Strike ballots in the health unions runs up to the end of September, with Unison's closing date on the 18 September and Unite on the 26th.
A pay offer of 1% for 2 years, with no rise at all for those who receive an incremental rise, has angered workers, but a good turn out in the ballot would be very significant.
The government has stopped the Health Pay Review Body from even going through the motions of reporting on annual pay this year. Instead it has been asked to propose cuts in unsocial hours pay, should further galvanise the vote.
The proposal to begin strikes in October with a four hour walk out is a good tactic in the NHS, which has proved effective in the past, for example in Australia during the campaigns on staff ratios.
Short strikes can have an impact without too much harm for patient care. Well supported strike action could give great confidence to health workers, and short strikes can give an opportunity to build amongst those who have concerns about action impacting too much on patients.
Another connected issue is the handling of emergency exemptions, which can be minimised if strikes are short.
It is vital that discussions on strike tactics are held at workplace level where union members know what action can be most effective and that these discussions happen now.