Unions and the Labour leadership have criticised the health secretary over a delayed pay rise for NHS staff, as it was revealed that he had emphasised “affordability” must determine the size of healthcare workers’ wage increases. In a letter to the NHS pay review body chair formally beginning the process on Friday, Matt Hancock repeatedly underlined that wage increases must be influenced by the country’s economic situation. Responding to his recurring calls for the review body to consider the financial climate, the Royal College of Nursing said the funding of health and social care was “a political choice”. It said: “A fair pay rise is vital not just for nursing and other NHS staff, but for patients and the health service as a whole.” The government expected “recommendations to take account of the extremely challenging fiscal and economic context, and consider the affordability of pay awards,” Hancock wrote to the chair, Philippa Hird. The letter makes constant reference to the need for affordability in the light of the country’s economic position. The letter goes on to acknowledge the importance of pay increases in continuing to recruit, retain and motivate NHS staff, while requesting that Hird describe “what steps she has taken to take account of affordability, the need for workforce growth and making best use of the funds available to deliver the best care for patients” in her final report. Hancock said the timing of the spending review announcement had delayed the start of the review process, and that the government aimed to “expedite the process as much as possible … and would welcome [the pay review body’s] report in early May 2021”. The delay has been met with anger from unions, several of whom have been urging the government to start discussions for a “fair and early” pay rise for all NHS staff since the summer. GMB’s national officer, Rachel Harrison, lambasted the health secretary for slipping out the letter late on a Friday in the hopes that attention was elsewhere. She said: “The health secretary’s ‘Scrooge’ letter in the week before Christmas will leave NHS workers worried that they will not receive the fair pay rise next year that they were promised.” She accused the government of “interfering with the pay process before any evidence is submitted”, adding that NHS staff will “rightly be angry”. Labour’s deputy leader, Angela Rayner, also hit out. She tweeted: “What a disgrace. There are never any delays in the cash being dished out hand over fist to Serco’s shareholders for failed test and trace or Matt Hancock’s ex pub landlord for testing kits but there’s no money left for our nurses.” Commenting on the news that the government has set the report deadline to May, Unison’s head of health, Sara Gorton, said: “It’s cruel to make staff wait until next summer to learn what their pay rise will be. The chancellor and prime minister must do the right thing and fund a decent wage increase now. This would give exhausted staff a morale boost and get services fit for the year ahead.” A DHSC spokesperson said: “We continue to listen to our valued staff and trade unions so everyone is rewarded fairly … Over one million NHS staff are currently benefiting from multi-year pay deals”.