a patient know about that if you are a patient and you haven't been told your appointment or operation has been cancelled, then please assume it is going to go ahead. i think the system is coping. i would want to make one point, though. which is that the reason we are managing reasonably effective today is because of the extra work being put in by nhs managers, so i would invite people next time they hear a politician or someone else attack managers in the health service recognise people i represent, they have abandoned their holidays, they have abandoned their holidays, they have been working tirelessly for several weeks to make sure we are able to manage the situation. but nevertheless, it will still have a major impact. nevertheless, it will still have a major impact-— nevertheless, it will still have a major impact. nevertheless, it will still have a ma'orimact. �* ~ ., major impact. and the knock-on could last for months _ major impact. and the knock-on could last for months and _ major impact. and the knock-on could last for months and months. - 350,000 operations cancelled as well as the many million on a waiting list. in as the many million on a waiting list. . , . ., list. in the health service, we have to deal with _ list. in the health service, we have to deal with this _ list. in the health service, we have to deal with this dual— list. in the health service, we have to deal with this dual challenge, i list. in the health service, we havej to deal with this dual challenge, to meet demand as it presents itself with gp surgeries and macro once

departments, and to make inroads into the backlog of care that built up into the backlog of care that built up and was building up before covid and built up a lot more during covid. that balancing act, meeting demand and making inroads into the backlog, is a tough thing to do it the best of times, it is impossible to do when you are losing around half your medical staff. so there is no question that the targets we have set for ourselves, the aims we have got to reduce those waiting lists are going to be dented by this and thatis are going to be dented by this and that is a real pity. because we had been making progress, we had got to the stage at the end of march where we massively reduced almost to zero the number of people waiting more than 18 months for example for a procedure. so it is kind of heartbreaking if you have been a leader in the health service, anyone in the health service, and you have got those waiting this down, you have got, achieve the balancing act and lost all the capacity we are going to lose this week.- and lost all the capacity we are going to lose this week. what is our view going to lose this week. what is your view on _ going to lose this week. what is your view on the _ going to lose this week. what is your view on the stalemate - going to lose this week. what is | your view on the stalemate now? going to lose this week. what is - your view on the stalemate now? the

bma is saying 35%, that is our negotiating position, that is where we are starting out. the government say that is completely unacceptable. the bma say, well, the government are not giving any suggestions as to where there is room for manoeuvre and the government are saying, we refuse to come to the table unless the bma move their position. i don't want to use the word blame, but if you had to pick it, where we it and where do they go from here? i think the --eole where do they go from here? i think the people i — where do they go from here? i think the people i represent, _ where do they go from here? i think the people i represent, the - where do they go from here? i think the people i represent, the leadersl the people i represent, the leaders i represent and the public share a mystification really about this. it is as if we have forgotten what the word negotiation means. so why do we negotiate? we negotiate because each side has got a starting point that is unacceptable to the other side and then you talk. and it is as if both sides are almost saying, well, we are not going to talk unless the other side adopts our position. that is what happens when a negotiation starts. i also find it surprising

but equally from the govan perspective because we went through this process with the nurses, with the paramedics —— the government perspective. the government reviews for two or three months to negotiate and we had strikes which caused problems and then negotiation started and they were remarkably short and a deal was agreed which most of the union is now recommended to their members. so i think the question everybody is asking is, look, this is inevitably going to end up in a negotiation, so why can't wejust get end up in a negotiation, so why can't we just get on with it? and that's why the confederation, the organisation i lead has called today for both sides to contact the conciliation service acas who were involved in the last time there was a junior doctor strike, so they are the specialist, at least a basis for to start. , , ., ., , to start. just out of interest, would it take _ to start. just out of interest, would it take both _ to start. just out of interest, would it take both sides - to start. just out of interest, would it take both sides to i to start. just out of interest, i would it take both sides to have to start. just out of interest, - would it take both sides to have to contact acas independently to move this forward, is that how this works? i

