Chris Page
BBC News Ireland correspondent

Rush-hour drivers in Belfast are sounding their horns in support as they drive past the City Hospital, where nurses have a picket line beside a busy commuter road.

Although this is the first ever UK-wide RCN walkout, members of the union here in Northern Ireland have gone on strike before.

On an equally cold December day in 2019, they took to the picket lines over similar issues.

Back then, as now, there was no devolved government due to a crisis at Stormont.

The previous strike was regarded as a catalyst for ending the political impasse after three years.

Now, local ministers are out of power again - after the Democratic Unionist Party vetoed the formation of a power-sharing coalition earlier this year over its opposition to the Brexit trade border with Great Britain.

While pay negotiations are carried out nationally, the devolved government generally pays out the salaries.

The power vacuum in Northern Ireland adds more difficulties - and many would say, causes more frustration - in this dispute.

Read more here.

Dianne Lutalo is a health visitor in London and voted in favour of strike action.

She says looking at her pay packet makes her wince and strike action was inevitable.

“For a long time, traditionally nurses just put up and shut up.

“This new generation of nurses are a lot more vocal, and we’re not going to be used as slaves.

”I feel like there’s this expectation‘you chose this job and you have to do it whether you like it or not," Diane adds.

"This is a choice to be a nurse. The more you strip us of our choices, the more you disarm us.

“I hope the government realises this isn’t a decision taken lightly. How they respond to these strikes will impact nursing forever.”

The starting salary for a nurse in England is just over £27,000 a year.

This is the bottom of pay band five of the NHS contract, known as Agenda for Change.

Staff such as healthcare assistants, porters and cleaners are on lower pay bands.

Under the contract, staff are entitled to in-the-job salary increases within their pay band.

A nurse with four years' experience would be expected to get close to £33,000 - the top end of pay band five.

Specialist nurses, such as those with extra qualifications to treat cancer and diabetes patients, can get up to £47,000.

The most senior nurse consultants can earn up to nearly £55,000.

There is a small number of nurses in senior or chief posts earning around £100,000.

Jim Reed
Health reporter, BBC News

Image source, PA Media

The ballot for this strike action was complex – rather than one single, national vote, nurses were asked to vote in each individual trust or health board.

Under trade union rules, local strikes could only go ahead if 50% of union members took part in the ballot in each individual area.

All health boards in Northern Ireland met that turnout threshold, as did all but one in Wales, the Aneurin Bevan.

In England, the vote in roughly half the 219 hospitals, mental health units and care boards was also above that level. In the others, the turnout was too low, so nurses are not legally allowed to strike.

The Royal College of Nursing (RCN) has not released the raw ballot results, but has said the “overwhelming majority” of its members voted for industrial action.

For tactical reasons, the two strikes in December are only taking place in around a quarter – 51 of 219 – trusts and boards in England.

The RCN has said it expects other areas of the country to be included in January unless a way is found to resolve the dispute.

Rebecca, a nurse striking outside St Thomas' Hospital in London, said she can't see herself doing bedside nursing for much longer.

"It’s too tiring, it’s too much, it’s just not safe for either the staff or the patients to continue the way it is now," she told BBC Breakfast earlier.

"More pay would help us in the future. We’re not asking for much, we’re not asking for a lot more than what we should already be getting.

"Over the years we’ve gradually lost more and more pay and more and more nurses. So to have that extra pay increase that we deserve, especially after Covid, will help invite more people to nursing and help bring the workforce back together."

Shaun Williams is a staff nurse in Birmingham who only started working in the profession at the beginning of this year.

Today he is on the picket line after voting yes to strike action.

“I didn’t think it would come to this. I thought the government would have seen sense. Obviously they haven’t.

”There’s a sense of resignation and anticipation about today.

“There is some perhaps confusion as well in terms of the difference between what frontline staff want to do and want managers want to do.

Shaun adds, "we’ve also got a situation where some people are inside delivering patient care who want to be outside in the cold.”

Health minister Maria Caulfield has accepted "it is difficult" living on a nurse's wage, but that a 19% pay rise is unrealistic.

Speaking earlier to BBC Breakfast, Caulfield, who has been a nurse for over 25 years, said government must balance demands with the "reality of the funding that's available".

Emily Leitch is a staff nurse on the wards at Leeds General Infirmary.

She’s been a nurse for four years.

She says she is striking today for the future of her career. She says on their ward they have 28 patients and they should have four staff on rota during the day and three at night.

She says she can be the only member of staff on at night, perhaps alongside an agency nurse.

No one goes into nursing for the money, she says.

Earlier this morning Pat Cullen, the head of the Royal College of Nursing, appeared on BBC Breakfast.

She was scathing about Health Secretary Steve Barclay claiming he was "disingenuous" when he claimed his door was always open for discussions.

Cullen said that was only the case for non-pay issues.

She added: "If this secretary of state stops digging in then we will come to the table and we will be realistic, we'll be reasonable and we'll talk to him.

20% has been lost in our nurses pay over this past decade and they are owed a decent wage."

On waiting lists and staff vacancies she said patients deserved better and so did her profession.

Nick Eardley
Chief political correspondent

The government and the Royal College of Nursing met on Monday for last-ditch talks.

It did not end well, with the RCN's leader accusing the health secretary of "belligerence" and turning his back on nurses.

There has been no contact since. At the moment, there are no further talks planned.

Labour has called this a badge of shame for the government. The opposition - with its links to the unions - has said more pay has to be on table in future talks.

But the prime minister has said a fair offer was made and suggested it was necessary to stand up to unions in pay rows.

Richard Knowles, 58, has resigned in protest from the Royal College of Nursing over the latest strike action.

