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Nurses' strike: A&E, cancer and intensive care units hit for first time Nurses' strike: Chemotherapy and intensive care units hit for first time
(32 minutes later)
RCN members walked out in January and February tooRCN members walked out in January and February too
Nurses in England are taking part in a fresh strike in what they describe as their biggest walkout so far.Nurses in England are taking part in a fresh strike in what they describe as their biggest walkout so far.
The Royal College of Nursing strike affects half of England's NHS trusts and will last until midnight on Monday.The Royal College of Nursing strike affects half of England's NHS trusts and will last until midnight on Monday.
It is the first time some nurses who work in A&E, intensive care and cancer services have joined the picket lines - the government said the action would be very disruptive. It is the first time areas such intensive care, chemotherapy and dialysis have been hit - ministers said the strike would be very disruptive.
RCN leader Pat Cullen said exemptions would be made for critical care. The RCN said exemptions are being made where hospitals were struggling to maintain life-preserving care.
This would apply to staff working in emergency departments, intensive care units, paediatric intensive care, neonatal units, and other acute and critical services. "Our nursing staff will be back in this morning, whilst on strike, continuing to care for their patients," RCN leader Pat Cullen told BBC Breakfast.
"Our nursing staff will be back in this morning, whilst on strike, continuing to care for their patients," she told BBC Breakfast. All hospitals have been guaranteed a minimum level of cover for intensive care and trauma.
This latest 28-hour strike comes ahead of a crucial meeting between a number of health unions, ministers and NHS bosses on Tuesday, when the government's pay offer of 5% will be discussed. A quarter of trusts involved in the strike have been given extra exemptions for services such as transplant and cardiac care - to allow them to call some striking nurses in because they have not been able to find other staff to fill the rotas.
This is to ensure a minimal level of cover - not normal staffing - as the RCN has to abide by trade union rules to ensure life-and-limb care can be provided during a walkout.
In previous walkouts services such as intensive care, chemotherapy and dialysis have been completely excluded from strike action
This latest 28-hour action comes ahead of a crucial meeting between a number of health unions, ministers and NHS bosses on Tuesday, when the government's pay offer of 5% will be discussed.
Ms Cullen denied suggestions there had been talks over the weekend with Health Secretary Steve Barclay or his department, and said it was "unfair to keep on saying that it is nursing staff who have created the seven million long waiting lists".Ms Cullen denied suggestions there had been talks over the weekend with Health Secretary Steve Barclay or his department, and said it was "unfair to keep on saying that it is nursing staff who have created the seven million long waiting lists".
"They [nurses] are selfless people, and they are standing up for their patients in an NHS that is totally broken," she said, adding that her union's members had taken six days' strike action in the past six months."They [nurses] are selfless people, and they are standing up for their patients in an NHS that is totally broken," she said, adding that her union's members had taken six days' strike action in the past six months.
The RCN previously rejected the government's pay offer and announced this new strike - their third this year - in a dispute over pay, recruitment and retention in the NHS.The RCN previously rejected the government's pay offer and announced this new strike - their third this year - in a dispute over pay, recruitment and retention in the NHS.
The health secretary described the RCN's decision to press ahead with its strike as "premature" and disrespectful to other unions taking part in Tuesday's meeting.The health secretary described the RCN's decision to press ahead with its strike as "premature" and disrespectful to other unions taking part in Tuesday's meeting.
Members of the Unite union at some NHS trusts and ambulance services in England are also taking part in strike action on Monday and Tuesday, after also voting to reject the latest pay offer.Members of the Unite union at some NHS trusts and ambulance services in England are also taking part in strike action on Monday and Tuesday, after also voting to reject the latest pay offer.
When are nurses and ambulance workers striking?When are nurses and ambulance workers striking?
Does the average nurse earn £34,000 a year?Does the average nurse earn £34,000 a year?
NHS England said the strike was the largest industrial action so far and warned patients to expect "disruptions and delays to services over the strike period".NHS England said the strike was the largest industrial action so far and warned patients to expect "disruptions and delays to services over the strike period".
It warned that staffing levels for some areas would be "exceptionally low, lower than on previous strike days" and the number of rescheduled appointments as a result of strike action was due to hit half a million next week.It warned that staffing levels for some areas would be "exceptionally low, lower than on previous strike days" and the number of rescheduled appointments as a result of strike action was due to hit half a million next week.
However, it said discussions over the weekend had secured "a number of national agreements" to ensure staff could provide care "to protect life and limb services".
These will cover intensive care units, including for neonatal and paediatric care, as well as major trauma and resuscitation units.
A spokesperson for the RCN, which represents two-thirds of UK nurses, told the BBC that a "national agreement was reached on raising staffing levels in some key areas to preserve life and limb".
This means a small number of RCN members will be asked to work to provide a minimum standard of cover and meet the legal requirement on trade unions for life-and-limb cover to be provided.
The RCN also added that this strike would be "more intense" than previous ones.
