TRADE union chiefs have insisted over the past fortnight that their doors remain open for "dialogue" with health officials in an eleventh-hour bid to avert strike action.
However, they have also pointed to the anger of their members who voted overwhelmingly to take to the picket lines over "unsafe" staffing levels and being paid less than their NHS counterparts.
For Department of Health civil servants, the issue comes down to their squeezed budget meeting the demands of a service under enormous pressure - resulting in no money being found to address the pay issue.
The fallout is that from next Monday, November 25, the union with the lion's share of the north's health and social care workforce will begin 'work to rule' action.
For a sector that often relies on the goodwill of its staff, from the nurses and paramedics to porters and domestic staff, the impact of Unison's decision will be felt most by patients.
As their "wave" of industrial action escalates, it will coincide with similar plans by colleagues in Royal College of Nursing (RCN) from the first week of December.
This will lead to potentially joint strike action on December 18, when RCN members will take the unprecedented step of withdrawing their labour from many hospital and community services for 12 hours.
When challenged about nurses' duty of care to patients, RCN chief Pat Cullen has defended the decision on the grounds that patients are "already suffering" with record high waiting lists and cancelled operations.
Both unions accept the impact of their decision on patients will be "significant" - but argue they must do this in ordered to be heeded by the department.
Despite quiet optimism that a deal could be reached, it appears that after more than a year of negotiations strike action is now inevitable.
