Nurses' strike begins as union insists critical care exemptions are in place for 28-hour walkout

National exemptions are in place to provide critical care during strike action by nurses, a union leader has insisted, telling Sky News staff would never leave patients unsafe or create more risk.

Royal College of Nursing (RCN) general secretary Pat Cullen was speaking to Sophy Ridge On Sunday ahead of a 28-hour walkout by members over pay.

The strike started at 8pm today.

Mitigations will be more limited and not cover whole services as they had previously, meaning the industrial action will be "more intense than before" although the duty to protect life remains.

The industrial action will run from 8pm today until 11.59pm on Monday night after the RCN voted to reject the latest government offer.

The government has warned strike action without exemptions "clearly does put patients at risk".

On Sunday afternoon, Steve Barclay, the health secretary, accused the RCN of being "disrespectful" and "premature" with its timing of the strike.

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Hospitals in some regions are bracing themselves for "exceptionally low" staff numbers while Great Ormond Street Hospital (GOSH) declared a "business continuity incident".

The RCN subsequently offered assurances after the hospital, which is the largest paediatric centre in the UK, raised "serious concerns" over staffing.

And Ms Cullen told Ridge national exemptions were in place.

According to the RCN website, limited safety critical mitigations would include allowing some staff "to preserve life-and-limb" care in emergency departments and intensive care units.

Ms Cullen said: "Our nurses, as I've said time and time again, will never leave their patients unsafe or create more risk that's already in the system at this point in time."

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Ms Cullen added: "There are national exemptions in place for a range of services, for emergency departments, for intensive care units, for neonatal units, paediatric intensive care units, those really acute services.

"In fact, it was the Royal College of Nursing contacted NHS England to ask for a process to be put in place so that we could make sure that the strike was safe for our patients."

'Lives are being put at risk every single day'

However, the union leader repeatedly refused to be drawn on whether the strike action would put patients at risk.

She said: "Well, clearly there will be an impact of course... but it's an impact that can be stopped by this government if they get round the table again and start to talk to me and the hundreds of thousands of nurses who have participated in this ballot."

Pressed again, Ms Cullen said: "They are going on strike because patients' lives are being put at risk every single day and why? Because we have tens of thousands of vacant nursing posts."

Asked a third time, she said: "I accept that on days of strike that services do not have the same level of nursing staff that they have on other days."

Health workers across the NHS have gone on strike several times in past months in disputes over pay and conditions.

Unions including Unison and the GMB have voted in favour of a government pay offer to end the strikes, while Unite and the RCN have voted against.

Nurses make up a quarter of NHS staff and are the biggest proportion of the health service workforce.

Pay offer 'fair and reasonable'

Warning of the danger of strike action without exemptions for emergency care, cabinet minister Mark Harper told Ridge: "It clearly does put patients at risk, which is why we urge the unions not to go ahead and do the strike."

Appealing to the RCN, the transport secretary added: "I would urge them to think again and to do what the other trade unions in the health service have done, which is to accept what I think is a fair and reasonable pay offer, reflecting the value that we do place on hardworking NHS staff."

'Strike action will be more intense'

A RCN spokesperson said: "Whole services are not derogated like previous strikes but national agreement was reached on raising staffing levels in some key areas to preserve life and limb.

"The RCN and the NHS are clear, however, that this is not usual staffing levels either. This strike action will be more intense than before but the duty to protect life remains".

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A spokesperson for NHS England said: "These exemptions do not represent a return to standard staffing.

"The industrial action will still have a very significant impact on other services during the strike period and patients can expect to see longer waits for care."

'I don't want to see strikes go ahead'

Speaking on the same programme, Labour leader Sir Keir Starmer refused to say whether he supported nurses going on strike without exemptions.

He said: "I don't want to see strikes go ahead.

"The way to avoid strikes is to get in the room with the nurses and resolve these issues."

A High Court judge ruled on Thursday it would be unlawful for the RCN strike to continue into Tuesday as originally planned, meaning it will now end just before midnight on Monday.