A psychiatric nurse on the Isle of Wight, he has been a nurse for 40 years, but thinks the strikes will harm patients.

He still remembers an industrial dispute when he started his training in 1982.

“I was just left alone on this ward of 40 elderly, severely mentally ill patients to look after them with just one nursing assistant for company while the rest of the nurses went out and manned the picket line or blockaded the hospital’s laundry so that we couldn’t get clean sheets for our doubly incontinent patients.

“I just vowed at that time that I would never go on strike or join a union that advocated strike action.

"So earlier this year I was mightily disappointed that the RCN had decided to ballot its members to go on strike with a recommendation that they voted for strike action.

“I immediately resigned after being a member for 40 years because I just absolutely don’t believe that nurses should go on strike. It’s completely abhorrent to me. It will harm patients.”

Clinical nurse Harry Eccles, 28, is taking part in the strikes.

Based on the south coast of England, Eccles is a specialist in addiction and mental health nursing.

“I am striking because the government are refusing to listen to our very real and valid concerns," he says.

He adds he's striking because more nurses than ever are leaving the profession and he's scared for the wellbeing of his patients if things are not addressed.

"I am striking for the future of the nursing profession, and the future of the NHS."

Harry says he sees missed opportunities for care and treatment due to short staffing and nurses thinking of leaving the profession as they cannot cope anymore.

“I hope the government engage with us and take responsibility for this situation - we all know nursing pay is a political decision."

"The so-called independent pay bodies are not fit for purpose.

"We do not want to strike. We want to work and do what we're good at.”

One woman has been telling the BBC how her husband won't be getting cancer treatment today because of the strikes.

Her husband, Neil, started his treatment five weeks ago, but his appointments have been postponed this week.

"It’s worrying because he’s been very delayed in being diagnosed in the first place due to the pandemic and cancelled appointments all along," she tells BBC Radio 4's Today programme.

"We feel time is of the essence now and we really need to crack on and try to make him more comfortable."

She believes that his treatment should have gone ahead despite the strikes.

"Working in the NHS, I’m in total, utter support for them. I have every sympathy, they work very hard for very little.

"But there are certain treatments, like my husband’s treatment - I don’t see that should be delayed any longer."

Sharon Barbour
BBC Look North

It was 07:30 this morning, and below freezing when nurses began to gather at the picket line in Newcastle - in front of one of the country's biggest and busiest hospitals: The Royal Victoria Infirmary.

Across the city they were gathering outside the Freeman Hospital, known around the world for its work in transplantation.

With both hospitals under extreme pressure, the decision to strike must have be a difficult one, but the Royal College of Nurses argues that they had no choice - they had run out of options.

But they must have been warmed by the support, with a constant sound of horns honking by many driving by - and many others as they entered the hospital grounds.

The Royal College of Nursing (RCN) says staff will continue to provide "life-preserving" and urgent care today.

But what counts as urgent?

Stephen Powis, medical director for NHS England, says that local hospitals have been speaking with RCN representatives, and that has "often occurred on patient by patient basis".

"That is where those decisions regarding degree of urgency will be taken," he tells BBC's Today programme.

"Clinicians do that all the time. They know which patients need to be treated quickest so those are the sort of conversations that will be going on very locally."

The majority of hospitals will be working normally, as well as pharmacies and ambulances services, Powis adds.

"The message is: if you haven’t had a message, if you haven't heard that your operation or patient appointment is going to be rescheduled, then please do turn up at hospital as normal."

People on the picket line at St Thomas' in London have been explaining why they have gone on strike.

One man told the BBC that it was difficult to pay bills and expensive travel costs made matters worse.

He said the cost of living was also affecting the numbers of international nurses and staff were leaving.

He added: "They are not that happy being here as they can't sustain their living costs."

Around half of all public-sector workers, including NHS staff, police officers and teachers, have their salaries negotiated by independent pay-review bodies.

These pay bodies - made up of individuals not directly attached to the relevant department but with experience in economics and employee relations - work with government departments, external, unions and other groups to come up with a recommendation on how pay should change each year.

This recommendation is non-binding - meaning ultimately the government decides.

Impact on patient care still not fully clearpublished at 08:10 Greenwich Mean Time 15 December 2022

08:10 GMT 15 December 2022

Hugh Pym
BBC News Health Editor

Image source, PA Media

The strike action is significant because its never happened before on this scale.

The Royal College of Nursing (RCN) called strikes in Northern Ireland in 2019 and early 2020 but never before in other parts of the UK.

What we may not find out today is precisely what patient care is disrupted by the walkouts.

Local negotiations between the RCN and employers were taking place on the detail of what would be protected, including which types of cancer surgery.

One hospital boss told me that A&E would function normally but might see longer waits.

When junior doctors were on strike in 2015 and 2016, consultants were drafted in to help cover their absences. It wont be so easy to organise equivalent levels of cover for nurses.

Health minister Maria Caulfield says she empathises with nurses but she also empathises with the British people when it comes to funding big pay increases.

She says the 19% pay increase being demanded by the nurses' union was "an unrealistic ask."

Speaking on BBC Breakfast she adds: "We have to have a balance for everyone."

More from Pat Cullen, the head of the Royal College of Nursing.

She points out that nurses are asking for the 20% that has been eroded from pay over the last decade to be "put back in".

"It's pay recovery, not asking for additional money," she tells BBC Breakfast.

Cullen believes there is room for negotiation and a resolution if the government is willing to talk about pay.

"But we can’t get there because every room I go into with the secretary of state he tells me we can talk about anything but pay.

"That’s going to resolve nothing."

She is asked about Health Secretary Steve Barclay saying his door is always open.

"His door is open to talk about non-pay issues and I find that really disingenuous. I made that very clear when I came out of his room the other night."