UNISON has opened a formal ballot of health and social care workers in Northern Ireland over the delayed 2026-27 pay award, the union confirmed on Tuesday 10 November 2026.

The ballot, which runs until 1 December 2026, asks eligible members whether they will take industrial action, including strike action and action short of a strike, over pay. No strike date has been announced, and the vote does not mean hospital appointments have been cancelled.

What is the dispute about?

At the centre of the dispute is a 3.3 per cent Agenda for Change pay uplift recommended by the NHS Pay Review Body for staff across all four UK nations. Staff in England and Wales received the uplift from April 2026, but it has still not been implemented for health and social care staff in Northern Ireland.

UNISON, the largest union in health and social services in Northern Ireland, also says a commitment to pay the Real Living Wage to the lowest-paid staff has not been delivered. The union says the commitment, at a rate of £13.45 an hour when it was made, was to be backdated to 1 April 2026.

UNISON Regional Secretary Patricia McKeown said members were being “denied pay justice”, caught between a UK Government that was not providing enough resources and an Executive that had not yet agreed how to put pay right for tens of thousands of public sector workers.

Ballot details

The ballot covers health and social care staff across Northern Ireland’s five Health and Social Care Trusts, including the Southern Trust serving Newry, Mourne and Down. Members are being asked to vote on both strike action and action short of a strike, so the union has the full range of options if members back industrial action.

UNISON had announced in October that the ballot would open on 10 November, after its Regional Council met in Belfast and demanded urgent action on public sector pay.

Wider pressure over NI health pay

UNISON is not the only union taking action over the stalled award. The Royal College of Nursing opened its own statutory ballot on 14 October, with papers due back by 20 November. The Royal College of Midwives has also reported that 96 per cent of members who responded to its consultative ballot said the delay was unacceptable and that they would be willing to take industrial action.

Health unions say Stormont has been unable to agree a budget for the current financial year, leaving the pay award without funding. The Department of Health has previously said it is committed to pay parity with the rest of the UK, but no implementation date has been set.

The result of the UNISON ballot is expected after voting closes on 1 December. If members vote in favour, the union would then decide whether and when to call industrial action.