Thousands of ambulance workers have voted to strike in England and Wales in an escalation of the row over NHS pay with ministers, raising the threat of widespread industrial action across the health service before Christmas. Unite announced that its members voted by up to 92% to take action, with more details to be announced in the coming days. The GMB union also said its members had voted to strike over the government’s 4% pay award, which it described as another “massive real-terms pay cut”. The union will meet with reps in the coming days to discuss potential strike dates over the next four weeks. The development comes less than 24 hours after another union representing ambulance workers and other health staff, Unison, announced that its members also intend to strike in the coming weeks. The Unite general secretary, Sharon Graham, said: “We will not sit back and watch as this government runs down our health service. This strike vote reflects the fact that ambulance staff, dedicated professionals to their core, have been left with no choice but to take a stand for the very future of the NHS itself and they have Unite’s 100% support. “Make no mistake, what the government is doing is a deliberate act of national self-harm. This is a political choice that the government knows will put the NHS on life support.” “Ambulance workers – like other NHS workers – are on their knees,” said Rachel Harrison, the GMB national secretary. “Demoralised and downtrodden, they’ve faced 12 years of Conservative cuts to the service and their pay packets, fought on the frontline of a global pandemic and now face the worst cost-of-living crisis in a generation. “No one in the NHS takes strike action lightly – today shows just how desperate they are. This is as much about unsafe staffing levels and patient safety as it is about pay. A third of GMB ambulance workers think delays they’ve been involved with have led to the death of a patient. “Something has to change or the service as we know it will collapse. GMB calls on the government to avoid a winter of NHS strikes by negotiating a pay award that these workers deserve.” GMB members working as paramedics, emergency care assistants, call handlers and other staff are set to walk out in the following trusts: South West ambulance service, South East Coast ambulance service, North West ambulance service, South Central ambulance service, North East ambulance service, East Midlands ambulance service, West Midlands ambulance service, Welsh ambulance service and Yorkshire ambulance service. While the industrial action is likely to begin before Christmas, rules requiring emergency care to be provided mean their impact will probably be limited. The development comes after Unison, the UK’s biggest trade union, announced thousands of ambulance workers intend to strike before Christmas. On Tuesday, Unison said that thousands of 999 call handlers, ambulance technicians, paramedics and their colleagues working for ambulance services in the north-east, north-west, London, Yorkshire and the south-west ​are to go on strike over pay and staffing levels after voting in favour of industrial action. The union’s general secretary, Christina McAnea, said: “The decision to ​take action and lose a day’s pay is always a tough call. It’s especially challenging for those whose jobs involve caring and saving lives. “But thousands of ambulance staff and their NHS colleagues know delays won’t lessen, nor waiting times reduce, until the government acts on wages. That’s why they’ve taken the difficult decision to strike. “Patients will always come first and emergency cover will be available during any strike but, unless NHS pay and staffing get fixed, services and care will continue to decline.” Separately, the Royal College of Nursing (RCN) has announced strikes on 15 and 20 December in its pay dispute with the government. The health secretary, Steve Barclay, said: “I’m hugely grateful for the hard work and dedication of NHS staff and deeply regret some will be taking industrial action – which is in nobody’s best interests as we approach a challenging winter. “Our economic circumstances mean unions’ demands are not affordable – each additional 1% pay rise for all staff on the Agenda for Change contract would cost around £700m a year.”