Ministers and NHS chiefs had previously warned patient safety would be put at risk.Ministers and NHS chiefs had previously warned patient safety would be put at risk.
On Sunday, Health Secretary Mr Barclay said the strikes would put "more pressure on the NHS and will be incredibly disruptive for patients".On Sunday, Health Secretary Mr Barclay said the strikes would put "more pressure on the NHS and will be incredibly disruptive for patients".
Doctor Jacob Mushlin, an accident and emergency consultant at Bradford Royal Infirmary, said the absence of nurses would create delays and lower the standard of treatment at his hospital and across the country.Doctor Jacob Mushlin, an accident and emergency consultant at Bradford Royal Infirmary, said the absence of nurses would create delays and lower the standard of treatment at his hospital and across the country.
"The nurses provide a vital service and one that can't be replaced by other members of staff," he said."The nurses provide a vital service and one that can't be replaced by other members of staff," he said.
"We're going to find that we're going to be unable to provide anything other than life or limb preserving care.""We're going to find that we're going to be unable to provide anything other than life or limb preserving care."
Dr Mushlin also said he had seen a rising number of cases of "dreadful" aggression and violence towards hospital staff increasing because of long waiting times in the NHS, which was severely impacting morale. Dr Mushlin also said he had seen a rising number of cases of "dreadful" aggression and violence towards hospital staff increasing because of long waiting times in the NHS, which was severely impacting morale. 
The walkout by RCN members started at 20:00 BST on Sunday and will end at midnight on Monday.The walkout by RCN members started at 20:00 BST on Sunday and will end at midnight on Monday.
It was originally supposed to continue into Tuesday but a High Court judge ruled it would be unlawful because a six-month mandate for action had expired.It was originally supposed to continue into Tuesday but a High Court judge ruled it would be unlawful because a six-month mandate for action had expired.
'I'm dismayed it's come to this - cancer nurse'
Preya Assi, a cancer nurse at University College London Hospital
Cancer nurse Preya Assi has not taken strike action so far because her team at University College London Hospital has been exempted during previous walkouts.
It was deemed a critical service by the RCN so members were asked to stay at work while colleagues from other parts of the NHS took to the picket line.
But this time Ms Assi will be involved.
She said: "I feel dismayed. I and all my colleagues had been hoping it would not come to this."
She said the pay offer made by the government was "untenable" because of inflation, which had left nurses struggling to pay their bills and look after their families.
"This is not an action we take lightly, but it feels like there is no other way to get them to take notice of our plight."
The strike was called earlier this month after RCN members rejected a government offer to nurses in England of a 5% pay rise for 2023-24 and a one-off payment of at least £1,655 to top up last year's salary, depending on staff grade.The strike was called earlier this month after RCN members rejected a government offer to nurses in England of a 5% pay rise for 2023-24 and a one-off payment of at least £1,655 to top up last year's salary, depending on staff grade.
RCN leadership had recommended members accept the offer but it was rejected by 54% to 46%.RCN leadership had recommended members accept the offer but it was rejected by 54% to 46%.
During nursing strikes earlier this year, in January and February, wider national exemptions were in place, meaning nursing cover was maintained in other critical areas.During nursing strikes earlier this year, in January and February, wider national exemptions were in place, meaning nursing cover was maintained in other critical areas.
On Monday, Unite members at the Yorkshire ambulance service and Guy's and St Thomas' NHS Trust in central London will walk out, and stage a protest march in central London.On Monday, Unite members at the Yorkshire ambulance service and Guy's and St Thomas' NHS Trust in central London will walk out, and stage a protest march in central London.
Then on Tuesday, Unite members at South Central, South East Coast and West Midlands ambulance trusts alongside workers at The Christie NHS Foundation Trust and Pathology Partnership, East Lancashire Hospitals NHS Trust and Sandwell and West Birmingham NHS Trust will all take part in industrial action.Then on Tuesday, Unite members at South Central, South East Coast and West Midlands ambulance trusts alongside workers at The Christie NHS Foundation Trust and Pathology Partnership, East Lancashire Hospitals NHS Trust and Sandwell and West Birmingham NHS Trust will all take part in industrial action.
Unite national lead Onay Kasab told BBC Radio 4's Today programme that the union would continue industrial action if the health secretary attempted to impose a pay offer.Unite national lead Onay Kasab told BBC Radio 4's Today programme that the union would continue industrial action if the health secretary attempted to impose a pay offer.
"We will ballot, and where we have current mandates - some of them lasting up to September - then we will continue taking action, and we will escalate," he said."We will ballot, and where we have current mandates - some of them lasting up to September - then we will continue taking action, and we will escalate," he said.
He said the ongoing disruption was "a national crisis" and urged Prime Minister Rishi Sunak to get involved to resolve it.He said the ongoing disruption was "a national crisis" and urged Prime Minister Rishi Sunak to get involved to resolve it.
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