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Members of the Royal College of Nursing are to go on strike again after they voted against the latest government pay offer.

This is despite a recommendation from union leaders that they accept it and means there will be a round-the-clock 48-hour strike – without exemptions – from 8pm on 30 April to 8pm on 2 May.

Unison members had voted in favour of the pay deal on the grounds it was the “best that could be achieved through negotiation”.

All of this comes as a 96-hour walkout staged by junior doctors comes to an end this morning.

Senior officials within the Royal College of Nursing (RCN) have suggested that they may consider coordinating future industrial action with junior doctors in an attempt to increase pressure on the government.

For the first time, the RCN’s strike will involve staff working in emergency departments, intensive care units, cancer care and other services that were previously exempt from strikes

More than six in 10 of eligible members took part in the ballot, with 54% voting to reject the government’s offer and 46% voting for it. Turnout was 61%.

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RCN General Secretary Pat Cullen said she had written to the government to notify it of “imminent” strike action, as well as a new ballot and a request for a fresh round of talks.

Final day of walkout by doctors and updates on nurses – politics latest

In a letter to Health Secretary Steve Barclay, Ms Cullen said what nurses had been offered was “simply not enough”.

She said: “Since our talks in February, we have seen the pressures on the NHS continue to increase.

“Until there is a significantly improved offer, we are forced back to the picket line.

“After a historic vote to strike, our members expect a historic pay award.”

The development will come as a blow to the government, which hoped a settlement with nurses would pave the way for breakthroughs in other sectors gripped by industrial action.

Instead, there is the likelihood of further strikes over the summer months after teachers also voted to reject the government’s offer.

However, the government will be buoyed by the “decisive” Unison result, in which three-quarters of 288,000 NHS workers across England voted to accept the offer.

Unison’s head of health, Sara Gorton said that while health workers “would have wanted more … this was the best that could be achieved through negotiation”.

The health unions are lodged in their own dangerous game of divide and rule

It’s not a good news, bad news type of situation – it’s a mess. By rejecting the government’s pay offer, nurses from the RCN are now in conflict with their health worker colleagues from Unison who have overwhelmingly decided to accept it.

At the start of the process the unions warned that the government was playing a dangerous game of divide and rule. Now they have managed to do it to themselves.

Other health unions including the GMB, Unite and those representing physios and dieticians are consulting their members. They have until the 28 April.

Until then we are in limbo. In early May all the unions will go back to the government with their decision. Unison has said it will ask the government to impose its pay deal on their members.

But the RCN has already announced further strike dates and will ballot its members for more action over the last six months of the year.

It raises the prospect of nurses and junior doctors standing together on picket lines for the first time. That is a situation that will fill NHS Trust leaders with dread.

The outcome will not be known until at least May. It means more uncertainty for long suffering patients.

Under the deal, Unison health workers will receive an additional one-off payment for the year 2022/23, along with a 5% pay rise for 2023/24 – 10.4% for the lowest paid.

Unison, GMB and Unite the Union all also represent nurses in some capacity, as well as paramedics, 999 call handlers, midwives, security guards and cleaners.

According to the RCN, if the majority of members across all unions vote to accept the deal, then the government could still implement it.

A Unison source told Sky News they will be pushing for the government to implement the pay offer their members voted for, even though RCN members have rejected it and other unions may do as well.

A government spokesperson said: “It is hugely disappointing that the Royal College of Nursing membership has rejected the pay deal recommended by their leadership.

“Following constructive discussions, all parties agreed this was a fair and generous offer which is demonstrated by Unison, representing the largest share of the NHS workforce, choosing to accept it.

“The fact that the Royal College of Nursing has announced an escalation in strike action with no derogations, based on a vote from the minority of the nursing workforce, will be hugely concerning for patients.”

Read more:
‘The system is broken’: On the A&E frontline during the strikes
Strike organiser on holiday as junior doctors stage 96-hour walkout

The pay deal rejected by RCN members would have seen nurses awarded a one-off payment of 2% of their salary, plus a COVID recovery bonus of 4% for the current financial year and 5% for the year after.

Mr Barclay previously explained that, under the offer, a newly qualified nurse would have received more than £1,800 this year on top of a pay rise of more than £1,300 next year.

