Sara Gorton thought the Covid pandemic was as bad as things could get for the NHS. But now, as nurses, ambulance staff and other health workers plan more strikes in a service already on its knees, the woman leading pay negotiations for the health unions believes she was wrong. “This is worse – because it is a situation we are in because of political choice,” she says. Prime minister Rishi Sunak and his ministers like to portray union leaders as leftwing militants, modern-day Arthur Scargills. By doing so they believe they can turn the public against the strikers as the disputes drag on and sympathy wears thin. But Gorton, the head of health at Unison, the country’s biggest union, and chair of the NHS Staff Council representing staff in pay talks with ministers and employers, does not fit that stereotype at all. Mild-mannered by nature but prepared to speak some brutal truths, she is a lethal weapon for those fighting for better pay. Armed with 20 years of experience of NHS pay rounds, Gorton is furious at the political games being played with the health service. Covid was global and beyond our control, she says. But the current disaster is made by Tory politicians in Westminster. “With the pandemic, it felt like we were responding to something that was nobody’s fault. Whereas this feels like the people who are making decisions, particularly about funding, don’t care.” It is a strong accusation to make against those she is negotiating with but she seems confident of when to lay things on the line, and when to be businesslike around a table. She describes meetings with ministers and officials, including one last Monday which yielded the first tentative signs of progress, as “always civil”. “They are cordial. We don’t sit in rooms and shout at people. But the steely side of me does come out. I am not a pushover.” That is clear as she criticises ministers again and says unions are in tune with the public. “If you really cared about the population, you would see all of the opinion polls, the social attitudes surveys, that demonstrate that people in the UK prize having a good and efficient health service almost above everything, and you would reflect that in the way you run the country.” In the battle for public opinion – the contest for hearts and minds – it is the unions who, if anything, seem to be winning in the early weeks of 2023. The Sunak tactic of trashing the unions in the Commons, and claiming Labour is in their pockets week in, week out at prime minister’s questions, seems to be in serious danger of backfiring – and the likes of Gorton can sense it. Our Opinium poll on Sunday shows the nurses and their leaders are far more popular than the government. While 34% of the public approve of the nurses’ handling of the dispute, 21% disapprove. Just 14% approve of the government’s stance, while 48% disapprove. Figures on the ambulance dispute are also tilted heavily in favour of the strikers. Labour’s lead is up two points since the last poll three weeks ago, after a period in which the news has been dominated by the crisis in the NHS and strikes. There is other evidence that the unions are drawing strength from the current crisis. Health unions at the heart of the dispute, such as the Royal College of Nursing (RCN), have seen their memberships soar over recent weeks. The RCN’s is understood to have leapt by around 10% since last summer and has hit an all-time record of more than 500,000. Unison too reports strong growth. One union source said: “People realise what we are doing is right. They identify with the cause.” Last week, in a stilted party political broadcast, Sunak made no mention of the NHS strikes, and instead talked about how the government had pumped in record resources to pay for more more nurses and more doctors. But there are signs that others at the top of government, including the health secretary, Steve Barclay, are growing increasingly concerned at the escalating crisis. New figures showing the worst ambulance response times on record in England caused serious alarm among Tory MPs and inside the government. The number of people waiting 12 hours or more to be admitted to A&E reached an all-time high. Average response times for people with a stroke, severe burns or chest pain was 93 minutes, five times the target of 18 minutes. One senior Tory MP said toughing out the pay dispute and insisting there was no more money than the sums already offered was leading his party to certain disaster. “If this goes on into the spring and close to the May local elections, we will be murdered,” he said. Gorton says that, at last Monday’s, talks Barclay hinted for the first time that there needed to be a change of approach and that more money than had been previously offered had to be put on the table. “I think he now wants to work with us to do this,” she said. “Whether he can or not, I think, depends on the chancellor [Jeremy Hunt] – which is ironic given his previous role [as health secretary] – and the prime minister.” She added: “What is needed immediately is to settle the dispute, and what is required to do that is for the chancellor to commit funding over and above what has been invested this year so far.” Intriguingly, Gorton told the Observer that Barclay actually asked that the unions help him persuade the Treasury that more investment in the NHS would yield greater efficiency. Paying more in wages and salaries would help retain staff, whereas leaving the recruitment crisis to worsen would add to problems and increase costs. Asked if she could see some light ahead, Gorton said: “I can. Whether the light is extinguished quickly or not depends on the chancellor and the prime minister. The pressure has now moved upwards, and it feels like the secretary of state now understands the need not only for a swift resolution to the dispute but the need to invest in pay in order to deliver on promises for service renewal.” She added: “Last Monday, he talked about asking us to help make the case to the Treasury for the investment needed. All of the agreements I have been involved with in the past have involved a certain amount of showing the benefits of investing.” This weekend, Gorton is writing to Sunak and Hunt to ask them to host a meeting with the unions. The unions, it seems, may be succeeding in making sure that the crisis from now on is focused on Downing Street.