Even by the standards of political expectations management, Greg Hands’ message in his Sunday morning interviews was stark: the Conservative party, which he chairs, should expect to lose more than 1,000 councillors in next month’s local elections. When party bigwigs make such predictions, they usually do so against a context of significant wins the last time the seats were contested. But in May 2019, Theresa May was weeks away from announcing her departure, and the Tories lost more than 1,300 seats. It was a notable contrast to recent signs of tentative Conservative optimism, with some MPs saying openly – if so far privately – that Rishi Sunak’s relatively steady hand on the No 10 tiller and policy successes such as the revamped Northern Ireland protocol could even see the Tories squeak to a hung parliament at the next general election. What changed? In one sense, nothing: what upbeat murmurs had emerged were arguably based more on hope than anything tangible, despite a couple of signs of Labour’s current poll lead perhaps tightening a touch. But in terms of optics and the mood inside No 10, the blow came last week when Royal College of Nursing (RCN) members voted by 54% to 46% to reject what had been billed as a final offer on pay. While there is no sign of a solution to separate strike action by junior doctors, civil servants and all manner of other public professions, ministers had hoped that a deal over non-doctor NHS pay would at least deliver a sense of progress. Instead, they now face an RCN promise of strikes carrying on until Christmas. Hands, never the most reliably news-generating of MPs at the best of times, was pointedly vague about what might come next, stressing that no decisions can be made until two other health unions, GMB and Unite, announce their ballots on pay awards. With members of Unison, the biggest single health union, having accepted the government offer by a margin of 74% to 26%, the best hope for Sunak and Steve Barclay, the health secretary, is that the other unions follow suit, leaving the RCN isolated and under pressure to compromise. However, the GMB and Unite results will not come until 28 April, less than a week before voting across 230 English councils which, while often decided on local issues, will be widely seen as a verdict on Sunak’s attempts to move on from the chaos of his two predecessors in the job. Sunak and Barclay can claim, perhaps with some justification, that the RCN vote is an unexpected reverse, not least since the union’s leadership recommended the offer to members. But this is politically thin stuff, for two key reasons. One is that the determination of nurses and other public sector staff is a factor of not just current pay woes but of the corroding effects of 13 years of low investment and deteriorating services under Conservative rule. More potent even than this is the fact that voters are understandably less interested in the complex reasons why it is difficult for a government to solve a problem than the fact that it remains unsolved. Wes Streeting, Labour’s shadow health secretary, had a typically expressive response to Barclay’s response to the RCN vote, a hand-wringing Sunday newspaper article warning about patient safety: “There’s no point writing to a newspaper like an agony aunt, health secretary – show some leadership.” Leadership is just what Sunak has promised, not least through his headline “five pledges” – one of which, the cutting of NHS waiting lists, is being jeopardised by the strikes. With the mitigating factors of Covid and the invasion of Ukraine, some voters seemed willing to cut the prime minister some slack over a winter of discontent. Will they be less forgiving if this now becomes a summer, autumn and second winter? We should get a clue on 4 May.