Michael White on the Liberal Democrats' conference

Michael White

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Apart from Norman Lamb's platform speech and a short midweek debate on the urgent needs of mental health, the health service wasn't very prominent on the Liberal Democrats' conference agenda in Bournemouth.

But that's not to say it wasn't present in the minds of delegates or at briefings and fringe meetings, though it was hard to get a hearing for anything except Labour's turmoil over Gordon Brown's leadership and the global financial upheavals.

Nick Clegg himself, engaged in trying to stave off an election hammering from the resurgent Tories in the south, raised it himself in a pre-conference interview to justify his own plans to cut £20bn of public spending to help fund tax cuts for low and middle earners.

The Lib Dem leader told The Guardian that the failure of Labour's "extraordinary experiment" in pumping billions into public services - without too much to show for it - threatens to drive the middle class out of the health service as it has done from state schools in some big cities.

Solidarity in the NHS

What Mr Clegg calls a lack of "cross-class solidarity" is a serious NHS issue which has long worried thoughtful Labour politicians too. Is he right? Personally, I don't know of solid evidence that it is, quite the reverse in my limited metropolitan experience: Labour's billions have helped stave off a middle-class flight to health insurance.

More urgent is inter-generational solidarity, which also surfaced in BoMo, as I persist in calling this south coast resort after a failed ad campaign to make it sound trendier. I'll come back to that after noting that Clegg, Vince Cable and other spokesmen took repeated prods at the NHS's IT programme. If they get the chance, it will be cut back.

Tables were turned a little when Charles Clarke addressed a Lib Dem fringe. If there is ever to be greater co-operation with Labour to promote the "progressive agenda", he said, then Lib Dems must embrace more consistent, less opportunist policies and stop pandering to populism by saying that British politics are "fundamentally corrupt, untrue and damaging."

A good point. Clarke also challenged Clegg to admit that, if he backs health service "co-payments" (as Clarke did in a recent pamphlet) in the shape of privately purchased wonder drugs and other top-ups, he must also admit he was wrong to oppose education co-payments in the shape of student tuition fees, which Clarke pushed through in 2005. Good point No 2.

Fellow Norfolk MP Norman Lamb's own conference speech was a bit of a platform rant, hammering Labour as hectoring, micromanaging and wasteful, as if Blair-Brown hadn't doubled the health service budget. The Lib Dem health spokesman's remedy: locally elected primary care trusts, bottom-up control, top-ups for those wonder drugs, £80 spot fines for rowdyism in hospitals.

He was in more thoughtful mood at a fringe meeting on how we should address the crisis in social care, which was also addressed by pillars of the insurance industry. As the father of the bride put it at an August wedding I attended: "Be nice to your kids, they're the ones who decide what quality of care home you get."

Missed trick

The mood of the session was that though the government missed a trick in not getting Lord Turner's pensions commission to address social care too, it is consulting furiously now and has the rare opportunity to forge a Turner-style consensus on the issue. Why? Because everyone knows need is growing fast and costs are rising.

Current Lib Dem policy would commit an extra £2bn, but it's not enough. What Mr Lamb, insurance chief Stephen Haddrill and Age Concern's Gordon Lishman want is a partnership between government, the insurance industry and individuals which would nudge voters towards insuring their future needs - you have to start 20 to 30 years before you need it - but also underpin the costs to make it affordable.

As well as dignity and companionship in death, quality is also an issue among would-be consumers. The present generation has a guilty conscience about hasty decisions made for its own parents, said Lishman. Mr Haddrill made the useful point that car and home insurers no longer leave the customer to sort out repairs, they ensure the job is done properly themselves.

Time for the industry to get stuck into inadequate care homes which cause so much distress.