First pictures from picket lines across Northern Ireland as eleventh hour bid fails to end NHS walkout
Secretary of State under fire as he refuses to meet politicians
Northern Ireland's health service is facing meltdown today after the Secretary of State refused to meet politicians in a bid to broker a deal with unions.
Julian Smith has come under fire for the apparent snub with concerns raised that he has failed to act to stop the strike action by thousands of health service employees.
However, a source close to the Northern Ireland Office (NIO) has insisted that Mr Smith remains committed to finding a resolution to the political deadlock that has led to Wednesday's devastating strike.
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It can be revealed that Mr Smith was given permission by Prime Minister Boris Johnston to miss the first cabinet meeting so that he could be in Northern Ireland this week for the political talks.
Despite this, the Royal College of Nursing (RCN), Nipsa, Unison and Unite will stage crippling strike action. Nurses and paramedics are among the health service employees who will be on the picket line.
The unions have provided exemptions to a number of services, including chemotherapy treatments, intensive care units and palliative care services.
However, emergency departments will be affected by the strike action, while a number of minor injury units will close their doors altogether. Meanwhile, paramedics will only attend the most life-threatening calls and there are concerns that overstretched police officers may be affected as a result as people turn to them for help.
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Hopes had been raised on Tuesday that the strike could be diverted after the political parties returned to talks on Monday.
The leaders of the five main parties met on Tuesday evening and subsequently wrote a letter to Mr Smith which they said provided cover for him to intervene in the row between the Department of Health and the unions.
They said any health and finance ministers in any Executive formed before 13 January 2020 would restore pay parity.
Sinn Fein vice president Michelle O'Neill said: "On this basis, we invited the Secretary of State to come and meet with the five party leaders, where he would provide a commitment to deliver this in the event of no agreement by that date. Regrettably he refused to meet the leaders."
SDLP deputy leader Nichola Mallon said she was angry that Mr Smith had snubbed parties.
She said that "it is unacceptable that the Secretary of State chose not to engage with parties this evening. What message does that send to healthcare staff?"
However, it is understood the letter did not provide the legal cover for Mr Smith to act.
The NIO source added: "If it was as easy as a letter, this matter would have been resolved a long time ago."
Mr Smith has attracted criticism for his stance that health in Northern Ireland remains a devolved matter.
As it currently stands, while Mr Smith is in a position to gather additional funds, he cannot instruct the Northern Ireland Civil Service on how it should be spent.
And the Department of Health has said there is no legal basis for it to allocate any additional funds from Westminster to be used to provide pay parity for health staff in Northern Ireland.
This can only be done by a health minister and fully functioning Executive.
A deadline of January 13 has been given to the political parties to set up an Assembly.
RCN Northern Ireland director Pat Cullen said: "Our members, who are taking this historic action, have been left with little choice.
"Patient care is being compromised by unsafe staffing levels and nurses' pay has been left to dwindle and fall behind that of colleagues from across the UK.
"When 92% of those balloted said they would take strike action to protect patients last month, it should have kick-started the Department of Health into finding a solution, but it hasn't.
"With around 2,800 vacant nursing posts in the HSC (Health and Social Care), record levels of money being spent on agency staff to plug gaps, and nurses' pay sliding further and further behind the rest of the UK, our members have had enough.
"The concerns of nurses were raised again and again over a number of years, but this has continued to fall on deaf ears.
"Our members in Northern Ireland are making clear to those in power that they and their patients will not be ignored and this crisis allowed to worsen.
"To patients we say that this is action that we hoped we would never have to take, and our members have committed to ensuring essential life-preserving services are not affected."
Dame Donna Kinnair, Chief Executive and General Secretary of the RCN, said: "This is a moment that every nurse wishes had never come, but faced with an abject failure to tackle unsafe staffing levels and severe pay inequality with colleagues from across the UK, our members in Northern Ireland are saying enough is enough.
"Nurses are taking a stand for their patients, and also for their colleagues, and it is about time that the powers that be finally sat up and took notice because the crisis in the HSC cannot be allowed to continue."
Further targeted strike action by the RCN is planned on January 8, 10, 20, 22, 24 and on dates in February and March.
Meanwhile, Unison Regional Secretary Patricia McKeown said: "Everyone with power and authority in this society has conceded that our cause is just.
"We have had 'sympathy' from the UK Government through the Secretary of State, from all political parties that stood on our picket lines and from the leadership of the health service. But we have no resolution.
"Unison has agreed emergency cover and our members have volunteered to provide it.
"It would appear that health workers, patients and the public at large are being used as pawns in a political game.
"As we enter this significant period in the industrial struggle the consequences lay firmly on the shoulders of the UK Government, our elected politicians and the leadership of the civil service.
"The decision they take in the next few hours will have lasting consequences in our society either for good or for ill."
East Londonderry MP Gregory Campbell has said that he will place a motion in the House of Commons on Wednesday calling on the issue of pay parity to be "rectified as a matter of urgency".
"I along with our DUP MPs are calling on the Secretary of State to establish how the approximate £22m shortfall for the pay dispute can be implemented," he added.