NHS workers have urged the government to reopen pay talks because an 8% three-year deal agreed earlier this year is leaving hundreds of thousands of staff struggling to make ends meet.
Union leaders told ministers that nurses and other workers are facing "mounting pressures", including a record number of nurses seeking help to manage their debt or deal with the threat of having their house repossessed.
It has also been revealed increasing numbers of NHS workers are having to take second jobs because of rising costs.
In new evidence to the NHS pay review body, unions including Unison and the Royal College of Nursing (RCN) warned that the health service faced "severe" staff shortages because of an ageing workforce and students having to quit courses for financial reasons.
Dr Peter Carter, general secretary of the RCN, said: "NHS staff put their faith in the government when they accepted their pay deal. Now it's time for the government to honour the day-in day-out commitment of NHS staff by agreeing to reopen talks."