The NHS has been accused of staffing hospitals on the day of the royal wedding “on the cheap”, as a row continued to flare over payment for working on the bank holiday.

The body NHS Employers said individual health trusts and other organisations will have to decide pay rates at local level, despite union calls for staff to be paid enhanced rates if they work on 29 April.

The employers said the cost to the NHS of the “unexpected” bank holiday was £200m, rising to £230m if enhanced rates were paid.

A spokesman for NHS Employers said: “Employers recognise that staff will want to celebrate the royal wedding and this proposal means many of them will be able to have paid time off on the day of the wedding. Those staff that will need to work to care for patients on the day will be able to take a paid day off at a later time.

“The NHS is facing a very challenging financial climate and employers are looking for arrangements which help them meet that challenge while also protecting jobs and continuity of services for patients.

“In that light, the NHS Employers organisation is disappointed that almost all the health trade unions have not accepted this fair proposal for the royal wedding bank holiday.

“The inability to reach agreement on this issue means individual NHS organisations will now have to decide pay rates for the bank holiday at local level, and trade unions will need to enter into local pay bargaining.”

GMB’s national officer Rehana Azam said: “GMB’s 30,000 health service members in England will be disgusted that the NHS Employers will not treat the royal wedding day as a bank holiday for calculating the pay of the staff who have to keep our NHS running when most people will be enjoying the celebrations.

Scotland, Wales, Northern Ireland and many NHS trusts are already paying up in full but it seems the NHS Employers in England want to spoil the great day by having hospital staff in on the cheap.”