In response to the result of votes by Royal College of Nursing (RCN) and Unison members, NHS Providers director of communications Adam Brimelow said:

"The RCN vote is a setback and it's extremely worrying.

"It is positive, though, that a large proportion of Unison's members voted to accept the pay deal.

"Members of other unions are still voting on the government's pay offer. The offer was not just for nurses, but all NHS staff (excluding doctors and the most senior leaders). The result of their votes will also be important.

"Safe and effective patient care, the top priority for NHS trust leaders and staff, is harder to guarantee amid escalating strikes.

"This week's four-day walkout by junior doctors has seen hundreds of thousands of appointments and procedures postponed and staff cover spread too thinly despite trusts' best efforts to manage the risk.

"Trust leaders understand the frustration of nurses, junior doctors and other staff who have seen their pay fall behind inflation year after year.

"It's really important that the unions and government find a way through this to prevent more strikes and let the NHS focus on its big challenges including cutting waiting lists and transforming services, instead of having to resort to 'all hands on deck' just to get through the day."