The government has done well so far not to become ensnared in the trap over health service pay that engulfed the last Labour government in 1974. Back then, with NHS staff pay falling badly behind and public service workers' expectations of a new Labour government running high, ministers swiftly acceded to an independent inquiry which resulted in wage rises the health service simply could not sustain.

We live in a different world now. Trade unions lack the clout they had a quarter of a century ago. Chancellor Gordon Brown's whole public spending strategy has been aimed precisely at keeping expectations down in the early years in order to prevent the spectacle of public spending cuts as the next election looms. And health ministers have been anxious to talk down any idea of big pay boosts. Remember the standing ovation the Royal College of Nursing gave health secretary Frank Dobson last year when he told them just that?

Yet none of that makes the problem go away. The promise of 15,000 extra nurses for the NHS is all very well. But as Mr Dobson is surely aware, the problem is not a shortage of money with which to fund the posts, but a shortage of people willing to take them up. Flexible working hours and other family-friendly initiatives will help. But the fact remains that nurses' pay in particular is in one of its periodic doldrums. And the precedents for that are not good: each time NHS pay has slumped far below that of other groups, the result has been an explosion or rapid 'catch- up' of some kind. Remember clinical grading? Ten years on, the rows are not over yet (see News, page 6)

Negotiations on a new pay structure for the NHS, which are due to begin this autumn, offer an opportunity to address this problem - and not just in terms of ensuring that nurses' pay gets the sustained improvement over several years it needs. Managers should be brought back into the broad pay determination system that covers all staff - as Unison and the NHS Confederation agree (see News, page 3). Deprived under the senior manager pay system of the incremental rises which have given the otherwise restrained salaries of their colleagues a regular boost, managers have also, in the words of NHS Confederation human resources committee chair Andrew Foster, often had to forgo pay rises'voluntarily' as an 'example to the rest'. Putting NHS managers' pay back into the system can only help both managers and ministers by neutralising it as an issue.

But will all this get off the ground? As the various interest groups lay the groundwork for a new system, the British Medical Association is adopting its time-honoured negotiating stance: 'We are against it, therefore it won't happen.' This position has served some of its members well in the past. Women doctors, and those who are black or work in less prestigious specialties might feel that such a position on the merit awards system has not been entirely in their interests, but their views have not yet outweighed those of the dinosaurs. And less in sympathy than in a fit of possibly unproductive principle, the RCN has decided that if the doctors will not play, then neither will nurses (notwithstanding the RCN's inability to hold not just its members but all other nurses to such a position).

All of which does not bode well. Talks of job evaluation may be of a purely technical nature, but if the staff-side organisations cannot even agree to sit at the same table for this, what chance do they have of concluding a national deal with the employers?

Few today are willing to defend the Whitley system. Yet for decades it served the NHS well - certainly far better than the local pay experiments aimed at supplanting it. The opportunity now exists to construct a similarly robust and inclusive system. Not to do so for sectarian professional reasons would be a calamity.