Tens of thousands of nurses and ambulance staff in Britain walked off the job on Monday in an escalating pay dispute, in what unions called the biggest strike in the history of the country's public health system, putting further strain on the state-run National Health Service (NHS).

The walkout is the latest in a wave of strikes that have disrupted Britons’ lives for months, as workers – especially in the public sector – demand pay raises to keep pace with double-digit inflation. Teachers, train drivers, airport baggage handlers, border staff, driving instructors, bus drivers and postal workers also have all walked off their jobs in recent months to demand higher pay.

Teachers, health workers and many others say their wages have fallen in real terms over the last decade, and a cost-of-living crisis fueled by sharply rising food and energy prices has left many struggling to pay their bills.

Britain's annual inflation rate was 10.5% in December, a 41-year high. The Conservative government argues that giving public sector staff pay increases of 10% or more would drive inflation even higher.

Nurses and ambulance workers have been striking separately on and off since late last year, but Monday's walkout involving both, largely in England, is the biggest in the 75-year history of the NHS.

The strike piles more pressure on the NHS, already staggering under demand from winter viruses, staff shortages and backlogs built up during the COVID-19 pandemic.

Nurses will also strike on Tuesday, while ambulance staff will walk out on Friday and physiotherapists on Thursday, making the week probably the most disruptive in NHS history, its Medical Director Stephen Powis said.

Health workers are demanding a pay raise that reflects the worst inflation in Britain in four decades, while the government says that would be unaffordable and cause more price rises, and in turn, make interest rates and mortgage payments rise.

Around 500,000 workers, many from the public sector, have been staging strikes since last summer, adding to pressure on Prime Minister Rishi Sunak to resolve the disputes and limit the disruption to public services such as railways and schools.

The Royal College of Nursing (RCN) trade union wrote to Sunak over the weekend asking him to bring the nursing strike "to a swift close" by making "meaningful" pay offers.

"We've got one of the busiest winters we have ever had with record levels of funding going into the NHS to try and manage services," Maria Caulfield, the minister for mental health and women's health strategy, told Sky News on Monday.

"So every percent of a pay increase takes money away."

The government has urged people to continue to access emergency services and attend appointments during the strikes unless they had been canceled but said patients would face disruption and delays.

Nursing unions said emergency care and cancer treatment would continue during their 48-hour walkout, but thousands of appointments and procedures are likely to be postponed.

Nurses leaving

The NHS, a source of pride for most Britons, is under extreme pressure with millions of patients on waiting lists for operations and thousands each month failing to receive prompt emergency care.

The RCN says a decade of poor pay has contributed to tens of thousands of nurses leaving the profession – 25,000 over just the last year – with the severe staffing shortages impacting patient care.

The RCN initially asked for a pay rise of 5% above inflation and has since said it could meet the government "half way," but both sides have failed to reach an agreement despite weeks of talks.

Meanwhile, thousands of ambulance workers represented by the GMB and Unite trade unions are set to strike on Monday in their own pay dispute. Both unions have announced several more days of industrial action.

Not all ambulance workers will strike at once and emergency calls will be attended to. But Business Secretary Grant Shapps said the strike could put lives at risk, leaving people with "a postcode lottery when it comes to having a heart attack or a stroke."

Sharon Graham, general secretary of the Unite union representing some ambulance staff, said Sunday there were "no talks at any level whatsoever with the government" about pay. She urged Sunak to "come to the table and negotiate – roll your sleeves up and negotiate on the pay in the NHS – that is what’s required."

In Wales, nurses and some ambulance workers have called off strikes planned for Monday as they review pay offers from the Welsh government.

Sunak said in a TalkTV interview last week he would "love to give the nurses a massive pay rise" but said the government faced tough choices and that it was funding the NHS in other areas such as by providing medical equipment and ambulances.

Sunak’s government has angered unions by introducing a bill that will make it harder for key workers to strike by setting "minimum safety levels" for firefighters, ambulance services and railways that must be maintained during a walkout.