Britain's nurses yesterday raised the prospect of taking the first industrial action in their union's history because of anger at government cuts to NHS services.

Nurses would refuse to work more than their contracted hours, take all their allotted meal breaks and decline to fill in paperwork outside their normal job description, under plans being discussed at the annual conference of the Royal College of Nursing (RCN) in Liverpool.

The RCN's general secretary, Peter Carter, said the union did not have a no-strike agreement, although he played down the threat of a full-scale walkout among its 400,000 members.

The move puts further pressure on the Health Secretary, Andrew Lansley, who will meet nurses' representatives at the congress tomorrow. He is already under acute pressure over his controversial health reforms.

A Department of Health spokeswoman said the nurses have no justification for strike action. She said health expenditure was increasing every year in comparison with other areas of public spending, and that all the "savings" made by the NHS would be reinvested in the service.

The Coalition fears that the £20bn worth of savings the NHS will have to make over the next four years – in order to meet increasing health demands with almost no increase in the overall budget – is being confused by voters with the effect of the reforms.

In addition, some members of the Government are worried that trying to push through such whole-scale reform of the NHS while trying to find huge savings could further destabilise the service. "There is certainly a case across Government that we could have sold these reforms more clearly than we have done up until now," said one source. "We have to let the public know that these reforms are not the problem, they are the solution."

About 50 nurses will meet Mr Lansley tomorrow as part of the Coalition's "listening exercise". Government officials have tried to insist that he meets the nurses in small groups and that the meetings are held behind closed doors.

Dr Carter said he was disappointed that the event was not going to be open to all nurses. "This is a public health service. I think the Secretary of State should be relaxed about it," he said. Later, there was hissing when details of the meeting were announced.

He upped the ante by suggesting that there were many ways nurses could take action to oppose cutbacks, including only working their contracted 37 and a half hours a week. "This is not about pay. Our members have accepted the two-year pay freeze. It is about cuts," Dr Carter said. "The Government will not get away with wilfully damaging patient care. It is a symptom of the frustration that our members are talking about industrial action."

Delegates also called for the RCN to take a tougher line with the Government. David Baker, from Hampshire, accused the union's leadership of "cosying up" with ministers. "Where has that got us?" he asked. "Let's start acting like the union we could be and make our members proud."

Earlier, Nick Clegg played down a threat from one of his closest allies to quit over the health reforms. The Deputy Prime Minister said the Government was "listening" to concerns over the shake-up, and was willing to "change things where necessary". But he stressed that his chief political adviser, Norman Lamb, agreed with the principles of giving GPs more control over commissioning services and stripping out bureaucracy.

Mr Clegg told the BBC that neither Mr Lamb nor his party's grass roots wanted to "reopen the Pandora's box of the basic design of a new system". "These basic building blocks are still in place," he said. "The detail of exactly how you make these principles work in practice are, of course, things that we want to get right. We have to get this right. The NHS is too precious. It's too precious to me, it is too precious to everybody else who relies on it in the country, to not get the principles translated properly into practice."

John Healey MP, Labour's shadow health secretary, said the NHS reorganisation was piling extra pressure on the health service on top of the cuts. "Patients are starting to see the NHS going backwards again under the Tories with waiting times rising, front-line nursing jobs cut and services cut back. This is not what people expected when David Cameron promised to 'protect' the NHS," he said.

Case study: The nurse: 'I really believe that patient care will suffer'

Denise McLaughlin has been a nurse for more than 15 years and has never seen things so bad. She works with adults with learning disabilities – trying to keep them in their own homes and dealing with their health needs. She has to be the master of everything – from diabetes, to depression and even dealing with the criminal justice system.

Over the past year her workload has increased by 25 per cent as people who leave are not replaced. It means she has less time to spend with each of her patients – which is especially difficult when communication is not always easy.

She has a lot of sympathy for the Primary Care Trust that employs her in South Tyneside which, she says, has done its uttermost not to cut frontline services. And she also knows that most of the people she works for will be out of a job when the PCTs are abolished under the Government's health reforms.

It is, to Ms McLaughlin, this combination of cutbacks and reform that is causing such anger and which is making nurses consider industrial action.

"Andrew Lansley came to speak to us last year and promised us that frontline staff in the NHS would not be affected by the Government's cutbacks. But in my experience that has not been the case. I have many more clients than I did and I am not able to spend as much time with them as I think they deserve.

"And at the same time as we are having our budgets cut, the Government is carrying out more change for the sake of change. I really believe that patient care will suffer."

Ms McLaughlin is one of the 50 nurses who will get to meet Mr Lansley tomorrow to express their concerns. He is certain to get a piece of her mind.