Tens of thousands of nurses are going on strike for the first time across England, Wales and Northern Ireland.
Picket lines are being set up at dozens of hospitals in a dispute over pay, with the Welsh Government saying services will be “significantly impacted”.
Thousands of NHS appointments and operations have been cancelled because of the strike, with the health service running a bank holiday-style service in many areas.
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) has said it will still staff chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care.
Some areas of mental health and learning disability and autism services are also exempt, while trusts have been told they can request staffing for specific clinical needs.
But it’s inevitable that some operations or appointments will have to be rescheduled and trusts are pulling out all the stops to minimise disruption— Saffron Cordery, interim chief executive of NHS Providers
When it comes to adult A&E and urgent care, nurses will work Christmas Day-style rotas.
Saffron Cordery, interim chief executive of NHS Providers, told the PA news agency NHS trusts were “pulling out all the stops” to lessen the impact on patients.
She said: “The picture will vary across the country as trust leaders work out service levels with unions locally.
“But it’s inevitable that some operations or appointments will have to be rescheduled and trusts are pulling out all the stops to minimise disruption.
“The cold snap has ramped up demand that was already at or close to record levels, but on strike day NHS trusts will do everything they can to ensure that essential services are properly staffed and patient safety, always the number one priority, is safeguarded.”
RCN chief executive Pat Cullen has accused Health Secretary Steve Barclay of “belligerence” after he refused to discuss the issue of pay.
He has repeatedly said the Government is sticking to the recommendations of the independent pay review body, which said nurses should get a pay rise of around £1,400.
The RCN has been calling for a pay rise at 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.
Meanwhile, in Scotland RCN members are being consulted on a revised pay offer from the Scottish government.
Ms Cullen said: “Nurses are not relishing this, we are acting with a very heavy heart.
“It has been a difficult decision taken by hundreds of thousands who begin to remove their labour in a bid to be heard, recognised 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 governments.
“Our commitment to patients and safe care means that vital services are kept running.
“The scaremongering we have seen did upset some but also demonstrated the disrespect afforded to nurses for raising their voice.
“My plea to patients is to know that this strike is for you too – it’s about waiting lists, treatments that are cancelled year round and the very future of the NHS.”
Ms Cullen also said “nothing at all” had been done on Wednesday to avert the looming strike, telling BBC Newsnight: “The Government has turned their back on us”.
The RCN has also raised the issue of huge staff vacancies in the NHS, with 47,000 nurse vacancies in England alone.
Mr Barclay said nurses were “incredibly dedicated to their job” and “it is deeply regrettable some union members are going ahead with strike action”.
He added: “My number one priority is to keep patients safe – I’ve been working across government and with medics outside the public sector to ensure safe staffing levels – but I do remain concerned about the risk that strikes pose to patients.
“Nevertheless, the NHS is open and patients should continue to seek urgent medical care – and attend appointments – unless they’ve been contacted by the NHS.”
He said paying nurses more “would mean taking money away from frontline services at a time when we are tackling record waiting lists as a result of the pandemic.”
But pressure is mounting on the Government find a compromise on pay, with former Conservative Party chairman Sir Jake Berry saying it “is going to have to improve its offer”.
“We need to find a way as a Government, and the union does too, to get to that centre point, that point of agreement straight away,” he told Talk TV.
During the strike, nurses will man picket lines 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.
Unless the Government indicates a willingness to negotiate on pay-related matters, further strike dates will be announced by the RCN for January 2023 and beyond— Danny Mortimer
Several trusts have already given details of cancelled 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 Centre and South West Acute Hospital.
Some eight planned inpatient and day case procedures have also been cancelled.
The trust said there would also be reduced staffing in community nursing services including rapid response nursing, district nursing, community respiratory nursing and continence services.
In Wales, the Welsh Government said non-urgent or routine appointments are likely to be postponed.
Meanwhile, the Walton Centre NHS Foundation Trust, the only specialist hospital trust in the UK dedicated to neurology, neurosurgery, spinal and pain management services, said outpatients and some elective treatments have been postponed or cancelled, but other patients should attend as normal.
Kettering General Hospital said it will be “stepping down some planned services and those patients affected will be contacted directly by our hospital”.
On Wednesday, the head of NHS Employers said “real concerns” remain 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 talks with the RCN had been disappointing and warned that “unless the Government indicates a willingness to negotiate on pay-related matters, further strike dates will be announced by the RCN for January 2023 and beyond”.
A second RCN nurse 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.
Elsewhere, midwives and maternity support workers in Wales have voted to strike, though the ballot in England did not meet the legal turnout threshold.
