(Bloomberg) -- Nurses in England, Wales and Scotland voted to strike in the biggest course of industrial action in the Royal College of Nursing’s 106-year history.

In a fresh blow to the UK’s already strained National Health Service, the majority of nurses employed by the NHS are supporting action over patient safety concerns and as they seek a pay rise of 5% above inflation.

Many of the country’s biggest hospitals will see strikes, including Guys and St Thomas which treated former Prime Minister Boris Johnson during the initial stage of the Covid-19 pandemic, as well as Royal Infirmary of Edinburgh and University Hospital Wales in Cardiff. 

The strikes could start before the end of this year and the mandate lasts until May 2023, the RCN said in a statement. The historic ballot came after the government offered them a package in July that would see the average nurse’s pay increasing 4%.

Strikes have been sweeping across the UK from rail to ports as the worst inflation in four decades erodes workers’ real incomes and living conditions. Staff in the country’s health sector are under particular pressure as the Covid-19 pandemic enters its third year and flu cases rise. Many hospitals are struggling to cope with long waiting lists of patients needing treatment and packed Accident & Emergency departments. 

The NHS has a plan to minimize disruption and ensure emergency services can continue to operate during any strikes, said Health and Social Care Secretary Steve Barclay. Exercises to test the NHS’s capacity to operate at the minimum staff levels will take place next week, he added. 

Barclay said the government’s pay offer had given more than 1 million NHS workers a pay rise of at least £1,400 a year, on top of a 3% pay increase last year.

Industrial action will only take place in health-care settings that met the relevant legal requirements but the majority of NHS employers will be affected, the RCN said. 

“Anger has become action - our members are saying enough is enough,” said Pat Cullen, RCN General Secretary & Chief Executive. “Our members will no longer tolerate a financial knife-edge at home and a raw deal at work.” 

Unison is currently balloting 350,000 other NHS employees across England, Wales and Northern Ireland to strike over pay. Other health unions like The Royal College of Midwives and the Chartered Society of Physiotherapy are also organizing ballots for their members in November, and could form part of this coordinated action. 

Junior doctors will also vote for strikes in early January. “Like us, nurses are showing that they have had enough of being undervalued by this government,” said Emma Runswick, deputy chair of the BMA Council.

A strike across the NHS this winter isn’t inevitable, however, according to Unison’s head of health Sara Gorton who said that unions “want to work with ministers to solve the NHS staffing crisis and its impact on patient care.”

Research from London Economics in October showed that experienced nurses recorded a 20% pay decline in real terms over the last 10 years, with staff working the equivalent of one day a week for free. The erosion of salaries makes it harder to recruit with thousands of health-care vacancies across the UK. 

(Adds government reaction and industry comment throughout.)

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