Health officials have offered fresh talks with trade unions on staffing proposals in a last-ditch bid to avert strike action planned for this week.

In a direct appeal last night, Northern Ireland's top health official said dialogue rather than industrial action represented the best way forward.

The crisis gripping the health service continued yesterday with midwives here beginning to vote on taking part in industrial action.

Nurses from the Royal College of Nursing (RCN) will tomorrow stage their second day of strike action over staffing levels and pay.

A further strike has also been planned for Friday. However, last night the permanent secretary of the Department of Health said it was still not too late for trade unions to defer the industrial action and get back around the negotiating table.

Richard Pengelly said the Royal College of Nursing has written to the department detailing a series of proposals on staffing.

He said: "Up to this point, discussions with unions had concentrated on pay issues. Now, the RCN has itemised specific demands in respect of safe staffing levels. In our view, these proposals can provide the basis for serious engagement.

"We have repeatedly made clear that our door remained open for discussions, with the specific aim of drawing up a detailed, costed implementation plan on staffing.

"We see no good reason why such dialogue cannot begin immediately. Deferring strike action would be in the best interests of patient and patient safety and would provide the necessary space for fresh dialogue.

"Our hospitals are already under severe pressure at present, even before the planned industrial action takes place this week."

Mr Pengelly added demands for pay parity was a matter for consideration by a minister. The position, he said, cannot be changed by industrial action.

"In terms of political resolution, all main political parties have already publicly supported the calls for parity with England and talks are ongoing about restoration of the devolved institutions," he said.

"It is only that process that can provide the mechanism for a sustainable solution on pay.

"In that context, we would encourage unions to reflect on what possible objective could be served by further industrial action at this time."

The ballot by the Royal College of Midwives (RCM) opened yesterday and will close on January 29.

They urged members to "vote yes", calling for industrial action up to and including strike action.

The RCM claims the decision to ballot its members "comes after nine years of pay restraint which has seen midwives and Maternity Support Workers (MSWs)... earn up to £2,000 less than their colleagues in England".

Karen Murray, the RCM's director for Northern Ireland, explained: "We have exhausted every avenue over a number of years in trying to resolve this dispute with the Department of Health.

"Despite our best efforts to negotiate a fair pay deal for our members, the department have failed to come to an agreement.

"Our midwives here are much worse off in their pay packet than their colleagues in other parts of the UK.

"This is simply neither right nor fair. That is why we are recommending our members to vote yes to industrial action."

Meanwhile, additional strike action from the Royal College of Nursing (RCN) is set to take place tomorrow and Friday, while members of the largest healthcare union Unison will walk out on Friday.

Belfast Telegraph