A union leader has accused the government of choosing to “punish” nurses after a health minister insisted there would be no re-examination of NHS pay for this year, as the health service in England faces what is expected to be the biggest strike in its history. The industrial action on Monday is the first time NHS nurses and ambulance staff in England have stopped work simultaneously, amid an ongoing dispute over pay and staffing. On a busy picket line outside St Mary’s hospital in Paddington, west London, Pat Cullen, the general secretary of the Royal College of Nursing, said: “We are in a situation today where this government has chosen to punish the nurses of England instead of getting round a table and talking to me about pay in the same way as they’ve done in Wales and Scotland.” Surrounded by nurses holding placards with signs reading “It’s time to pay nursing staff fairly” and “Today’s shortages cost lives”, Cullen said hundreds of thousands of nurses were striking, giving the RCN the “strongest mandate of any nursing profession throughout the world”, and they would not give up until the government “wake[s] up and listens to their voice”. The RCN, which is staging two days of action, has said it is calling out twice as many of its members as it did during earlier strikes in December and January. Ambulance crews and call handlers will return to work on Tuesday but are then due to stop work on Friday. Nurses on the picket line shared how low wages and high workloads were pushing them away from the NHS. Yoga Sundaram, who moved from India two years ago to work in the NHS after five years as a nurse and midwife in his home country, said many doctors and nurses who came from overseas left the NHS within months “as they come to learn about the level of pay and they can’t do anything”, while those who stayed had to take loans just to pay bills. Angela Unufe, a former NHS nurse in Nottinghamshire, said she had moved to a role as ward manager at a private mental health clinic in 2019 to improve her pay and work-life balance. She said wards were regularly operating on “dangerously low numbers”. “It’s got to a situation where as managers we have to fill in for nurses who are not on shift, because we can’t get the nurses because there are no nurses there, as no one wants to work for peanuts,” she said. Victoria Busk, a trainee nursing associate striking in Birmingham, said: “It’s only going to get worse because more and more people will leave the profession. Because if you could get paid the same amount of money for doing something that’s a lot less responsibility and a lot less stress, why wouldn’t you? It’s the few of us that are really passionate about what we do that are still here and want to stay here. We’re just asking for the government to enable us to do that.” Speaking to broadcasters in Bristol, the Labour leader, Keir Starmer, said Monday’s widespread strikes were “ a badge of shame for the government”. He said many people would be “absolutely flabbergasted that the government is still sitting this one out, not showing any leadership in the middle of a cost of living crisis, making the situation much worse than it otherwise would be.” Starmer added: “Nobody wants to see these strikes, nobody wants to be on strike – the last thing nurses want to do is to be on strike. What they do want is a government that can show leadership, get around the negotiating table and settle this dispute.” Maria Caulfield, the minister for mental health and women’s health strategy, who is also a nurse and an RCN member, said pay would be on the agenda for any future talks, “but only next year’s deal”. She told Sky News on Monday: “We’ve been pretty clear that we’re not going to look at the current year’s pay award. That was agreed in April by the unions and by the government and accepted in full. We really want to focus on the forthcoming pay awards.” On TalkTV, she urged health unions to “get back round the table and call the strikes off”, as health unions have done in Scotland, where they are negotiating on next year’s pay settlement. Steve Barclay, the health secretary, who has reiterated his call for unions to call off the strikes, has not held talks with the health unions since last month, with no apparent attempt being made to restart negotiations. Asked whether Barclay had in effect given up, Caulfield pointed to the talks in January, saying he “held almost weekly meetings with a range of them”. Cullen said she had written to Rishi Sunak urging him to “resolve this impasse”, saying it was pointless devoting more funding to the NHS without proper staffing levels. “The record money that’s going into the health service is certainly not addressing the crisis within the nursing workforce,” she told ITV’s Good Morning Britain. “And he will only resolve the issues within the health service if he resolves the issues within nursing. It’s a false economy, putting money into short-term projects and short-term measures instead of actually looking at a more strategic long-term plan for the health service.” NHS Providers, which represents trusts, has urged the public to use emergency services “wisely” during the strikes, as it said the health service was approaching a “crunch point”. Unions in Wales largely suspended similar action after the Welsh government came forward on Friday with an improved pay offer, including for the current year. The Unite union’s general secretary, Sharon Graham, said a deal was “tantalisingly close”, with the only sticking point a 3% uplift as a one-off payment rather than on wages. Asked about this by Sky, Caulfield said the Westminster government would not follow suit for England. Over the weekend, the business secretary, Grant Shapps, angered ambulance unions when he accused them of putting patients’ lives at risk by refusing to inform employers of details of their strike action. The NHS Providers chief executive, Sir Julian Hartley, said it understood why so many of its staff had reached a “tipping point” as he urged ministers to sit down with unions to thrash out a settlement. He said 88,000 appointments had already been cancelled as a result of the industrial action. “We’re facing a crunch point. Monday’s coordinated walkout by nurses and ambulance workers could see the worst disruption yet for the NHS,” he said. “We face a very real risk that tens of thousands more patients will have their care disrupted in the coming days by this double whammy of strikes, especially as they’re coming right after a weekend when we know demand for care tends to build up.”