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Junior doctors across England have begun a four-day walkout, expected to be the most disruptive in NHS history.
More than a quarter of a million appointments and operations could be cancelled, and some hospitals say up to half of planned treatment is affected.
The British Medical Association, which is asking for a 35% pay rise, said "we've had no offer whatsoever" from Health Secretary Steve Barclay.
Mr Barclay said it was "extremely disappointing" patients were at risk.
The BMA said there were plans to pull doctors off picket lines if lives were in immediate danger. Under trade union laws, life-and-limb cover must be provided.
The junior doctors' approach contrasts with recent strikes by nurses and ambulance workers, which saw unions agree to exempt certain emergency services.
But doctors say they are striking for patient safety as much as about pay, saying that current pay levels are affecting recruitment and leading to many doctors leaving the profession.
Dr Emma Runswick, deputy chairwoman of the BMA, said they are hoping this round of industrial action will be the last - but "we will continue" if the government does not move.
She told BBC One's Breakfast. "This is not a situation where we are fixed in our position. We are looking for negotiations and Steve Barclay isn't even willing to talk to us.
"He hasn't put any offer at all on the table. If we want to start a negotiation there has to be two sides in the discussion."
Mr Barclay accused organisers of timing the strike just after the Bank Holiday Easter weekend - a period when the NHS already faces increased demand and greater staff absence - "to maximise disruption".
He said he had hoped to begin formal pay negotiations with the BMA last month but said its demand for a 35% pay rise was "unreasonable". He added this would would result in some junior doctors "receiving a pay rise of over £20,000".
Speaking to BBC Radio 4's Today programme as the walkout began on Tuesday morning, Mr Powis warned it "will take weeks" to recover from the strikes as "services will undoubtedly be affected".
During last month's three-day walkout by junior doctors, more than 175,000 treatments and appointments were cancelled.
But Prof Sir Stephen added the expectation is to see "considerably more" cancellations this time around due to the strike lasting four days. Estimates from other senior NHS figures have suggested between 250,000 and 350,000 appointments and operations could be cancelled.
Mental health services and some GP surgeries are also expected to be impacted, while the NHS said it will prioritise keeping critical care, maternity, neonatal care, and trauma operations running.
Dr Vivek Trivedi, co-chairman of the BMA junior doctors' committee, advised people to still ring 999 if they have a life-threatening illness as "the service is working as normal and we have prioritised emergencies".
The patients left in limbo
Dr Paul Turnbull, 61, from Hampshire, who is an occupational health doctor, needs a prosthetic femur bone implanted in his leg.
His operation has been cancelled twice - once in December, because he developed deep vein thrombosis, and the second time because of the first junior doctors' strike. The operation is now due to take place on 18 April, after the four-day strike.
He has limited mobility and is unable to work.
"As a doctor, I don't believe doctors should strike. I think our first responsibility is to our patients and I think using patients as pawns in a dispute with the government is not something we should be doing."
Neuroscientist Dr Camilla Hill, 42, from Nottingham, has also been affected. She has had two knee operations cancelled because of the junior doctors' strikes - one this week and one back in March. She now has a third date scheduled for 25 April.
She has been unable to do some of her favourite hobbies, which include hiking and sailing, in part because of the pain in her knees.
"I feel really frustrated. It's messed me about, it's messed about my employer, it's messed about my husband - and it's messed about his employer as well. It's not just the patient whose operation is cancelled that's impacted, it's everybody around them."
Junior doctors say their demanding for a 35% increase in pay is to compensate for 15 years of below-inflation wage increases.
But the government has said the pay demand is unrealistic, pointing to the deal other health unions have recommended to their members - which includes a 5% pay rise and one-off payment of at least £1,655.
More than 40% of the medical workforce are classed as junior doctors, with two-thirds of them members of the BMA.
The term junior doctors covers those who are fresh out of medical school through to others who have a decade of experience behind them.
'Stretched to our limits' - junior doctors
Rabiat is in her third year of junior training, working in a hospital in the south east of England.
She is planning on striking this week, saying it is as much about safety as it is pay.
"It's quite a common thing that junior doctors are left alone with wards of patients to look after, with their seniors having gone down to A&E or an acute assessment area, for example.
"We feel really left out and unsupported. Not because our seniors don't want to support us, but because we are all stretched to our limits.
"I really hope that the strikes will make the government realise that this is really having a big impact on junior doctors - and the whole of the NHS - and more actually needs to be done."
Additional reporting by Sean Seddon and Rachel Russell.
Are you a junior doctor with a view on the strike? Are you a patient affected? Share your experiences by emailing haveyoursay@bbc.co.uk.
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After a largely dry and bright Easter bank holiday weekend, the region is now in for unsettled weather.
