As the gulf between NHS staff and their employers widened on Monday, the chief executives of the health trusts issued a statement warning of "significant risk to patient safety".

In it, they made reference to "the extent and scope of the action that is now unfolding" and "the level of escalation, in what is only week two".

Both comments suggest that the action being taken by Unison and the Royal College of Nursing (RCN) is somewhat unexpected.

It is difficult to understand this position - the unions have long warned that their members have been propping up the health service by working countless unpaid hours.

Meanwhile, anyone who has had any interaction with the NHS in recent years will know that staff frequently work outside of their own job descriptions to ensure the patient journey is as smooth as possible. The health service was barely coping before the industrial action began.

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Emergency departments are snarled up with people lying for hours on trolleys, either because there aren't any beds to send them to or, in an even more basic failing, there is no-one available to take them from A to B.

Waiting times for hospital appointments, care in the community, diagnostic tests and surgical procedures and treatments are spiralling out of control.

Is it really a surprise, therefore, that the impact of any industrial action is so severe?

The latest development in this sorry tale, which has seen the Belfast Trust cancel thousands of operations and appointments, only reveals how heavily we have been relying on the goodwill of staff to keep the NHS running. The situation has been ongoing for years and the goodwill that has kept the health service in Northern Ireland limping along has finally run out.

Now it has emerged that even patients with suspected cancer have been caught up in the debacle.

Of course, those in charge have said they have been left with no option but to cancel swathes of appointments and elective procedures, laying the blame squarely at the feet of the unions.

In doing so, they ignored the fact that less than a fortnight earlier, three trusts, including the Belfast Trust, were forced to suspend all non-emergency operations due to staff shortages.

At the time, they gave no indication of when normal service would resume and said the issue had arisen due to difficulties in recruiting experienced theatre nurses.

It is little wonder, therefore, that the decision to cancel clinics and surgical lists, and to inform the public so late in the day, is regarded by many as a cynical attempt by those in charge to ramp up the pressure on the unions to step down their action.

As it stands, the Department of Health is refusing to budge on its stance that it neither has the budget or the authority to meet the demands of the unions - something which is rejected by the unions.

The Department of Health and the health trusts have vehemently stated that patient safety is of the utmost importance.

The unions have argued that without the changes they are demanding, patients will continue to be put at risk.

It is clear we are at an impasse and it is even more apparent that the reaction of the employers has only deepened the resolve of the unions.

At this stage, it is difficult to see how an accord can be reached.

Belfast Telegraph