NHS staff have expressed disappointment at the money offered for the NHS in the Budget, which fell short of what bosses said was needed and did not offer a firm promise on pay rises for nurses.
Speaking on Wednesday, chancellor Philip Hammond said £6.3 billion of additional funding would be offered to the NHS over the course of this parliament.
He said £1.6 billion will be handed over the next year, while an immediate £350 million will be offered from that amount to tackle additional pressure on the NHS this winter. In the main Budget document, however, this latter figure appears as £335 million. A spokesperson for the Treasury was not immediately able to explain the discrepancy.
The offer falls short of the £4 billion of additional funding NHS England chief Simon Stevens said the health service needs over the next year.
Bruce Keogh, medical director of NHS England, said he found it "worrying" that the shortfall in funding would likely lead to longer waiting times.
"Budget plugs some, but definitely not all, of NHS funding gap," he said. "Will force a debate about what the public can and can’t expect from the NHS."
Chris Hopson, CEO of NHS Providers, said: "Since the increases fall short of the £4 billion asked for, we will have some difficult choices to make around what can be delivered."
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While Hammond did offer additional funding for NHS wages – in line with health secretary Jeremy Hunt's pledge to lift the freeze on pay rises – he said details of any new funding would be not be decided until after Hunt has negotiated "pay structure modernisation" with unions.
The Royal College of Nurses (RCN) has previously estimated that nurses have seen a 14% pay reduction in real terms since the government's pay freeze in 2010, and has pushed for a pay rise of at least 3.9% for NHS staff, including nurses and midwives.
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"Once again there is always a delay, and it's just getting to be a joke now," Nadia Trail, a nurse at a large hospital in central London, told BuzzFeed News.
"We are told by Jeremy Hunt himself that the pay cap was to be lifted, and then nothing."
Trail accused the government of "stalling" on pay increases for NHS staff, which unions have said could lead to walkouts if pay rises offered do not match inflation.
"They are trying to stall the inevitable, which will be nurses striking!" she said.
"We have reached breaking point, and this announcement will not help matters."
Trail added that she wasn't confident that a pay rise agreed following Hunt's negotiations with unions would be sufficient. "Jeremy Hunt will find a way around not awarding the much-needed pay rise."
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Last month Hunt said contract negotiations would focus on “the ways that we could improve productivity,” which many took as a hint nurses might lose antisocial hours increments that boost their basic pay.
"I would look at a different job if that was the case," one midwife who preferred not to be named told BuzzFeed News. "It wouldn’t be worth it. My basic pay wouldn’t be enough if they got rid of unsocial hours increments."
Phil Noyes, a nurse and RCN union rep from the Midlands, told us many NHS staff would view Hammond's offer of additional funding for pay with "suspicion".
"The kind of things likely to be 'modernised' are enhanced payments for unsocial hours," he said.
"The fact is that the lowest-paid staff in the NHS are likely to be the vast majority of those receiving these, and any loss will really eat into a percentage raise."
Noyes said it was difficult to judge whether a sufficient pay rise was on the horizon until detailed figures were made available from the government.
"The fact is that staff cannot manage on their reduced pay as inflation bites in, and this has had a catastrophic effect on retention," he added.
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Danielle Tiplady, a newly qualified nurse working in London and an RCN member, said the current offer to nurses was "insulting".
"They are going to try and force a contract on us like with the doctors," she told BuzzFeed News, referring to last year's dispute between junior doctors and Hunt, which focused around the reduction of antisocial hours payments. "Nurses are rightly angry and we will resist any changes that are a detriment to our patients or our profession."
The RCN said Hammond's statement needed to translate into a "meaningful pay rise" following upcoming contract negotiations.
"The NHS has been running on the goodwill of its staff for too long, and with more talk of reform and productivity, Hammond runs the risk of insulting nurses who regularly stay at work unpaid after 12-hour shifts," said, Janet Davies, chief executive of the RCN.
"Their goodwill will not last indefinitely. Nursing pay has fallen further and further below the cost of living for the last seven years, with a gap now worth £3,000 a year."
Gill Walton, general secretary of the Royal College of Midwives, agreed that a substantial pay rise would be essential in ensuring there were enough midwives, but also worried that the level of funding offered may not be enough to support maternity services overall.
“The chancellor has given more money to the NHS but not enough to cope with demand," Walton said. "We would hope to see more money in the future so that our maternity services and the NHS have the investment needed.”
The Kings Fund, an independent health think tank, criticised the lack of funding for social care in the budget. "‘We are disappointed, though, that the chancellor did not find any extra funding for social care, which faces a £2.5 billion funding gap by 2019/20," director of policy Richard Murray said.
"While the forthcoming green paper offers the prospect of reform, any meaningful change is a long way off and will be of little comfort to the many people who need help now but cannot access it."
Doctors were cautious in welcoming the additional funding.
"It all depends where this money actually ends up," David Rouse, an emergency medicine registrar, told BuzzFeed News.
He was also concerned that the upfront winter funding could be too little, too late.
"It isn't enough of a cash boost to provide more beds quickly enough in time for this winter and also employ the nursing and support staff to keep them safe," Rouse said.
"Is this money going to social services to be able to discharge patients home quicker, improving flow in our hospitals? If so, how?"
Amar Mashru, also an emergency medicine specialist, felt more positive about the immediate cash injection, but felt more needed to be offered to support the NHS in the future.
"It recognises how desperate and how dangerous the situation has become," he told us. "But if we could develop long-term, cohesive funding strategies we could actually improve the quality of care, not just try and stop the ship from sinking."