Government hopes of limiting next year's health service pay awards have been dented as pay review bodies resist pressure to keep within departmental spending limits.
Professor Clive Booth, chair of the nurses' pay review body, wrote to health minister Alan Milburn last week, saying it 'could not be constrained to a pre-determined envelope of money'.
Brandon Gough, chair of the doctors' and dentists' review body, has written to Mr Milburn in similar terms, rejecting any change to its terms of reference unless they are agreed with the professions.
The assertion of independence has angered health service employers. But the unions, which fear that ministers' insistence on 'fair and affordable' pay awards will lead to increases too low to stop staff leaving the health service, are delighted.
Andrew Foster, chair of the NHS Confederation's human resources committee, accused the review bodies of exercising 'power without responsibility'.
He regretted their 'outright rejection' of the prime minister's request in July that they should take into account both the Department of Health's spending plans and the government's inflation target.
The review bodies' defiance emerged as the DoH moved to head off growing staff anger over pay by calling for a higher starting salary for qualified nurses.
In its evidence to the nurses' review body, the DoH also calls for an increase in London weighting, which has been frozen since 1994, and 'if affordable, improvements in career progression for staff nurses'.
Health minister Alan Milburn said that to improve nurses' starting pay and end the staging of pay awards 'the review bodies need to come up with recommendations that allow the NHS to live within its means'.
But Professor Booth insisted that the review body must 'remain free to give equal attention to the evidence presented by all the parties and to recommend levels of awards which it feels are appropriate in all the circumstances'.
The British Medical Association's council welcomed the sentiments of Mr Gough's letter in a resolution that deplored 'the attempts of the government to change the terms of reference unilaterally'.
MSF national health secretary Roger Kline said he was 'delighted at the assertiveness of the review bodies in standing by their original remit'. He hoped the result would be awards that 'reflect the needs of the service, not the needs of the Treasury'.
But Mr Foster said the moves suggested that the review bodies are 'contemplating making a pay award that is significantly higher than inflation'.
That could have three possible consequences, he said, all of them bad. Either the Treasury would have to give more money, the award would have to be staged, or employers would have to pay the bill, which would mean fewer staff.
The DoH is also calling for a fair and affordable award for doctors and dentists who, it says, are 'already well rewarded' and have a 'consistently healthy position on recruitment and retention'.
BMA chair Ian Bogle said that was 'a staggering display of wishful thinking', when there were 1,000 unfilled GP partnership places and shortages in key hospital specialities.
'However, we would now look to a fair assessment of the situation by our independent review body, ' he said.
RCN calls for£1.2bn to give nurses pay parity with teachers
In its evidence to the nurses' review body, published this week, the Royal Collage of Nursing calls for a£1.2bn boost to nurses' pay. Staff nurses would need an increase of 17 per cent to bring their wages into line with teachers' starting pay.
An independent survey from the Institute for Employment Studies shows that 86 per cent of newly qualified nurses believe they could be making more money for less effort if they left nursing.