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Royal College of Nursing members backed it overwhelmingly after the union advised them to do so, but Unison did not recommend the deal.

Unison head of health Karen Jennings said: ‘The ballot result shows what a tough decision it has been. The 2.75 per cent on offer this year is the best in the public sector and the three-year deal offers stability.

‘However, the rising costs of everyday items such as food, fuel and energy obviously make members wary about being locked into a three-year deal. That is why we negotiated a re-opener clause that we will not hesitate to trigger if inflation continues to rise.'

Both the Royal College of Midwives and the GMB union have rejected the deal however, and Ms Jennings pledged to meet them to ‘discuss a way forward'.

Gill Bellord, director of pay, pensions and employment relations at NHS Employers, said: ‘We would like to see these arrangements implemented as soon as is practical and will be talking to the unions and DH about issuing a pay circular to achieve this.'

Nick.bostock@haymarket.com

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