Most NHS staff receive a 3% automatic pay rise each year, Mr Hunt said the additional 1% for all staff could risk another Mid Staffs scandal

NHS workers will strike again this winter unless the Government agree to their pay demands, unions warned today in the wake of the first walk out for 30 years.

As the colder weather approaches, so too does the health service's most challenging time of the year.

But if health secretary Jeremy Hunt refuses to grant all NHS staff a one per cent pay rise, more industrial action will result, bosses have said.

Unite, one of seven unions taking part in industrial action today, said they are already planning more action.

Their head of health, Rachael Maskell, said: 'We are already planning, and will definitely be taking, further industrial action if the Government doesn't put more money on the table and doesn't talk to us.

'There will definitely be more industrial action by NHS staff if Jeremy Hunt doesn't sit down and talk and make more money available.'

The warning comes as members of the military were forced to step in when more than 400,000 NHS staff staged a four-hour walk out this morning.

But it emerged only a fraction of workers who belong to unions taking part, voted to strike in the row over pay.

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The military today stepped in as more than 400,000 NHS staff including nurses, midwives and paramedics walked out for four hours this morning in a row over a one per cent pay rise. A soldier helps a paramedic with a stretcher outside the Royal Liverpool Hospital

Soldiers help ambulance crews with an emergency admission at St Thomas' Hospital in central London

A member of the Armed Forces is pictured helping an ambulance crew transport a patient at the Royal Liverpool Hospital during today's strike - the first action of its kind by NHS staff since 1982

An ambulance is driven by a member of the military through central London

Laura Mackenzie with her son Gabriel, four months, and Biz Rance and her 11-week-old son Finn, on the picket line outside London's King's College Hospital

Royal College of Midwives' members waves flags calling for action to 'Protect maternity services' outside King's College Hospital in London

Staff outside Saint Michael's Hospital in Bristol take part in the action. Members from eight unions took part in the strike from 7am to 11am

A child brandishing a Unison poster calling for 'Fair pay for NHS staff' stands on the picket line outside the Bradford Royal Infirmary (left), while an NHS worker carries the same placard at the Royal Berkshire Hospital

Hundreds of thousands of health workers are set to bring the NHS to a halt today by walking out in a row over pay. Staff protest outside the Royal Berkshire Hospital in Reading this morning

Picket lines were mounted outside hospitals across England, including the Royal Berkshire, this morning from 7am. They are set to stay in place for four hours

Fewer than half those balloted for the controversial health strike voted in favour of the action - the first since 1982 - the Daily Mail revealed.

And Unison, one of the biggest unions representing around 300,000 healthcare workers, could persuade fewer than one in ten – 9.5 per cent – of eligible members to vote for the controversial walkout.

None of the other six trade organisations involved managed to get a mandate from more than half of those balloted.

Yet 400,000 nurses, midwives, paramedics, specialist health staff and hospital porters and cleaners staged the walk out from 7am for four hours.

They will take other forms of industrial action, in the form of work-to-rule, for the rest of the week, including ensuring staff take their allotted breaks and refusing to work any overtime.

Further action is expected to take the form of another four-hour walk out but union sources warned it could escalate to a full day strike.

Ms Maskell told the Guardian: 'It's clear that the Government are going to have to find money (to settle) this (dispute).'

Hospital bosses said today's action had a 'minimal effect' on patients and services, while union leaders said it had represented a 'tremendous display of courage, strength and solidarity'.

A spokesman for the Poole Hospital NHS Foundation Trust said the strikes had caused a 'minimal effect'.

He added: 'I wouldn't say it's been business as usual but it's been close to it.'

Meanwhile a spokesman for the Hampshire Hospitals NHS Foundation Trust, which covers hospitals in Andover, Winchester and Basingstoke, said that the trust had encountered no major incidents, no cancellations and no disruption to its hospitals' maternity services during the strike.

'We worked closely with the unions and staff to make sure there was minimal impact on patients,' he said.

