Even before I set out for the Conservative conference, a neighbour asked me how David Cameron plans to fund residential end of life care for a flat-rate insurance contribution of £8,000.

Good question and typical of the residual scepticism surrounding much of this week’s conference, despite Mr Cameron’s lead in most polls. Conservative commentators agree the election result is less certain than it should be.

Lansley sought to answer Labour’s charge of “no price tags” by providing credible detail without being pinned down too much

My neighbour’s father is in a very bad way, so she knows just how much care costs. “£8,000 doesn’t go far,” she said.

Indeed not. With average life expectancy now 78 (it was 66 when the NHS was founded) the average cost of care is put at £30,000 - though for severe cases, Alzheimer’s for instance, it might be £200,000.

When health secretary Andy Burnham launched Labour’s “big care debate” - belated, but welcome - in July he envisaged three possible models of payment, involving insurance, the state or both. It would cost a payment of £20,000-£25,000, possibly to be taken after death from the estate.

In fairness to the Tories, their vote-catching home protection scheme idea is limited: it aims to spare elderly people the need to sell their homes to fund care.

“We’ve costed it with the insurance industry, but we recognise it’s one specific proposal, only part of the wider solution,” one backroom brain on the shadow chancellor’s team told me.

Shadow health secretary Andrew Lansley’s conference speech on Monday made reassurance about Tory intentions towards the NHS central.

“We will invest in the future of the NHS. We will give people the security of the healthcare they need when they need it” without “making the people pay for Labour’s debt crisis” by denying them care.

But he combined this with a clear attempt to provide specific financial targets which the NHS must meet after 2011. Remember, chief executive David Nicholson is already seeking efficiency cuts equivalent to 7 per cent of the budget. Lansley will go further.

His target? Controlling “spiralling NHS bureaucracy.” His goal? Localised, lean decision making which delivers a better service for less money. His hoped-for savings? £1.5bn of NHS funds - one third of the £4.5bn cost of “bureaucracy” shifted to frontline services over a four year period.

Mr Lansley specified four areas over which a secretary of state has direct control and which have burgeoned over the past six years:

  • PCT costs up by 50 per cent to £2.14bn;
  • quangos still costing £1.94bn despite John Reid’s drive to cut them;
  • the £100m cost of strategic health authorities
  • the £200m cost of running the Department of Health itself.

Mr Lansley would combine all four budgets and slash them, seeking to prevent costs simply being redistributed. He would also, he told party activists, abolish central NHS targets and shift responsibility for much primary care from PCTs to GPs, who are better placed to handle it.

The media has been complaining that the Cameroons do not sound sufficiently authoritative and weighty in promoting many of their policies. Clearly Lansley sought to answer Labour’s charge of “no price tags” - which he levels against ministers too - by providing credible detail without being pinned down too much.

With George Osborne promising drastic public spending cuts Mr Lansley is relatively lucky; his budget is protected. But the International Monetary Fund this week added its gloomy voice to those calling for lower health spending and a higher retirement age to help pay off UK debt. His speech gives a flavour of things to come - whoever wins.