NHS: will strike-busting pay rises for nurses and ambulance staff come from health budget?

The government has yet to shed much light on how it plans to foot the bill for a breakthrough pay deal it is offering NHS workers, but promises frontline healthcare services won't be in the firing line.

Late last week, upcoming nurse and ambulance worker strikes were called off, with the government and the NHS Staff Council wrapping up negotiations and reaching a final offer.

Unions representing hundreds of thousands of British health workers had been locked in talks all week with the Department of Health and ministers, to try to break the deadlock and resolve a long-running dispute involving nurses, ambulance staff, and other NHS workers.

While recent nurses and paramedic strikes had been paused while the talks were held, the pay row has been ongoing for some time. A strike on 6 February was the biggest walkout in NHS history, with nurses, paramedics, call handlers, drivers and technicians all taking part.

The new deal is not yet set in stone, but health unions will be recommending their workers vote to accept it in upcoming ballots. But where will the money from these pay rises come from, and will it mean funding is diverted away from patient care?

How much more would NHS staff get paid if they vote for the new agreement?

On Thursday, the government put forward a new offer - which a spokesman confirmed included additional pay for 2022-23, and a pay settlement for 2023-24.

It includes a permanent, blanket 5% pay rise for 2023/24 and an “additional lump sum” for this year, meaning a newly qualified nurse would get an extra £1,800 this year on top of the existing deal and a pay rise of more than £1,300 next year.

The lump-sum payment would rise in value up the NHS pay bands. It is worth £1,655 for staff at the bottom of band two - like porters, cleaners and healthcare assistants - £2,009 for staff at the top of band five - like nurses, midwives, and physiotherapists - £2,162 at the top of band six - like paramedics, health visitors, senior occupational therapists - and £3,789 for staff at the top of band nine. Unison said the lowest pay point in the NHS will now be £11.45 an hour – 55p higher than the voluntary real living wage.

Where would the money for these pay rises come from?

The details around this are not yet clear, although The Guardian reports the breakthrough pay rise offer for nurses and ambulance workers will cost an estimated £1.5bn.

But according to senior cabinet minister Oliver Dowden, chancellor of the duchy of Lancaster, it may have to be funded within the existing NHS budget. Dowden, who helped coordinate government's response to the strikes, told Sky News: “Finding this money is not easy, but we think that in this context of ensuring that we reward nurses properly and we prevent disruption, that we can find the money to do this but it won’t be easy.”

Dowden added: “It is challenging to find this money. This is why the government held out for so long in respect of these negotiations, because there wasn’t some huge amount of money that we could turn to."

But he said he was confident they could find enough, either from the £160bn NHS budget, or from within “wider government spending”.

Will this mean money is diverted away from patient care?

Dowden also told Sky News that: “Given the pressure that health services around the world are under we’re not going to take services away from the frontline.".

On Thursday, Health Secretary Steve Barclay also assured the public that funding for the pay deal would not come at the expense of patients.

"Obviously how these things are funded are a matter for the Chancellor... [But] We have been very clear in terms of the discussions we have had with the trade unions this will not come from patient-facing aspects," he said.

"Of course we will look at areas of underspend, areas of administrative saving and discuss these things with the Treasury in the usual way," he said.