Nurses are threatening to stage a fresh wave of strikes in the new year on an even larger scale if ministers fail to respond in the 48 hours following next week’s walkout.

The Royal College of Nursing (RCN) is poised to escalate its industrial action in January to hit a greater number of hospitals if the Government falls foul of its deadline, as leader Pat Cullen called for the dispute to be “wrapped up” by Christmas.

The 48-hour countdown will begin after the RCN stages its second day of strikes on Tuesday.

The union has also warned it will scale back its support for non-emergency services if further walkouts go ahead next month, with a “less generous” offer for hospitals.

The RCN has said during the action so far it will still staff chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care.

Some areas of mental health and learning disability and autism services are also exempt, while trusts have been told they can request staffing for specific clinical needs.

Ms Cullen urged the Government to break the deadlock in the bitter dispute over pay by Christmas.

“Ministers can take away the worries of nurses who are expecting to start the year with such uncertainty,” she said.

“We aren’t looking for a miracle, it is in their gift to solve it.”

She said fresh strikes in January would see “more hospitals and more nurses taking part than at present”.

Ms Cullen previously warned that without a deal there would be a further “escalation” of the action in January.

The setting of a firm deadline for ministers means the threat is now locked in.

Despite the widespread disruption caused by the nurses’ first strike on Thursday, polling showed that the majority of the public were in favour of the action.

It involved around a quarter of hospitals and community teams in England, all trusts in Northern Ireland and all but one health board in Wales.

Across England, 9,999 staff were absent from work due to the strike, while nearly 16,000 appointments, procedures and surgeries were rescheduled.

Ms Cullen has said the union’s demand for a 19% rise – dismissed by ministers as “unaffordable” – is simply a “starting point” and that she would put any new offer to her members.

But the Government has repeatedly refused to stray from the advice of the independent pay review body, despite some Tories calling for a rethink.

Nurses were recommended a £1,400 raise, which is estimated to be an average of a 4.3% raise for qualified staff.

Business Secretary Grant Shapps insisted on Saturday the approach was “fair and proper”, warning people would “all end up much worse off” if ministers awarded inflation-busting pay rises.

But Ms Cullen accused the Government of using the pay review body for “cover”, with the RCN “seriously looking at whether we take part anymore”.

“We have been hoodwinked into lending credence to this process for years and if we aren’t being listened to then it cannot be independent,” she said.