Published: 05/12/2002, Volume112 No. 5834 Page 17

Taking Agenda agreement forward will serve the cause of modernisation Controlling expectations in the wake of last week's announcement on Agenda for Changewill be a key task for health service managers over the next few months. But calm heads will note that this is not a done deal (news, pages 4-5; politics, page 19).

Agenda for Change is perhaps the most significant and long-awaited pay reform in the NHS for a generation. Everybody involved wants to know how they are affected. The absence of much essential detail could allow speculation to run rife. Although it may mean a disrupted Christmas and new year for the negotiators, work on the 200 as yet undecided job profiles must be concluded as soon as possible.

In the meantime, managers need to stress that the broad thrust of Agenda for Change has survived its first major hurdle. Pay reform is linked to, and reflects, service redesign and changing roles, and the broad support of unions has been maintained. The government must be careful to acknowledge the contribution made to modernisation by the workforce if that endorsement is to continue.

It appears that managers can be reasonably satisfied with their part of the deal.

Payments for working unsocial hours is welcome recognition that dedication to a 24-hour service is not restricted to clinical staff. The apparent change of tack on gateways - through which staff will now pass to reach the next level unless managers have concerns about a shortfall in skills - is also good news. It suggests an expectation that staff will develop skills and progress their careers rather than placing the emphasis on a series of hurdles over which they have to jump to achieve greater rewards.

The 12 trusts charged with piloting the new system from spring 2003 - assuming that it is approved - will have a vital role to play. It is significant that the five acute trusts involved all have three-star rankings and are therefore potentially eligible to apply for foundation status. That would really test the promised flexibility of the new arrangements. l