The Government has been accused of hiding behind the independent body that determines pay as the bitter dispute over NHS wages deepens.
Tens of thousands of nurses have taken part in unprecedented national strikes in protest at meagre pay hikes - with some 10,000 ambulance staff also joining walkouts today.
Health Secretary Steve Barclay has repeatedly refused to discuss wages with union leaders, saying the Government accepted the recommendations from the independent pay review body earlier this year.
But union leaders have accused the Government of hiding behind the body, which made its recommendation in July - before energy bills rocketed and inflation hit its peak.
Mr Barclay finally conceded that ministers didn't have to accept pay review body recommendations, which aren't legally binding.
"When we haven't accepted in full the recommendations of the independent pay review body programmes such as yourselves have been the first to criticise us," Mr Barclay told BBC Radio 4's Today programme.
Former Health Secretary Jeremy Hunt rejected "unaffordable" advice on pay in 2014, while in July Justice Secretary Dominic Raab told MPs that he would not be accepting a 3.5% pay rise for judges, as recommended by the senior salary review body.
Several senior Tories have urged ministers to make an improved offer, with Health Committee chairman Steve Brine saying they should ask the pay review body to look again at the recommendations.
Jerry Cope, a former head of the body, said it should reconsider the pay as the world was "a rather different place in February" and the evidence was probably "out of date".
But unions have criticised the independence of the process, and the GMB union, which represents ambulance workers, has said it is pulling out.
Here's what you need to know.
What is the NHS pay review body and what does it do?
The NHS Pay Review Body is an advisory non-departmental public body, which advises on wages for health service staff.
It is sponsored by the Department of Health and takes evidence from the Government and trade unions before recommending a pay increase.
The eight-strong panel, which is made up of industry experts, weighs up things like recruitment demands, inflation and regional variations in the labour market when it makes its decisions.
This year, it recommended that the majority of NHS staff on "Agenda for Change" contracts were handed a £1,400 uplift in pay.
The Nuffield Trust has estimated that this is the equivalent to an average of 4.3% rise for qualified nurses - which unions argue is effectively a pay cut because it is well below inflation.
The Royal College of Nursing has been pushing for a 5% above inflation pay hike.
STRIKE MAP WIDGET: Enter your postcode below and hit the READ MORE button to see where ambulance staff are going on strike
Why do people say it's not independent?
The pay review body has to work within a spending envelope - which is set by the Government.
It was told that the current settlement had to be “affordable and within the budgets set” by the-then Health Secretary Sajid Javid.
Unions are unhappy that they are not represented on the body and that the members are appointed by the Government.
The GMB union, which represents thousands of ambulance workers due to strike next week, has decided to suspend its participation until "substantial reforms are made".
In an internal document, seen by the Mirror, the union criticises the body's failure to challenge the Government over pay.
It said: "We can no longer take part in a process that has been subverted from its original purpose, and which is being used to defend an unprecedented attack on public sector workers’ pay."
Unite also said it was "not independent", saying: "The Government sets the pay envelope which seriously limits the PRB’s room for manoeuvre."
It said its members had lost faith in the process and urged other unions to demand a shake-up.
UNISON's Sara Gorton said there was "no need to start another long-winded evidence round" and warned the only way to end the strikes was genuine pay talks with Government.
"Ministers are hiding behind the pay review body to wriggle out of any responsibility for the mess they've created," she said.
RCN General Secretary Pat Cullen said: “It's out of date, and it needs to be reviewed. It does not work for our nurses. It may work for this government, but it certainly doesn't work for the lowest paid workers in the health service.”
A union source said: "I don't think any of the unions are enamoured by it but they need to discuss what they do together when they meet in January."
Keir Starmer echoed the calls, with his spokesman saying: "The parameters have been set by the Government and they're now hiding behind that in terms of the excuses that are made."
What does the Government say?
No10 insists the pay review body is “independent” despite criticism from unions.
“We set affordability figures, and they came back with higher figures than what we set," the PM's official spokesman said.
Asked if they could ask the body to review its recommendations, the PM's spokesman said the Government would not tell the review body what to do.