this forward, is that how this works? , ., this forward, is that how this works? , . ~ w, this forward, is that how this works? , . ~ , ., , works? i understand acas will only intervene if— works? i understand acas will only intervene if both _ works? i understand acas will only intervene if both sides _ works? i understand acas will only intervene if both sides believe - works? i understand acas will only intervene if both sides believe an l intervene if both sides believe an intervention is necessary. if one contact —— one side contacts them, the other side would need to say yes. it is not reasonable for a conciliation service to resolve something if both sides are not committed to resolving it. that is what they are there for and we need something, both sides are in danger of getting into a position where any movement gets into a climb—down so it is a good time to bring in the experts and ask them to find a basis for talks. ~ ., experts and ask them to find a basis for talks. n, ._ ., ., ._ , for talks. matthew taylor, always aood to for talks. matthew taylor, always good to see _ for talks. matthew taylor, always good to see you. _ for talks. matthew taylor, always good to see you, thank— for talks. matthew taylor, always good to see you, thank you - for talks. matthew taylor, always good to see you, thank you for i good to see you, thank you for keeping us up—to—date. chief executive of the nhs confederation. let's cross to the newsroom and join our health correspondentjim reed who is following the latest developments. bring us up—to—date on the latest from the hospitals we are hearing. the latest from the hospitals we are hearinu. , ,, the latest from the hospitals we are hearin. _ , y., the latest from the hospitals we are hearinu. , ,, ., �* �* hearing. yes, you look on the bbc website at — hearing. yes, you look on the bbc website at the _ hearing. yes, you look on the bbc website at the moment, _ hearing. yes, you look on the bbc website at the moment, this - hearing. yes, you look on the bbc website at the moment, this is . hearing. yes, you look on the bbc| website at the moment, this is the live page from the bbc website and you will see updates from around the country, the latest from trafalgar square. matthew taylor, it was interesting listening to him, he

represents a lot of the big hospitals across england and he was making the point that a&e is slightly less busy than you would expect today, which will be a very big positive for many of the trust trying to juggle the strike and demand on the service at the moment. just looking at e—mails coming in from my colleagues across the country on that, the health correspondent in the south of england says, quiet in the south, low turnout on pickets, no indication of extreme pressures yet. nicky fox, our correspondent in the east, talking about the boss of ipswich and colchester hospitals, two very big hospitals in the east. he is talking about how they had to put consultants, the most senior doctors, through basic life support training. and they have pharmacies helping out in that part of the country. he is talking about there are fewer staff on strike today compared with last time, as he believes there are more worries about patient safety this time round

which is also interesting. matthew taylor made an interesting point in that interview, if you think about hospitals and this is oversimplifying things, but think about hospitals in two main parts. one part is dealing with those people coming into accident and emergency and they couldn't have predicted what would be wrong with them. the other part is dealing with so—called elective operations and appointments, this is people coming in for hip replacement surgery, maternity, you know roughly when you are going to give birth, those kind of appointments. and the issue they have got at the moment is if you try to protect accident and emergency through the strikes, you have junior doctor is going on strike in a&e and you try to move your most senior doctors who are not on strike, your consultants, over two want to cover, which is a positive for a&e because you have your most senior doctors and they can cover. the problem is, you then start having to cancel those elective operations, those appointments, those outpatient

appointments, those outpatient appointments, those outpatient appointments, those cancer scans, and that is exactly what happens in the last round ofjunior doctor strikes and that is what they worry is going to happen this time and thatis is going to happen this time and that is where the figure of between 250 and 350 possible cancelled or delayed appointments and operations comes from at the moment. so it is those elective, pre—booked procedures, which there is most concerned about through this junior doctors strike this week. but concerned about through this “unior doctors strike this week.�* doctors strike this week. but this into context. _ doctors strike this week. but this into context, because _ doctors strike this week. but this into context, because i— doctors strike this week. but this into context, because i don't - doctors strike this week. but this. into context, because i don't think the nhs in england has ever seen a strike as wides red and with such a huge impact as this, have they? ida. huge impact as this, have they? no, it comes after _ huge impact as this, have they? no, it comes after a _ huge impact as this, have they? iirr, it comes after a series of strikes —— widespread. from late december onwards. matthew taylor was talking about theirs, we had an industrial dispute involving paramedics, one involving nurses and now we have a junior doctor strike. involving nurses and now we have a junior doctorstrike. in involving nurses and now we have a junior doctor strike. in the future, there looks to be the possibility of a ballot of consultant doctors, more senior doctors as well. these industrial disputes are rolling on this year. interestingly, the government did come to a deal with

most unions representing those ambulance workers and those nurses so that is a 5%, roughly a 5% pay increase this year and a bonus for last year, a one—off payment of roughly £1600 each. unions are currently going away and consulting members on that, but the majority of unions representing those staff have recommended to the workforce that they should accept. so that part of industrial action appears to now be moving behind us, we will have to see what the result of those balances, but there is at least a glimmer of hope, to say the least. we are moving into this different stage where we still have this dispute involving junior doctors and potentially going forward, that could spread across the country. we have a ballot ofjunior doctors in stock —— in scotland going on at the moment and we should get the results in may. and also the possibility perhaps of consultant striking as well. so there is one problem for the government which appears to be easing but it looks like this are the problem involving more senior doctors and members of staff could