The Met Office has put two wind warnings in place, that covers most of the western parts of the UK, including Merseyside. The warnings are in place as a low-pressure system has developed meaning it's likely to be wet and windy from today, on Tuesday, April 11 and into Wednesday.
Forecasters have predicted that winds of up to 60mph will have the potential to cause travel disruption and large waves in coastal areas. Despite weather staying fairly warm, at 12C, severe gales are expected at times and temperatures could drop to 8C through the week.
Met Office deputy chief meteorologist Steven Keates said: "The focus for the medium-range forecast is a low-pressure system that’s likely to develop just to the southwest of the UK, potentially bringing a period of high winds and heavy rain late on Tuesday and into Wednesday.
"There’s a distinct possibility of some disruptive wind for parts of the UK, especially in southern and western areas, as well as potential for heavy rainfall and even some snow, though the latter probably confined to high ground in the north.
"Although subject to a large degree of uncertainty, gusts of wind could be in excess of 60 mph in some exposed upland or coastal regions, with around 35-50 mm of rain possible for some areas."
teenager was stabbed to death outside a suburban primary school on Easter Monday.
The victim, 17, was found dying from a single stab wound in Longshaw Road, Chingford at 9.20pm.
Paramedics, police and neighbours fought to save the teenager but he was declared dead at the scene.
A Met spokesman said: “Officers were on the scene within three minutes along with paramedics from the London Ambulance Service and London’s Air Ambulance.
“They found a 17-year-old boy with a stab wound.
“Despite the efforts of members of the public and the emergency services, he died at the scene.
“His next of kin have been informed.
“An investigation is underway and enquiries are ongoing.”
Barney Davis/Evening Standard
Forensic teams were seen sweeping the area outside the front gates to Longshaw Primary School on Tuesday morning.
Police have also sealed off an overflowing clothes bank on a high street.
One dog walker told the Standard: “I feel so sad for someone so young to lose their life like that. It could have been my boyfriend.”
No arrests have been made.
Any witnesses are asked to tweet @MetCC or call 101 quoting CAD 6358/10Apr. To remain anonymous contact the independent charity Crimestoppers on 0800 555 111.
Essex police have denied being rebuked by Suella Braverman for seizing a collection of golliwog dolls that were on display in a pub.
Officers from the force took several dolls from the White Hart Inn in Grays, Essex, last week as part of an investigation into an alleged hate crime reported in February.
A source close to Braverman suggested the home secretary’s unhappiness had been made “very plain to Essex police so they are under no illusions”, according to MailOnline.
It quoted the source as saying police forces “should not be getting involved in this kind of nonsense” and instead focus on “catching criminals”.
But sources at the force said no contact had been made by Braverman over the investigation.
A team of four officers and a trainee attended the pub on Tuesday after a report of someone being racially harassed, alarmed or distressed by the presence of the dolls, which are based on racist caricatures. The force said it was working closely with the Crown Prosecution Service on the matter.
No arrests were made.
The pub’s owner, Benice Ryley, said she has displayed the collection of about 30 dolls, donated by her late aunt and customers, in the pub for nearly 10 years. She told the PA Media: “They’re my childhood history, it’s a part of our inheritance. I can’t see any harm. I don’t know how they can find it offensive.”
Ryley’s husband, Chris, is set to be questioned when he returns from abroad in May.
In a statement, Essex police said: “We are investigating an allegation of hate crime reported to us on 24 February.
“Essex police have discussed the progression of this case with the Crown Prosecution Service. On Tuesday 4 April, officers attended a location off Argent Street, Grays, and seized several items in connection with that investigation.
“The force is proud of the work we do prevent crime, tackle offenders and build trust and confidence in all communities.”
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The junior doctors’ strike will lead to caesarean births being cancelled, an increase in the number of mental health patients detained, and issues transferring the critically ill for urgent care, according to leaked NHS documents that show that the impact of the 96-hour walkout will reverberate through the NHS for months to come.
The action over pay, which begins on Tuesday, will compromise critical care and major trauma services, while there will even be a delay to funerals because doctors will not be available to issue death certificates.
Patients were warned on Monday to avoid “risky” behaviour and stay away from A&E if possible, while hospital bosses estimated that 350,000 routine operations were likely to be cancelled.
Hospitals are expecting as few as half the number of consultants to cover junior doctor shifts as during the previous strike, because of “fatigue” among staff and planned leave over the school holidays.
Internal predictions sent to the Department of Health and Social Care (DHSC) last week also warned that low staffing levels in critical care services would affect clinical care for both adults and children, with patients not receiving medicines or assessments on time.
There is particular concern over hospitals in the South West, which are experiencing worse staffing shortages along with an increase in demand from tourists.
