The Government has confirmed that there will be no new money to fund the 3% pay rise for NHS staff in England.
No 10 said the rise – thought to cost £2.2 billion – would come out of the existing health service’s budget.
A spokesman for the Prime Minister said: “The pay uplift will be funded from within the NHS budget but we are very clear that it will not impact funding already earmarked for the NHS front line.
“You will already know that we gave the NHS a historical settlement in 2018, which saw its budget rise by £33.9 billion by 2023/24 and we’ve provided £92 billion to support the NHS and social care throughout the pandemic.”
Earlier, the head of NHS Employers, Danny Mortimer, told BBC Radio 4’s Today programme that leaders were concerned about where the money would come from.
He said they were “relieved that it’s 3%, not 1%”, but added: “The key question is, is the Government going to fund this pay award properly?
“What we can’t have is a situation where the assumption is that the NHS will make efficiencies, will cut the number of staff or reduce the services it provides to pay for this pay award.”
The chief executive of NHS Providers, Chris Hopson, said: “It’s important that this pay rise is fully funded without an impact on NHS patient care.
“It’s not clear at this point how that will happen given that, due to Covid-19, the NHS still doesn’t have its budget for the second half of the year.
“Until those conversations are complete, it’s impossible to know what the impact on NHS budgets will be.
“One obvious gap, which is a long-running problem, is NHS staff working on local authority contracts, for example in services like sexual health, because local authorities have not been funded for this increase but NHS staff will need to receive it.”
Shadow health secretary Jonathan Ashworth said: “In a sleight of hand Sajid Javid is refusing to back up the £2.2 billion pay settlement with the cash needed, instead expecting overstretched hospitals to find this extra money.
“The NHS is in a summer crisis with rising Covid admissions, cancer operations cancelled, emergency demand intensifying and ambulance trusts under pressure.
“The NHS needs a fully-funded plan to provide quality care, and bring ballooning waiting lists down.
“Alongside this, ministers must provide the NHS with the extra investment required to give staff a pay rise.”
It comes as the Speaker of the House of Commons, Sir Lindsay Hoyle, reprimanded the Government on Thursday over its handling of the pay announcement.
Health minister Helen Whately made no mention of pay during her initial speech to the House of Commons on Wednesday, attracting much criticism, and would only say the Government was still “seriously considering” the issue.
Just a few hours later a press release was rushed out by the Department of Health.
Sir Lindsay told the Commons: “I was far from happy that yesterday the House heard from a health minister giving us an NHS update with no mention at all of the pay deal for NHS, a point of great political interest.
“I find it hard to believe that any negotiations were still going beyond that time. I’d urge the Government again to ensure the House is the first, not the last, to know.”
Vaccines minister Nadhim Zahawi apologised for what happened, telling the Commons: “Can I offer the apology of the Secretary State and the Department Health on the inability of the department to make a statement on the acceptance of the independent pay review body…”
Health unions have said they will consult their members regarding industrial action following the “insulting” pay offer.
Nurses, paramedics, consultants, dentists and salaried GPs come under the new pay deal, which is three times higher than the Government’s initial 1% offer.
On Thursday morning, Pat Cullen, interim general secretary of the Royal College of Nursing (RCN), said the 3% was far below what was needed by nurses, who have worked throughout the pandemic and are facing serious staff shortages due to a high number of vacancies.
Asked if industrial action can be expected, she told BBC Breakfast “we will put that (the pay award) to our nurses next week in a consultative ballot and they will decide”.
“But, as their professional trade union, we will walk alongside them and their decision-making because nurses will do the best thing for patients,” she added.
Ms Cullen said the pay offer was “just short of £20 per week into a nurse’s pay packet” but added something needed to be done to stop “nurses from draining out of the health service”.
On the fact the money for the pay rise is coming from the NHS budget, Ms Cullen said later in a statement: “This pay announcement is fast unravelling.
“Not only is the figure scandalously low, but Downing Street has been forced to admit that the money isn’t new either.
“It is brutally unfair to force the NHS to do yet more with the same money.
“Ministers must be honest about the impact this would have on patient care.
“The Government is failing to give the NHS the money it truly needs. This current game of smoke and mirrors is dangerous for patients and nursing staff who care for them.”
Dr Tom Dolphin, a spokesman for the British Medical Association (BMA) and a consultant anaesthetist in central London, told Sky News that medics would also consider the option of industrial action.
While consultants will get 3% under the deal, thousands of doctors, including all junior doctors, are under a separate 2% per year pay deal.
He said “over the last 10 years, our pay has fallen in value by about a third”, adding that exhausted doctors were leaving the NHS.
Asked if workers would potentially consider industrial action, he said: “We’re not at that stage yet.
“What we’re going to be doing is we’re going to be sending out a survey to our members today and over the next week or so, to check and make sure that they are as angry and disappointed about this pay offer as we are at the BMA and, if so, what they’re prepared to do about it.
“And industrial action will be on that list of things they might want to consider, and we’ll see what people are prepared to do to defend their pay.”
In May, the Scottish Government announced that a pay deal with an average increase of 4% would be immediately implemented.
This came on top of a £500 thank you payment for health and social care workers.
On Wednesday evening, Wales announced it was following England with a 3% pay offer and has paid a bonus to staff in recognition of their work during the pandemic.
Northern Ireland has paid a bonus but is yet to make an announcement on pay.