Ambulance workers are to go on strike again after Unite members rejected the government's pay offer.
In a huge blow to ministers, it becomes the second NHS union to reject the pay deal after nurses from the Royal College of Nursing also voted against it.
Members of Unite, which represents thousands of blue light staff, rejected the offer by 52% in a consultative ballot on a turnout of 55%.
Unite boss Sharon Graham said it was "quite frankly a joke that NHS workers are being forced to fight for a decent pay".
Strikes by more than 4,000 NHS workers - including paramedics - across England who have a mandate for industrial action will now go ahead. The dates are so far unconfirmed.
Nurses are set to strike on Sunday evening and again on Monday.
Unite’s rejection of the Government’s most recent offer, which included a 5% pay rise this year and a cash payment for last year, will come as a blow to Health Secretary Steve Barclay.
He has claimed the pay deal has been a success after the Royal College of Midwives, the Chartered Society of Physiotherapists and Unison accepted the offer.
GMB, which represents thousands of ambulance workers, also announced this afternoon its members back the pay offer, with 56% voting in favour and 44% rejecting the offer.
But with Unite ambulance staff and the RCN's nurses set to go on strike again the bitter NHS pay dispute is far from over. GMB also acknowledged the pay offer as just "one step in the battle to restore NHS workers’ decade of lost earnings".
The relationship between Mr Barclay and nurses was further worsened yesterday after ministers brought legal action against the RCN.
A High Court judge yesterday ruled a 48-hour strike planned by nurses this weekend would be unlawful as the dates partly fell outside the union’s legal mandate for industrial action.
Nurses planned to take industrial action from 8pm on Sunday, April 30, to 8pm on Tuesday, May 2. Now they will have to cut their walkout short by a day.
Unite general secretary Sharon Graham said: “Unite was clear from the start it was very unlikely this offer would be accepted.
"It is quite frankly a joke that NHS workers are being forced to fight for a decent pay rise after years of pay freezes and all their sacrifices during the pandemic.
"The government should be delivering generous rewards for that instead of a parade of insults bullying and lies about our industrial action. Unite will be backing our NHS members 100 per cent.
“Unite’s members will now return to the picket line to continue their fight. Rishi Sunak now needs to take over this mess, roll his sleeves up and sort it. Isn’t that what a prime minister is supposed to do – lead for goodness sake?”
Unite added that the government's offer "doesn’t even match" the higher settlement approved by its members in Scotland.
Under the terms of the current offer a paramedic on a band 6 salary in England will earn almost £3,500 less per year than a corresponding worker in Scotland, it said.
Unite national lead officer Onay Kasab said: “It is increasingly clear that there is money to fund a fair pay rise, particularly from properly taxing the huge increases in profits made from the cost of living crisis by corporate profiteers.
"The government is choosing to let the NHS collapse. It must make the right decision, return to negotiations and put forward a better deal.”
Rachel Harrison, GMB National Secretary, said: "GMB members have voted to accept the offer, which means GMB union will vote in favour of the pay offer at the NHS joint staff council meeting next week.
"Our members recognise that progress has been made - from the Government originally offering nothing, health workers will be thousands of pounds better off.
“It also meets a key GMB demand of a huge pay uplift for the lowest paid, lifting them above the Real Living Wage."
She added: “But so much more needs to be done for workers if we are all to get the NHS we need. GMB now needs action for our ambulance members - starting by addressing their retirement and unsocial hours enhancements concerns.
“Today is just one step in the battle to restore NHS workers’ decade of lost earnings. GMB will continue this fight, so that the NHS and ambulance workers, who serve and care for the public, finally get the fair deal they deserve."
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