'Our staff are committed to ensuring our patients are safe at all times and would not do anything that places patients at risk.'

Members of Unison on the picket line outside London's St Thomas' Hospital in Westminster, just across the River Thames from the Houses of Parliament

But fewer than half those balloted for the controversial health strike voted in favour of the action, the Daily Mail can reveal

Seven unions taking part in the industrial action are calling for a one per cent pay rise for all NHS staff

Hospital chiefs in Kingston-on-Thames, Reading, Portsmouth and Slough also said the action had caused little disruption.

The strike involved workers from seven trade unions, including the Royal College of Midwives, which was taking action for the first time in its history. It involved nurses, midwives and ambulance staff but not doctors.

The damning turnout figures, which increase pressure for the urgent reform of unions' powers, are published as the NHS faces being brought to a standstill this morning.

Soldiers and police officers were called in to drive ambulances, taking the place of trained staff

The move sparked a row as unions claimed they had been kept in the dark about the plans.

Jason Killens, London Ambulance director of operations, said: 'We are expecting to be under significant pressure.'

The strike was in protest at the Government's decision not to accept a recommended one per cent pay rise for all NHS staff.

Instead, ministers took the 'divisive' decision to only award a one per cent pay rise for those on the top of their pay band, which unions say has denied it to 60 per cent of NHS workers.

But health secretary Jeremy Hunt said if the pay rise was implemented in addition to an automatic three per cent pay rise for most NHS staff each year, hospitals would be forced to lay off more than 14,000 nurses by next year.

Mr Hunt added that he would not be taking a nine per cent pay rise for MPs, calling the proposed increase wrong'.

Midwives, nurses and other health workers mounted a noisy protest outside St Thomas' hospital opposite Parliament in Westminster.

Most passing cars, buses and lorries tooted in support and patients arriving for appointments said they backed the action.

Midwives shouted: 'Don't push midwives - push fair pay.'

They said they never imagined having to go on strike but were at their wits' end.

Annie Black, who has been a midwife for 12 years, said: 'We haven't had a pay rise for years yet our workload keeps on increasing. It's time the Government took us seriously.

'It's weird being on strike, but we feel that enough is enough.'

For midwives and members of the Royal College of Midwives today's strike was the first in the union's history

They joined nurses, paramedics, hospital porters and cleaners among other staff to protest at the Government's decision

In total six different unions took part in today's walk out and will be taking more industrial action, just short of a strike, for the rest of this week

Ian Evans, a biomedical scientist at the Royal Sussex County Hospital in Brighton, said: 'For the last four years we have had a continuing reduction in pay and our earnings.

FIRST NHS STRIKE OVER PAY IN MORE THAN 30 YEARS The last time NHS staff walked out in a row over pay was 32 years ago. In 1982 restructuring and pay demands led to the longest NHS dispute. Nurses didn't strike but consultants were only treating emergency cases. The three-day strike rocked the health service, under Margaret Thatcher. Millions took part in the action and a national rally in London saw more than 120,000 people take to the streets, with demonstrations in towns across the UK. More recently, a one-day strike of public sector unions over pensions rights in 2011, led to some NHS walk outs. Today's strike by members of the Royal College of Midwives, marks the first walk out midwives and support staff since the union was founded during Queen Victoria's reign in 1882. Advertisement

'This year we were offered one per cent, well 40 per cent of us were offered one per cent.

'The rest were told, 'well you already get an increment anyway so you don't deserve a pay rise at all'.

'We argue and dispute the point that these incremental steps are the movement towards the correct pay, the genuine pay for the job.

'We do not believe people should be demonised or should suffer financially.

'We believe that everybody should be awarded a pay rise that actually mimics the living wage, which we are not getting.'

Outside the busy maternity unit at Newcastle's Royal Victoria Infirmary, around 40 midwives were on the picket line and cheered every time a driver tooted their horn in support.

