Thousands of nurses are staging a second walkout in a row over pay as a series of strikes hits the UK in the run-up to Christmas.
Around a quarter of hospitals and community teams in England are taking part in the strike, alongside all trusts in Northern Ireland and all but one health board in Wales.
The Royal College of Nursing (RCN) and the government are locked in a bitter dispute over pay, with ministers saying the salary rise demanded by unions is unaffordable.
On Wednesday, ambulance workers including paramedics, control room workers and technicians will also walk out in England and Wales, with health chiefs warning this represents the most serious threat to date.
The RCN has been calling for a pay rise of 5% above inflation, though it has indicated it would accept a lower offer.
When it submitted the 5% figure to the independent pay review body in March, inflation was running at 7.5%.
But inflation has since soared, with RPI standing at 14.2% in September.
The government has implemented the recommendations of the independent pay review body, which gave nurses a rise of about 4.75%, with a guaranteed minimum of £1,400.
During Tuesday’s strike, the NHS will be running a bank holiday-style service in many areas as thousands of operations and procedures are cancelled and rescheduled.
The RCN has said it will still staff chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care, as well as some other services.
Let’s get this wrapped up by Christmas. I will negotiate with him at any point to stop nursing staff and patients going into the new year facing such uncertainty— Pat Cullen, RCN
Speaking ahead of the strike, RCN chief executive Pat Cullen said: “The prime minister should ask himself what is motivating nursing staff to stand outside their hospitals for a second day so close to Christmas.
“They are prepared to sacrifice a day’s pay to have their concerns heard. Their determination stems as much from worries over patient safety and the future of the NHS than personal hardship.
“Rishi Sunak is under growing pressure in Westminster following last Thursday’s strike and he should listen to people around him.
“The public is increasingly with their local nursing staff and this government desperately needs to get on the right side of them. It is unprecedented for my members to strike.
“Let’s get this wrapped up by Christmas. I will negotiate with him at any point to stop nursing staff and patients going into the new year facing such uncertainty.
“But if this government isn’t prepared to do the right thing, we’ll have no choice but to continue in January and that will be deeply regrettable.”
Health secretary Steve Barclay said: “The RCN’s demands are unaffordable during these challenging times and would take money away from frontline services while they are still recovering from the impact of the pandemic. I’m open to engaging with the unions on how to make the NHS a better place to work.”
The only reason we're entrenched is because we've got no-one to talk to about what the issue is— Patricia Marquis, Royal College of Nursing
Mr Barclay will meet unions representing striking ambulance drivers in 11th hour talks on Tuesday, although the discussions are unlikely to avert the action.
He wants to discuss patient safety with Unison, GMB and Unite but his refusal to negotiate on pay means the following day’s strikes are bound to go ahead.
The health secretary is understood to hold concerns over whether all emergency calls will be covered, but unions said there would be “no strikes at all if ministers would only talk to unions and improve NHS pay”.
Patricia Marquis, RCN England director, told Times Radio on Monday nurses could strike for up to six months if the government does not sit down to negotiate on pay.
“The only reason we’re entrenched is because we’ve got no-one to talk to about what the issue is,” she said.
“Sadly if there is no resolution, then our members have taken a vote to take strike action and the mandate that lasts for six months. I really hope and I pray that that is not what happens.
“We do not want to see protracted strikes, nor do we want to see further disruption to the NHS and to the services that patients need.”
Prime minister Rishi Sunak told reporters on Monday the government had adopted a “fair and responsible approach to pay”.
He stressed the need to “combat inflation” which is “making everybody in the UK’s life difficult”, adding: “Part of us doing that is having a responsible and fair approach to pay.
“I’m really disappointed to see that the unions are calling these strikes, particularly at Christmas, particularly when it has such an impact on people’s day-to-day lives with the disruption it causes and the impact on their health.
The Government, for its part, is being responsible in putting in place contingency measures to make sure we are well prepared to handle the disruption that is coming— Prime Minister Rishi Sunak
“I would urge them to keep considering whether these strikes are really necessary and do everything they can to alleviate the impact it’s going to have on people.”
The government has announced controversial plans to deploy more than 1,000 civil servants and 1,200 troops to cover for striking ambulance workers and Border Force staff, who are preparing to walk out for eight days from December 23 until New Year’s Eve.
Unions have branded the move a “desperate measure”, warning the servicemen and women are not “sufficiently trained” to plug staffing gaps on the front line, while the Chief of the Defence Staff has said the armed forces should not be treated as “spare capacity”.
During Wednesday’s ambulance strike, the military will not drive ambulances on blue lights for the most serious calls but are expected to provide support on less serious calls.
Negotiations between unions and ambulance services are still ongoing to work out which incidents should be exempt from strike action.
All category 1 calls (the most life-threatening such as cardiac arrest) will be responded to, while some ambulance trusts have agreed exemptions with unions for specific incidents within category 2 (serious conditions, such as stroke or chest pain).
This means those who suffer trips, falls or other non-life-threatening injuries may not receive treatment.
In the North East, the ambulance service has said it “is clear that we will not be able to respond to all calls of a serious nature”.
It added “there are likely to be significant delays in response for patients who have less serious illness or injury”.
We have planned with great care for this strike, but our services will be extremely busy and we do expect them to be severely disrupted— Stephen Segasby, North East Ambulance Service
Stephen Segasby, chief operating officer at North East Ambulance Service, said: “We have planned with great care for this strike, but our services will be extremely busy and we do expect them to be severely disrupted.
“We also anticipate that the days after the strike will be busy and as we head into an extended bank holiday over Christmas, we want to encourage people to use services wisely and prepare where possible.
“Ambulances will still be able to respond during the strike, but this will only be where there is an immediate risk to life.
“This means that less serious calls will not receive a response for the duration of the strike action and some patients might be asked to make their own way to hospital, where it is safe for them to do so.”
Other trusts said negotiations were still ongoing, while London Ambulance Service said “patients whose conditions are not life-threatening are unlikely to get an ambulance on industrial action days”.
It said where the situation is not life-threatening, alternative support will be available through NHS 111 online or through NHS 111.
Members of the GMB are set to stage a second ambulance worker walkout on December 28.
Meanwhile, rail workers are preparing to continue their strikes, with a walkout planned for Christmas Eve.
