The NHS is facing a “hugely disrupted day” after tens of thousands of workers began the biggest walk out in the service’s history.
The Royal College of Nursing (RCN) said strikes will continue for “as long as it takes”, while Unite warned of a “constant cycle” of industrial action.
Union leaders implored the Government to act to prevent further strike action but ministers have insisted they cannot afford “inflation-busting pay rises”.
The NHS is expecting upheaval across England as nurses from the RCN stage walk-outs alongside GMB and Unite paramedics, call handlers and other staff at ambulance trusts.
Nurses will strike again on Tuesday, ambulance workers again on Friday and physiotherapists on Thursday.
NHS leaders described the “most disruptive week of strikes to date” – but urged people to seek urgent and emergency care if they need it and attend appointments as planned unless they have been contacted in advance.
Unions in Wales largely suspended similar action after the Welsh government came forward with an improved pay offer on Friday.
Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, told Sky News: “I think it’s going to be a hugely disrupted day across the NHS. It’s going to be incredibly challenging.
“With both nurses and ambulance staff out on strike today, and nurses again tomorrow – and we’ve got physiotherapist later in the week and some ambulance staff again on Friday – we’re planning for an incredibly disrupted week.”
She said hospital leaders will need to “step away” from day-to-day tasks, including clearing the backlog of care and implementing the Government’s new Urgent and Emergency Care plan.
“They will be focusing simply on getting through the next couple of days and that will have a knock-on effect on patients,” she said.
“This isn’t just about the here and now, it’s about the knock-on effect. What does it mean when someone has a procedure, a test, an operation, delayed for a number of days, a number of weeks? That will have an impact on them.”
While urgent and emergency care remains open, Ms Cordery said there could be an impact on cancer services in some parts of the country.
She urged the Government to negotiate with unions on 2022/23 pay.
“Well, I hope it ends by the Government coming around the table to negotiate a settlement for this year’s pay for NHS staff.
“I think that we need to recognise that NHS staff have faced soaring costs, cost of living has gone up, inflation has gone up, and the settlement from this year’s pay review body was made at a time when inflation wasn’t at the levels it’s at at the moment.
“So I think it’s really important that we focus on getting a deal for this year, as well as then thinking about what next year’s pay deal looks like.”
RCN general secretary Pat Cullen told the PA news agency: “Everyone can see the resilience of our nursing staff, these brilliant people that are standing on the picket lines today, losing another day’s pay. They are saying patients have had enough, they have had enough.
“They’re not willing to continue to see their NHS managing every day within a crisis.
Speaking at a picket line outside St Mary’s Hospital in Paddington, west London, Ms Cullen added: “Hundreds of thousands of nurses take part in this ballot and they’ve given me the strongest mandate of any nursing profession throughout the world, so they will continue to do this for as long as it takes for this Government to actually wake up and listen to their voice and listen to their voice on behalf of patients and do the decent thing.”
She added: “We are in a situation today where this Government has chosen to punish the nurses of England instead of getting round a table and talking to me about pay in the same way as they’ve done in Wales and Scotland.”
Sharon Graham, general secretary of the Unite union, said the Government should open negotiations on pay or face a “constant cycle” of walkouts.
She told PA: “This Government has not at any time in this dispute come to the table about the substantive issue on pay, and that is the real issue.
“There isn’t going to be any other way to end this dispute until they come to the table and talk about pay.
“What we need is the talks to happen with (Prime Minister) Rishi Sunak and/or (Health Secretary) Stephen Barclay on pay, we can get an offer and then we can put that off to the members.
“That’s what needs to happen. Until that happens, we are in this constant cycle of having strike action, which obviously nobody wants.
“Our members do not want to be on strike. They want to be at work serving the country.”
On 2022/23 pay, Ms Graham added: “They can’t just always sing ‘la la la la la’ and hope that the year goes by and we will forget what’s happened. This year’s pay needs to be addressed.”
Mental health minister Maria Caulfield suggested it would cost “billions of pounds” to reopen this year’s pay settlement for nurses in England because the Government would have to do the same for other public sector workers.
She told BBC Radio 4’s Today programme the “door is firmly open” to further talks with health unions regarding next year’s pay process.
Asked if there is a “possibility” negotiations could include looking at 2022/23 pay, she said: “The Secretary of State and the Prime Minister have been clear that that would be extremely difficult to do because it wouldn’t just be for nurses; you would have teachers saying, ‘Could we open this year’s pay settlement?’. You’ve got ambulance drivers, rail workers…
“There is a range of public sector workers who would also want the same request. Across the board, you’re talking about billions of pounds to pay for that and we want to put that into frontline services, as we are doing now.”
Speaking to TalkTV, Ms Caulfield said: “It is difficult then to go back and renegotiate for a whole year when that deal was done only in the latter part of last year and backdated to the previous April.”
She added: “We are very happy to talk about the forthcoming year’s pay award, which is exactly what they’ve done in Scotland and the RCN have called off the strikes as a result.”
Speaking to GB News, she added: “It is difficult for us now. If we are to give a pay (rise) to nurses, we would have to look at teachers, ambulance drivers.
“We just can’t afford inflation-busting pay rises that the unions are currently demanding.”
She said patients could be put at risk “the longer that strikes go on”.
Ms Caulfield told Sky News: “There is a risk to patients the longer that strikes go on.
“And with ambulance strikes, if someone’s having a heart attack or a stroke, that does increase someone’s risk the longer that response time is.”
Labour’s leader accused ministers of “sitting this one out” when it came to negotiating with striking nurses and ambulance workers in England over pay.
Sir Keir Starmer, speaking to broadcasters at Airbus in Filton, near Bristol, said: “The widespread strikes today are a badge of shame for the Government.
“Nobody wants to see these strikes, nobody wants to be on strike – the last thing nurses want to do is to be on strike.
“What they do want is a Government that can show leadership, get around the negotiating table and settle this dispute.
“Before Christmas, the nurses made clear that if the Government was to get in the room and talk to them about pay, they wouldn’t be on strike.
“I think many people listening to this will be absolutely flabbergasted that the Government is still sitting this one out, not showing any leadership in the middle of a cost-of-living crisis, making the situation much worse than it otherwise would be.”
Welsh Health Minister Eluned Morgan encouraged the UK Government to sit down to “talk and listen” with unions after strikes in Wales were largely suspended thanks to a new pay offer.
“I do think that there’s a lesson here for the UK Government – UK Government needs to understand that in order to get any kind of deal you need to sit down, you need to talk and you need to listen,” she told PA.
“They’re not doing any of that, and I would encourage them to do that.”
Meanwhile, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, told PA: “While strikes may disrupt emergency care and pose a risk for patient safety, we know that patient safety has long been at risk as a result of years of under-resourcing, under-funding, lack of staff, lack of beds and inadequate and insufficient community and social care.
“This is why it is absolutely critical that every effort is made to retain existing staff in the health service, working on the frontline and delivering for patients.
“As colleagues take industrial action, patients should be reassured staff in hospitals will continue to deliver care and ensure the protection and safety of patients.”
The RCN, which is staging two days of action, said nurses are set to strike at 73 trusts in England, up from 55 during January’s strike days and 44 in December.
Ambulance crews and call handlers will return to work on Tuesday but are due to walk out again on Friday.