Unions attacked the Government today after ministers confirmed that NHS and other public sector workers will have their pay frozen for a second year unless they earned £21,000 or less.
Employees earning less than that will receive a £250 rise next month, but the rest will face another wage freeze as ministers stressed the need for restraint in the current economic climate.
Unison said nurses, therapists, paramedics, midwives and other health staff have seen the value of their wages fall by 11.6% since the coalition came to power.
The £250 award will still leave thousands of workers struggling to make ends meet because of the rising cost of living, said unions.
The pay announcement covers around 1.3 million NHS workers across the UK.
The Department of Health said 450,000 workers in England will receive the £250 payment, including around 100,000 who work part-time.
The Government said it had accepted recommendations from public sector review bodies, covering NHS staff, as well as prison officers and the armed forces, who will also receive a rise of £250 if they earn £21,000 or less.
Officials stressed that the pay freeze was first raised in the 2010 Budget.
Health Secretary Andrew Lansley said: "NHS staff carry out a vital role in caring for the nation. Pay restraint is essential right across the public sector, and the NHS as the largest public service in the country cannot be exempt from that.
"That's why we are reducing spending on managers, cutting back office administration costs and giving more power to doctors and nurses so we can put patients at the heart of the NHS. Every penny saved from the reduction in management cost will be re-invested into frontline care.
"We made a commitment to protect those on low incomes, which is why I am pleased to confirm that lower-paid NHS staff earning £21,000 or less will receive a flat rate increase of £250 from April 1."
Christina McAnea, Unison's head of health, said: "Coupled with massive discontent about the hated Health and Social Care Bill, privatisation, cuts and job losses, the pay freeze sends out another message that the NHS is suffering under the coalition Government.
"We are disappointed at the Government's decision, which means the pay of staff in the NHS is now worse than when this Government came to power.
"It is a tough job being a nurse, paramedic, therapist or midwife and surely we want them to concentrate on their patients and not to be worrying about paying rapidly rising bills.
"Continuing to freeze pay in this way will also deter young people from entering healthcare professions and we could soon be back to the bad old days where gaps in the workforce could only be plugged by raiding the trained staff of other countries."
In its evidence to the pay review body, Unison warned that a "toxic combination" of increasing demand, shrinking resources and the pay freeze, was putting staff under severe pressure.
Brian Strutton, national officer of the GMB union, said: "A £250 pay rise for the lowest paid in the NHS is not enough to keep pace with the rising cost of living. All GMB members in the NHS will be struggling to make ends meet and this Government's pay restraint will lead to recruitment and retention problems across the health service and in our hospitals."
Rachael Maskell, the Unite union's head of health, said: "This is a Trojan horse. Regional pay cuts will hit hard-pressed local communities.
"The reason that those covered by the Agenda for Change national pay agreement are paid the same, whether they work in Penzance or Penrith, is that their commitment should be reflected in equal pay for equal work.
"If there are issues about the cost of living then this should be covered by regional allowances and recruitment and retention agreements, which recognises that some parts of the country are more expensive than others."
Royal College of Nursing general secretary Dr Peter Carter said: "Nurses are one of the lowest paid professional groups in the public sector and another year of an effective pay cut at the same time as the cost of living continues to rise, means that many families are already struggling to make ends meet."