The members of the public service union Unison were balloted on Monday in a dispute over meal breaks.

The workforce at North East Ambulance Service NHS Trust, including paramedics and other A&E staff, voted in favour of action short of strike action.

Unison said this could include a ban on overtime and refusal to cover events such as football matches.

This is not about money but about providing a service to the people of the North East Karen Loughlin, Unison

Karen Loughlin, Unison regional officer, told BBC News Online that about 460 members could be involved in the action, in Teesside, Tyneside and Wearside.

The row follows months of negotiations on a new NHS Pay Structure - Agenda For Change.

The structure is currently being piloted throughout England and Wales, including at the North East Ambulance Service Trust and City Hospitals, Sunderland.

Ms Loughlin said: "A&E staff have always been on stand-by during meal breaks but now the trust are refusing to pay them for this.

"This is not about money but about providing a service to the people of the North East.

'Substantial benefits'

"Unison remains eager to resolve this dispute before any action is necessary."

North East Ambulance NHS Trust said it had been working closely with staff representatives and regional Unison officials and would continue to try to resolve the issues.

Trust chief executive Simon Featherstone said: "I'm sorry that we have not been able to reach agreement on the local implementation of the national package of terms and conditions with the unions and staff representatives.

"Agenda for Change is bringing substantial benefits for many of our staff, including major increases in salary, annual leave benefits and overtime payments.

"We are committed to ensuring that staff have as few interruptions to their meal breaks as possible."