The Health Bill introduced into Parliament last week reveals the government equipping itself for daunting battles ahead. In the tough discussions which must inevitably take place soon with the pharmaceutical industry and the medical profession, it appears ministers intend still to talk softly, but they have just picked up a much bigger stick than they have ever wielded before.
The strategy will be to endeavour to keep agreements voluntary - whether on drug prices or professional regulation - but to leave no one in any doubt that ministers have the power to enforce their will with the minimum of procedural fuss in the event of recalcitrance. It will be interesting to observe whether the psychology of this is sufficient on its own to achieve the desired ends.
Managers will raise two cheers at the prospect of the secretary of state limiting drug prices and fining manufacturers£10,000 a day for breaching the regulations. Many have felt besieged by the demands on their inadequate budgets fuelled by pharmaceutical companies' high-pressure marketing techniques. The so-called 'lifestyle' drugs - high-cost and equally high-profile - will accentuate the trend.
No doubt health secretary Frank Dobson hopes he will never get into such confrontation that he has to use his new powers; officials stress that the voluntary Pharmaceutical Price Regulation Scheme survives. But he has strengthened his hand conspicuously.
Similarly, in talks with the doctors, Mr Dobson may quietly point out that he can amend legislation regulating the profession by order if he wishes. Quick, clean, efficient - and as this would bypass Parliament, it would leave Mr Dobson to decide a range of key issues. The profession may huff and puff and shake as many shrouds as it wants, but the health secretary will have the unequivocal last word as never before.
Perhaps the messiest part of the bill deals with primary care. Ten years to the week after fundholding was unveiled in Working for Patients , the Health Bill formally announced its abolition. But as the bill won't be law by 1 April, it has to allow for a residual fundholding scheme to run alongside primary care groups. This will take some managing, not least by finance directors struggling to close fundholders' accounts as staff desert to PCGs or are made redundant.
PCGs are the most volatile feature of Labour's reforms, as trusts were for the Conservatives 10 years ago. Expect instant turbulence from them on 1 April: events in Shropshire and Leicestershire (see news, page 7) are a harbinger of what is to come. And should 50 to 60 PCGs seek trust status in their first year, the winds of change will reach hurricane force.