The government and the Royal College of Nursing met on Monday for last-ditch talks.
It did not end well, with the RCN’s leader accusing the health secretary of “belligerence” and turning his back on nurses.
There has been no contact since. At the moment, there are no further talks planned.
Labour has called this a badge of shame for the government. The opposition – with its links to the unions – has said more pay has to be on table in future talks.
But the prime minister has said a fair offer was made and suggested it was necessary to stand up to unions in pay rows.
It was 07:30 this morning, and below freezing when nurses began to gather at the picket line in Newcastle – in front of one of the country’s biggest and busiest hospitals: The Royal Victoria Infirmary.
Across the city they were gathering outside the Freeman Hospital, known around the world for its work in transplantation.
With both hospitals under extreme pressure, the decision to strike must have be a difficult one, but the Royal College of Nurses argues that they had no choice – they had run out of options.
But they must have been warmed by the support, with a constant sound of horns honking by many driving by – and many others as they entered the hospital grounds.
The Royal College of Nursing (RCN) says staff will continue to provide “life-preserving” and urgent care today.
But what counts as urgent?
Stephen Powis, medical director for NHS England, says that local hospitals have been speaking with RCN representatives, and that has “often occurred on patient by patient basis”.
“That is where those decisions regarding degree of urgency will be taken,” he tells BBC’s Today programme.
“Clinicians do that all the time. They know which patients need to be treated quickest so those are the sort of conversations that will be going on very locally.”
The majority of hospitals will be working normally, as well as pharmacies and ambulances services, Powis adds.
“The message is: if you haven’t had a message, if you haven’t heard that your operation or patient appointment is going to be rescheduled, then please do turn up at hospital as normal.”
People on the picket line at St Thomas’ in London have been explaining why they have gone on strike.
One man told the BBC that it was difficult to pay bills and expensive travel costs made matters worse.
He said the cost of living was also affecting the numbers of international nurses and staff were leaving.
He added: “They are not that happy being here as they can’t sustain their living costs.”
Around half of all public-sector workers, including NHS staff, police officers and teachers, have their salaries negotiated by independent pay-review bodies.
These pay bodies – made up of individuals not directly attached to the relevant department but with experience in economics and employee relations – work with government departments
, unions and other groups to come up with a recommendation on how pay should change each year.
This recommendation is non-binding – meaning ultimately the government decides.