What is happening?

National Health Service (NHS) nurses in the UK staged a strike on Thursday, their first ever national walkout, as a bitter dispute with the government over pay ramps up pressure on already-stretched hospitals at one of the busiest times of year.

An estimated 100,000 nurses will strike at 76 hospitals and health centers, canceling an estimated 70,000 appointments, procedures and surgeries in the UK's state-funded NHS.

The UK is facing a wave of industrial action this winter, with strikes crippling the rail network and postal service, and airports bracing for disruption over Christmas. 

Inflation running at more than 10 percent, trailed by pay offers of around 4 percent, is stoking tensions between unions and employers. 

Of all the strikes, though, it will be the sight of nurses on picket lines that will be the stand-out image for many Britons this winter.

"What a tragic day. This is a tragic day for nursing, it is a tragic day for patients, patients in hospitals like this, and it is a tragic day for people of this society and for our NHS," Pat Cullen, the Head of the Royal College of Nursing (RCN) union, said to the BBC on a picket line. 

The widely admired nursing profession will shut down parts of the NHS, which since its founding in 1948, has developed national treasure status for being free at the point of use, hitting healthcare provision when it is already stretched in winter and with backlogs at record levels - partly due to COVID-19 delays. 

Why are they striking?

The industrial action by nurses on December 15 and December 20 is unprecedented in the UK nursing union's 106-year history, but the RCN says it has no choice as workers struggle to make ends meet.

Nurses want a 19 percent pay rise, arguing they have suffered a decade of real-term cuts and that low pay means staff shortages and unsafe care for patients. 

"(For nurses) the job is getting harder and harder all of the time for a salary that is worth less and less," Patricia Marquis, director of the RCN in England, said.

The government has refused to discuss pay, which Cullen said raised the prospect of more strikes. 

"Every room I go into with the Secretary of State, he tells me he can talk about anything but pay," she said. "What it is going to do is continue with days like this." 

Outside St Thomas' Hospital in central London, Ethnea Vaughan, 50, a practice development nurse from London, said she felt nurses had no option but to strike, blaming a government that had ignored their concerns for years. 

"Nothing is changing and I've been in nursing for 27 years and all I can see is a steady decline in morale," she said. 

What steps has the government taken?

The government in Scotland avoided a nursing strike by holding talks on pay, an outcome that the RCN had hoped for in England, Wales and Northern Ireland.

But the government has said it cannot afford to pay more than the 4-5 percent offered to nurses, which was recommended by an independent body, and that further pay increases would mean taking money away from frontline services.

UK Health Minister Steve Barclay said it was deeply regrettable that the strike was going ahead. 

"I've been working across government and with medics outside the public sector to ensure safe staffing levels - but I do remain concerned about the risk that strikes pose to patients," he said. 

Barclay said patients should continue to seek urgent medical care and attend appointments unless they have been told not to.

Some treatment areas will be exempt from strike action the RCN has said, including chemotherapy, dialysis and intensive care. 

How has the public reacted?

Polling ahead of the nursing strike showed that a majority of Britons support the action, but once the walk-outs are underway politicians will be closely monitoring public opinion.

UK Prime Minister Rishi Sunak, only six weeks into the job, has said the government cannot afford pay rises for public sector workers which cover inflation and has called union leaders unreasonable. 

But as strikes lead to non-urgent surgeries being canceled and longer ambulance waiting times, public anger at the state of the country could force the government to give ground. 

UK's wave of industrial action

The walkout comes as strikes cripple the rail network and postal service, airports brace for disruption and junior doctors, midwives and teachers prepare to ballot, threatening to further jam up an economy that is likely already in recession. 

Unions are seeking double-digit pay rises to keep pace with inflation that hit 11.1 percent in October, the highest rate in 41 years.

But the government has so far refused to budge on pay and is instead looking to tighten laws to stop some strikes, meaning there is no end in sight for what has been dubbed a new "winter of discontent" in reference to the industrial battles that gripped the UK in 1978-79. 

Strikes are due on each day this month. Union estimates forecast more than 1 million working days will be lost in December, making it the worst month for disruption since July 1989. 

Susan Milner, a professor of European politics and society at the University of Bath, said the current strikes were "very different" to previous bouts, pointing to the wide array of sectors affected and the depth of the cost-of-living crisis. 

"There's the potential for them to stretch out and (for striking workers to) dig themselves in and then that could really be something that we haven't seen for quite a long time," she said.