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| NHS staff stage four-hour strike | NHS staff stage four-hour strike |
| (35 minutes later) | |
| NHS workers, including nurses, midwives and ambulance staff, have staged a four-hour strike in England as part of a pay dispute. | NHS workers, including nurses, midwives and ambulance staff, have staged a four-hour strike in England as part of a pay dispute. |
| They were protesting about the decision not to implement a 1% rise for all staff recommended by a pay review body. | They were protesting about the decision not to implement a 1% rise for all staff recommended by a pay review body. |
| Members of nine unions walked out at 07:00 GMT in England and at 08:00 GMT in Northern Ireland. | Members of nine unions walked out at 07:00 GMT in England and at 08:00 GMT in Northern Ireland. |
| A Department of Health spokesman said it could not afford the rise without risking frontline jobs. | A Department of Health spokesman said it could not afford the rise without risking frontline jobs. |
| Non-urgent care | Non-urgent care |
| Unions said the industrial action would not have affected urgent care, although pre-booked outpatient appointments and non-emergency surgery and operations may have been delayed. | Unions said the industrial action would not have affected urgent care, although pre-booked outpatient appointments and non-emergency surgery and operations may have been delayed. |
| Out of some 450,000 staff who were due to be at work today, NHS England estimates around 12,500 were absent - meaning about one in 35 staff took part in the strike. | Out of some 450,000 staff who were due to be at work today, NHS England estimates around 12,500 were absent - meaning about one in 35 staff took part in the strike. |
| Nick Triggle, health correspondent, BBC News | Nick Triggle, health correspondent, BBC News |
| The words strike and NHS are enough to send a shudder down the spine of any patient. | The words strike and NHS are enough to send a shudder down the spine of any patient. |
| But many of the people using the health service in England or Northern Ireland on Monday morning may not have noticed a huge difference. | But many of the people using the health service in England or Northern Ireland on Monday morning may not have noticed a huge difference. |
| Why? Walkouts in the NHS are quite different from other sectors. When tube drivers, council staff or teachers strike the aim is to cause disruption. It is the first rule of industrial action: make your contribution count. | Why? Walkouts in the NHS are quite different from other sectors. When tube drivers, council staff or teachers strike the aim is to cause disruption. It is the first rule of industrial action: make your contribution count. |
| However, the terms of engagement are somewhat different when NHS workers take part. While unions members want to make a point, they commit to not harming urgent and emergency services. | However, the terms of engagement are somewhat different when NHS workers take part. While unions members want to make a point, they commit to not harming urgent and emergency services. |
| Unison said there had been a picket line at every acute hospital and ambulance station in England, as well as action at many community health organisations. | Unison said there had been a picket line at every acute hospital and ambulance station in England, as well as action at many community health organisations. |
| And some staff who turned up to work would have had exemptions from strike action to ensure emergency care was provided. | And some staff who turned up to work would have had exemptions from strike action to ensure emergency care was provided. |
| Independent review | Independent review |
| Dave Prentis, general secretary of Unison, told the BBC: "Really it is to get over a message to the public about what is happening and to get the message to the government about the importance of our members providing our health services. | Dave Prentis, general secretary of Unison, told the BBC: "Really it is to get over a message to the public about what is happening and to get the message to the government about the importance of our members providing our health services. |
| "An independent pay review body that looks at public service workers recommended a 1% increase in line with the government's own pay policy. | "An independent pay review body that looks at public service workers recommended a 1% increase in line with the government's own pay policy. |
| "But the secretary of state reneged on it. | "But the secretary of state reneged on it. |
| "The effects on morale has been absolutely dreadful. The feel they are not wanted, they have had no pay increase for four years and now an independent body has been ignored." | "The effects on morale has been absolutely dreadful. The feel they are not wanted, they have had no pay increase for four years and now an independent body has been ignored." |
| The strike will be followed by up to six days of work-to-rule. Measures will include members claiming pay for extra hours or refusing to work overtime. And staff will take all breaks to which they are entitled. | The strike will be followed by up to six days of work-to-rule. Measures will include members claiming pay for extra hours or refusing to work overtime. And staff will take all breaks to which they are entitled. |
| The decision follows a four-hour strike on 13 October, the first in the NHS over pay for 30 years. | The decision follows a four-hour strike on 13 October, the first in the NHS over pay for 30 years. |
