Who caught my attention at the Tory conference this year? Not Andrew Lansley, I think. He had his £164m cancer screening announcement pinched by David Cameron (a PM’s prerogative) and also made a rather lacklustre speech of his own from the platform.

On a more positive note, I sat between health minister Anne Milton and veteran NHS guerilla fighter Roy Lilley as they cheerfully took great bites out of each other at a Health Hotel fringe meeting, and enjoyed it. She’s a tough cookie, that Milton.

There was certainly ill-ease around the conference halls, bars and fringe meetings over the scale of the PCT-to-GP transfer of commissioning

And in the main conference hall, Mr Lansley introduced Joan Pritchard, a speaker who also struck a chord. Registered nurse and speech therapist turned joint-managing director of Central Surrey Health, Ms Pritchard told Tory activists how she had helped create an innovative provider of primary care services which now employs 750 staff who are also co-owners.

Wealthy mid-Surrey is far from typical. But hers was a good story of adapting what had been a PCT service into a profit-making business, albeit one which re-invests its profits rather than pays dividends. She made it sound easy. If everywhere could be like this, well, who knows?

Do these impressions matter? I think they do. Tory activists need reassuring that the coalition deal with the muesli-eating (just kidding) Lib Dems was right for them and the country. When I bumped into David Cameron on the circuit he said the activists are on board. I remarked that - for a newly elected party - they’re subdued.

There was certainly ill-ease around the conference halls, bars and fringe meetings over the scale of the PCT-to-GP transfer of commissioning, which no amount of bland conference management skill could magic away.

Lansley’s reforms have got them rattled and his speech, which love-bombed the NHS and reminded them he comes from a public service family (NHS dad, teacher and policeman brothers, a civil servant in his youth), did not do the trick.

What he should have done was make the intellectual case for the PCT upheaval, which various experts have argued could cost £1.2bn-£1.8bn, at a time of sharp spending cuts from which - despite the Cameron/Osborne rhetoric - the NHS will not be exempt.

Thus at that Health Hotel event I chaired the first question was: “The white paper makes a commitment to evidence-based policy-making. What is the evidence base for introducing GP commissioning?” Ms Milton was adamant that there is plenty of evidence that moving commissioning closer to the patient would be better than distant and unresponsive PCTs.

NHS capo Mark Britnell, now global health honcho at KPMG, cited the experience at Kaiser Permanente in the US to justify what would be the eighth or ninth structural NHS reform since the Thatcher purchaser/provider split in 1989. Needless to say Roy Lilley said it would be “a big, long, expensive loop to reinvent what we have now”.

It was Lilley, later on, who said he would be happy to see governments “put their hand in the fridge” and tell people what to eat; Ms Milton who insisted that individuals must accept that they have choices about what they put in their mouths; and me who said (again) that these events rarely mention the food, fags and drink industries of which governments all seem so scared.

The rant I will cherish also came from Roy Lilley. The country faces a “national emergency” over dementia which will overwhelm local authorities, now warehousing the elderly infirm, unless we act, he told Tories of all ages.

What to do? Pour money and tax breaks into the pharmaceutical companies until they find an answer, roared Lilley. At least he sounded more persuasive than the secretary of state.