A leading health union has rejected the government’s improved pay offer to NHS staff, raising the prospect of prolonged strikes and disruption to health services. Members of Unite working in the NHS in England voted by 52% to 48% to turn down a deal that would have given them higher than originally offered pay rises for last year and this. Unite is the second big union, alongside the Royal College of Nursing, to spurn the deal that emerged from weeks of negotiations between health unions and Steve Barclay, the health secretary. “Unite was clear from the start it was very unlikely this offer would be accepted,” said Sharon Graham, Unite’s general secretary. “Unite’s members will now return to the picket line to continue their fight.” Turnout in the union’s consultative ballot was 55%. Two other smaller unions – the Royal College of Podiatry and the Society of Radiographers – have also rejected the offer. It would give NHS staff in England, apart from doctors and dentists, a one-off payment of between £1,250 and £2,000 for 2022-23, on top of the £1,400 they have already received – the sum that triggered a series of strikes by nurses, ambulance staff and other health workers from mid-December. It also includes a 5% rise in basic pay for 2023-24. However, three other unions – Unison, the Royal College of Midwives and the Chartered Society of Physiotherapy – have accepted those terms and agreed to stop striking. The ballot results so far, including Unite’s, mean it is uncertain whether the NHS Staff Council – the 12-union body that represents more than 1 million NHS staff in England – will accept or reject the offer when it meets on Tuesday. A lot will hinge on the outcome of the GMB vote, the results of which will be announced at 4pm. Graham appealed to Rishi Sunak to resolve the NHS pay dispute. The prime minister should “take over this mess, roll his sleeves up and sort it”, she said. Unite’s decision was expected as it was the only health union to reject the improved offer when it was put forward on 16 March, and it had said last week that many members were unhappy with it. However, the proportion of members rejecting the offer was smaller than anticipated. Unite stressed in its announcement of the ballot result that members working in frontline NHS services were most likely to reject the deal. For example, 70% of paramedics refused to accept it, including three-quarters of Unite members at the West Midlands ambulance trust. Before publishing its ballot results, Unite had already disclosed that its members at Guy’s and St Thomas’ trust and the Yorkshire ambulance service would strike on Monday – a day on which nurses will also be carrying out a stoppage. In addition, it had said its members in the South Central, South East Coast and West Midlands ambulance services, and at the Christie cancer hospital in Manchester, the East Lancashire hospitals trust and the Sandwell and West Birmingham trust would stage a stoppage on Tuesday.