Junior doctors' strike: Second all-out stoppage hits NHS
Junior doctors are taking part in their second all-out strike in England in protest at the imposition of a new contract.
The stoppage lasts from 08:00 BST until 17:00 BST with consultants and nurses providing cover in emergency care.
This follows Tuesday's stoppage which many hospitals said they coped well with after being quieter than expected.
Similar reports have emerged on Wednesday with patients reporting they have received quick and efficient care.
Liam Walker, 35, from London, said his partner had been well cared for while in labour.
"There are three consultants instead of three juniors," he said. "We've had fantastic treatment."
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Retired health visitor Maureen Gaunt, from Dewsbury, West Yorkshire, went to accident and emergency for a dog bite.
"The staff were very welcoming," she said. "I waited no longer than 20 minutes. Even the staff said it was quiet."
But patients who have seen their treatment delayed have spoken about the problems it has caused.
Senior nurse Wendy Ginsing's daughter Hannah, 21, has been waiting for treatment for a brain tumour since before Christmas. She was due to be admitted on Tuesday, but that was postponed.
"Understandably Hannah is devastated and very annoyed about this," her mother said.
But Ms Ginsing said she still supported the junior doctors' action, adding: "I have seen how dangerous sleep disruption in doctors can be."
Why have hospitals coped so well?
There are a variety of factors. The NHS has had five weeks to prepare for these strikes and by cancelling routine appointments and operations in advanced it was able to free up consultants and nurses to work in emergency care.
Consultants have been largely supportive of their junior colleagues - in some cases even encouraging them to go out - and so have been only too willing to make sure services run smoothly.
The increased presence of senior doctors may have actually speed up processes. For example, Milton Keynes Hospital said having more consultants in A&E enabled quicker decisions to be made about what treatments patients needed.
The public also seem to have heeded warnings to stay away unless absolutely necessary. But that doesn't mean hospitals have got away with it. The number of delayed routine treatments - including cancer care - is piling up, while some hospitals fear there could be a spike in demand in the coming days.
Barry Edwards, who has had open heart surgery and had a follow-up appointment and scan postponed, was more critical.
"I am left in a situation of not knowing if my medication is appropriate, if I am on the mend and recovering as I should," he said.
Mr Edwards said he did not support the strike, adding junior doctors were no longer held in great esteem.
This week's strikes are the first time doctors have stopped providing emergency care in the history of the NHS.
Emergency protocols have been agreed to allow hospitals to call for junior doctors to return to work if patients are at risk. But they have not been used by any NHS trust yet.
NHS England's Anne Rainsberry said that was down to the hard work of staff that were on duty - consultants and nurses were redeployed to emergency services following the cancellation of more than 100,000 routine appointments and nearly 13,000 non-emergency operations.
"This is an unprecedented situation and staff across the NHS have made Herculean efforts to ensure continued safe services for patients."
A dedicated webpage has been set up on NHS Choices to provide information about the strike.
On Tuesday 78% of doctors expected at work did not turn up. But many hospitals said contingency plans had worked well.
Dr Cliff Mann, president of the Royal College of Emergency Medicine, said demand at his hospital trust - Taunton and Somerset - had been quieter than normal and he was "absolutely" sure lives had not been put at risk because of the cover provided by other doctors and nurses.
Frimley Health NHS Foundation Trust in Surrey said services had run "smoothly", while Doncaster and Bassetlaw Hospitals NHS Foundation Trust said it had not seen "undue pressure", although it did "anticipate a surge in demand" once the strikes were over.
But patient groups have warned the accumulation of postponed treatments - nearly 40,000 operations have now been delayed during the whole dispute - is taking its toll and causing harm. Alongside routine treatments, there have been reports of cancer patients facing delays.
The dispute is over a new contract that the government announced in February would be imposed from the summer. This followed the breakdown of talks between the two sides in January.
The contract makes it cheaper to rota doctors on at weekends - something ministers say is needed to improve care on a Saturday and Sunday.
The BMA has argued it is unfair and the NHS needs extra investment to pay for seven-day services.
Before this week's strikes, there had been four walkouts but all involved emergency care being maintained by junior doctors.