A major nursing union has promised to fight a new staff incentive system which includes changes to sickness benefit. Sarah Zanoni from the Royal College of Nursing said staff should also be appropriately rewarded and described pay proposals put forward by a consortium of local health trusts as a "cartel". A document containing the proposals notes potential opposition to such changes from unions and raises the possibility that, to secure them, "trusts would be obliged to dismiss and re-engage staff".