Thousands of nurses will stage a walkout in a row over pay as Britain braces for a series of strikes in the run-up to Christmas.
The strike will add to a crisis for the UK's state-run National Health Service, which is already struggling with long waiting times, staff shortages and financial black holes.
A record 7.1 million people are waiting for treatment, with long delays for tests, routine and emergency care.
On Friday, the Royal College of Nursing (RCN) said its members would stage their first national strike on December 15 and the second on December 20.
The strikes, the first in the British nursing union's 106-year history, will take place in England, Wales and Northern Ireland.
RCN general secretary Pat Cullen said: “Nursing staff have had enough of being taken for granted, enough of low pay and unsafe staffing levels, enough of not being able to give our patients the care they deserve.”
Rachel Power, chief executive of The Patients Association, said patients are already experiencing long waits for planned elective care because of the pandemic backlog.
"We respect the right of any employee to consider industrial action," she told Radio 4's Today show on Friday. "And we have been calling on the government for a long time for a fully funded workforce strategy that looks at both recruitment and retention. That’s really needed now."
Britain has been blighted by strikes in recent months.
There were picket lines outside schools, universities and Royal Mail centres on Thursday as tens of thousands of workers went on strike in worsening disputes over pay, jobs and conditions.
About 70,000 members of the University and College Union were due to strike on Thursday and Friday in a dispute over pay, pensions and contracts, with another protest action planned for next Wednesday.
It will be the biggest strike of its kind, affecting about 2.5 million students, with the union warning of escalated action next year if the row is not resolved.
The walkout by nurses next month heaps further misery on the much-loved but creaking institution, at a time when winter illnesses are beginning to bite and as the country faces a prolonged recession.
The move comes as members of the rail, maritime and transport workers union announced a series of 48-hour strikes next month and in January by its members at Network Rail and 14 train companies — and an overtime ban over Christmas and New Year that is expected to cause travel chaos over the festive period.
The RCN has rejected the “final” offer and is pressing ahead with a series of strikes in the coming weeks, including on Black Friday and on December 24, Christmas Eve.
The nursing group said it was calling strikes after the UK government turned down its offer of formal, detailed negotiations as an alternative to the protest action.
Richard Sullivan, a cancer care specialist, said about 14,000 prostate cancer cases were “missing” owing to a lack of diagnosis, with about one in 18 waiting more than a year.
“You shut down your health system … you are going to lead to a massive number of people with stage shifts, where their cancers become more advanced,” he said.
Difficulty in replacing departing staff has deepened the crisis.
Record inflation has led to gloomy forecasts of a prolonged recession and cuts to public spending, potentially extending the crisis.
Mr Chukwudubem Ifeajuna, a nurse in the south of England, has seen members of his team leave to work in supermarkets, where there is less stress and better pay, while he has had to cut back on spending.
“I have a few staff who are using food banks at the moment. I have had to cut down on a lot of things with the kids which I can't afford to provide for them because of the high cost of living. So, it is really, really tough, for everyone, not just myself,” he told Reuters.
“We are striking because we deserve to be paid better. We haven't had decent pay for over a decade now.”
Mr Sullivan, professor of cancer policy and global health at King's College London, said the NHS was “burning hot for years” even before Covid-19 placed extra burdens on its services.
“Once you start overheating the motor and constantly burning it … you are wearing it out,” he said.
“I think we are in for a really rough ride over the next few years.”
The RCN this month announced that nursing staff at the majority of NHS employers across the UK had voted to take strike action over pay and patient safety.
It said that despite a pay rise of about £1,400 ($1,700) awarded in the summer, experienced nurses were now worse off by 20 per cent in real terms as a result of successive below-inflation awards since 2010.
Until the early 1990s, the UK spent about 5 per cent of its gross domestic product on the NHS, which is funded through a tax on earnings of employees, employers and the self-employed.
Buoyed by a strong economy during the late 1990s and early 2000s, the Labour government at the time almost doubled spending to 9.9 per cent.
But it remained around that level after the 2008 financial crash as an incoming Tory-led government battled to rein in public debt, despite an ageing population.
Compared with its nearest European neighbours, the UK was seventh highest in terms of healthcare spending as a proportion of GDP in 2019. Germany and France both spent about 11 per cent.
The UK figure shot up to 12 per cent during the pandemic, when NHS workers were hailed as heroes, with weekly doorstep applause, but is now falling again.
As well as denting public finances, inflation has caused a wider cost-of-living crisis that has led to large-scale protest action across many sectors.
The RCN said the economic argument for paying nursing staff fairly was clear when billions of pounds was being spent on agency staff to plug workforce gaps.
It added that in the past year, 25,000 nursing staff across the UK left the Nursing and Midwifery Council register, with poor pay contributing to staff shortages across the UK, a dearth it said was affecting patient safety.
There were 47,000 unfilled registered nurse posts in England’s NHS alone, the RCN said.
The college maintains that surveys show huge public support for nurses receiving a bigger pay rise, as well as the right to take protest action.
Other health unions are balloting workers over the prospect of protest action, while ambulance staff in Scotland are due to walk out on Monday.
A ballot among hundreds of thousands of Unison members closes on Friday and among Unite’s NHS members next week.
Midwives and physiotherapists are also voting on strikes, while a ballot of junior doctors opens in the new year.
Health unions have been warning for months that workers are quitting in huge numbers over pay and low morale, leading to staff shortages in hospitals and other parts of the NHS.
Health and Social Care Secretary Steve Barclay said he was “hugely grateful for the hard work and dedication of nurses” but regretted the decision to take the protest action.
But, he said, the RCN's current demands were “not affordable” and would cost the government an additional £10 billion.
“Our priority is keeping patients safe,” he said. “The NHS has tried-and-tested plans in place to minimise disruption and ensure emergency services continue to operate.”