THE first of more than 478,000 strike ballots will reach NHS staff today after sneering coalition wage-breakers flouted Pay Review Board recommendations and denied the sector’s poorest workers a raise.

Unite is opening the ballot to 88,000 members in England, Wales and Northern Ireland today, while 350,000 Unison members will vote from Thursday and GMB’s 30,000 members will be polled soon after.

Unions have been highly critical of what they say has been a confused and divisive policy over pay and conditions across Britain’s four administrations.

In Scotland, workers have accepted a £300-a-year offer from Holyrood to lift low-paid workers to the living wage.

In Wales the living wage and one-off payments of £160 have been offered but disagreements over terms have led to its inclusion in the wider ballot, while Northern Ireland is yet to make a decision.

Tory Health Secretary Jeremy Hunt however has slapped down all talk of increases for the bottom rungs in England.

His decision in April to reject a Pay Review Board recommendation of 1 per cent for all workers meant that only people at the top of their pay bands received the increase, leaving 60 per cent of NHS England workers out in the cold.

An estimated 50 per cent of the workforce will therefore have to rely on their annual incremental increase, which is not necessarily guaranteed.

Unite head of health Rachael Maskell warned that the department’s “contemptuous behaviour” has infuriated NHS staff. She said: “Our members have an opportunity to send a stark message that the Health Secretary should sit down with the unions and listen. We are confident of a positive result.”

The union estimates that the NHS’s 1.3 million workers have seen pay fall by up to 15 per cent in real terms since 2010.

Unison general secretary Dave Prentis said: “The government’s refusal to give the vast majority any pay increase this year is a slap in the face. Families are suffering and morale is hitting rock bottom — a well-motivated workforce saves lives.”

In Wales, the Labour government blamed the stand-off on Tory austerity. A spokesman said: “The reality is that by 2015-16 the Welsh government’s budget will be nearly £1.7 billion less than it was in 2010-11. Our priority is to maintain jobs.”

Balloting will end in September with strike action possible from October.