The government is under mounting pressure to reconsider its proposed 1% pay rise for NHS staff in England, with four trade unions writing a joint letter to the chancellor, Rishi Sunak, to express their “dismay” and calling for a fair pay deal. The British Medical Association (BMA), the Royal College of Midwives, the Royal College of Nursing and Unison said the pay deal “fails the test of honesty and fails to provide staff who have been on the very frontline of the pandemic the fair pay deal they need”. “Our members are the doctors, nurses, midwives, porters, healthcare assistants and more, already exhausted and distressed, who are also expected to go on caring for the millions of patients on waiting lists, coping with a huge backlog of treatment as well as caring for those with Covid-19,” the letter adds. NHS Providers, which represents hospitals and other NHS trusts in England, said the government had previously set out funding for a five-year period that assumed a 2.1% pay rise in 2021/22. Labour has said the 1% increase is a real-terms cut to wages. Saffron Cordery, the deputy chief executive of NHS Providers, said a pay rise had been “baked in” to spending assumptions in 2019. She added: “We are really clear that the government had already budgeted for a pay raise. Given where the NHS is at, given what frontline staff have been through, it seems absolutely wrong to take from their pockets right now the pay rise that was due to them.” The Department of Health and Social Care officially recommended the 1% pay rise to the independent panel that advises the government on NHS salaries. The panel is due to make its own pay recommendations in early May, when ministers will make their final decision. The health secretary, Matt Hancock, on Friday insisted the decision to recommend such a small increase was due to an assessment of “what’s affordable as a nation” after the economic toll taken by the coronavirus crisis. Patricia Marquis, the Royal College of Nursing’s south-east regional director, described the offer as a “slap in the face from the government”. Asked whether nurses would strike during a pandemic, she told Times Radio: “I think the answer to that is no, we are not talking about striking tomorrow. “What we are talking about as an organisation is preparing ourselves for what we see will be a few months of opportunities for the government to change its mind and to do something different, but in the meantime we need to prepare ourselves for if they don’t change their mind, and we need to take the next steps, which initially will not be strike or industrial action – there is a long way to go before we get to that – but it is certainly in the minds or our members.” Marquis added that significant numbers of nurses who feel undervalued could leave the profession. She said there were 40,000 vacancies when the country went into the pandemic and people were working to cover those roles. Sara Gorton, the head of health at the Unison union, said if the government stuck to its 1% pay offer to health service workers it would “cause widespread industrial upset”. She told BBC Breakfast: “Unions and health workers all over the country are calling for the public to support them and show the government there really is an appetite to support health workers, to get something more significant, in organising a slow handclap on Thursday night in reaction to this news. “The issue is we want the chance to make the economic case.” The BMA believes the pay proposal “will in fact be a pay cut” because the Office for Budget Responsibility is predicting inflation will rise to 1.5% in the coming year. Simon Walsh, the deputy chairman of the BMA’s UK consultants committee, told BBC Breakfast the “derisory” recommendation “reflects that the government is really out of touch with the feeling of the public on this”. Alex Norris, a Labour shadow health minister, told BBC Radio 4’s Today programme that if his party were in government it would recommend a “real-terms increase in NHS pay” to the pay body and “let them come back and set the figure based on the calculations that they make”.