In the Mental Health Trust where I work, now a Foundation Trust, the primary anxiety for workers is not about pay but about the future of their jobs.

Of course, rising prices and a lousy pay deal - coupled with the Trust's intention to hold an across the board 'banding review' - piles on the pressure, but the fact that repeated structural changes, resulting in cuts in the management structure, have saved no real money and, now, all vacant posts have been abolished (rather than frozen, as has been usual in the past) has drawn attention to a very pressing threat to jobs.

Having cut away at management - no great loss there, in most cases - and effectively privatised support services, there is nothing left to cut but clinical posts. The planned banding review is partly an attempt by the Trust to avoid redundancies and, whilst people are far from happy about it, it appears that most staff take the view that it isn't the main immediate problem.

The NHS workforce, certainly here, is an aging one and the senior clinical staff have enough service to secure them 36 months protection, thus forestalling the immediate impact of any down-banding of posts. On the one hand, this means that the Trust will make only a paltry saving on the exercise and, on the other, that very experienced and highly trained clinicians (including senior nurses and psychotherapists) are queuing up to tell me that if they are down-banded they'll work towards retirement and, then, go into private practice.

The idea of going private has nothing to do with a preference for that, after all these are people who consciously chose to work in socialised health care, but is more a response to the reality of the situation. Down banding will not simply cut wages, in the medium to long term, but will also mean many specialists being unable to work in the way for which they have been trained. The push is to adopt 'standardised' approaches like CBT and to do short-term work.

It's a recipe for disaster as far as the patients are concerned and here comes the irony: everyone knows that if senior clinicians leave to go private, many will end up being contracted in by the Trusts and Social Services on a sessional basis, which will cost more than paying the in-house hourly rate. The anarchy of the market!

I don't believe we'd see support for industrial action over pay here, but that job losses may well lead to a very different situation. The Trust bosses seem to share my view and are trying to limit the danger of that. In the meantime, our wages are being eaten away by a combination of government policy, UNISON collusion, and workers' anxiety about their jobs.