Tens of thousands of British nurses will go on strike for the first time over demands for better pay, their trade union said on Wednesday, adding to pressure on Prime Minister Rishi Sunak during an economic crisis.

Nurses at the majority of state-run National Health Service (NHS) employers across Britain have voted to strike, the Royal College of Nursing (RCN) said, in action that threatens major disruption to an already strained health system.

The RCN, which has more than 300,000 members, said industrial action would begin before the end of the year following the first ever strike vote in its 106-year-old history.

“Anger has become action — our members are saying enough is enough,” RCN General Secretary Pat Cullen said in a statement. “This action will be as much for patients as it is for nurses. Standards are falling too low.”

NHS nurses have seen their salaries cut by up to 20% in real terms over the last 10 years, the RCN has said. The union is asking for a pay hike of 5% above inflation.

Britain has seen a wave of industrial unrest this year across a range of professions as pay hikes fail to keep up with inflation running at 10%.

Sunak’s spokesperson told reporters earlier on Wednesday the government wanted to strike a balance between the “crucial role” played by nurses and its fiscal challenges.

The RCN’s demands would amount to combined pay rises costing £9 billion ($10.25 billion) which would be “simply not deliverable,” the spokesperson said, adding there were contingency plans in place for any “staff impact.”

The strike will come as the NHS faces its worst ever staffing crisis while it is still recovering from the hit to services during the Covid pandemic.

The much-cherished British institution, which has provided health care free at the point of use since 1948, is now dealing with a record 7 million patients on waiting lists for hospital treatment. Accident and emergency departments are also under strain.

“We are all hugely grateful for the hard work and dedication of NHS staff, including nurses, and deeply regret that some union members have voted for industrial action,” health minister Steve Barclay said.

“Our priority is keeping patients safe during any strikes. The NHS has tried and tested plans in place to minimize disruption and ensure emergency services continue to operate.”

Sunak has already faced pressure on the issue since becoming prime minister two weeks ago, when he was confronted by an elderly patient during a hospital visit who told him he needed to “try harder” on nurses pay.

Cullen called for “serious investment” from the government as it prepares to announce a budget next week aimed at repairing the nation’s public finances.