NHS Providers Director of Communications Adam Brimelow said the RCN vote was a “setback” and was “extremely worrying”.

“Trust leaders understand the frustration of nurses, junior doctors and other staff who have seen their pay fall behind inflation year after year.

“It’s really important that the unions and government find a way through this to prevent more strikes and let the NHS focus on its big challenges, including cutting waiting lists and transforming services, instead of having to resort to ‘all hands on deck’ just to get through the day.”

The nurses’ dispute is separate from the junior doctors row. Ministers have repeatedly insisted they will not enter into talks with the British Medical Association (BMA) until the union drops its demand for a 35% pay rise for junior doctors.

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Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated

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Unlicensed Botox-like injections spark outbreak of disease many doctors have never treated

A woman who thought she was being injected with Botox was left unable to swallow and doctors thought she had suffered a stroke – after she contracted a life-threatening illness from a potentially illegal product.

Nicola Fairley is one of dozens of people who have developed botulism linked to unlicensed anti-wrinkle injections.

She had the procedure done with her regular beautician after winning a Facebook competition for three areas of “Botox”.

Nicola Fairley
Image:
Nicola Fairley

“Within two or three hours my forehead and the sides of my eyes had started to freeze,” Nicola says.

“At first I thought ‘amazing’, that’s what I wanted – then it just carried on.”

Nicola was eventually sent to A&E in Durham, where she met several other patients who all had similar symptoms.

Doctors were stumped. “They thought I’d had a stroke,” she says.

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“We all had problems with our eyes, some of us with our breathing. I couldn’t swallow – they put me on nil by mouth because they were worried I would choke in the waiting room.”

Nicola Fairley
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Doctors were worried Nicola could choke after she was injected with a suspected illegal product

It turns out all of the patients had recently had anti-wrinkle injections containing botulinum toxin.

Health officials believe they were imported, illegal products.

Botulism – the disease they caused – is so rare many doctors never see it in their entire careers.

It can cause symptoms including slurred speech and breathing problems, and can be deadly.

The disease is so unusual, and so many cases were coming in, that doctors exhausted their stocks of anti-toxin and had to ask hospitals as far away as London to get more.

Botulism

The UK Health Security Agency has so far confirmed 38 cases of botulism linked to cosmetic toxin injections, but Sky News has been told of several more.

The outbreak began in the North East but cases have now been seen in the East of England and East Midlands as well.

There are only a handful of legal botulinum toxin products in the UK – of which Botox is one.

But cosmetic treatments are largely unregulated, with anyone allowed to inject products like fillers and toxins without any medical training.

Cheap, illegal products imported from overseas are easily available.

Steven Land
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Dr Steven Land

‘It’s the Wild West’

Dr Steven Land runs Novellus Aesthetics clinic in Newcastle upon Tyne. He worked for decades as an emergency medicine doctor before moving into aesthetics.

He says he has been warning health officials of an outbreak for years.

“It’s the Wild West,” Dr Land told Sky News.

“Because anyone can do this, there is a lack of knowledge around what is legal, what’s not legal, what is okay to be injected.

“These illegal toxins could have 50 units, 5,000 units or rat poison – there could be anything in there.”

Read more from Sky News:
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Scots divided as Trump flies in for visit

Botulism

Dr Land showed us messages that he says he gets on a weekly basis, from sellers trying to push him cheap, unlicensed products.

They advertise “limited time offers” and cheap bundles on toxins imported from overseas. He calls them “drug dealers”.

“They are preying on the lack of knowledge among non-medical practitioners,” he says.

Consultations on how to regulate the aesthetics industry have been ongoing for years – but so far, no changes have been introduced.

The UK government now says it does plan to regulate certain procedures, but it’s not said how it will do this, or when.

“What will it take?” Nicola says. “One of the women we were with did almost die – she had to be resuscitated.”

Nicola’s beautician has stopped responding to her messages, so she says she still has no idea what the product was “or how much of it is in me”.

She doesn’t know how long her symptoms will last, but just hopes she will eventually recover.

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Trump issues warning to leaders as he arrives in Scotland

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'Immigration is killing Europe': Donald Trump issues warning to leaders as he arrives in Scotland

Donald Trump has landed in Scotland for a four-day trip including high-level meetings – praising Sir Keir Starmer as “a good man” but calling illegal migration a “horrible invasion” that is “killing Europe”.