be continuing. find doctors and members of staff could be continuing-— doctors and members of staff could be continuing. and the number that the bma are _ be continuing. and the number that the bma are asking _ be continuing. and the number that the bma are asking for _ be continuing. and the number that the bma are asking for come - be continuing. and the number that the bma are asking for come at - be continuing. and the number thatj the bma are asking for come at this 35% pay rise which they say is mainly restitution and pay rises they have not had for many years, if it did come to it, what kind of amount would that look like for the government, do we know? —— asking for, this 35%. government, do we know? -- asking for, this 35%-— for, this 35%. that is the interesting _ for, this 35%. that is the interesting thing, - for, this 35%. that is the interesting thing, when l for, this 35%. that is the i interesting thing, when you for, this 35%. that is the - interesting thing, when you talk aboutjunior doctors, that is a wide range of both experience and wages and that is where you reach some confusion about the numbers being used. if you start off as a junior doctor, your basic salary would be roughly £29,000. you would get slightly more with overtime work and working at weekends and night shifts, that kind of thing, roughly another 10%, 20%. the most experienced junior doctors after maybe eight or ten years on the job can expect a basic salary of £60,000, plus 20% on top of that through those extra payments. that is where you see this wide range of

figures being talked about. so if there was a 35% wage increase across there was a 35% wage increase across the board, that would mean different amounts depending on the experience, that would involve a couple, well, about £3 extra per hour for the least experienced members of staff, but the government makes the, the most experienced member of staff could get another £20,000 or so every year so it really does depend how much experience you have got and at what point in your career you are as a junior doctor. find at what point in your career you are as a junior doctor.— as a junior doctor. and we have certainly been _ as a junior doctor. and we have certainly been around - as a junior doctor. and we have certainly been around the - as a junior doctor. and we have l certainly been around the country with our correspondent on the picket line who say they are hearing lots of people drive past a beeping which the doctors asked saying may be in support of them, but do we know from opinion polls where the public sit on the strikes?— on the strikes? really difficult to sa at the on the strikes? really difficult to say at the moment, _ on the strikes? really difficult to say at the moment, interesting l say at the moment, interesting looking at the less junior doctor strikes, there have only been a few junior doctor strikes in the history of the nhs, the last one was in 2016 over a different contract being imposed onjunior over a different contract being imposed on junior doctors and that was resolved through the use of the

reconciliation service acas. when you looked at the opinion polls at the time, there was quite strong support forjunior doctors at the time, there was quite strong support for junior doctors at the beginning, but is that dispute went on for weeks and months, you saw some of that support ebbing away and it will be interesting to see what we see in this dispute. we are only at the second round of strikes for junior doctors and this has only gone on three or four weeks and that support from the public appears to be holding up. the question is what happens if this goes on longer, what happens if this goes on longer, what happens if this goes on for another three orfour months? happens if this goes on for another three or four months? there has happens if this goes on for another three orfour months? there has been speculation the press today this could run until the next general election in 2024, this industrial dispute, so whether that support from the public holds up in the longer term is a different question and a different matter. gk. longer term is a different question and a different matter.— and a different matter. 0k, thank ou. we and a different matter. 0k, thank you- we are _ and a different matter. 0k, thank you. we are looking _ and a different matter. 0k, thank you. we are looking at _ and a different matter. 0k, thank you. we are looking at the - and a different matter. 0k, thank you. we are looking at the life - you. we are looking at the life scenes from trafalgar square where the rally byjunior doctors is taking place, lots of people, a lady with a child, people with placards, several thousand at a guess, all there to protest against pay and

conditions and to demand negotiations with the government, both sides entrenched, stalemate at the moment. neither side coming to the moment. neither side coming to the table. well, let's go to yorkshire next, where bbc north reporter has been speaking to striking doctors on the picket line in leeds. ~ ., ., , ., in leeds. well, “unior doctors have turned out — in leeds. well, “unior doctors have turned out in — in leeds. well, junior doctors have turned out in the _ in leeds. well, junior doctors have turned out in the picket _ in leeds. well, junior doctors have turned out in the picket line - in leeds. well, junior doctors have turned out in the picket line here l turned out in the picket line here outside leeds general infirmary, this is the first of four days of strike action. i am with doctor chris morris, a junior doctor in leeds, why are you here today? junior doctors have faced a real—terms pay cut over the last 15 years. _ real—terms pay cut over the last 15 years. this — real—terms pay cut over the last 15 years, this has gone on for too long _ years, this has gone on for too long it — years, this has gone on for too long it is _ years, this has gone on for too long. it is leading to colleagues either— long. it is leading to colleagues either choosing to leave the profession or choosing to work abroad — profession or choosing to work abroad for— profession or choosing to work abroad for better pay and conditions. 98% ofjunior doctors conditions. 98% of junior doctors voted _ conditions. 98% of junior doctors voted for— conditions. 98% ofjunior doctors voted for the strike action, we feel something — voted for the strike action, we feel something needs to be done to restore — something needs to be done to restore our pay. the something needs to be done to restore our pay. something needs to be done to restore our -a . , restore our pay. the government says ou are restore our pay. the government says you are asking — restore our pay. the government says you are asking for — restore our pay. the government says you are asking for a _ restore our pay. the government says you are asking for a 35% _ restore our pay. the government says you are asking for a 35% increase - you are asking for a 35% increase and that is unreasonable and unaffordable. it and that is unreasonable and unaffordable.— and that is unreasonable and unaffordable. ._ , ~ ., and that is unreasonable and unaffordable. , ~ ., , unaffordable. it may seem like a big ask, but unaffordable. it may seem like a big ask. but that — unaffordable. it may seem like a big ask, but that is _ unaffordable. it may seem like a big ask, but that is in _ unaffordable. it may seem like a big ask, but that is in the _ unaffordable. it may seem like a big ask, but that is in the background i ask, but that is in the background of 15_

