[London] Hundreds of thousands of workers in England's state-run National Health Service went on strike Monday for the first time since 1982 following the government's rejection of a blanket pay rise.
NHS staff including nurses, ambulance crews and midwives stopped working for four hours from 7:00 am (0600 GMT), some forming picket lines.
Emergency services, notably, were continuing but unions recommended patients defer their appointments.
The move is intended to pile pressure on Health Secretary Jeremy Hunt, who rejected the recommendations of an independent pay panel for a below-inflation, one-percent wage increase for all health service staff.
He has agreed to implement the one percent rise, but only for the four in 10 workers who are not already receiving an incremental salary increase.
"The majority of NHS staff get an automatic three per cent increment but we can't afford to give a one percent rise to people already getting that," Hunt said.
"The most important thing here is doing the right thing for patients. It would be irresponsible for any health secretary to accept a pay package that means the NHS has to lay off nurses." The Conservative-Liberal coalition government has roughly halved Britain's budget deficit from 11 percent since taking office in 2010.
But the continued belt-tightening has been criticised by trade unions, citing the health of the British economy, which is expected to grow by three per cent in 2014.
Trades Union Congress (TUC) general secretary Frances O'Grady, who joined a picket line in London, said morale had hit "rock-bottom".
"NHS staff faced year-on-year cuts in the relative value of their pay." Union leaders say that low pay increases plus inflation mean the value of NHS pay has fallen by 12 per cent since 2011.
Among the unions taking industrial action, the Royal College of Midwives is going on strike for the first time in its 133-year existence.
"After years of stress, pressure and overwork, being told they face another year of rising bills but static pay is just too much. They have said enough's enough," Jon Skewes, the RCM's director for employment relations, told AFP.
Hunt said he was prepared to talk to the unions, but only if they were prepared to consider reforming the "unclear and unfair" system of increments.
The striking unions count more than 400,000 members among the 1.3 million English NHS staff.
Only the Chinese army, the Indian railways and US supermarket chain Wal-Mart have more employees than the NHS, according to the British government.
Created in 1948 and paid for through taxation, the NHS provides universal healthcare free at the point of delivery.
The strike comes seven months ahead of the May 2015 general election, and the opposition Labour Party is putting the NHS at the heart of its campaign pitch.
It accuses the Conservatives of planning to dismantle the health service by running it down and selling it off.
Prime Minister David Cameron has accused Labour of scaremongering and spreading "complete and utter lies" about their intentions.
A TUC-organised national protest will be staged in London on Saturday under the banner Britain Needs A Pay Rise.
Kristian Niemietz, a senior research fellow at the London-based Institute of Economic Affairs said the NHS would "always be a key election topic", but predicted a "very shallow debate".
"The only politically palatable statements on the NHS are to shower it with praise, and to promise to spend more money on it," he said.
He said British health workers were "not underpaid" compared to other countries and while pay rates have stagnated, "the same is true for most sectors of the economy" during what has been a prolonged slump and slow recovery. AFP