NHS staff in England could lose their extra “unsocial hours” payments for working Saturdays and Sundays, under radical changes to shift-patterns aimed at keeping down the costs of running 24/7 health services.

The move is among options being considered to bring about a big reduction in night and weekend pay made under “archaic and out-of-line” contracts. A Department of Health submission to the pay review body for most non-medical staff says unsocial hours and shift work, not counting overtime, already costs £1.8bn a year for such workers.

Options outlined by the department include removing unsocial hours payments for working on Saturdays and Sundays; only axing those for working Saturdays; lowering rates for Sundays and bank holidays; changing night-shift starts from 8pm to 10pm; and “rewarding” staff for flexibility in working hours, perhaps along the lines of the AA, where pay levels reflect how readily staff are prepared to work any shift within a 24-hour period.

Changes also need to be made in the way staff move up pay scales to make them “more affordable”, the department says.

Unison, the public services trade union, suggested the proposals could be “the final straw” in retaining, let alone recruiting, staff.

The government insists consultants, as professional leaders, “should be available when they are needed and there should be no contractual barriers to that”, though pay should reflect the fact that some consultants will have to do more unsocial hours than others. Ministers say the new arrangements would not mean staff working harder or more frequently, only more flexibly.

Ambulance staff, who have different out-of-hours agreements and nearly all of whom get shift-working payments, could also find those bought into line with other staff under the new arrangements.

A separate submission to the doctors’ and dentists’ pay panel makes clear that ministers want contractual changes that would mean consultants having to do far more non-urgent work at weekends.

The department argues changes would mean more efficient rostering of staff and use of expensive equipment as well as reducing “unnecessary bedblocking (in hospitals) because senior decision makers are not available at weekends”.

It says the service would be safer under a seven-day system, citing evidence that mortality rates are higher for patients admitted at weekends. At the same time, NHS trusts must reduce the £2.6bn a year spent on agency staff, trying harder to reduce the rates agencies are charging and to recruit permanent or bank staff.

NHS unions are already incensed by successive 1% pay limits for those not on incremental increases – further industrial action is looming – and the new proposals are bound to cause further tensions.

Talks between the government and the British Medical Association on new working patterns to allow seven-day services broke up last year. The Department of Health says options on the table then, including on hours worked by doctors, may now be changed.

“The case for seven-day NHS service provision to reduce mortality rates, speed up diagnosis and discharge times and reduce the amount of time that patients need to spend in hospitals is proven. Making this happen will require consistent quality NHS care every day of the week, led by trained doctors and with less reliance on doctors in training.”

Making its own submission to the pay body last week, the BMA warned against an “unfunded, undefined” strategy for a seven-day service that was “wholly unrealistic” given the health service’s chronic staffing and financial problems.

Christina McAnea, head of health at Unison, said: “For four years the government has either frozen or held NHS pay down, forcing staff to rely on the extra cash they get from working unsocial hours simply to get by.

“By raising the prospect of further cuts, the government will simply worsen what is already a big problem for the NHS – how to recruit and hold on to enough skilled healthcare staff to provide the services we all rely on.” McAnea said

“If these extra payments are cut, not only would staff suffer directly but it would also be difficult for the NHS to get cover for evenings and weekends.

“NHS workers now feel so taken for granted that many say they want to leave - these plans could prove the last straw.”

Barry Brown, Unite’s head of health, accused ministers of “seeking to squeeze even more out of an NHS already buckling under unprecedented funding cuts”.

He said the government was demonstrating “rank hypocrisy” by ignoring the review body on pay but seeking a seal of approval to attack agreements on conditions.