Nurses in Wales could announce further strikes after rejecting the Welsh Government’s new pay offer.
However most health unions in the principality have “narrowly” accepted an average pay rise of more than 7% for 2022/23.
The increase offers workers an additional 3% plus the 4.5% average pay rise staff have already received this year.
The package was agreed through the Wales Partnership Forum made up of representatives from health unions, NHS Wales management and the Welsh Government.
Minister for Health and Social Services Eluned Morgan said in a statement: “Trade unions, as the Wales Partnership Forum, have collectively narrowly accepted the enhanced pay offer proposed by the Welsh Government for 2022/23.
“Whilst we are pleased that the offer has been accepted, we recognise the strength of feeling amongst members.
“We will continue to work together in partnership to work through the implementation of this offer, and also to begin immediate discussions on next steps, including continued meaningful conversations on the nature of the pay award for 23/24 and additional non-pay elements to improve the conditions and well-being for our NHS staff.”
She also said money passed on to Wales through any higher pay award to English healthcare workers would be passed on to Welsh staff.
The Royal College of Nursing said its members in Wales voted overwhelmingly against the new offer and it will write to Ms Morgan to ask her to begin negotiations to resolve the dispute.
RCN Wales director Helen Whyley said: “This offer has not been accepted by RCN members.
“I have today written to the minister to urge the Welsh Government to return to the table to negotiate directly with RCN.
“If this does not happen within the five working days I set out in my letter, I will have no other option but to announce further dates for strike action.
“Strike action is always the last resort; our members do not want to strike, but this additional offer does not restore the years of being undervalued and understaffed.
“Nursing staff feel once again that they have been left with no alternative.”
The Royal College of Midwives said 82% of members who voted rejected the offer in an online consultation on a 32% turnout.
Despite this the union will enter into talks with the Welsh Government on implementation of the new offer and a pay settlement for next year.
Julie Richards, director for Wales at the RCM, said: “This was an improved offer which we believe was made in good faith by the Welsh Government to move us forward on pay, and will start to improve maternity services for staff and for women.
“It is clear from this result that our members remain frustrated with their level of pay, with their working conditions, and also with the lack of resources to deliver the best possible care.
“The Welsh Government have made it clear that there is no more money on the table to improve the pay offer, hidebound as they are by the money they get from the Westminster Government.
“The Welsh Government have committed to improve their offer if more money does come through.”
Members of the Chartered Society of Physiotherapy in Wales voted to accept the revised pay offer alongside other health unions.
Jim Fahie, assistant director of union services at the CSP, said: “Members recognised this was a reasonable offer secured through negotiation.
“We welcomed the Welsh Government’s constructive approach to the dispute, which was borne out of a very real anger our members felt at an original award that did nothing to help them manage the cost-of-living crisis or solve the severe shortages of staff currently seen in the NHS.
“The improved offer was only possible through the brave decision our members and those in other unions took to vote in favour of strike action and shows the strength of health unions.”