Becky Banks, 41, who has been a midwife for 18 years, said the public's support for their strike action had been 'overwhelming'.

She said: 'It is incredibly unusual to be on strike. Strike action is something we are undertaking with a heavy heart because we do not want to jeopardise any care for women and their babies.

'We need to show Jeremy Hunt how angry we are. He has backed us into a corner and left us with no other option.

NHS staff who are members of the Unite and Unison unions stand in protest outside Bradford's Royal Infirmary

The last time NHS staff staged a walk out was more than 30 years ago in 1982

Workers carrying Royal College of Midwives placards strike outside the Luton and Dunstable hospital

PREGNANT WOMAN RUSHED TO HOSPITAL BY POLICE OFFICERS A woman who went into labour during the strike action was helped to hospital by police as thousands of midwives went on strike for the first time. Officers were called by the London Ambulance Service, whose crew needed help getting the heavily pregnant woman down stairs at a block of flats in Highbury, because there was no lift. She was experiencing contractions every 90 seconds and was eventually taken to a hospital in north London by ambulance. The condition of mother and child is not yet knowm. A Met Police spokesperson said: 'We were called at approximately 8.10am to an address in Highbury by the London Ambulance Service who requested assistance to deal with a woman who was in heavy labour. A solo paramedic had attended the scene. 'Officers attended the property where the woman was experiencing contractions every one and a half minutes. 'She lived on the third floor of the block of flats, which had no lift, and therefore required assistance to get down the stairs. 'A second paramedic arrived at the address and the woman was taken to a north London hospital by ambulance. 'Officers were able to provide a convoy on blues and twos to ensure she could be transported as swiftly as possible. 'We await an update as to the baby's arrival.' Advertisement

'It's absolutely not a life-changing amount of money but it was recommended by the Independent Pay Review Body that we were awarded this one per cent.

'We are wanting what we deserve, we work very long hours. It is a marvellous job and it is an honour to do the job, but we do deserve recognition for that, we still have bills to pay.

'Public support has been overwhelming. We are absolutely buzzing from the support we have had.

'Anybody who comes into contact with midwives knows what an amazing job we do and we work very hard to care for the women we look after, so public support is right behind us.'

Colleague Kate Robison, who joined the NHS in 1972 has only been on strike once before.

The 60-year-old midwife said: 'Jeremy Hunt needs to come on the shop floor and work with some of the midwives and see what we do.

'Come and work a 13 hour shift without a break, and do overtime that is not paid, because that is the reality for many midwives working within the NHS today.

'Clients do back us because they appreciate what our job is.

'We want it recognised that in real terms, our pay is back where we were in 2006.'

Christina McAnea, national officer of Unison, said: 'This is the first time in 32 years that NHS workers take industrial action over pay, and for many, it will be the first time.

'Up and down the country, hundreds of thousands of workers are out fighting for fair pay and for the NHS.'

An ambulance carrying a member of the armed forces, drafted in as part of the Department of Health's contingency plans, drives past a protest at the Royal Liverpool Hospital

Nurses, midwives, paramedics, hospital porters and cleaners on the picket line outside Leeds General Infirmary protesting at the Government's decision not to award a one per cent pay rise to all NHS staff

Mark Boothroyd, a staff nurse at St Thomas', said: 'We have had a pay freeze for four years, so not accepting a recommended one per cent from the pay review body was the last straw.

ANGER ON THE PICKET LINES OVER MPS' 10% PAY RISE Anger erupted among striking NHS staff over a planned 10 per cent pay hike for MPs. Health secretary Jeremy Hunt made it clear he will not be accepting the pay rise, which he branded 'wrong'. But staff on picket lines across the UK critcised the 'ridiculous' situation. Paul Larkin, 47, who works as part of a community mental health team, said: 'I'm here because of the injustice of members of parliament who have given themselves a 10 per cent pay rise, but will not agree to a one per cent increase for NHS staff, even though an independent body said it was affordable and necessary. 'I have never done anything like this before, but it seems to me that they are slowly eroding the service, while giving themselves a 10 per cent pay rise, it is ridiculous.' TUC general secretary Frances O'Grady, said the situation was 'stupid'. She said: 'We don't feel sore about MPs getting a pay increase, but when MPs who have voted for public service workers to get real pay cuts, it feels pretty sore if they get a much bigger increase themselves. Advertisement

'There is chronic under staffing and increasing workloads, while the NHS is being privatised.