ask, but that is in the background of 15 years— ask, but that is in the background of 15 years of real terms pay cuts. the reason — of 15 years of real terms pay cuts. the reason it is a big ask isjunior doctors _ the reason it is a big ask isjunior doctors have _ the reason it is a big ask isjunior doctors have faced a huge pay cut over that — doctors have faced a huge pay cut over that period. just to break it down _ over that period. just to break it down into— over that period. just to break it down into what that means per hour, junior— down into what that means per hour, junior doctors working in the nhs today— junior doctors working in the nhs today paid £14 per hour. we are asking _ today paid £14 per hour. we are asking that to be put back up to £19 per hour~ _ asking that to be put back up to £19 per hour. our colleagues in 2008 were _ per hour. our colleagues in 2008 were paid — per hour. our colleagues in 2008 were paid at similar levels and we don't _ were paid at similar levels and we don't think— were paid at similar levels and we don't think we are with anything less _ don't think we are with anything less. , ,., . , ., less. the big impact this will have is on patients _ less. the big impact this will have is on patients today, _ less. the big impact this will have is on patients today, the - less. the big impact this will have . is on patients today, the government so you wish —— you are risking patient safety, what is your message?— patient safety, what is your messaue? ~ ., ., , message? we want to patients affected with — message? we want to patients affected with cancellations - message? we want to patients affected with cancellations for| affected with cancellations for planned care, but i want to reassure patients _ planned care, but i want to reassure patients senior colleagues such as consultants and specialist doctors are covering emergency care that junior— are covering emergency care that junior doctors would usually cover. we feel— junior doctors would usually cover. we feel we — junior doctors would usually cover. we feel we have been forced into this position by the government, they failed to meet with the bma on multiple _ they failed to meet with the bma on multiple occasions and have failed to put— multiple occasions and have failed to put a _ multiple occasions and have failed to put a credible off at the table. the government have said they will consider negotiations again of the strikes are called off and if the bma make significant moves as regards their pay demands —— a

credible offer on the table. we will have more on this on bucknell tonight at 6:30pm. its, have more on this on bucknell tonight at 6:30pm.— have more on this on bucknell tonight at 6:30pm. a lot of numbers fl in: tonight at 6:30pm. a lot of numbers flying around — tonight at 6:30pm. a lot of numbers flying around and _ tonight at 6:30pm. a lot of numbers flying around and it _ tonight at 6:30pm. a lot of numbers flying around and it is _ tonight at 6:30pm. a lot of numbers flying around and it is hard _ tonight at 6:30pm. a lot of numbers flying around and it is hard to - tonight at 6:30pm. a lot of numbers flying around and it is hard to keep l flying around and it is hard to keep up flying around and it is hard to keep up with them —— more on this on look north. let's break down the numbers. let's go through a few figures, we have 75,000 junior doctors in england. that represents about half the number of doctors in hospital. so it is a high representation of that workforce. these are people who have done medical school and had beenin have done medical school and had been in thejob have done medical school and had been in the job for about ten years. the labeljunior probably not quite accurate. let's look at what they get paid. as you can see, there is lots of different scales. i will talk you through it. this is the first scale when you are just entering the workforce after medical school and you can see the average pay is about £30,000. then there are extras, that covers over time and things like working on weekends and unsociable hours. then as you go through and get more qualified, this

is years one and two, the pay increases. when we look at band five, around year eight, you can see the pay is around 60,000, with extras to take it to almost 80,000. that is how the pay compares in england. this is what they want. this figure is less seen as a realistic demand, but more as a plea for the government to come to the negotiating table, but it seems to have had the opposite effect. and you can see this update has come into the newsroom in the past hour quoting a downing street spokesperson saying that the 35% pay demand must be abandoned before the government will come to the table, describing that figure as unreasonable and not affordable for the british taxpayer. the spokesperson also says that the strikes must be called off because —— before the government will negotiate.

this is the