Support for nurses remains strong amid warnings that strikes could go on for a further six months, Rhys Williams reports.
The Royal College of Nursing (RCN) warned that strikes could go on for six months unless an agreement can be reached with the government.
But, speaking on the picket line at the Royal Victoria Infirmary in Newcastle, RCN general secretary Pat Cullen said industrial action can be brought to an end if the government moves on its current offer.
The government maintains that the pay rise demanded is unaffordable and said it will discuss other concerns, such as staffing and working conditions, but not pay.
Ms Cullen said she is "truly sorry" to every patient that has their care affected during the walk outs, as she urged the Rishi Sunak to "do the decent thing" and get round the table with them.
Prime Minister Sunak has not met any of the striking unions, said Downing Street, saying it was a matter for relevant secretaries of state.
In a last-minute intervention, Matthew Taylor, chief executive of the NHS Confederation, has written to Mr Sunak requesting an end to the deadlock with unions, warning NHS leaders cannot keep patients safe during strikes and there is “deep worry”.
Thousands of nurses up and down the country joined the picket lines on Tuesday, with around a quarter of hospitals and community teams in England taking part, alongside all trusts in Northern Ireland and all but one health board in Wales.
On the same day, at least three ambulance services declared critical incidents following "huge" and "sustained pressure" due to the volume of 999 calls and hospital handover delays.
It came a day before ambulance workers including paramedics, control room workers and technicians walk out on Wednesday in England and Wales, with health chiefs warning this represents the most serious threat to date.
During Tuesday’s strike, the NHS is 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.
What pay increase are striking nurses asking for?
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 (PRB) 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.
Speaking by a picket line in Newcastle, RCN general secretary's Ms Cullen said: “I want to say to the prime minister this morning, please step in now and do the decent thing on behalf of every patient and member of the public of this country".
She earlier 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," she said. "Their determination stems as much from worries over patient safety and the future of the NHS than personal hardship.
“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.”
Do Britons support the strikes?
Fresh YouGov data, polling more than 1,700 adults, found:
Two thirds (66%) of Britons support recent strike action by nurses, with similar support for ambulance staff (63%) and firefighters (58%)
The public is more divided on other industries such as rail workers (43%), postal workers (49%), and border force (40%)
Recent strike action by nurses is the only industry tested with higher support than opposition among 2019 Conservative voters (49% vs 47%)
Brits are also divided on who is to blame for the strikes, apart from with nurses (56%) and ambulance staff (54%) where the majority say it is the government’s fault
Government 'won't discuss pay' - a matter for the independent pay review body
Health Minister Will Quince told ITV News the government is "not digging in" over the dispute and denied it has lost control of the issue.
"What we do have control over is the independent pay review body recommendation - and the government has the choice whether they accept or reject that recommendation," he said.
"In this case the government accepted that in full."
When asked if the government will look at that recommendation again, Mr Quince said "no" as he said the body has been relied upon for "a number of years".
"Our position has been clear - that we're very happy to have conversations with the RCN," he added. "They say this isn't just about pay. Well, we're very happy to have conversations about the issues that are not pay related."
The NHS Pay Review Body is an advisory non-departmental public body but is sponsored by the Department of Health. It takes evidence from government and unions before recommending a pay increase.
However, one union, GMB - which represents tens of thousands of health-workers including ambulance workers - is pulling out of the process, ITV News revealed last week.
The GMB says its credibility is under "greater strain than at any point in its 50-year process", adding: "Our members want to participate in a meaningful process, but the trust has been lost."
A Department of Health spokesperson said the independent pay review bodies (PRB) are "made up of independent, industry experts" who "carefully consider evidence submitted to them from a range of stakeholders, including government and trade unions".
Health Secretary Steve Barclay earlier 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.”
Final crunch talks before ambulance strikes on Wednesday
Mr Barclay is meeting unions representing striking ambulance drivers in eleventh-hour talks on Tuesday, although the discussions are unlikely to avert the action.
He said he wanted 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.
Rachel Harrison, from the GMB trade union, said they have been working round the clock to put arrangements in place to protect patients' safety, and so is "not sure why" the health secretary wanted to meet them if it's not to discuss a pay offer.
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”.
Ms Harrison earlier hit out at the conditions faced by healthcare workers in recent years, telling the government: “We’re not making a demand, we’re saying make us an offer.”
Appearing at the Commons health committee, she told MPs: “Pay is the crucial thing and that is the legal dispute, because we’ve got hospitals setting up food banks.
“How can our pandemic heroes be having to access food banks, not being able to put fuel in their cars?"
PM's response 'a slap in the face for all healthcare staff, the public and patients'
Prime Minister 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," he added.
“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.”
Speaking from a picket line outside St Thomas’ Hospital in London, nurse Mamta Pun, 25, said Mr Sunak’s stance on the pay dispute was “a slap in the face for all healthcare staff, the general public and patients”.
Ms Pun said she and her colleagues finish shifts “anxious, scared, terrified” about the amount of work they are expected to do because nurses are leaving their jobs “faster than I can run”.
The intensive care unit (ICU) worker said that due to staff shortages, nurses are being asked to double up on Level 3 patients – “the sickest of the sick” – rather than being assigned just one, as they would normally.
“We’re losing nurses faster than I can run. I’ve had so many shifts recently where we’ve had to double patients at Level 3. (I feel) anxious, scared, terrified. I have cried so many times.”
Outside Aintree University Hospital, a nurse called Nicola, who did not want to give her surname, said she joined the picket line because working conditions have “worsened significantly”.
She said: “We have been forced to do this, we have no other option.
“I didn’t sleep last night making the decision to do this and if I get delegated to go back in I will go back immediately because patient safety is important to me.
“We can’t continue. There are so many vacancies and working conditions are so bad. We’re not getting new nurses and if we don’t get new nurses, we don’t get more people, we’re not going to improve".
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How will the nurse and ambulance strikes affect patients?
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.
A senior officer has admitted there will be “nerves” among military personnel on Wednesday as they are drafted in to help as ambulance drivers during NHS strikes.
Lieutenant Colonel James Shaw, Brigade Major of the Household Division at Wellington Barracks in London, said troops were “hugely confident” and had “a lot of initiative” but added members of the armed forces will want to do “the best (they) can possibly do”.
Some of the 600 soldiers, sailors and aviators who are to be drafted in will never have driven an ambulance before, he said.
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”, adding: “There are likely to be significant delays in response for patients who have less serious illness or injury”.
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...
“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.