Ambulance workers are set to take a vote on whether to take industrial action.
The GMB union is opening a ballot for its members on October 24 across 11 trusts, including the North West Ambulance Service, and if they are in favour, it is likely action will be taken before Christmas.
The union says its members felt that cuts and shortages meant they were unable to deliver safe standards of patient care.
GMB Union has announced industrial action ballot dates for more than 15,000 ambulance workers across 11 trusts in England and Wales for strike action.
The ballots follow consultative votes across all the trusts in which workers voted strongly in favour of strike action.
Workers are angry over the Government’s imposed four per cent pay award, which leaves them facing yet another massive real terms pay cut, the union said.
Rachel Harrison, GMB national officer, said: “Ambulance workers have just had enough. They’ve not been on strike in decades, but they are at the end of what they can take.
“Pay has been systematically slashed for more than 10 years and we now face the worst cost of living crush in a generation. Meanwhile vacancies are at record highs and we have the worst A&E delays ever – and it’s not even the winter flu season yet.
“But this is about more than pay and conditions. Cuts and shortages mean GMB members feel they are unable to deliver safe standards of patient care. Things can’t go on like this – something has to give.”