Health unions have criticised the 3.3% pay rise imposed on 1.4 million NHS staff in England as “an insult”, with one threatening to strike over the below-inflation award.

They described the increase announced by Wes Streeting, the health secretary, as a “betrayal” of the frontline workers – including nurses, midwives and porters – who will receive it for 2026-27. The 3.3% is less than inflation, which stood at 3.4% last month, but above the rate of inflation that is expected during the next financial year.

In a written statement to MPs Streeting stressed that the 3.3% was higher than the Office for Budgetary Responsibility’s forecast that inflation would rise by 2.2% in 2026-27.

Unions responded angrily and said the award would not help NHS staff recover from below-inflation pay rises in recent years having led to a fall in the real-terms value of their salaries. They accused the government of acting in bad faith for not fulfilling a promise of direct talks about the size of next year’s salary increase and instead deciding to impose the 3.3%.

The Royal College of Nursing (RCN) and Royal College of Midwives (RCM) called the 3.3% “an insult” because it did not keep pace with the true cost of rising prices. “Unless inflation falls, the government is forcing a very real pay cut on its NHS workers. This knife-edge gameplaying is no way to treat people who prop up a system in crisis,” said Prof Nicola Ranger, the RCN’s general secretary and chief executive.

The RCN will wait to see what pay awards other NHS staff and groups of public sector workers get for next year before deciding what action, if any, to take. “Nursing staff will not tolerate the disrespect of other years, when we were bottom of the pile,” she added.

Gill Walton, the RCM’s general secretary, said: “This real-terms pay cut is an insult to midwives who work 100,000 unpaid hours every week just to keep maternity services running. Our members are sick and tired of these broken promises to sort out pay and staffing and their anger is justified.”

Unite was the only union to explicitly threaten to strike over an award it described as “an act of political cowardice and financial betrayal of NHS workers”.

“It beggars belief that a Labour government should seek to ride roughshod over the health unions when deciding on NHS pay. For too long NHS workers have been overworked, underpaid and undervalued,” said Sharon Graham, its general secretary.

Richard Munn, Unite’s national officer for health, said the union would consult its members once fuller details of the deal were available.

Ministers would need to use forthcoming talks with unions on long-promised structural reforms to NHS pay to address a series of grievances “or else members will be left with little option other than industrial action”, Munn said.

Streeting told MPs the 3.3% was higher than the 2.5% rise that the government told the NHS pay review body last autumn was the most it could afford for 2025-26.

The success of NHS trusts and integrated care boards in staying within budget this year, as a result of implementing savings programmes, had freed up money that represented “the foundations of the government’s ability to fund this within the [NHS’s] existing settlement”, he added.