More than 50,000 health workers are being balloted on strike action in a dispute over pay for NHS staff.
Unison is balloting health workers in Scotland after the 5% increase offered by Health Secretary Humza Yousaf was rejected.
The union said it is the first time since devolution that health workers have been balloted for strike action over pay.
Unison Scotland’s health committee said the pay offer is a “real-terms pay cut” and is recommending that members vote for strikes.
Wilma Brown, chairwoman of Unison Scotland’s health committee, said: “These are unprecedented times and NHS staff are struggling to make ends meet.
“The Scottish Government’s pay offer is nowhere near enough and leaves everyone in the NHS worse off. It’s a real-terms pay cut across every single NHS salary band.
“We’re in the biggest cost-of-living and NHS staffing crisis in history and yet the Scottish Government want hard-working health workers to accept a real-terms pay cut.”
The ballot opened on Monday and runs until October 31.
Matt McLaughlin, Unison Scotland’s head of health, said: “Ministers need to understand the anger of health staff who are working in an underfunded, understaffed NHS.
“It’s already an extremely stressful environment without having to worry about how you will pay your bills and feed your family.
“Nobody wants to take strike action but without an improved pay offer, our members will be left with no choice.”
Mr Yousaf said: “Any ballot for industrial action is disappointing.
“We are engaged with health unions and I hope we can come to an agreement on pay in the near future.
“This work continues in the context of our Emergency Budget Review following the UK Government’s fiscal event.”
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