Tens of thousands of nurses are on strike today for their first mass walkout in a century across England, Wales and Northern Ireland.
The action, an attempt to secure pay rises above inflation, continues afterwards talks to avert it ended in a stalemate.
Picket lines are being set up at dozens of hospitals and thousands of NHS appointments and operations have been cancelled, and the healthcare system operates a public holiday service in many areas.
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The Royal College of Nursing (RCN) has said it will continue to staff chemotherapy, acute cancer services, dialysis, intensive care units, neonatal and pediatric intensive care.
Some areas of mental health and learning disability and autism services are also exempt from the strike, while trusts have been told they can request staffing for specific clinical needs.
When it comes to emergency departments for adults and emergency care, nurses will work Christmas Day style.
Saffron Cordery, interim chief executive of NHS Providers, said the agency NHS trusts were “pulling out all the stops” to reduce the impact on patients.
She said: “However, it is inevitable that some operations or appointments will need to be rescheduled and trusts are pulling out all the stops to minimize disruption.
“The cold spell has increased demand which was already at or near record levels, but on strike day NHS trusts will be doing everything they can to ensure essential services are properly staffed and patient safety, always the first priority, is safeguarded. “
How strike action will affect A&E and other NHS services – and which hospitals are affected
RCN chief Pat Cullen has accused Health Secretary Steve Barclay of “war power” after he refused to discuss the pay issue – because the Government has already accepted NHS Pay Review Body (PRB) recommendations to provide below-inflation pay rises of around 4%.
This would have seen them receive a pay rise of around £1,400.
The RCN has asked for a pay rise of 5% above inflation, although it has indicated it will accept a lower offer.
When it submitted the 5% figure to the independent pay review body in March, inflation was at 7.5%.
But inflation has since risen, with RPI at 14.2% in September.
“A Tragic First”
Meanwhile, in Scotland, RCN members are being consulted on a revised pay offer from the Scottish Government.
Cullen said: “Nurses don’t like this, we act with a very heavy heart.
“It has been a difficult decision made by hundreds of thousands who are beginning to remove their workforce in an effort to be heard, recognized and valued.
“It is a tragic first for nursing, the RCN and the NHS.
“Nursing staff on picket lines is a sign of failure on the part of the government.
“My plea to patients is to know that this strike is for you too – it’s about waiting lists, treatments being canceled all year round and the very future of the NHS.”
The RCN has also raised the issue of large vacancies in the NHS, with 47,000 nursing roles empty in England alone. And it has warned the strike may have to continue into January if the government does not renegotiate wages.
The health secretary said nurses were “incredibly dedicated to their jobs” and it was “deeply regrettable that some union members are embarking on strike action”.
Barclay added: “My number one priority is keeping patients safe – I have worked across government and with non-public sector medicines to ensure safe staffing levels – but I remain concerned about the risk strikes pose to patients.
“However, the NHS is open and patients should continue to seek urgent medical care – and attend appointments – unless they have been contacted by the NHS.”
He said paying nurses more “would mean taking money from frontline services at a time when we are dealing with record waiting lists as a result of the pandemic.”
Who is on strike this winter and why?
But pressure is mounting on the government to find a compromise on pay, with former Conservative Party leader Sir Jake Berry saying they are “going to have to improve the offer”.
“We have to find a way as a government, and so does the union, to get to that middle ground, that point of agreement right away,” he told Talk TV.
During the strike, nurses will staff the strike at major NHS hospitals, including Guy’s and St Thomas NHS Foundation Trust in London, Addenbrookes Hospital in Cambridge and University Hospitals Birmingham NHS Foundation Trust.
Several trusts have already provided details of canceled outpatient appointments and planned treatments.
The Western Trust in Northern Ireland said it had “regrettably taken the decision to cancel some non-emergency services”, with 587 outpatient appointments postponed across Altnagelvin Hospital, Omagh Primary Care and Treatment Center and South West Acute Hospital.
The trust said there would also be reduced staffing in local nursing services, including rapid response nursing, district nursing, shared respiratory nursing and continence services.
In Wales, the Welsh Government said non-urgent or routine appointments were likely to be postponed.
On Wednesday, the head of NHS Employers said there were still “real concerns” about the level of cover nurses will provide for cancer patients during the strike.
In a letter to NHS leaders, Danny Mortimer said some aspects of the talks with the RCN had been disappointing and warned that “unless the Government indicates a willingness to negotiate on pay-related issues, further strike dates will be announced by the RCN for January 2023 onwards”.
A second RCN nurses’ strike is set for December 20, while thousands of ambulance workers will go on strike on December 21.
The RCN has urged agency workers not to cover for striking staff.
Members of the Rail, Maritime and Transport (RMT) union began the first of two 48-hour strikes at Network Rail – and 14 train companies – on Tuesday, which will run until Friday.
Industrial action is also planned in a whole range of British spheres, including paramedics, postal workers, Border Force agentsfirefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.