Cancer nurses will be on strike for the first time on Monday as a union head suggested that industrial action could last for years.
Members of the Royal College of Nursing (RCN) in more than 100 NHS trusts are carrying out a 28-hour strike that ends at midnight on Tuesday.
Health leaders warned that the third strike in six months by the union will have a “very significant impact” on patients.
But in an interview on Sunday, Pat Cullen, RCN general secretary, said strikes could go on for years unless the Government changes its approach.
The union agreed at the last minute to provide more nurses for emergency departments and intensive care wards.
However, no exemptions have been made for cancer services, meaning staff from those wards will walk out for the first time in the union’s history.
The escalated action differs from the RCN's previous strikes, when cancer care was protected.
Steve Barclay, the Health Secretary, said the union’s strike was “premature” and “disrespectful” to other NHS unions.
The move comes as Ms Cullen faces significant pressure to negotiate a new deal for her members after they rejected a Government pay offer that she recommended they accept.
NHS sources have suggested that the RCN leadership came out of last week’s High Court battle “wounded” after a judge ruled that the union had been "incompetent in looking at its calendar".
One senior nurse and RCN member told The Telegraph that nurses were “angry” at the union over the ordeal, as it could have put their professional registration at risk.
Asked if there was a risk that strikes could go on for years, Ms Cullen said: “If we have the same approach to pay negotiations next year, do we just grind the cycle again?
“Well, there is a strong possibility, because it appears that for our nursing staff that is the only way that they can get their voice heard.”
Hours before the strike began on Sunday night, NHS England announced that a number of national exemptions had been agreed with the RCN to ensure staff could protect life-and-limb services - including in neonatal intensive care units (ICU), paediatric ICUs, general ICUs and emergency departments.
Dame Ruth May, chief nursing officer for England, said: “We are grateful to the RCN for agreeing a process of safety-critical mitigations and we continue to support all nurses, those who work and those who take industrial action.
“These mitigations do not represent a return to standard staffing. The industrial action will still have a very significant impact on services during the strike period and patients can expect to see longer waits for care.”
The last-minute exemptions will be seen by many as an attempt to retain public support for the strikes.
On Friday, Great Ormond Street Hospital issued a plea for more nurses during the action to keep sick children safe. The RCN later agreed to provide additional staff.
Last week, Oxford University Hospitals Foundation Trust said staff had received “aggressive verbal abuse” when cancelling patient appointments due to the action.
Hospital leaders said the national agreements were a “positive step”.
But Saffron Cordery, deputy chief executive at NHS Providers, added: “The situation remains extremely difficult, with a lasting disruptive impact that’s bad for patients, staff and the NHS.”
Prof Pat Price, oncologist and co-founder of the CatchUpWithCancer campaign, said: “Whatever the rights or wrongs of the industrial action this will clearly have an impact on cancer patients, which is desperately sad for everyone.”
The Teenage Cancer Trust said patients should be prepared to have appointments cancelled as a result of the action.
It comes as more than two-fifths of patients are waiting more than 62 days for their first treatment from urgent GP referral, NHS figures show.
Members of the NHS Staff Council, which represents 14 health unions, will meet on Tuesday to confirm the results of their members’ ballots on the Government’s pay deal.
The deal includes a 5 per cent pay increase for 2023-24 plus a one-off payment of at least £1,655 for 2022-23.
The Staff Council, which works on an electoral college style of voting system, is expected to agree to accept the offer after the GMB union - which carries significant weight in the council - backed it.
It means that nurses will receive the pay deal, even though they voted to reject it.
Mr Barclay told broadcasters on Sunday: “I think this strike is premature and is disrespectful to those trade unions that will be meeting on Tuesday.”
He also emphasised that Ms Cullen had “recommended this deal to her own members”.
Health sources have also suggested that Ms Cullen might find it harder to organise future strike action if RCN members get the one-off pay packet with the backdated rise while inflation falls at the same time.
The RCN has said it will re-ballot nurses for a further six months of action.
Ahead of the strike, Ms Cullen said the Government’s current offer was not enough and suggested nurses should be given a separate pay rise.
The RCN originally demanded a 19 per cent increase.
“Only negotiations can resolve this and I urge ministers to reopen formal discussions with the college over pay specifically,” she said.
“Nursing staff are looking for a fair settlement that shows the Government values and understands their profession.
“We appear a long way from that currently but I remind ministers it is entirely in their gift.”
In an interview with The Independent, Ms Cullen said hospital leaders had offered nurses triple and quadruple their normal hourly rates to work rather than stand on the picket lines, but that staff had seen it as an insult.
The RCN had previously argued there should be a separate single pay spine for nurses, something other health unions had strongly opposed.
'Fair pay should be a bare minimum'
Mr Barclay is due to meet junior doctors’ leaders on Tuesday for initial talks following their 96-hour walkout at Easter.
On Sunday the British Medical Association (BMA) encouraged its members to visit RCN picket lines to show solidarity with nurses.
Prof Philip Banfield, BMA council chairman, said: “As doctors, we see the tireless work and dedication of nurses first-hand day in, day out.
“They give their all while grappling with an understaffed and under-resourced health service. Fair pay should be a bare minimum.”
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