| Thousands of healthcare workers took part but disruption was minimised after the seven unions involved agreed staff would ensure emergency and urgent care were covered. | Thousands of healthcare workers took part but disruption was minimised after the seven unions involved agreed staff would ensure emergency and urgent care were covered. |
| Case study: Anna Kent, 33, midwife | Case study: Anna Kent, 33, midwife |
| Anna picketed outside City Hospital in Nottingham. | Anna picketed outside City Hospital in Nottingham. |
| "I was quite nervous about striking as it is not something that comes naturally to me - it was a last resort. But I am absolutely humbled by the amount of public support we have had. | "I was quite nervous about striking as it is not something that comes naturally to me - it was a last resort. But I am absolutely humbled by the amount of public support we have had. |
| "I just don't know what else we can do. A lot of my colleagues are getting paid less this year than last year even though they are more experienced. | "I just don't know what else we can do. A lot of my colleagues are getting paid less this year than last year even though they are more experienced. |
| "For me, it's not actually about the money. It is the inequality between people in power and people on the ground. I feel undervalued. I love my job but it is not sustainable to work 13 hours with no break and get a pay cut. This is about feeling valued." | "For me, it's not actually about the money. It is the inequality between people in power and people on the ground. I feel undervalued. I love my job but it is not sustainable to work 13 hours with no break and get a pay cut. This is about feeling valued." |
| Two further unions backed the second round of strikes. | Two further unions backed the second round of strikes. |
| The nine unions involved represent more than 400,000 staff and include: | The nine unions involved represent more than 400,000 staff and include: |
| Members of the British Dietetic Association and Hospital Consultants and Specialists Association are considering taking part in action short of strike action from 25-30 November. | Members of the British Dietetic Association and Hospital Consultants and Specialists Association are considering taking part in action short of strike action from 25-30 November. |
| Doctors and staff with the Royal College of Nursing were not part of this strike action. | Doctors and staff with the Royal College of Nursing were not part of this strike action. |
| Pay award | Pay award |
| Ministers in England have awarded NHS staff a 1% increase, but only for those without automatic progression-in-the-job rises. | Ministers in England have awarded NHS staff a 1% increase, but only for those without automatic progression-in-the-job rises. |
| Automatic pay rises are given to about half of all staff. They are designed to reward professional development and are worth 3% a year on average. | Automatic pay rises are given to about half of all staff. They are designed to reward professional development and are worth 3% a year on average. |
| An independent pay review board had said the 1% increase should be across the board. | An independent pay review board had said the 1% increase should be across the board. |
| It was implemented in full in Scotland. Northern Ireland has yet to make a decision on pay. Trade unions in Wales accepted a two-year pay deal set out by the government this month. | It was implemented in full in Scotland. Northern Ireland has yet to make a decision on pay. Trade unions in Wales accepted a two-year pay deal set out by the government this month. |
| A Department of Health spokesman said: "NHS staff are our greatest asset and we want to make the current pay system fairer - which is why we have put forward proposals that would guarantee all staff would get at least a 1% pay rise this year and next, but these have been rejected by the unions. | A Department of Health spokesman said: "NHS staff are our greatest asset and we want to make the current pay system fairer - which is why we have put forward proposals that would guarantee all staff would get at least a 1% pay rise this year and next, but these have been rejected by the unions. |
| "We have taken tough decisions to increase the NHS budget, but we can't afford a consolidated pay rise in addition to increments without risking 10,000 frontline jobs." | "We have taken tough decisions to increase the NHS budget, but we can't afford a consolidated pay rise in addition to increments without risking 10,000 frontline jobs." |
| A spokesperson for the Royal College of Midwives, said: 'We are seeing overwhelming support from our members across England for this industrial action and thousands of them are right now out on the picket lines. | A spokesperson for the Royal College of Midwives, said: 'We are seeing overwhelming support from our members across England for this industrial action and thousands of them are right now out on the picket lines. |
| "They know they have the support of the public and at the end of the day they are simply asking for a very modest 1% pay award. | "They know they have the support of the public and at the end of the day they are simply asking for a very modest 1% pay award. |
| "Momentum is building and those denying NHS workers a pay award need to now that midwives and other NHS staff are determined to continue." | "Momentum is building and those denying NHS workers a pay award need to now that midwives and other NHS staff are determined to continue." |