Over a million public sector workers including NHS managers, nurses and other healthcare staff are being balloted this week on strike action over pensions changes

As revealed on hsj.co.uk last week, Managers in Partnership’s 5,500 members – including 200 chief executives - will be included in Unison’s ballot, issued on Monday. Other unions, including Unite and the Chartered Society of Physiotherapy are also balloting members.

If members vote “yes”, a coordinated “day of action” will take place on 30 November, potentially leading to a series of strikes.

MiP chief executive Jon Restell has written to members explaining the “extraordinarily difficult” decision to ballot.

Mr Restell’s letter said MiP members were “united in anger and concern about the unfairness of the changes” and the union had “heard more from members on this issue [of pensions] than any other”.

However, it also stated that industrial action was an “extraordinarily difficult issue for a managers’ organisation” and said MiP would “respect” members opposed in principle to taking industrial action.

The changes would see final salary pensions scrapped, higher employee contributions and a raise in the retirement age.

NHS Employers director Dean Royles responded by warning that “patients will find the prospect of industrial action upsetting particularly when discussions over pensions have not yet concluded”.

In a statement fo HSJ, he also acknowledged the “important role” managers had traditionally played in “protecting services and ensuring contingency plans are implemented”.

“Organisations will expect managers to undertake responsibilities in the delivery of important and essential services, in the event of industrial action,” he said.

Many of the main health unions – including the Royal College of Nursing and British Medical Association - have held off against industrial action for now.

On Monday the Nursing and Midwifery Council was forced to back down after issuing a statement suggesting nurses who went on strike could be breaching their code of conduct.

This came three days after Unison had threatened the regulator with legal action, calling the NMC’s statement “intimidating”.