NHS bosses are being handed pay rises of more than £5,000 and bonuses of tens of thousands of pounds while front-line staff are worried about how they will pay their bills, leading nurses have said.
The Royal College of Nursing (RCN) said pay for NHS executive directors has increased by an average of 6.1% over the last two years while nurses, midwives and health visitors have only seen a 1.6% rise in earnings.
Half of NHS trusts have awarded a salary increase of at least £5,000 to one or more executive directors, according to freedom of information responses from 126 NHS trusts in England.
And numerous executives are being paid substantial bonuses on top of their salaries, the RCN said, with two chief executives receiving bonuses of at least £40,000.
At the same time, nurses have struggled to keep pace with the rising cost of living, the College's latest report, All In It Together?, states.
The RCN said most nurses will not get a cost of living increase this year, and those who are getting something will be receiving less than £5 extra a week.
The College, which meets today for its annual congress in Liverpool, has criticised the Government's decision not to implement a 1% pay rise for all NHS staff working in England.
The pay review body (PRB) recommended a 1% increase for all health staff, but ministers rejected the decision, saying the 1% will only be given to employees not entitled to an incremental pay increase. Unions have estimated this will leave 70% of nurses facing a wage freeze this year.
A poll of 17,000 nurses across the country found that almost all (96%) feel "undervalued and under-appreciated ".
Some 83% said the Government's decision was causing anxiety about family finances and household bills. And two thirds said the ruling over pay has made them think seriously about leaving NHS employment.
An RCN spokesman said ministers leave NHS trusts to set their own pay but expect them to exercise these freedoms with sensitivity to the position of staff that are subject to national pay restraints.
Dr Peter Carter, chief executive and general secretary of the RCN, said: "The findings in this report are yet another kick in the teeth for hard-working and loyal nursing staff.
"It's extremely worrying that the Government believes that trusts are acting responsibly when it's clear many are failing to show the leadership they should on senior management remuneration.
"The Government has maintained an iron grip on the pay and benefits of front-line staff whilst the senior managers pay bill has seemingly gone unchecked. This is the worst kind of double standard and makes a mockery of their insistence that fairness has been at the heart of their decision-making on public sector pay.
"The Government must also address the crisis in nursing morale. This country has one of the finest health care systems in the world and relies on talented and dedicated nursing staff to deliver the care and support that we depend on.
"Failing to pay nursing staff a decent wage will continue to affect nurses' living standards and morale and cause many more to consider leaving the NHS, which is bad for nurses, bad for the NHS and bad for the country.
"The Government should do the decent and honourable thing and give nurses a decent wage."
A Department of Health spokesman said: "We have an available budget of nearly £1 billion for pay increases. We have offered to look at any proposal the unions make on how to use this money. However they have not put forward any proposals to help the lowest paid. Our door remains open if they wish to reconsider their position.
"The RCN's figures should be used with caution - they have included exit packages for executive directors but not nurses. In fact, the latest independent evidence shows that for the third year running, there was no increase in median executive board pay."
In a speech to delegates, Dr Carter added: "In March, the Westminster Government did a ruthless u-turn on its promise of a one per cent pay rise for all NHS staff, deciding that staff in England would get either an incremental payment, or a one per cent rise, but not both.
"This completely contradicts the independent Pay Review Body's recommendation of one per cent for everyone. ...The Scottish Government is honouring that recommendation - and we commend them for their fairness.
"Nursing staff in Wales and Northern Ireland are still waiting for a decision.
"Last year a different independent pay review body recommended that MPs should receive an 11.5% pay rise.
"Now this may surprise you Congress - I actually don't have a problem with that. They looked at what MPs should be earning and that's what they recommended.
"My problem is that the Government chose to disregard your pay review body. It's a double standard, it's insulting, and it's blatantly unfair.
"The Government even has the audacity to claim that a fair wage for nurses and health care assistants in England would threaten job losses and come at the cost of safe staffing levels. This is shameful spin.
"We're not naive - we know how difficult NHS finances are.
"We know that people are beginning to worry that the NHS won't be able to cope.
"But does that mean that nurses and health care assistants should be paying the price?"
He said that nurses are feeling a "crushing" level of demand every day when they go to work.
He added: "I meet a lot of nurses and health care assistants and far too often they tell me they're feeling utterly de-motivated and disillusioned."
But he urged nurses to steer away from strike action, saying that it would "leave patients in the lurch".
Dr Carter urged nurses to contact their local MPs to determine their views on health workers' pay.
He said that, in the run-up to the next general election, many MPs will be "looking over their shoulders" and wondering whether or not they will be re-elected.