Thousands of nurses have gone on strike in England, Wales and Northern Ireland, as the prime minister, Rishi Sunak, insisted he would not back down in the face of Britain’s most significant wave of industrial action in a generation. From rail journeys to Christmas card deliveries and passport checks at airports, key services across Britain are being hit by industrial action, which has intensified in the run-up to Christmas. Tuesday’s nurses’ strike was the second of two days of industrial action – the first time they have ever held a nationwide strike – as workers fight to protect their living standards in the face of soaring inflation. This will be followed on Wednesday by a day-long stoppage by ambulance staff. Trade unions have struck “life and limb” agreements, which they say will ensure emergencies are properly dealt with; but bosses from Britain’s National Health Service (NHS) have warned that some patients may be put at risk. Matthew Taylor, the chief executive of the NHS Confederation, which represents healthcare employers, warned “people tomorrow with urgent needs will not be attended to … we can’t avoid additional risk and additional harm to patients”. Workers across the taxpayer-funded sector in the UK have faced a decade or more of pay restraint, as successive Conservative governments have sought to “balance the books” by repeatedly freezing or capping their wages. With inflation running at 40-year highs, unions say many people are struggling to cope. The Royal College of Nursing (RCN) has claimed some members have been forced to use food banks – charity-backed handouts of essential groceries. All four unions involved in the NHS action this week have also expressed concern at the fragile state of the system, which has faced unprecedented pressures through the Covid pandemic and is struggling to tackle a huge backlog of patients waiting for care. NHS staff have been offered a pay rise of at least £1,400 each, equivalent to about 4% on average for nurses, but are pushing for a rise that at least keeps pace with the double-digit UK inflation. With average pay across the economy growing at 6% as many employers struggle with labour shortages, NHS bosses have warned that they are losing staff to other sectors such as supermarkets. Pat Cullen, the general secretary of the RCN, has called the strikes “a battle for the absolute soul of the NHS, to bring it back from the brink and from falling totally over the precipice.” Rachel Harrison, the national secretary of the GMB, which represents striking ambulance workers, said: “Something has to change or the service as we know it will collapse”. Alongside NHS workers, public sector employees across many different departments are taking staggered strike action over the coming weeks, including border staff who check passports at ports and airports, and driving test examiners. They are joining postal and rail workers, who have already been taking industrial action for several months over pay and conditions. So far, the fledgling Sunak government has refused even to discuss pay with NHS workers. The Conservative leader has been in office for less than two months, after the disastrous short-lived premiership of his predecessor, Liz Truss. With Truss forced out after financial markets rejected her plans for bumper spending on tax cuts, Sunak is determined to keep a tight rein on public spending – and has refused to budge on nurses’ pay. In an interview with a supportive newspaper, the Daily Mail, the prime minister insisted: “I’m going to do what I think is right for the long-term interests of the country – combating inflation.” He has called the existing pay offer “appropriate and fair”. Meanwhile, nurses have suggested they could continue to take action for months if they deem it necessary – though much is likely to depend on which side can maintain the support of the public. Sunak’s government is certainly not popular: with a general election expected in 2024, the Conservatives are languishing around 20 percentage points behind the opposition Labour party in the polls. That’s an improvement on the 30 points seen at one point during Truss’s spell in the top job – but appears to point to a collapse in support for a party that has been in power for 12 years. Labour has close historic connections to some trade unions (though not the RCN), which help to fund the party and have seats on the committee that makes key decisions about its direction. Sunak has sought to exploit these links politically, accusing Starmer of supporting the strikes; but the Labour leader has repeatedly insisted it is for the prime minister to “roll up his sleeves” and get involved in negotiations to bring the industrial action to an end.