Nurses in England are preparing to escalate their dispute with the government by involving staff from NHS A&E departments, intensive care and cancer wards in a series of 48-hour strikes.
The Royal College of Nursing (RCN) is understood to be considering walkouts across two consecutive days and nights, rather than limiting action from 8am to 8pm as they have done so far.
The union is preparing to step up the dispute by ending a process where the RCN had agreed to local exemptions from strike action with hospitals.
The process, involving around 5,000 derogations or exemptions at a local level, had been decided through joint committees of NHS and RCN staff.
The RCN told NHS leaders on Friday it is preparing to ask its members working in emergency departments, intensive care units and oncology to join the strike.
But the union will make a limited set of provisions for the most urgent clinical situations as part of a legal obligation not to endanger life.
An RCN source said: “NHS leaders are fearing this escalation and they must bring pressure to bear on government to get it stopped.
“They were expecting an escalation but had not prepared for the removal of the committees and derogation process that too many had manipulated at local level and applied pressure on nurses to break the strike.”
Dates for the next strike by nurses in England are expected to be announced within days, and the escalated action expected to take place within a couple of weeks.
Nurses from the RCN took part in two days of strike action last week in England but a walkout in Wales was cancelled following an improved pay offer from the Labour government in Cardiff.
RCN general secretary Pat Cullen has made clear that strikes will be called off if Rishi Sunak’s ministers are prepared to talk about a 7 per cent pay rise offer of the kind offered by the Welsh government.
Union leaders have implored health secretary Steve Barclay to act to prevent further strike action in England – but Mr Sunak’s government has indicated it will not budge on one of the main points of contention – 4 per cent pay for 2022/23.
Ministers have said they want to “look forward” to the pay award for next year, but unions have said that current pay rates need to be addressed given the spike in the cost of living as a result of soaring inflation.
Mr Barclay is believed to have presented the idea of a one-off payment, but the Treasury and No 10 have made clear the government would not sanction extra money ahead of next year’s pay review.
Despite calls to speed up the pay review process, the health secretary told MPs last month that the Treasury wanted to coordinate an approach across government as he explained by health officials have missed the 11 January deadline for submitting evidence.
Ms Cullen wrote to Mr Sunak with a direct appeal for talks but a week later the PM has not replied and there has been no contact with the Department of Health and Social Care (DHSC).
A DHSC source said: “It is disappointing that the RCN are escalating their strikes. Industrial action in the NHS is already having an impact on patients, with more than 80,000 appointments cancelled. These further walkouts, with less strike-day cover being promised, will worsen that impact and put more patients at risk.”
They added: “Our priority is keeping patients safe. The NHS has tried and tested plans in place to minimise disruption and ensure emergency services continue to operate.”