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Thousands of paramedics and other personnel in NHS ambulance services across England and Wales will strike for between 12 and 24 hours on Wednesday, leaving the NHS unable to respond to many of the 999 calls it usually receives.
On Tuesday, NHS bosses and a government health minister advised people to behave in a "sensible" way during the strike in order to avoid ending up needing to go to A&E so that ambulance services can concentrate on helping those in greatest medical need.
Prof Sir Stephen Powis, NHS England's national medical director, asked the public to ring 999 only if it involved a life-threatening emergency and instead to call the 111 telephone advice service.
"But people can also help by taking sensible steps to keep themselves and others safe during this period and not ending up in A&E, whether that is drinking responsibly or checking up on a family member or neighbour who may be particularly vulnerable to make sure they are OK," said Powis.
Will Quince, a health minister, urged people to play their part in reducing the pressure on overstretched NHS services by not engaging in "risky activities", in case they got injured.
"Where people are planning any risky activity, I would strongly encourage them not to do so because there will be disruption on the day," he told BBC Breakfast.
Downing Street declined to specify what pursuits Quince meant. But the minister clarified to BBC Radio 5 Live that "if there is activity that people are undertaking tomorrow, whether it's, for example, contact sport, they may want to review that."
Asked if people should still go running, he replied that that was not a "hugely risky" activity. But, he added: "Would I go running tomorrow if it was still icy? No I wouldn't, because that would encompass additional risk."
Powis and Quince spoke out after the campaign group GP Survival on Monday criticised NHS England for not preparing the public for the huge disruption Wednesday's strike will entail. It should have advised them to refrain from pursuits that involve danger and set out how to move and transport injured and acutely unwell people to hospital who cannot get an ambulance to take them.
Talks were continuing on Tuesday between the health secretary, Steve Barclay, and Unison, Unite and the GMB, the three unions whose members in ambulance services will be on strike.
Unions and NHS bosses have already agreed that ambulance crews will respond to all "life or limb" category one calls, which involve patients who are at immediate risk of dying, for example because they are in cardiac arrest or have stopped breathing.
However, Tuesday's talks were about whether ambulance personnel would also attend category two calls, which involve situations such as suspected heart attacks and strokes, in which patients must receive treatment fast to give them the best chance of survival.
The unions' joint action is the first shot in a campaign for a bigger pay settlement from the government than the £1,400-a-head it has offered. Thousands of nurses also staged strikes on Tuesday across England, Wales and Northern Ireland for the same reason.
The warning came as Rishi Sunak's cabinet ignored the strike action on Tuesday morning and focused instead on the prime minister's meetings in Estonia and Latvia as well as plans for the coronation of King Charles III next year. Steve Barclay, the health secretary, will however meet ambulance unions for talks later on Tuesday.
Speaking earlier, Quince said that people should not take unnecessary risks during the strikes. "Where people are planning any risky activity, I would strongly encourage them not to do so because there will be disruption on the day," he said.
Downing Street later declined to set out what "risky" activities might include, with the prime minister's official spokesperson telling reporters: "The public, as we saw through Covid, can be trusted to use their common sense."
Women planning home births should get advice via their antenatal care, the spokesperson said, stopping short of advising expectant mothers in labour to go to hospital.
Quince stressed that those with chest pain should call 999 despite the ambulance strike in England and Wales on Wednesday but admitted that people experiencing such pain were waiting an average of 47 minutes.
People with chest pains or who have had a bad fall - category 2 cases - were waiting more than an hour in some areas, Quince said. But he insisted that life-threatening emergencies would be covered on Wednesday and that the most critical category 1 calls were being answered in under 10 minutes.
"If you have chest pains, call 999 and the expectation is, and I've been really clear with you, I don't think that there is any paramedic, ambulance technician, anyone working in our NHS, whether they're on a picket line or not, that would not respond to a 999 call where somebody has chest pains and there is a threat of a heart attack," he told BBC Radio 4's Today programme on Tuesday.
The ambulance workers' strike on Wednesday will involve up to 10,000 staff. Union officials have suggested that paramedics, call handlers and emergency care assistants would come off picket lines for the most serious cases. Those who are members of the GMB will then strike again on 28 December.
Meanwhile, at least three ambulance services declared critical incidents as NHS services face "unprecedented" pressure. North East ambulance service, South East Coast ambulance service and the East of England ambulance service have all moved to the status as staff work to respond to calls.
The former operates across Northumberland, Tyne and Wear, County Durham, Darlington and Teesside; South East Coast ambulance service covers Brighton and Hove, East Sussex, West Sussex, Kent, Surrey and north-east Hampshire; while the latter works in Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk and Cambridgeshire.
Declaring a critical incident allows an ambulance service to instigate several additional measures to protect patient safety, which include seeking mutual aid, cancelling all training to allow for the redeployment of all clinical staff, not taking bookings for urgent non-emergency transportation and increasing third-party provider provision.
In other industrial action affecting the health service, nurses were striking for a second day on Tuesday. The head of the Royal College of Nursing, Pat Cullen, said there was no route to negotiations with the government to end the dispute because ministers would not discuss pay.
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