The Government has been accused of being “on strike” itself during the biggest walkout in NHS history.

The service saw a “hugely disrupted day” after tens of thousands of workers in England took part in the industrial action.

Union leaders have implored ministers to act to prevent further strike action, but ministers in England have indicated that they will not budge on one of the main points of contention – pay for 2022/23.

The Royal College of Nursing (RCN) accused Prime Minister Rishi Sunak, Health Secretary Steve Barclay and Business Secretary Grant Shapps of being “missing in action”.

RCN general secretary Pat Cullen told the PA news agency: “No Health Secretary and no Business Secretary were there to answer urgent questions in Parliament today – and no response from the Prime Minister after I wrote to him this weekend.

“People may wonder if the Government is also on strike.

“In Parliament today, we heard more of the same from a Government whose most senior figures seem to be missing in action.

“The Westminster Government is punishing England’s nurses and looking increasingly isolated as the Welsh and Scottish governments come to the table.

“It is clearer than ever that the Prime Minister has failed to deliver on his promises to the NHS.

“Rishi Sunak is letting the country’s most important and beloved institution deteriorate rapidly – but it is not too late. I am urging him to come to the table to negotiate and halt this action now.”

Health minister Will Quince, who responded on Mr Barclay’s behalf, said Mr Barclay was attending a Cobra meeting so could not be in the House of Commons to answer urgent questions.

Nurses from the RCN staged walkouts alongside GMB and Unite paramedics, call handlers and other staff at ambulance trusts.

It was the first time ambulance workers and nurses walked out on the same day.

Nurses will strike again on Tuesday, ambulance workers again on Friday and physiotherapists on Thursday.

NHS leaders said it would be the “most disruptive week of strikes to date” – but urged people to seek urgent and emergency care if they need it and attend appointments as planned unless they had been contacted in advance.

Unions in Wales largely suspended similar action after the Welsh Government came forward with an improved pay offer on Friday.

Saffron Cordery, deputy chief executive of NHS Providers – which represents NHS trusts, told Sky News: “I think it’s going to be a hugely disrupted day across the NHS. It’s going to be incredibly challenging.

“With both nurses and ambulance staff out on strike today, and nurses again tomorrow – and we’ve got physiotherapist later in the week and some ambulance staff again on Friday – we’re planning for an incredibly disrupted week.”

She urged the Government to negotiate with unions on 2022/23 pay.

“I hope it ends by the Government coming around the table to negotiate a settlement for this year’s pay for NHS staff,” she said.

But during a visit to Kingston Hospital in south-west London, the Health Secretary appeared to rule out coming to a new agreement on 2022/23 pay.

Mr Barclay said: “We have been discussing this coming year – from April – pay with the unions,” he said.

“We have this process through the pay review body; it’s an independent process and we’re keen to get the evidence so that that reflects the pressure that the NHS has been under and the wider context in terms of inflation.

“I don’t think it’s right to go back to last year, back to April, retrospectively.”

Meanwhile, Downing Street said it wants to look forward and “not backwards” when it comes to negotiating on pay with health unions.

The Prime Minister’s official spokesman, asked what is Mr Sunak’s plan for ending the strikes, said: “We want to keep discussing how we can find a path forward with the unions.

“Our long-standing position is that above-inflation pay rises are not acceptable, given the impact it would have on taxpayers and the risk of increasing inflationary pressures.

“But we do want to find a path forward. We think the right way to do that is to talk about this year’s (2023/24) pay offer prior to evidence being submitted to the pay review body.”

Asked whether unions should “give up hope” of negotiating on 2022/23 pay, the No 10 official said: “I think we would say we want to keep talking about ways forward.

“We think it is right to focus on this year’s pay and not look backwards. As the minister said this morning, our door remains open.”

But Labour accused ministers of “sitting this one out” when it comes to negotiating with striking nurses and ambulance workers in England over pay.

Party leader Sir Keir Starmer, speaking to broadcasters at Airbus in Filton, near Bristol, said: “Nobody wants to see these strikes, nobody wants to be on strike – the last thing nurses want to do is to be on strike.

“What they do want is a Government that can show leadership, get around the negotiating table and settle this dispute.

“I think many people listening to this will be absolutely flabbergasted that the Government is still sitting this one out, not showing any leadership in the middle of a cost-of-living crisis, making the situation much worse than it otherwise would be.”

Health minister Mr Quince said around 88,000 procedures or outpatient appointments have been postponed because of industrial action over the last eight weeks.

Answering an urgent question from Labour on Monday, he said: “Over a million NHS staff have been given at least a £1,400 increase in their pay, representing a 9.3% rise for those on the lowest salaries.

“Last year NHS staff also received a 3% pay rise even when pay was frozen across the rest of the public sector. We’ve done this because we know how hard NHS colleagues work and we recognise that there are cost-of-living pressures on NHS staff.

“Our goal has always been for a resolution that is fair for colleagues and fair for the country, to find a way forward that ensures that we are spending money where it’s needed most, helping the NHS recover from the pandemic, and not on pay hikes that would stoke the inflation and ultimately make us all poorer.”