Unite, the third largest union in the NHS, is to ballot its members on the proposed three-year NHS pay deal, with a recommendation for rejection.
This "increase in militancy" follows the refusal of employers and Health Secretary Alan Johnson to reopen the negotiations on pay with those unions, including Unite, that had rejected the three-year pay proposal.
It is also asking its members that, if they vote against the deal, whether they wished to have a further ballot on taking various forms of industrial action.
Unite Head of Health, Kevin Coyne said: "The three-pay deal currently on the table is in effect a substantial pay cut when you consider the very real inflationary trends in the economy, such as soaring petrol prices, increased mortgage payments and runaway utility costs."
Indeed, food prices have risen by 6.6% over the past year – the highest rate since 1997 – according to the Office for National Statistics.
The three-year pay deal has been heavily promoted by the government and NHS Chief Executive, David Nicholson, who has warned that this year's award could be staged, if unions don't accept the three-year package.
Kevin Coyne added that Unite wished to defend and strengthen the independence of the Pay Review Body (PRB) to arbitrate pay on an annual basis. The PRB recommended a 2.75% pay award for this year, 2008/9.
Kevin Coyne has already stated that last year's 2.5% staged award in England - while NHS colleagues in Scotland, Wales and Northern Ireland received the full amount from 1 April 2007 - created "an atmosphere of seething and simmering resentment that must not be repeated".