'The tough pay round is a blatant 'clawback' and I don't think doctors can expect much sympathy'

As if health ministers don't have enough unappetising problems piled up on their plates, they now face the prospect of rolling trade union militancy in the wake of Gordon Brown's insistence on a very tough pay round for NHS staff. Or do they?

I'm not so sure. Nor are Labour MPs I consult. Their union sources tell them members are in no mood for serious industrial action, despite the 'health workers are the biggest losers' headlines after Mr Brown accepted the pay review board's austere recommendations.

He added his own twist: awarding the rise in two phases, which saves the Treasury a further£200m. (He has exempted the army from this: not only are soldiers being killed in action, they have a recruitment shortage, something which is not an NHS problem.)

Health secretary Patricia Hewitt was reported to be surprised at the chancellor's tough tactics, not a wise admission to let slip. It did not stop a weekend of union demos around the country, orchestrated by the TUC under its NHS Together national day of action umbrella.

At a rally in Sheffield - attended by just 500 people, one sympathetic Labour MP told me - TUC general secretary Brendan Barber warned: 'There is a rising tide of cynicism about the NHS. People tell pollsters that the service has got no better since the government has come to power, even while saying that their own personal experience has been good.' He urged people to ignore the cynics and help to protect an improved NHS.

Unions such as Unison, Amicus and the TGWU/GMB (not to mention the toughest of the lot, the BMA) already had accumulated grievances: cutbacks to meet the deficits; excessive reforms since 1997, not all of them consistent; the arrival of competition; and, worse, a new transparency which exposes poor medical performance.

Some unions are threatening to turn resentment into support for Jon Cruddas, a former Number 10 staffer and now MP for Dagenham, who is running to be Mr Brown's deputy. He is a much more impressive leftwinger than John McDonnell and Michael Meacher, who are running for the top job.

Yet they might also get support from unions keen to 'punish Gordon', unions which have militant wings that need to be appeased. Incidentally, I still don't think Alan Milburn (pin-up boy in last week's HSJ survey) will persuade David Miliband to run.

What masochism prompts Mr Brown's action at this sensitive time? First, he is genuinely afraid of a return of inflation. The consumer price index is now 2.7 per cent, and the old retail price index 4.2 per cent, the highest for a long time and - many voters suspect - a more accurate measure.

That is bad for everyone, especially public services, as older readers will remember from the inflationary 70s and 80s, and especially when a squeeze on funding looms. Sorry, but in that context nurses' 2.5 per cent (phasing only makes it 1.9 per cent for the first year) isn't bad.

Second, Mr Brown has a hunch that NHS staff, especially GPs and consultants, got too much for too little. An MP friend recalls how frustrated the chancellor privately felt over Mr Milburn's new contracts. The tough pay round is a blatant 'clawback' and I don't think doctors can expect much sympathy if they make a fuss. Nor do MPs.

To verify this hunch, I checked with Richard Brooks of the Institute for Public Policy Research think tank whom I found crunching numbers for a 'public services at a crossroads' pamphlet. He notes that there are 9 per cent more teachers than in 1997, 11 per cent more police, 35 per cent more hospital doctors and GPs (112,000 in 2005 against 83,000), and 26 per cent more nurses (322,000 against 256,000).

To Mr Brooks's surprise, pay rose by a pre-inflation 46 per cent in both public and private sectors from 1997-2006.

However, private-sector pay averages are distorted by huge earnings at the 'City bonus' top and slave wages at the bottom. Those factors do not exist in the NHS or police. Also, private-sector workers have lost final-salary pensions and seen retirement ages creep up, but the public sector has been largely protected from this.

In other words, the public sector has done better, irritating though it is to be reminded.