The government can expect a "backlash" if it goes ahead with a proposed 1% pay rise for NHS staff in England next year, a nursing union has warned.
The health department has made the recommendation in a submission to the independent panel that advises on NHS salaries.
The Royal College of Nursing called the suggested rise "pitiful" and said nurses should be getting 12.5% more.
NHS staff have been excluded from a pay freeze for most public sector workers.
The NHS Pay Review Body is due to recommend salary levels for health service staff before early May, before ministers then make a final decision.
In its submission, the health department said awarding NHS staff a "headline" pay increase of more than 1% "would require re-prioritisation".
Health department officials said the Covid pandemic had placed a "huge strain" on NHS finances, whilst the economic outlook "remains uncertain".
They added that this increase was still above the CPI rate of inflation, whilst some staff would see a higher rise under a previously agreed three-year deal.
Some 1.3 million public sector workers will see a pay freeze next year, while those earning less than £24,000 guaranteed a pay rise of at least £250.
Speaking on BBC's Question Time, Business Secretary Kwasi Kwarteng said he was sure the pay round "has been discussed and established at the right level".
"No one is doubting that the NHS hasn't been absolutely first class in this pandemic. What I am suggesting is that the whole economy has been under pressure," he added.
But Labour said a 1% increase for NHS staff was "the ultimate kick in teeth to our NHS heroes who have done so much to keep us safe over the past year".
The party's shadow health secretary Jonathan Ashworth said staff "deserve a fair pay rise," adding the proposal was "an absolute insult".
NHS pay in England has been out of the news since 2018 when a three year deal was agreed and welcomed by unions.
But the issue is firmly back on the agenda with a new deal needed for the upcoming financial year.
This is just the start of the process.
The government has made its submission to the NHS Pay Review Body. But the fact that ministers think a 1% pay rise is reasonable has angered health unions.
They see it as scant reward for the huge efforts of staff during the pandemic.
Government sources say that inflation is so low that 1% still represents a real terms increase and that public finances are constrained.
This is shaping up to be a tense few months with pay added to the many difficult issues facing the NHS.
RCN Chief Executive Dame Donna Kinnair said the government was "dangerously out of touch with nursing staff, NHS workers and the public".
"Nursing staff would feel they are being punished and made to pay for the cost of the pandemic. It is a political decision to underfund and undervalue nursing staff.
"With the time remaining before the Pay Review Body recommendation, the government can expect a backlash from a million NHS workers. Taxpayers are supportive of a significant and fair pay rise for NHS workers - this year of all years."
One nurse, Carmel O'Boyle, said she was "disgusted".
"We just want something that reflects the work that we do. We want a fair wage and I don't think the government understands at all what the nursing workforce does," she said.
"I understand it is a very difficult year for the whole world... but this is a political decision," she added.
The British Medical Association (BMA) said the recommendation was "a kick in the teeth".
Its chair of council, Dr Chaand Nagpaul, accused the government of a "total dereliction" of its "moral duty and obligation to a workforce that is keeping the NHS on its feet and patients alive".
He said: "Throughout the pandemic, doctors have cared for more critically ill patients than was ever thought possible and worked round the clock despite suffering from extreme stress and exhaustion.
"The government should demonstrate that it recognises the contribution of a workforce that has literally kept this country alive for the past 10 months."
A government spokesperson said they would "consider carefully" the recommendations made by the NHS Pay Review Body when it reports in the spring.
The government "will continue to provide pay rises for NHS workers", despite the wider freeze on pay in the rest of the public sector, the spokesperson said.
They added multi-year pay deals had delivered a pay rise of over 12% for newly qualified nurses, and will increase junior doctors' pay scales by 8.2%.
How is public sector pay awarded?
- Pay awards for approximately 45% of the public sector - including the armed forces, the police, teachers, the senior civil service and the NHS - are decided by government ministers based on the recommendation of eight Pay Review Bodies
- Pay Review Bodies are independent, non-departmental public bodies who issue annual reports based on remits set by ministers
- Pay for NHS staff was exempted from the public sector pay "pause" announced by the chancellor for 2021-22
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