Pay talks for a million health workers may be reopened because the credit crunch is leaving hundreds of thousands of NHS staff struggling to make ends meet.
Unions say that a previously accepted three-year pay deal has been overtaken by events, including the rising costs of fuel, food and childcare.
Ministers have been told that a record number of nurses are being forced to seek help to manage their debts, or deal with threat of having their houses repossessed.
The Royal College of Nursing (RCN) has warned the NHS pay review body that the health service faces severe staff shortages because of an aging workforce and students having to quit courses for financial reasons.
Dr Peter Carter, General Secretary of the RCN, said: "It's time for the government to honour the day-in, day-out commitment of NHS staff by agreeing to reopen talks to secure a fairer pay deal across the health service."
The NHS is increasingly relying on agency workers to make up for staff shortages, according to the unions, which has also submitted evidence from independent pay experts of the disparity between the current economic climate and the situation when the pay deal was agreed.