When Hassan*, an emergency call handler employed by London Ambulance Service (LAS), gets home from work, the only thing he can muster up the energy to do is watch TV. ‘I don’t speak to my family members,’ he says, ‘because my mind is so exhausted from answering call after call. They never stop.’

On top of an perilously high workload, caused in part by severe staffing problems, Hassan and his colleagues take on a lot of trauma. ‘It’s frustrating, and very depressing,’ he says. ‘It’s not just the stress of the job, but it’s also listening to the frustrations of the patients.’

Hassan isn’t alone. A GMB survey from this summer found that 82% of ambulance workers felt the current pressure on the ambulance service puts them at an unacceptable level of stress. Many are experiencing serious worries about the ​challenges of ​overstretched and underfunded service​s providing the care for which they’re intended; a third had witnessed cases where a patient’s death was linked to a delay. 72% had even considered leaving the service.

This is why, in the face of a 4% pay rise—a massive real-terms pay cut, with CPI inflation once again hitting double figures last month and RPI up to 12.6%—15,000 ambulance workers and members of GMB in eleven ambulance trusts in England and Wales today begin voting on whether to take strike action.

As Paul Turner, a paramedic and a GMB Deputy Branch Secretary at the North West Ambulance Service (NWAS), points out, the vote comes after more than a decade of austerity and real-terms pay cuts across the NHS, and under a burgeoning staffing crisis. Funding for the ambulance service is non-recurring, Turner says, so trusts simply don’t have the money to recruit; beyond that, there is little incentive for people, particularly paramedics, to join the service.

No bursaries available for those in training, for example, meaning the majority are already burdened with debt when they start their careers. ‘Then when you come into the role, the salary is effectively capped for the first two years, and only increases every five years after that,’ he continues. The rise in retirement age, from 60 to 67 in 2015, led even more people to leave the service. ‘I started when I was 20 and I can’t retire until I’m 67. So I’ve got 47 years of just pure torture, and the mental stress that it all brings.’

Emergency call handlers like Hassan, being balloted alongside their paramedic colleagues, answer distressing call after distressing call, especially on weekends and evenings, making them acutely aware that people aren’t getting the help they need as soon as they need it. The average time it took ambulances to respond to Category 1 calls in February was eight minutes and 51 seconds—almost two minutes longer than the seven-minute target. In April this year, the average response time for serious ambulance calls was 51 minutes, compared with 20 minutes a year before.

Hassan and his colleagues face the ‘brunt’ of patients’ frustration. ‘It’s impossible not to take that stress home,’ he says.

‘The demand [for the service] is well outstripping resources,’ says Turner, who works in Lancaster. Previously, he tells Tribune, ambulances wouldn’t leave their area, going as far as Morecambe, which is 4.7 miles away, at a push. ‘But now we’re travelling even further, to Blackpool [30 miles away] or Preston [20 miles away], meaning we’re leaving areas uncovered.’

At the same time, Turner says that paramedics are often left ‘doing the work of GPs, but for less pay,’ like taking on urgent care, mental health calls, and welfare checks, instead of responding to life-threatening calls like strokes and heart attacks. On top of this, a lack of beds in A&E, caused in part by a concurrent round of cuts and shortages in the social care sector, means that paramedics and other ambulance staff are left queuing outside hospitals, sometimes for up to eight hours, waiting to bring patients in. ‘Or we’re pushing trolleys around trying to clear a room for our patients,’ he adds.

These experiences have a profound impact on the mental health of ambulance workers, which in turn leads to even more workers leaving the service for less intense and better paid roles. A survey by Unison, whose NHS members, including ambulance workers, will also begin balloting for strike action on Thursday, found that more than half (57%) fe​el ‘overwhelmed’ by work, and that 53% were struggling to cope with the demands of their jobs.

In some cases, staff are then forced off work themselves with stress and other mental health concerns. ‘We’ve got people who are sick with depression and anxiety, and that’s because when they go to work, there isn’t enough staff there to make the place safe,’ he says. ‘People are not in a good place.’

Add money worries to that stress, and the consequences are severe. Hassan, who lives with his wife and their two children, is worried about the effect rising bills will have and is already cutting back on spending. ‘Our energy bills have doubled, and our rent is going up,’ he says. ‘We think twice about buying things in terms of groceries and always go for the Smart Price items.’ He says if their pay not only matched inflation, but also the stress and importance of the work he and his colleagues do, they wouldn’t need to worry so much about making ends meet.

The impact of all these problems on patients in turn is dire. ‘Patients do not exist in isolation,’ Samantha Wathen wrote in Tribune last week. ‘Healthcare professionals are on the same side, and only want the best for those they care for. In order to do that, they need an environment which also recognises and supports their needs.’ As Rachel Harrison, GMB’s acting national secretary, put it, ‘Ambulance workers have been telling the government for years things are unsafe. No one is listening. What else can they do?’

‘There’s never a good time to take any strike action,’ says Turner. ‘But we’re already running well below the safe levels in the ambulance service to be able to provide to the public, so when is the best time? We have people waiting 12 hours for ambulances. That’s just not acceptable.’

Considering everything, workers are feeling ‘massively undervalued,’ a sentiment reflected across the whole of the NHS—which is why not only the GMB and Unison, but also the Royal College of Nurses, the British Medical Association, and Unite are gearing up to ballot members working in the NHS in the coming days and weeks.

‘Two years ago, we were the heroes who came to the front door,’ says Turner. ‘Now, we’re not worth anything.’ This ballot sets out to prove why that can’t go on any longer.