Junior doctors strike: Shropshire medics join first all-out walk-out in NHS history

For the first time junior doctors will not staff A&E units, intensive care, emergency surgery, or other areas of care at Royal Shrewsbury Hospital and Telford's Princess Royal Hospital, from 8am to 5pm today and again tomorrow.

Bosses at Shrewsbury and Telford Hospital NHS Trust have assured patients that disruption will be kept to a minimum during the strike.

Earlier this morning there were no signs of pickets at either hospital.

NHS England has also asked all trust boards across the country to provide assurance that they have adequate plans in place to manage the impact of the strike.

Nationally, trusts have reported that they expect there will be 12,711 postponed elective operations over the period of April 18 to May 2.

They have also reported that there will be have been 112,856 postponed outpatient appointments over the same period.

Health Secretary Jeremy Hunt appealed directly to medics on Monday not to withdraw emergency cover, which he said had particular risks for A&E departments, maternity and intensive care.

Despite an intense three days of letters back and forth and a phone call between Mr Hunt and the head of the BMA on Monday, no agreement on a way forward has been reached.

Mr Hunt said he was motivated by a desire to improve weekend services in the NHS and told MPs that " no trade union" had the right to veto a Government manifesto commitment to do so.

He said the disruption over the next two days is "unprecedented" but the NHS has made "exhaustive efforts" to ensure patient safety.

He said: "No trade union has the right to veto a manifesto promise voted for by the British people.

"We are proud of the NHS as one of our greatest institutions but we must turn that pride into actions and a seven-day service will help us turn the NHS into one of the highest quality healthcare systems in the world.

"I wish to appeal directly to all junior doctors not to withdraw emergency cover, which creates particular risks for A&Es, maternity units and intensive care units."

Mr Hunt said the NHS was "busting a gut to keep the public safe".

An Ipsos Mori poll for BBC News has found 57% support the doctors' cause while a quarter oppose it.

The majority still think the Government is most at fault for the dispute - but a rising number think the Government and doctors are equally to blame.

Dr Anne Rainsberry, national incident director for NHS England, said: "The NHS exists to care for and treat patients and it is with enormous regret that we find patients put in this position.

"We have focussed our efforts on essential services including emergency care but the effects of this action will be felt far and wide with thousands of people having their operations postponed and their care disrupted, for which we sincerely apologise."

"NHS organisations have tried and tested plans to deal with a range of disruptions to seek to ensure continued safe services for patients, which is always our top priority. The NHS has been pulling out all the stops to minimise the risks to the quality and safety of care but this is an unprecedented situation during a time of heightened risk."

The BMA has defended the walkout, repeating its stance that it would have called off the strike if Mr Hunt agreed to lift his threat to impose the contract.

The head of the BMA, Mark Porter, told Monday's BBC Radio 4 Today programme the Government had "distorted" weekend death statistics and stressed emergency cover would be provided by consultants during the strike.

Responding to Mr Hunt's claim that lives were being put at risk by the strike, he added: "The Health Secretary is trying to find some way to throw mud at the junior doctors of this country who have been providing weekend and night emergency cover since the NHS started."

Earlier on Monday, more than a dozen presidents of royal colleges and faculties urged David Cameron to step in "at the 11th hour" to break the stalemate.

Labour leader Jeremy Corbyn said Mr Hunt should "back off ", adding: "We must stand up and defend the NHS."

He also asked if there was a "deeper agenda" to reduce the efficiency of the NHS while promoting private industry.