Trade unions have reacted with fury over comments by the Health Secretary accusing them of making a "conscious choice to inflict harm" on patients, as thousands of ambulance staff walk out on the first of two one-day <a href="https://www.thenationalnews.com/tags/strike">strikes</a>. The public has been urged to take “extra care” after last-ditch talks with the unions on Tuesday failed to avert planned industrial action by about 25,000 staff in <a href="https://www.thenationalnews.com/tags/england">England</a> and <a href="https://www.thenationalnews.com/tags/wales/">Wales</a>. Writing in <i>The Daily Telegraph</i>, Health Secretary Steve Barclay said: “We now know that the NHS contingency plans will not cover all 999 calls. “Ambulance unions have made a conscious choice to inflict harm on patients.” Rachel Harrison of the GMB union said ambulance workers have been left "seething" over the comments. "Ambulance workers are seething at such a crude, insulting attempt to divert attention from the Government's continued chaos in the NHS," she said. "The public know it's not ambulance workers who have presided over a decade of failure. "Already today paramedics and ambulance workers have left picket lines to attend to emergency calls. They'll always put the public first. "It's time for the Government to follow their example." The unions angrily accused the <a href="https://www.thenationalnews.com/tags/uk-government/" target="_blank">government</a> of putting lives at risk by refusing to engage with them on the issue of <a href="https://www.thenationalnews.com/tags/salaries" target="_blank">pay</a> as <a href="https://www.thenationalnews.com/tags/nhs" target="_blank">National Health Service</a> leaders warned they could not guarantee patient safety. Unite general secretary Sharon Graham said claims that many serious calls would receive no response were “misleading” and “at worst deliberately scaremongering” by ministers. She told the Today show on Radio 4 on Wednesday that doctors will be triaging category 2 calls, such as heart attacks and strokes, to ensure an ambulance is sent if it is needed. "We have been in discussions for weeks now to make sure we minimise impact," she said, adding that staff will come off picket lines if necessary. She said staff had been offered a "well below inflation" pay increase and she called on Prime Minister Rishi Sunak to come to the table and negotiate. "I understand compromise. I do it all the time. I have been negotiating deals every day this year. Come to the table and negotiate and put this nonsense to an end," she said. Christina McAnea, the Unison general secretary, said that if there were any deaths during the strike it would “absolutely” be the fault of the government. “They have been totally irresponsible,” she told TalkTV. “It’s completely irresponsible of them to refuse to open any kind of discussions or negotiations with us.” Mr Barclay told Radio 4's <i>Today</i> show on Wednesday the government was standing by its independent pay review process, which has made a recommendation it has accepted in full. "There are 1.3 million on the agenda for change programme, if we were to cede to the demands in terms of a 19 per cent increase that would be akin to the full budget of the Ministry of Justice. "The demands from the unions, from the RCN, has been for 19 per cent. And if we look at the GMB's position in Scotland, they have refused to accept the offer there, which was way in excess of the headline figure of 7.5 per cent." Earlier, the NHS Confederation and NHS Providers, which collectively represent all NHS organisations, wrote to Prime Minister Rishi Sunak warning they were entering “dangerous territory” and urging him to end to the deadlock. “With less than 24 hours to go until the ambulance strike, there is deep worry among NHS leaders about the level of harm and risk that could occur to patients tomorrow and beyond,” they said. Stephen Powis, National Medical Director of NHS England, told Radio 4's Today show on Wednesday, it will be a "difficult day" for the NHS. "We have been working very closely with unions to ensure that emergency services for life threatening services are maintained. And that will include stroke and heart attacks," he said. Mr Powis repeated calls for the public to take care and avoid unnecessary trips to the emergency department. "We have asked everyone to be sensible, to bear that in mind as everyone goes about their daily lives. It is a season of parties, pre-Christmas, so do enjoy yourselves but obviously don’t get so drunk that you end up with an unnecessary visit to A and E. That’s good advice at the best of times," he said. But Mr Sunak told the House of Commons liaison committee that the government could not accede to inflationary pay claims that would stoke soaring prices. Meanwhile, nurses in England, Wales and <a href="https://www.thenationalnews.com/tags/northern-ireland/" target="_blank">Northern Ireland</a> — who held a second 12-hour strike on Tuesday in support of their pay claim — said they would be announcing more strike dates on Friday unless ministers came forward with new proposals. With fewer ambulances on the road, ministers have appealed to people to drink responsibly, think again about contact sports and avoid running on icy roads. About 600 armed forces personnel are being used to cover for striking ambulance staff, providing support for paramedics although their role will be strictly limited. They are not due to be sent on critical emergency calls or carry out clinical tasks, and will not be allowed to break red lights or turn on blue lights when driving. As the government’s emergency civil contingencies committee prepared to meet again on Wednesday to discuss the situation, Mr Barclay insisted patient safety was his “number one priority”. “The government and NHS colleagues have been working to protect safe staffing levels,” he said. “However, there will be fewer ambulances on the road due to industrial action and the NHS will be prioritising those with life-threatening needs. “My message to the public is to take extra care tomorrow and plan your activity accordingly. You may also want to check up on more vulnerable friends, family and neighbours.” The industrial action affects all the ambulance trusts in England, apart from East of England and the Isle of Wight, and all those in Wales, with each of the unions involved striking at slightly different times. Unison’s actions runs from noon until midnight on Wednesday, while the GMB action runs from midnight on Tuesday to midnight on Wednesday, and Unite’s from midnight on Tuesday to midday on Wednesday. It is expected that all category 1 calls — the most life-threatening, such as cardiac arrest — will still be responded to along with the most serious category 2 calls, which cover serious conditions, such as stroke or chest pain. After the unions’ meeting with Mr Barclay, Ms McAnea said it appeared his “hands are tied” on the issue of pay as she warned that further strikes in January were now on the cards. “He was concerned about the strike, sympathetic to ambulance and other health workers but has no room for manoeuvre apparently, so I don’t know where we go with this,” she said. “His hands are tied apparently … he has to decide where the money goes and it’s not going to staff.”