On Monday, NHS Confederation chief executive Matthew Taylor urged the government and junior doctors’ unions to call in the Acas conciliation service in order to end their stalemate and avoid further “catastrophic” strikes.
Speaking to Sky News, Mr Taylor said: “There’s no point hiding the fact that there will be risks to patients, risks to patient safety, risks to patient dignity, as we’re not able to provide the kind of care that we want to.”
He advised the public to use NHS services in “the most responsible way you can”, and to avoid “risky behaviour” of a sort that could result in a visit to A&E during the strike.
“The health service has to meet high levels of demand, at the same time as making inroads into that huge backlog that built up before Covid, but then built up much more during Covid,” he said.
“That’s a tough thing to do at the best of times; it’s impossible to do when strikes are continuing.”
The walkout begins on Tuesday and will last for 96 hours
Junior doctors are set to walk out for 96 hours, with no exceptions applied to any services, including emergency care – although in a letter last week, NHS England said the British Medical Association (BMA) had agreed that, should a major incident occur, the NHS would be able to ask the union to send striking staff back to work.
The medical director of NHS England, Stephen Powis, has warned that the action will have “unparalleled levels of disruption”, with 350,000 operations expected to be cancelled according to the NHS Confederation, which represents hospital trusts. This is double the 175,000 appointments cancelled during the three-day strike in March.
The documents sent to the DHSC last week warned that there could be “significant” and “widespread” cancellations to outpatient services, including for people needing life-saving care, such as cancer appointments and chemotherapy. The effects are expected to outstrip by far the impact of the previous strike.
Mental health services are also expected to be more widely affected this time, with fewer doctors to carry out patient assessments on hospital wards. This could lead to “unnecessary continued detentions under the Mental Health Act”, according to the documents.
Junior doctors are looking for a 35 per cent pay rise
There are also expected to be worse delays for mental health patients attending A&E, because of staff shortages. Even in normal circumstances, these patients can be left waiting for days in emergency departments.
With staffing focused on critical and emergency care, there are expected to be delays in doctors signing death certificates, leading to further delays in coroners’ services and funerals.
To try to minimise the impact of the four-day strike, NHS England is planning to move staff working in community care to emergency services.
During the last junior doctors’ strike, hospitals experienced the highest levels of emergency demand they’d seen this year.
Health secretary Steve Barclay says the demands of junior doctors are ‘unrealistic’
A checklist sent by the BMA to the NHS for emergency situations includes questions about the pay rates hospitals have offered doctors.
According to the list, which has been seen by The Independent, hospitals are being “forced” to comply with minimum rates set by the BMA for consultant cover, which can be as high as £260 per hour.
The BMA has asked the government to address a 26 per cent real-terms pay cut to junior doctors’ wages since 2008-2009, which would require the government to sign off on a 35 per cent pay increase this year.
Health secretary Steve Barclay has described the demand as “unrealistic”, and said that the strikes had been planned to “cause maximum disruption”.
“This demand is widely out of step with pay settlements in other parts of the public sector at a time of considerable economic pressure on our country,” he wrote in The Sunday Telegraph. “A salary hike of this size would see some junior doctors receiving more than an extra £20,000 a year,” he said.
“I recognise their hard work and dedication. But it is deeply disappointing that this industrial action has been timed by the British Medical Association Junior Doctors Committee to cause maximum disruption to both patients and other NHS staff.”
Praising the Good Friday Agreement, Mr Sunak said it was "born of partnership between the British and Irish governments".
"As we will see from President Biden's visit this week, it continues to enjoy huge international support from our closest allies," he said.
"But most importantly it is based on compromise in Northern Ireland itself.
"As we look forward, we will celebrate those who took difficult decisions, accepted compromise, and showed leadership - showing bravery, perseverance, and political imagination.
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"We commemorate those who are no longer with us and the many who lost their lives by trying to prevent violence and protect the innocent.
"We give thanks to them as we reflect on the new generations that have grown up and continue to grow in a world in which peace and prosperity has prevailed."
When Northern Ireland was created in 1921 it remained part of the UK while the rest of Ireland became an independent state.
That created a split in the population between unionists, who wish to see Northern Ireland stay within the UK; and nationalists, who want it to become part of the Republic of Ireland.
From the late 1960s until 1998 - a period known as the Troubles - thousands of people were killed and injured as violence flared between the two sides.
Mr Sunak said that while it was important to reflect on the progress made "we must also recommit to redoubling our efforts on the promise made in 1998 and the agreements that followed".
"One of economic opportunity, prosperity and stability - it is a promise we must continue to fulfil," he said.
But the DUP believes it cuts Northern Ireland off from the rest of the UK, and it voted against a key aspect of the deal.
"We stand ready to work with our partners in the Irish government and the local parties to ensure that the institutions are up and running again as soon as possible," said Mr Sunak.
