'A centre-left party in a centre-right coalition needs to tread carefully'

Along with tax-and-spend, education and Trident missiles, health is a sensitive subject, albeit confined to the conference fringe, not the main agenda in the Echo Arena. Some sparks have flown.

Thus Nick Clegg saying “fairness should never be a numbers game” raised hackles in the way that George Osborne did when he spoke of “lifestyle choices” which some people make on welfare.

We all knew what they meant. It is not all about money and not everyone on benefit is eager to find work, even in Liverpool, where one third of employees are in the public sector. Labour failed the poor, Clegg loyalists insisted all week.

But a centre-left party which finds itself in a centre-right coalition needs to tread carefully not to offend floating voters. It must also plan an exit strategy well ahead of the promised 2015 election so it can fight as an independent party - as Clegg promises - not a Tory subsidiary, as some Tories would like.

Medico-politician Evan Harris, who lost his Oxford seat on 6 May, reminds his leader that their party remains “basically anti-Conservative” and that it had been a major error to talk of “fair cuts” - though they are less unfair than mere Tory ones.

Easy for Dr Harris to talk. But how did health minister Paul Burstow fare? I missed his fringe meeting, but his message was clear: the Liberating the NHS white paper is “full of Liberal principles” because “the secretary of state and I wrote it together”.

That is not quite right. My information is that the Lib Dems were seriously caught off guard by the white paper, largely a fait accompli. The hunch that Norman Lamb, Clegg’s health spokesman, was vetoed for a job in Lansley’s team, reinforces that notion.

Mr Burstow tells it thus: that Labour’s top-down experiments with private sector contracts, its costly IT plan, its obsession with targets which cost lives in Maidstone and Mid Staffs, all “tested to destruction the belief that you can run the NHS from Whitehall”.

That is a rewrite too, but never mind. Burstow says the white paper devolves power and money (“less money, more freedom”, as Treasury ministers put it) to both patients and NHS professionals. It is not true that GP consortia will be unaccountable.

“They will be accountable to me and the secretary of state through the mandate we will agree with the NHS Commissioning Board,” Burstow told activists.

It is not disruptive, not backdoor privatisation that will disadvantage the poor either. And most of it was flagged in the manifesto, he says, though not the bit - “I saw an opportunity” - which will give locally elected councillors a role in setting health strategy.

Well, perhaps. I like to give new teams the benefit of any doubt and so did the Liverpool conference.

But when activists got the chance to quiz Norman Lamb they complained about creeping NHS privatisation, central control of commissioning and cuts hurting the mentally ill.

Despite “compromises”, Norfolk Lamb remains loyal, reminding colleagues they had long favoured choice, decentralisation and integration of social care.

For far too long GPs have irresponsibly referred patients to hospitals “with gay abandon”, a trend we can no longer afford.

All the same I formed the view that Lamb thinks it might have been wiser to pilot GP consortia first and that what we must now call the Lansley-Burstow plan may prove a risky gamble. Indeed it is.