By the time I reached Birmingham for the Liberal Democrats’ autumn conference, the threatened drama about the fate of Andrew Lansley’s much-amended Health and Social Care Bill was all over bar the inevitable shouting.

“Thank goodness,” I murmured. “We have reached the point with this bill where it’s time to get on with it.”

Besides, it frees up space and energy to talk about other things. What happened to the threats, from the likes of the ex-MPs Evan Harris and Shirley Williams, to force a vote this week to sustain resistance to the bill? Attempts to suspend standing orders failed to win the necessary two-thirds majority: so no vote.

That didn’t mean there was no discussion either on the conference floor, notably Wednesday’s debate on adult social care, or (“come to an extra NHS meeting with Shirley Williams”, said Monday’s flyer) on the fringe where activists were quick to tell me that the NHS and localism have been the dominant themes of the week. “There will be lots of inappropriate language and attacks on the leadership,” one old lag predicted correctly. You may have been watching them out of the corner of one eye.

But the Birmingham conference has highlighted a familiar division between the theoreticians and the pragmatists, between those who relish opposition – all that denunciatory rhetoric on the podium – and those who want to grab whatever opportunities arise to do things and get on with it.

Pragmatic localists say they can live with most of the Lansley bill which will – for the first time – mean that decisions on local hospitals and public health will be taken by locally elected politicians, not the nationally elected health secretary.

“Labour is a centralising party that has micromanaged my city’s hospitals from Whitehall without knowing much about them,” is the sort of thing that Lib Dems have been heard saying when not being cross with Lansley. Which allows me a backward glance at Whitehall’s decision – at last – to confirm reconfiguration of Chase Farm Hospital on the northern fringes of London. It has been as long a drama as the Travellers’ stand-off in nearby Essex, not least because David Cameron went there in 2007 and made all sorts of “bareknuckle fight” promises about listening to local feelings.

It led to Lansley’s post-election postponement of the “top-down” closure of accident and emergency and maternity in favour of a four point test of acceptability. Surprise, surprise, that test was deemed passed by a review panel, a decision endorsed by Andrew Lansley last week. NHS London, the King’s Fund and other high-minded bodies weighed in to welcome the overdue rationalisation of scarce resources. Labour’s John Healey accused ministers of humbug: “You can’t trust the Tories.”

Labour-controlled Enfield council felt stuffed. But so does the local Tory MP, Nick de Bois. “I wrote to David Cameron to tell him my constituents feel let down,” he told me when I rang. In truth the MP knows his campaign has been squeezed by larger forces. Both North Middlesex Hospital at the Tottenham end of the borough and nearby Barnet hospital have had private finance initiative millions poured into them and now need to service their debts. “We’ll go bankrupt without reconfiguration,” a North Middlesex manager admitted to him.

With Labour’s Number 10 expert, Paul Corrigan, this week urging radical hospital reform, de Bois has already shifted his focus to trying to ensure that North Middlesex and Chase Farm merge into a single foundation trust and use new local powers – the kind the Lib Dem conference likes – to plan a better future.

He’s cross that GPs’ support and public consultation were manipulated (mid-week meetings at 2pm!), but there’s an old saying: don’t get mad, get even.