Government hopes of resolving the bitter public sector pensions dispute were dealt a fresh blow today when a group of health workers rejected the controversial reforms.
The GMB union, which represents 30,000 NHS employees, said its members voted by 96% against the planned changes in a turnout of around 60%.
The union, whose members include paramedics, ambulance staff, hospital and community and district nurses, as well as ancillary staff, said it will meet later this week to decide its next move.
Rehana Azam, the GMB's national officer for the NHS, said: "GMB has always said that the Government was premature to table an offer on pensions in the NHS with many issues outstanding and not concluded, including the costs of pensions to staff.
"GMB officers and shop stewards have spent the past few months in a detailed consultation with our members and have extensively outlined the pension offer so that members can decide how best to respond.
"The ballot is a clear mandate voiced by the members to reject the proposals. The GMB's consultative bodies for NHS, ambulance and nursing will meet later this week to decide the next steps.
"In addition the GMB will continue to meet with other NHS unions and will continue to press Government to make progress on the issues outstanding."
The union said it will press for guarantees about how the pension reforms will hit lower paid workers in the health service.
Earlier this month GMB members voted to accept the Civil Service pension proposals, while the union is still involved in negotiations over changes to the pensions of local government workers.
Unite said a growing number of health workers had now rejected the pension plans, making clear their opposition to being made to work until they are 68.
National officer Rachael Maskell said: "The Government can no longer ignore the growing chorus of dissent. Around a million NHS workers, represented by seven trade unions, are overwhelmingly opposed to its plans.
"The Government must now realise that its plans are simply untenable. It needs to face the reality of how their pension scheme proposals will compromise the safety of patients and staff and get back around the negotiating table.
"Members have sent a clear message to ministers that they need to engage in genuine and meaningful talks. The idea of a nurse or paramedic lifting patients at the age of 68 is worrying to many.
"The public sector pension plans have little to do with affordability and everything to do with paying off the deficit, caused by the banking elite."
Doctors are being balloted on whether to take industrial action over pensions, with the result due next week.