If one image of the dole queue helped finish off Labour in 1979, just imagine what might happen if the jobless wore white coats. The prospect of making large numbers of consultant posts redundant is one rarely articulated in public. That changes this week with HSJrevealing the Department of Health's draft long-term workforce strategy.
There is no lack of headlines in these documents but it is the reported 3,200 consultants that the DoH says the NHS won't be able to afford that will make the most waves.
The DoH wants foundation trusts to take responsibility for this. FTs have talked tough on addressing consultant power, particularly on clinical excellence awards. Now they would need to back it up with action on these more difficult issues. Autonomy cuts both ways ñ ©¦ foundations do accept the case for oversupply, it will be up to them to solve it.
The DoH is rightly concerned that the British Medical Association will oppose many of the measures we report this week, and spark a bloody year of strife ñ ¡¬most certainly facing a new prime minister impatient of vested interests.
There is a logic that a significant shift in care from acute to primary settings has to be matched with a reduction in fixed cost. The same applies to local pay negotiations for nurses. The rationale is fairly obvious ñ ©´ should not need an academic study to tell the DoH that most nurses are recruited locally.
But it is not enough to be right; can they make the case to the public, to employers and to the professions themselves?
The groundwork has been poor. The health secretary's first year neglected relationships with the unions. This is exacerbated by that other shortfall ñ£¬inicians' support for reform. There have been efforts to make up ground on both, but they start from a low base.
This is the first major seismic tremor before this year's comprehensive spending review. It will be a defining period for the NHS's relationship to its professions.