Health Secretary Therese Coffey has said nurses won't get a higher pay offer despite the looming threat of walkouts.
Hundreds of thousands of nurses are being balloted for strike action for the first time in the Royal College of Nursing's (RCN) 106-year history following a dispute over pay and staffing shortages.
This UK-wide ballot comes in response to a £1,400 pay rise announced by the Government in the summer - which amounts to real terms pay cut after inflation.
It works out at around 4% on average, while in Scotland nurses were given a 5% rise before inflation. Both have been rejected by unions.
Ms Coffey, who is also deputy PM, told Sky News: "I understand that the ballot is now open, we've honoured the independent pay review body's recommendations on this.
"That was higher than many of the other pay rises that other public-sector workers are getting.
"Dare I say it, having respect of the independent pay review body, I'm not anticipating that we'll be making any further changes."
Asked then that it seems a strike is inevitable, she said: "That's a decision for nurses who decide how to vote in this next coming month."
RCN boss Pat Cullen branded the Health Secretary's comments "astonishing" and accused her of burying her head "firmly in the sand".
And she said the Government's offer of a 3% wage rise "makes a difference to a nurse's wage of 72p a week".
Responding to Ms Coffey's comments, Mrs Cullen said: "This is an astonishing admission from the Health Secretary - she has already decided she won't be listening to our half a million members. Ms Coffey has her head firmly in the sand.
"Nurses and support workers hearing this will be angry but it will make them even more determined.
"Members should find their ballot papers today and show the Health Secretary we have a strong voice that she cannot dismiss.
"Ignoring nursing staff is akin to ignoring patients. We have overwhelming public support for the government to do what's fair by nursing staff and what's needed for safe patient care."
The RCN ballot closes on November 2.
It comes as midwives will also be balloted over strike action over pay next month.
The Royal College of Midwives (RCM) announced it would consult its members from November 11 for a period of four weeks on whether to take industrial action.
Health workers in other trade unions are also being balloted for industrial action over pay.
Earlier this year, the Government gave most NHS workers a £1,400 pay rise, significantly below what unions were calling for.
