By Michael McHugh, PA
Thousands of nurses in Northern Ireland have started another day of strike action in a row over pay.
The protest follows a similar strike last month over salary rates that lag behind colleagues in Great Britain, and staff shortages.
Thousands of hospital appointments are expected to be cancelled.
🎥@RCN_NI members are back on the picket line this morning for the second time ever, as they continue to campaign for better staffing levels and pay. pic.twitter.com/Gc8T0dfHJ2
— Q Radio News (@qnewsdesk) January 8, 2020
The Department of Health has urged trade unions to return to talks. They broke down without agreement in December, when a fresh 3.1% pay offer was rejected by unions.
The Royal College of Nursing (RCN) is leading members away from patient bedsides on Wednesday and Friday, while members of Northern Ireland's largest health workers' union, Unison, will also stage walkouts on Friday.
Midwives are also being asked if they are willing to take strike action over pay.
Unions have called for pay parity with their colleagues in the rest of the UK.
The department's permanent secretary, Richard Pengelly, has warned that hospitals are already under severe pressure.
Northern Ireland has some of the longest waiting lists for treatment in the UK, and the political paralysis at Stormont has hampered efforts to address problems in the NHS.
Numerous appointments and treatments have been cancelled and a number of services across hospitals and the community care sector have had to be stood down or reduced due to industrial action, health service providers said.
All emergency departments will remain open as normal, but they are under extreme pressure due to winter demand.
Reduced staffing levels on Wednesday and Friday will significantly affect the ability of the system to discharge patients and further compound pressures throughout hospital and community services, health and social care organisations said.
The South Tyrone Hospital Minor Injury Unit (MIU), Mid Ulster MIU and Bangor MIU will be closed on Wednesday.
Around 5,000 medical appointments were cancelled following the unprecedented nurses' strike which paralysed parts of the NHS late last year.
Healthcare workers said they were tearful and "at the end of their tether".
Stormont politicians stepped up efforts to restore devolved power-sharing and urged immediate action to address a "humanitarian" crisis in health.
Routine medical appointments were cancelled, minor injury units closed and there were delays to some ambulance responses.
Pickets formed across the region and thousands of nurses walked out in their first ever strike.
Pay parity and safe staffing strike
— Q Radio News (@qnewsdesk) January 8, 2020
Message from the pickets to the politicians ...@RCN_NI chief Pat Cullen - "Listen, take action and bring our health service back from this crisis."#Stormont #safestaffingsaveslives pic.twitter.com/YQq12Saz0z
Pat Cullen, director of the Royal College of Nursing in Northern Ireland, has been visiting picket lines as nurses stage their second day of strikes over pay and staffing levels.
Earlier she visited the picket line at Belfast City Hospital.
"Our nurses are back in today providing life-preserving services, those services have been exempted and whilst nurses are on picket lines - I have just come from one - its nurses coming off night duty, nurses coming in off their leave, and on their day off standing out in the cold and the rain speaking up for their patients, speaking up for our profession that they value and a health service that they value," she told the BBC.
"But our nurses, it must be very clearly stated, are in providing those life preserving services for their patients today whilst they are still on strike."
Nurses and medical staff at Altnagelvin Hospital in Derry-Londonderry are taking industrial action again today to call for better pay and safer staffing levels on wards. Cars, buses, lorries beeping their horns passing. More action is planned throughout January pic.twitter.com/TglKZqGBjV
— Q Radio News (@qnewsdesk) January 8, 2020
🎥 Nuala Murray from @RCN_NI says “enough is enough” as members strike for the second time ever over staffing levels and pay. She says the health service is in the worst state it’s ever been in, in her 37 years of nursing. pic.twitter.com/GRfsxWJwlQ
— Q Radio News (@qnewsdesk) January 8, 2020