“I’m not touching that, it’s a quagmire,” said the health minister fleeing from HSJ’s question at last week’s Conservative Party conference.

The query that caused the minister to take to their heels concerned the possibility of doing a deal on NHS pensions. HSJ had suggested that, with the NHS pension fund in a relatively healthy state and the Department of Health desperate to avoid a row, it was the Treasury’s intransigence that was preventing a settlement being reached.

Number 11’s hard line on NHS pensions is driven not only by a political zeal to reform what it believes are overly generous public sector rewards, but also specifically by a hardening view that the health service must not be given special treatment again. “We protected the NHS budget and our poll ratings on health still dived,” goes the thinking.

This week many HSJ readers will receive ballot papers asking them to consider industrial action if the government continues with the proposed public sector pension reform. Those who are members of the British Medical Association and Royal College of Nursing will face the same decision soon.

How readers vote is a matter for them. The danger of undermining public sympathy for NHS staff at a time of austerity must be balanced against the justifiable anger over yet another reform and a further squeeze on remuneration, especially at a time when some are now being asked by their own employers to give up holiday and work for free.

However, even if the various ballots do back strike action very few managers and clinicians are likely to risk undermining care by withdrawing their labour. Even working to rule and “withdrawing cooperation” is likely to be very limited. In the words of one clinical union leader, staff will be restricted to creating “noise in the system”, staging demonstrations and expressing their anger in the media.

Government negotiators, of course, know this and will use it to their advantage. The NHS will suffer the impact on staff morale precisely at a time when the DH wants it shored up to deal with NHS reform and the £20bn efficiency drive.

What a pity health ministers have burned all their political capital in pursuing ill-managed reform and seem unable to influence government thinking on pensions. No wonder they flee.