The pay award was announced by chancellor Rachel Reeves in late July as she accepted the recommendations of the NHS Pay Review Body (PRB), awarding a 5.5% consolidated pay increase across all bands. This is expected to be paid next month and will be backdated to 1 April 2024.

RCN said a record 145,000 eligible members cast a vote, with 64% of them saying they didn't accept the 5.5% award.

In a letter to the Secretary of State for Health and Social Care Wes Streeting, RCN general secretary and chief executive Professor Nicola Ranger, said: ‘To raise standards and reform the NHS, you need safe numbers of nursing staff and they need to feel valued. Nursing staff were asked to consider if, after more than a decade of neglect, they thought the pay award was a fair start. This outcome shows their expectations of government are far higher.

‘Our members do not yet feel valued and they are looking for urgent action, not rhetorical commitments. Their concerns relate to understaffed shifts, poor patient care and nursing careers trapped at the lowest pay grades – they need to see that the government's reform agenda will transform their profession as a central part of improving care for the public.'