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Midwives, nurses and ambulance workers are among more than 400,000 NHS workers in England being balloted on industrial action, including strikes, over pay.

Unison, the Royal College of Midwives, GMB and Unite made the announcements in a coordinated response to the pay deal put forward by the government in March.

It is the first time in their history that midwives have been balloted.

Ministers have given NHS staff 1%, but it does not apply to those who get automatic progression-in-the-job rises.

These are designed to reward professional development and are given about half of staff and are worth 3% a year on average.

But the decision by ministers went against the recommendation of the independent pay review board, which had called for an across-the-board rise.

In Scotland, the recommendation was agreed to in full. Northern Ireland is yet to make a decision, while Wales is doing the same as England but has given extra money to the lowest paid.

'End of their tether'

Unison has about 300,000 health members, including nurses, therapists, porters, paramedics, medical secretaries, cooks, cleaners and healthcare assistants, while 26,000 midwives are being balloted.

Unite is balloting nearly 90,000 members, including those in Northern Ireland and Wales, while the GMB has about 30,000 NHS members, including ambulance staff.

If they vote yes to industrial action, it is likely to start in October.

Unison head of health Christina McAnea said: "Balloting for strike action is not an easy decision - especially in the NHS. But this government is showing complete contempt for NHS workers."

Cathy Warwick, chief executive of the Royal College of Midwives, added: "Midwives are at the end of their tether."

The main nursing union, Royal College of Nursing, has decided not to ballot members over industrial action.

Instead, its general secretary, Peter Carter, has urged his members to campaign against the pay deal, including targeting MPs in marginal seats in the run-up to the election.

Dean Royles, of NHS Employers, said: "I completely understand the frustration and anger staff and trade unions feel.

"They are clearly annoyed at the government and I understand they will want to protest.

"But timing ballots and industrial action for the busy winter period is bound to impact on care. This is a critical time when a union campaign risks a prolonged period of real distress for patients this winter."

A Department of Health spokesman said: "We cannot afford a general pay rise on top of incremental pay increases without risking frontline jobs.

"We are disappointed that unions are balloting for industrial action. There is still time for the unions to put patients first and accept our offer to come back to the negotiating table."