England's hospitals prepare for first all-out walkout by junior doctors

England's hospitals are preparing for the first all out strike in NHS history after junior doctors voted in favour of industrial action.

The huge Yes vote means the British Medical Association - the doctors' union - will now go ahead with three days of action next month, including two full walk outs by junior doctors.

This is no shock result. But - unless a last minute solution can be found - it is very bad news for an NHS already struggling to cope with winter pressures, staff shortages and deepening financial problems.

Watch ITV News Health Editor Rachel Younger's full report here:

What will it mean for patients? There are over 50,000 junior doctors in England and they are often described as the backbone of the NHS.

In 2012, when more limited action was taken over pensions, the Department of Health estimated one in ten patients had an operation, outpatients appointment or treatment rescheduled - around 2,700 in total. The BMA reckoned a quarter of non urgent care had to be postponed.

This time round the BMA is insisting once again the walkout isn't about disrupting care but to communicate the scale of doctors' anger.

Like every junior doctor I have spoken to, Accident and Emergency doctor Amar Mashru doesn't want to strike, saying it goes against all his instincts as a medic.

He insists the decision to act is not about pay, but the harm doctors believe the new contract Jeremy Hunt wants to introduce will cause patients.

Although Dr Mashru accepts the strike will inconvenience them, he doesn't accept it will put anyone at risk, thanks to the help of the people he works with.

With so much at stake it's not surprising that Labour's Shadow Health Secretary Heidi Alexander has intervened, telling the Prime Minister the medical profession has lost faith in Jeremy Hunt.

We expect political point scoring at difficult moments like this. What matters more is that she has added her voice to those calling for independent arbitration. And that would seem to make perfect sense in a dispute that has become increasingly and depressingly personal.

Because neither side has covered itself in glory. The BMA walked out of negotiations unexpectedly last year, leaving the government with little choice but to pursue a proposal without much needed talks.

And the Department of Health has, on occasion, found it easier to leak details to the press, rather than think more creatively about ways to break the impasse.

Now it seems the Medical Royal Colleges - who normally steer well clear of contract negotiations - might step in to the breach.

They are calling for independent arbitration.

With the first planned walkout less than a fortnight away there is no time to lose.