No, I didn’t really expect Ed Miliband to snatch the Labour leadership from his big brother, now you come to mention it. I did expect Andy Burnham to end up where he did in the contest, fourth out of five after a respectable campaign which has raised his political profile for the future.

What does it mean for health and social care? Much too early to say, of course, although MPs who follow these things were pleased the new party leader name checked the proposed National Care Service which Burnham regarded as the biggest idea to emerge from the 2010 election campaign.

I’ll come back to that. The pre-election “death tax” row over Burnham’s plan to fund long term care via a tax on people’s estates (£10,000 was his target figure) continues to reverberate around Andrew Lansley’s regime at health, a source of mistrust between parties.

In Manchester this week, one well placed Labour MP predicted Mr Lansley will prove to be “the Tory Frank Dobson,” a secretary of state who took the wrong path right from the start and was quickly replaced by an impatient  leader.

We’ll see. In the short term the coming cuts package, which chancellor George Osborne is due to unveil on 20 October, is casting a dark shadow over all this year’s party conferences. One chum reports that cuts as large as 50 per cent are being modelled in some public services, local and national. The mood is apprehensive, but desperate measures may generate fresh creativity in the delivery of services. It usually does.

Coalition supporters were quick to claim IMF endorsement for their own deficit hawks’ medicine, whereas Labour is now pointing to Ireland’s problems. Dublin raised taxes, slashed spending and became the poster boy of the hawks. Yet its interest rates are soaring as the fickle financial markets decide it is in a downward spiral.

“Labour’s best chance to break the coalition will come in two years, not five,” one shrewd ex-Cabinet minister confided in Manchester. In other words, if David Cameron and Nick Clegg can keep their alliance lashed together as the cuts bite deepest they could survive not five years but even 10.

The spectacle of David Miliband faltering suggests he hadn’t thought through what it meant to move on from Tony Blair’s New Labour, to signal effectively that he represents change. Burnham certainly thinks that Blair himself became blinkered about the unique rightness of his own policies, reluctant to accept his brand is tarnished.

Ed M’s leader’s speech on Tuesday was designed to embrace change (reproaching his old boss, Gordon Brown, for that “no more boom and bust” nonsense) while telling voters he’s not really the “Red Ed” of Fleet Street branding. Labour edged ahead in a new poll, but he is a real unknown. It will take time.

Reading Labour’s 2010 report on the year’s health policy development at this week’s conference reminded me how everyone accepted Tory promises that there would be no more “pointless reorganisations” of the NHS. One story I heard in Manchester suggests that Mr Lansley’s white paper caught Number 10 off guard too.

“Is it true you are abolishing primary care trusts?” Downing Street was asked on publication day. “No,” came the answer. David Cameron had never focused on the NHS, believing Lansley was a safe pair of hands, I was told. Big mistake.

True or false, such stories resonate. The NHS budget may be ringfenced, but PCT reform may come to look a costly distraction. So will Pink Ed ask Burnham to forgo the promotion he probably feels he deserves so he can deploy his NHS expertise against a vulnerable coalition team? If so, Handy Andy would do his duty and say yes.