THE threat of a nurses' strike has left a further cloud over the controversial shake-up of East Lancashire hospital services.

For the first time health unions - upset at a Government decision to introduce their wage rises in two stages - have threatened to mutiny over pay.

An 11th-hour pay offer by Whitehall could avert the strikes among nurses, health visitors and other NHS workers.

But the possibility of action at what would be a crucial juncture for the service in East Lancashire has not gone away.

The next couple of months will be the busiest ever seen in the Health Service in East Lancashire as the Meeting Patients Needs programme arranges service transfers between the Royal Blackburn and Burnley General hospitals before a November 1 deadline.

While contingency arrangements would come into force, in the event of industrial action, one of the last things health chiefs wanted was the threat of disruption.

Nick Hayes, East Lancashire Hospitals NHS Trust's head of human resources, said: "Should any of the unions announce that their members are to take strike action, the trust would hold urgent talks with the unions to agree minimum staffing levels.

"This ensures minimum disruption to our patients throughout the industrial action. This is what routinely happens when industrial action is imminent and is not particular to the current Meeting Patients Needs programme of planned changes." Last Friday Health Secretary Alan Johnson held out an olive branch to nurses, promising greater increases for lower grades, which could end up tipping the balance.

Lower pay band nurses would receive at least a £400 rise and staff in grades three and four would get 2.5 per cent, plus an additional £38.

The same rate would be available for grades five to eight, with the £38 payable for professional fees.

From the Royal College of Nursing (RCN) through to the health sections of unions Unite and Unison there has been widespread discord about this year's pay settlement.

Months of tense talks have followed the NHS management's offer of a 1.5 per cent backdated to April, with the remaining one per cent increase paid in November.

The reaction to the pay deal has divided the main union representatives, with some sounding more optimistic than others.

Kevin Coyne, head of health at Unite, formerly known as Amicus, said: "This is a breakthrough in the pay negotiations.

The new package offered by the treasury gives extra help to the low paid and for staff in England. This pay remains staged. However there is also a commitment to review future pay and conditions."

But Dr Peter Carter, RCN general secretary, was more guarded - the results of the union's original ballot will be made known this week.

Dr Carter said: "By running a hard-hitting campaign and an industrial action ballot, we have focused the minds of ministers, brought them back to the negotiating table and secured an improved offer for nurses."