Crowds gathered at Prestwick Airport in Ayrshire amid a major security operation for the US president’s visit.

Mr Trump told reporters: “I like your prime minister. He’s slightly more liberal than I am… but he’s a good man… he got a trade deal done. It’s a good deal for the UK.”

The pair are expected to discuss potential changes to the UK-US trade deal which came into force last month.

Trump left Air Force One to head to Turnberry, one of his Scottish golf courses. Part of the trip will include the opening of another course in Aberdeenshire, billed as “the greatest 36 holes in golf”.

Trump supporters watch on as a plane carrying US President Donald Trump arrives at Prestwick Airport
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Trump supporters waved as Air Force One landed. Pic: PA

“There’s no place like Turnberry. It’s the best, probably the best course in the world. And I would say Aberdeen is right up there,” the US president said.

Sean Connery helped get me the [planning] permits. If it weren’t for Sean Connery, we wouldn’t have those great courses,” he added.

During the trip, President Trump will also hold discussions with Scotland’s First Minister John Swinney and EU Commission President Ursula von der Leyen, who is keen to secure a trade deal with the US.

President Donald Trump speaks to members of the media after he arrived at Prestwick Airport in Ayrshire, Scotland, Friday, July 25, 2025.(AP Photo/Jacquelyn Martin)
Image:
Donald Trump spoke to reporters after landing at Prestwick Airport, Ayrshire. Pic: AP

Mr Trump told reporters there was “a good 50-50 chance” of an agreement with the EU but added there were “maybe 20 different” sticking points.

EU diplomats say a deal could result in a broad 15% tariff on EU goods and half of the 30% Trump is threatening to impose by 1 August.

A motorcade carrying U.S. President Donald Trump drives to Turnberry, in Minishant, Scotland, Britain, July 25, 2025. REUTERS/Phil Noble
Image:
He travelled to Turnberry, one of his Scottish golf resorts, amid tight security. Pic: Reuters

The US president touched on illegal immigration and gave European leaders a stark warning.

“You better get your act together or you’re not going to have Europe anymore. You got to get your act together,” he said.

“But you’re allowing it to happen to your countries and you got to stop this horrible invasion that’s happening to Europe. Immigration is killing Europe.”

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What do Scots think of Trump visit?

He was also scathing about the installation of wind turbines across the continent.

“Stop the windmills. You’re ruining your countries,” he said. “It’s so sad. You fly over and you see these windmills all over the place, ruining your beautiful fields and valleys and killing your birds.”

Read more from Sky News:
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Ghislaine Maxwell questioned
Epstein questions keep coming

Domestically, Mr Trump faces the biggest political crisis of his second term in office over his administration’s handling of files linked to disgraced financier and sex offender Jeffrey Epstein, who died in prison in 2019.

He faced another round of questions after stepping off Air Force One.

“You’re making a big thing over something that’s not a big thing. I’m focused on making deals, not on conspiracy theories that you are,” he said.

Mr Trump added that “now’s not the time” to discuss a pardon for Ghislaine Maxwell, Epstein’s imprisoned accomplice.

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Trump in Scotland amid Epstein storm

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While the president’s visit did attract some enthusiastic flag-waving supporters at Prestwick Airport, he is also likely to trigger a number of protests, prompting Police Scotland to call in support from other forces in the UK.

The Stop Trump Scotland group has planned demonstrations on Saturday in Edinburgh, Aberdeen and Dumfries.

About 70% of Scots have an unfavourable opinion of Mr Trump, while 18% have a positive opinion, an Ipsos poll in March found.

Mr Trump is staying at his Turnberry property on Scotland’s west coast this weekend, before travelling to Aberdeenshire on Monday, where he will open a second 18-hole course.

He is due to return to the UK in September for a state visit hosted by the King – the first world leader in modern times to undertake two UK state visits.

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‘Immigration is killing Europe’: Donald Trump issues warning to leaders as he arrives in Scotland

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'Immigration is killing Europe': Donald Trump issues warning to leaders as he arrives in Scotland

Donald Trump has landed in Scotland ahead of a four-day trip, which includes high-level meetings, praising Sir Keir Starmer as “a good man” but also calling illegal migration a “horrible invasion” that was “killing Europe”.

