'Staging the award will be a relief to those who would otherwise have to find money the NHS does not have, but it will have done little to inspire the confidence of staff who will see their salaries fall in real terms this year'

Nothing highlights the need for the NHS to get its act together on pay better than this year's review body recommendations and their aftermath (see News, page 7; News Focus, page 11). The current system is anachronistic, inequitable and unsustainable in a sector so reliant on its staff.

The problems are legion: for a start, the review body set-up covers only some of the health service's one million employees; the charade of negotiation which determines the pay of many others in the Whitley council system is, if anything, worse still.

While the British Medical Association may blanch at the very idea, any new system of pay determination must apply equally to all staff. There must be a far larger element of consistency, if not in outcome then at least in methodology.

Few equal-value claims have yet worked their way through the system, though the case of speech therapist Pam Enderby, who last year won her legal battle for equality with clinical psychologists on pounds4,000 a year more, provides a costly warning that any new approach must be fair and must be seen to be so.

There is also a need for some independence from ministers. Staging the award will be a relief to those who would otherwise have to find money the NHS does not have, but it will have done little to inspire the confidence of staff who will see their salaries fall in real terms this year. The pressure on the Cabinet will always be to balance the national budget, which inevitably means bearing down on the public sector pay bill; given that healthcare professionals generally do not go on strike, and the need to ensure they have no reason to, a powerful external influence on their behalf is vital.

Previous Labour governments have found themselves in economic difficulties very early on because they have given way to pressure from NHS staff with genuine grievances on pay. This government shows no inclination to go the same way. If anything, its policy is one of equal misery for all.

It may be that it can get away with that. But to do so it will have to offer something in return. In the past that has meant trading pay against job security (which seems to appeal to ministers again now). What it should also involve is a pay system in which managers, staff and public have confidence.