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The Royal College of Nursing is assessing the mood for strike action in protest over pay.

The largest nursing union is asking 270,000 members across the UK whether they want to strike before deciding whether to issue a formal ballot.

It says a combination of pay freezes and caps on pay rises since 2010 have effectively led to a 14% pay cut due to the rising cost of living.

The Department of Health said "affordable" pay was protecting jobs.

The news comes as A&E performance figures in England for February show an improvement from their record low with 87.6% of patients admitted, transferred or discharged from A&E within four hours. The figure for January was 85.1%, but the target is 95%.

The data also shows there has been a 39.3% increase in the total number of patients waiting over 18 weeks for planned treatment since February 2016. The figure for February was 367,094. It has been a year since the 92% target for all patients to be seen within 18 weeks has been met.

There was a campaign of strike action over NHS pay in 2014. But while some nurses took part, the Royal College of Nursing did not.

Now the union says unprecedented pressure in the NHS means nurses have never worked harder, and for so little.

The latest review of public sector pay announced a 1% rise.

Janet Davies, the chief executive of the RCN, said: "Years of real-terms pay cuts have left too many struggling to make ends meet.

"Nurses should not have to fund the NHS deficit from their own pay packets.

"Whatever nurses decide, it is becoming clear that their goodwill cannot be relied on indefinitely."

She says pay is one reason there are tens of thousands of unfilled nursing posts, which risks harming patient care.

Nurse shortage 'could last for years'

Nurses will also be asked if they are interested in other forms of industrial action, such as working only their contracted hours or refusing to do work expected of more senior staff.

A Department of Health spokesperson said: "The dedication and sheer hard work of our nurses is crucial to delivering world-class patient care — that's why the NHS offers flexible working, training and development opportunities, competitive pay and an excellent pension scheme.

"As is usual practice, the government accepted independent recommendations about this year's pay uplift.

"Ensuring pay is affordable helps protect jobs - there are an extra 12,100 nurses on our wards since 2010 - which means frontline NHS services are protected at a time of rising demand."

The poll of RCN members will close on Sunday 7 May and the results will be announced at the union's annual conference later that month.