'At the same time, MPs are being paid a double digit pay rise because David Cameron says he cannot interfere with what is being recommended. It's just not fair.'

Several unions were involved in the action, including the Royal College of Midwives for the first time in its history.

Speaking ahead of the walk out, Jane Cummings, NHS England's chief nursing officer, said: 'We would ask the public to help, for example, by only calling an ambulance if it is a life-threatening situation.

'As ever, the safety and care of patients is our top priority and we have robust plans in place to cope.'

Militant union leaders are furious they have been denied a one per cent salary rise.

But turnout data suggests they have failed to capture the full support of their members.

Conservative MP Dominic Raab, who calculated the figures, said: 'It is totally wrong for militant union leaders to be striking, putting the NHS at risk.

'Everyone in the NHS will be getting a 1 per cent pay rise, and most low and middle income staff substantially more.

'This explains why not one of the striking unions has the support of a majority of its members, with Unison mustering less than 10 per cent support.

'The hardliners need to take a long hard look in the mirror – they are hurting their members, the NHS and the wider public.'

NHS workers man a picket line outside University College Hospital in central London this morning

An ambulance passes strikers protesting outside the Royal Liverpool Hospital. It is the first walk out by NHS staff for more than 30 years, the last strike action being taken in 1982

Placards outside the Royal Liverpool Hospital make calls to 'Save our NHS from the enemy within,' bearing pictures of David Cameron, Nick Clegg and George Osborne

Staff have said 'enough is enough' after a six-year pay freeze. But the Government claim meeting the recommended pay deal would force hospitals to lay off nurses

Signs brandished by Unison members outside UCH in central London called for 'Fair Pay for NHS Staff'

But in contrast, union leaders said there had been 'tremendous support' for the strike across the country.

Len McCluskey, general secretary of Unite, accused the Conservatives of 'lying' over their treatment of the NHS.

He told strikers at St Thomas' Hospital: 'By taking action on such a miserable morning you are sending a strong message that decent men and women in the jewel of our civilisation are not prepared to be treated as second-class citizens any more.

'We also have a message for the Labour Party that if they get elected next year they have to invest in the NHS and the staff.'

Mr Hunt said the Government has been prepared to talk to the unions throughout the row, recognising the invaluable work front line staff do.

He said: 'We will talk to them if they're prepared to look to reform the system of increments, which is unclear and unfair.

'I recognise frontline staff do a magnificent job in the NHS. We have had more than 650 NHS volunteers who are willing to put themselves in harm's way to help tackle the Ebola crisis in West Africa.

'We have magnificent people.

'We're offering them all a one per cent rise. The majority of NHS staff get an automatic three per cent increment but we can't afford to give a one per cent rise to people already getting that.

Ambulance crews protest outside the Whipps Cross University Hospital in Waltham Forest, London today

Staff from Kings Mill Hospital in Nottinghamshire join thousands of NHS workers taking strike action

Unimpressed: Conservative MP Dominic Raab (above), who calculated the figures, said the 'hardliners need to take a long hard look in the mirror - they are hurting their members, the NHS and the wider public'

'We're coming through a very difficult period with the tragedy of Mid-Staffordshire.

'We now have got 5,000 more nurses in just a year. We're recruiting nurses like crazy at the moment and to put that in reverse would not be the right move at the moment.

'The most important thing here is doing the right thing for patients.

'It would be irresponsible for any health secretary to accept a pay package that means the NHS has to lay off nurses.'