Crowds gathered at Prestwick Airport in Ayrshire amid a major security operation for the US president’s visit.

Mr Trump told reporters: “I like your prime minister. He’s slightly more liberal than I am… but he’s a good man… he got a trade deal done. It’s a good deal for the UK.”

Trump latest: Donald Trump arrives in Scotland

The pair are expected to discuss potential changes to the UK-US trade deal which came into force last month.

Trump left Air Force One to head to Turnberry, one of his Scottish golf courses. Part of the trip will include the opening of another course in Aberdeenshire, billed as “the greatest 36 holes in golf”.

Trump supporters watch on as a plane carrying US President Donald Trump arrives at Prestwick Airport
Image:
Trump supporters waved as Air Force One landed. Pic: PA

“There’s no place like Turnberry. It’s the best, probably the best course in the world. And I would say Aberdeen is right up there,” the US president said.

Sean Connery helped get me the [planning] permits. If it weren’t for Sean Connery, we wouldn’t have those great courses,” he added.

During the trip, President Trump will also hold discussions with Scotland’s First Minister John Swinney and EU Commission President Ursula von der Leyen, who is keen to secure a trade deal with the US.

President Donald Trump speaks to members of the media after he arrived at Prestwick Airport in Ayrshire, Scotland, Friday, July 25, 2025.(AP Photo/Jacquelyn Martin)
Image:
Donald Trump spoke to reporters after landing at Prestwick Airport, Ayrshire. Pic: AP

Mr Trump told reporters there was “a good 50-50 chance” of an agreement with the EU but added there were “maybe 20 different” sticking points.

EU diplomats say a deal could result in a broad 15% tariff on EU goods and half of the 30% Trump is threatening to impose by 1 August.

A motorcade carrying U.S. President Donald Trump drives to Turnberry, in Minishant, Scotland, Britain, July 25, 2025. REUTERS/Phil Noble
Image:
He travelled to Turnberry, one of his Scottish golf resorts, amid tight security. Pic: Reuters

The US president touched on illegal immigration and gave European leaders a stark warning.

“You better get your act together or you’re not going to have Europe anymore. You got to get your act together,” he said.

“But you’re allowing it to happen to your countries and you got to stop this horrible invasion that’s happening to Europe. Immigration is killing Europe,” he told reporters.

Please use Chrome browser for a more accessible video player

What do Scots think of Trump visit?

He was also scathing about the installation of wind turbines across Europe.

“Stop the windmills. You’re ruining your countries,” he said. “It’s so sad. You fly over and you see these windmills all over the place, ruining your beautiful fields and valleys and killing your birds.”

Read more from Sky News:
Epstein risks following Trump
Ghislaine Maxwell questioned
Epstein questions keep coming

Domestically, President Trump faces the biggest political crisis of his second term in office over his administration’s handling of files linked to disgraced financier and sex offender Jeffrey Epstein, who died in prison in 2019.

He faced another round of questions after stepping off Air Force One. “You’re making a big thing over something that’s not a big thing. I’m focused on making deals, not on conspiracy theories that you are,” he said.

Mr Trump added that “now’s not the time” to discuss a pardon for Ghislaine Maxwell, Epstein’s imprisoned accomplice.

Please use Chrome browser for a more accessible video player

Trump in Scotland amid Epstein storm

👉 Follow Trump100 on your podcast app 👈

While the president’s visit did attract some enthusiastic flag-waving supporters at Prestwick Airport, he is also likely to trigger a number of protests, prompting Police Scotland to call in support from other forces in the UK.

The Stop Trump Scotland group has planned demonstrations on Saturday in Edinburgh, Aberdeen and Dumfries.

About 70% of Scots have an unfavourable opinion of Trump, while 18% have a positive opinion, an Ipsos poll in March found.

President Trump is staying at his Turnberry property on Scotland’s west coast this weekend, before travelling to Aberdeenshire on Monday, where he will open a second 18-hole course.

He is due to return to the UK in September for a state visit hosted by the King – the first world leader in modern times to undertake two UK state visits.

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