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(Bloomberg) --

Hospital waiting lists are growing. Pharmacies are running out of antibiotics. Nurses have been taking industrial action for the first time in their history and over the next week ambulance drivers will join them — with strikes planned for Wednesday.

The UK’s National Health Service is beginning to look sicker than some of its patients. After limping through the Covid-19 pandemic, the NHS is finding the aftermath even more challenging. 

Even before nurses took to the picket line on Thursday after failing to agree on a new pay deal, Britain’s system of publicly funded care was under pressure. More than 7 million people are waiting for routine operations and staff are resigning at record rates.

Rishi Sunak’s government faces escalating action from nurses in the New Year if ministers fail to join talks with unions this week. On Sunday, Cabinet Office minister Oliver Dowden told the BBC the government was “resolute” and that it would “be irresponsible to allow public sector pay and inflation to get out of control”. Health Secretary Steve Barclay accused unions representing ambulance workers of being “less than co-operative in negotiations” in an uncompromising article for the Mail on Sunday.

“The NHS is in the biggest crisis in its history,” said Wes Streeting, the opposition Labour MP and shadow health secretary. “People are finding it impossible to get a GP appointment or operation when they need one. In an emergency, there’s no guarantee an ambulance will arrive on time, if one arrives at all.”

The NHS is Britain’s biggest employer, with a workforce of 1.4 million and an annual budget of £180 billion. It’s often been held up as a model, delivering universal care and good results at a lower cost than other health systems around the world.   

However, after almost three years of pandemic, its staff are exhausted, and accident and emergency departments are so full that some patients are waiting more than 12 hours to be seen by a doctor. At the same time more than 40,000 NHS employees left the service in England in the 12 months to the end of June this year.

“It’s difficult to think of a time when the NHS has been under this amount of sustained pressure,” said Sally Warren, director of policy for the King’s Fund, an independent think-tank that advises on health-care policy. “You would always have spikes of a particular illness that the NHS would deal with, but this is a spike of illness on top of a quite prolonged set of strains the system is in.”

Health officials had warned of a possible increase in flu cases this winter, but it is the recent rise in incidents of the bacterial infection strep A, especially among children, that has provoked a more immediate problem for the NHS and the government of Prime Minister Rishi Sunak.

Professor Susan Hopkins, chief medical adviser for the UK Health Security Agency, which is responsible for public health, revealed on Wednesday that five times as much of the antibiotic penicillin, used to treat strep A, was being used now compared with three weeks ago. Her comments alarmed patients already worried about shortages. 

Within 24 hours the government was forced to take action to allow pharmacists to supply alternative forms of penicillin. Strep A has killed 74 people in the UK so far this year, including 19 children. Parents had reported having to visit a string of pharmacies to obtain antibiotics prescribed for sick children.

Critics argue that years of underfunding, compounded by the impact of the pandemic, has left the health service and many of its staff struggling. In his autumn statement Jeremy Hunt, the chancellor, committed an extra £3.3 billion to the NHS budget in each of the next two years. He added that workforce shortages were one of the biggest issues facing the NHS.  

Many nurses believe they had little choice but to strike. Newly qualified NHS nurses are paid £27,055 ($32,866) with those in inner London paid £32,466 — leaving many unable to afford to pay their bills even before the impact of this year’s soaring inflation. 

A survey of NHS leaders for the Royal College of Nurses by London Economics found that 99% were moderately or extremely concerned about the impact of the cost of living on the mental wellbeing of staff. More than 40% reported a significant or severe impact on staff who were struggling to afford to eat meals while on shift.

“I never thought I’d be rich,” said Mary Smith, a nurse on a picket line outside London’s St. Thomas’ Hospital on Thursday, “But I never thought I’d have to go on strike just to get fair pay.” 

The 26-year-old added that the staffing crisis had made it unsafe for patients the “whole year round.” 

The Royal College of Nurses is demanding action over patient safety and a 19% pay rise for its members — well above inflation.

Mark Farmer, a regional director for the RCN, said the biggest issue for nurses in London was the “unaffordable” cost of transport and accommodation. “We’re seeing increasing numbers of staff leaving the profession and leaving London because the salary just isn’t enough to keep them in the profession,” he said.

Fresh strikes by the nursing unions are scheduled for Tuesday. Ambulance workers will begin industrial action the following day, which is expected to aggravate already lengthy waiting times for hospital treatment. 

NHS England warned the strikes at nine out of 10 ambulance trusts would cause “extensive disruption,” the Daily Mail reported. It has told hospitals to empty beds and ensure ambulances hand over patients within 15 minutes so they can reach more emergency calls, according to the report. Hospitals have also been told to prioritize cancer diagnostics and treatment.

The strike by nurses was met with a wave of public support. Footballer turned broadcaster Gary Lineker tweeted: “They’ve cared for us in our moment of need. Here’s hoping we care for them in their moment of need.”

Some argue the NHS now needs that same level of care. 

--With assistance from Anchalee Worrachate and Alex Wickham.

(Updates with Daily Mail report in the 19th paragraph.)