Mr Hunt said that hospitals would be forced to lay off staff if the recommended pay award was met in full.

'Nearly 60 per cent of NHS staff get an automatic pay rise through their increments of an average of three per cent.

'We can't afford to offer a one per cent on top of the three per cent,' he told the BBC Radio 4 Today programme.

'We have had very clear analysis that if we did that, hospital chief executives would lay off around 4,000 nurses this year and around 10,000 nurses next year.

'The NHS has just come through a terrible tragedy with Mid Staffs when we discovered the most appalling care happening there and indeed some other hospitals as well.

'We have turned the corner on that by recruiting in hospital wards around 5,000 extra nurses in the last year alone. We don't want to turn the clock back on that.'

Mr Hunt said the majority of NHS staff already get an automatic three per cent pay rise each year, adding the Government cannot afford to give a one per cent rise on top of that. He said the NHS has 'turned a corner' since the Mid Staffs scandal after recruiting 5,000 nurses, adding: 'We don't want to turn the clock back on that'

TUC general secretary Frances O'Grady, who joined a picket line near Euston in London, said: 'NHS staff are always reluctant strikers - there hasn't been a national strike over pay in the health service since 1982 - and they will do everything they can to protect patients in their care. But morale has hit rock-bottom.

'It is no surprise that the NHS is finding it hard to recruit and retain staff as they find themselves squeezed between falling living standards and covering up for NHS cuts.'

Cathy Warwick, chief executive of the RCM, said: 'At a time when MPs are set for a 10 per cent pay hike, we're told that midwives don't deserve even a below-inflation one per cent rise.

'And politicians wonder why the public does not afford them more respect.

It would be irresponsible for any health secretary to accept a pay package that means the NHS has to lay off nurses

'It feels to a great many people, including midwives, that there is one rule for them and another rule for everybody else.

'The independent panel of experts who advise the Government on NHS pay recommended a one per cent pay rise for midwives, nurses, paramedics and other NHS staff.

'Unfortunately, Health Secretary Jeremy Hunt rejected that recommendation, and he and the employers decided that midwives and others won't get a pay rise this year.'

Public sector workers are still earning thousands of pounds a year more than those in the private sector, the Institute for Fiscal Studies reported last week.

The average public-sector pay and pension deal is worth 17 per cent more than the private sector, it found.

The Tories have long promised action to prevent unions holding walkouts without any popular mandate.

But aides say any attempt to change the law in this Parliament would have been thwarted by the Liberal Democrats.

Cabinet Office Minister Francis Maude said the next Tory manifesto would include the requirement for at least half of eligible union members to vote in order for a strike to be lawful.

There would also be a three-month time limit after the ballot for the action to take place and curbs on picketing.

NHS workers strike in 1982, mounting a picket line outside London's Hammersmith Hospital

Millions took part in the three-day action in a dispute over pay. More than 120,000 people took to the streets of London as part of a rally during the strike

Mr Maude said: 'None of the union leaders pushing this irresponsible strike action could persuade a majority of their members even to vote, let alone to support a strike.'

But union leaders object to the proposals. Frances O'Grady, general secretary of the Trades Union Congress, has previously said that any such actions would be 'designed to make legal strikes close to impossible'.

She added: 'Not a single MP would have been elected under these rules.'

Of the seven unions striking today, turnout data has been published for four, none of which managed to persuade a majority of their members to vote for the action.

We are expecting to be under significant pressure Jason Killens, London Ambulance director of operations

Only 14 per cent of eligible Unison members returned their ballots.

While 68 per cent of those who voted approved industrial action, giving them the legal mandate to strike, only 9.5 per cent of all eligible members actually backed the action.

The Royal College of Midwives had the best result, but even it managed to persuade only 40 per cent of members to vote for the strike.

Three of the other unions taking action today - Unite, the British Association of Occupational Therapists, and the NHS bosses' union Managers in Partnership - refused to publish their turnout data.