealistic within the bounds of what our— unrealistic within the bounds of what our government feels the public should _ what our government feels the public should be _ what our government feels the public should be respected for. the amount we are _ should be respected for. the amount we are asking for is a drop in the ocean— we are asking for is a drop in the ocean in— we are asking for is a drop in the ocean in terms of the entire nhs budget— ocean in terms of the entire nhs budget and there is never any hesitation to provide more money for aggressive _ hesitation to provide more money for aggressive warfare or to bail out businesses or give them cheap credit — businesses or give them cheap credit. :, ., businesses or give them cheap credit. ., ,, , ., ., ., credit. ok, thank you for “oining us. a credit. ok, thank you for “oining a smaufi credit. ok, thank you for “oining us. a small picket * credit. ok, thank you for “oining us. a small picket here _ credit. ok, thank you forjoining us. a small picket here because j credit. ok, thank you forjoining i us. a small picket here because of the people taking part have already gone up for a further protest in london later today. the government's view very much that this is a

militant action and they feel the pay demand is simply not feasible. simon, thank you. sanchia berg is outside the university college london hospital. i'm interested what junior doctors are i'm interested whatjunior doctors are saying to you about the fact that there is a potential for patients lives to be put at risk because of what they are doing today. because of what they are doing toda . , , because of what they are doing toda. , because of what they are doing toda. _., , ., because of what they are doing toda. , ., , today. they say, as they have been sa in: to today. they say, as they have been saying to simon — today. they say, as they have been saying to simon and _ today. they say, as they have been saying to simon and other- saying to simon and other colleagues, they feel they have very little choice. it is worth pointing out that ucl h managers when we spoke to them earlier today told us that they had been working with the bma had to do their very best to provide urgent and emergency care. so whilst the nhs confederation and others have been saying they cannot guarantee patient safety, from the point of view of hospital managers and also the bma, they are saying that they have put measures in place to provide urgent and emergency care and this is the beginning of a four

day strike. you can probably hear from all the noise behind me that at this point there is a huge amount of energy in it. we will obviously have to see what happens over the next few days. to see what happens over the next few da s. :, ., to see what happens over the next few da s. ., ,, ,., to see what happens over the next few da s. ., ,, y., ., to see what happens over the next fewda s. ., ,, ., , , few days. thank you at university colle . e few days. thank you at university college london. _ all the latest on those strikes in our bbc website. you are watching bbc news.

live from london. this is bbc news. a doctor's strike that threatens to be the most disruptive in the history of the nhs begins in england. final preparations for a president — joe biden heads to northern ireland to mark 25 years of the good friday agreement. we will be live in belfast throughout the day looking ahead to the president's visit and speaking to people here about what the agreement means to them. and the head of the uk's largest business lobby, tony danker, has been sacked over �*misconduct�* claims.

hello and welcome to bbc news.