A war of words has erupted between health bosses and unions as each side blames the other for the chaos being experienced by patients across Northern Ireland.

Just one week into industrial action by Unison and as members of the Royal College of Nursing (RCN) prepared to work to rule today, the relationship between staff and NHS chiefs has hit crisis point.

A third union, Unite, last night announced that its members have also voted in favour of striking, with industrial action beginning on December 18.

Meanwhile, despite that fact the Belfast Trust has said more than 10,000 outpatient appointments and surgeries have been cancelled this week, it has refused to reveal how many staff are involved in industrial action.

It has also refused to say whether it made a specific request to Unison to exempt cancer diagnostic services from the strike action.

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It comes after chief executive of the trust, Martin Dillon, revealed suspected cancer patients are among those caught up in the swathe of cancelled appointments and that diagnoses may be delayed as a result.

Have you been affected by the industrial action? Contact digital.editorial@belfasttelegraph.co.uk

However, it can be revealed that some patients were seen yesterday after turning up to a variety of clinics which the Belfast Trust said on Friday would be cancelled.

A source said: "The doctors were told they had to come in even though the trust had announced their clinics had been cancelled.

"The nurses were there as well and they were basically told that if any patients turned up for their appointment that they should be seen and anyone who didn't turn up should be marked down as a cancellation.

"To say staff are angry about what is happening is an understatement."

The trust has come under fire after it issued a press release to the media shortly after 4.30pm on Friday cancelling the majority of outpatient clinics and elective surgeries this week.

Within minutes, however, patients received text messages from the trust to remind them to attend their appointments this week.

It is understood patients have not been sent cancellation letters meaning that some people turned up for appointments yesterday oblivious to the ongoing row.

The unions have said it is further proof of the mismanagement of the situation by those in charge at the trust.

Speaking last night, Unison's regional secretary Patricia McKeown said: "In discussions with the Belfast Trust last week our members were asked to exempt cancer services. Unison agreed to this along with a range of other exemptions.

The trust did not indicate any intention to cancel cancer diagnostic treatment. If it had done so it would have been exempted. Patricia McKeown, Unison

She said her union's members met with the Belfast Trust yesterday "and again made the position clear that as far as Unison is concerned, cancer services are exempted from the industrial action".

"The trust was not able to offer any reasonable explanation as to why cancer diagnostic appointments had been cancelled. Nor did they indicate how they will rectify the situation," she said.

"This is unacceptable. The public deserves an explanation as to why these appointments were cancelled."

Meanwhile, Pat Cullen, the director of the RCN in Northern Ireland, said: "For some health trusts to cancel operations this week and, alongside the Department of Health, to attempt to blame nurses for this decision is outrageous.

"It has significantly increased the levels of anger amongst nurses and made us more determined than ever to intensify our demand for safe and effective patient care for the people of Northern Ireland."

Ms Cullen was speaking as thousands of RCN members prepared to make history today as the row over pay, conditions and patient safety reaches breaking point. It marks the first time in the 103-year history of the RCN that members will be taking industrial action.

While neither the RCN nor Unison will be on strike today, they are both staging action that includes a 24-hour ban on working overtime.

Services across the health trusts are being disrupted as a result of the stand-off between the unions and the Department of Health.

However, the Belfast Trust has imposed the largest number of cancellations as a result.

Trust chief executive, Martin Dillon, has insisted they were left with no alternative as they were unable to guarantee patient safety.

And last night, a joint statement was issued by all Northern Ireland's trust chief executives, which said: "We have been struggling with a system where funding has been made available on a yearly basis, which makes it impossible to plan for the long-term. Demand is increasing and will continue to do so meaning that the current system is simply unsustainable.

"Given the immediate risk arising from the industrial action, it is essential that we find a means of resolving the dispute in the short-term.

"We accept that this is not possible without ministerial intervention and further resource. We now all need to urgently find a resolution to the current dispute."

Belfast Telegraph