I must confess that I was called out of the NHS debate at the Liberal Democrat conference by an MP who wanted to talk about the chances of introducing proportional representation for Westminster elections.

Not much chance, in my opinion, Tony Blair being sufficiently beset by troubles without picking another fight with his own party. Charles Kennedy's supporters think otherwise. Charles, a relaxed sort of chap, is biding his time and seeing how Blair's majority looks after the next election, they explain.

'It's arithmetic-driven, 'Kennedy told me recently, insisting that he's not wasting time on coalition talk, PR talk or talk of Cabinet places when there's not much he can do about it, sensible chap. In fact, aides say, he doesn't expect to fight the 2005 election on PR either, so he wants Lib Dem candidates to win second place (not third) in Tory-held southern seats in 2001 - ready for the big push.

More ambitious than you'd think, is Charlie. But what about the health debate, staged on the last morning, between one on slavery (real slavery, not nursing) and one on ageism in the public sector - with particular regard to the 'do not resuscitate' controversy last April?

When I was called out of the debate someone had just warned against a 'haemorrhaging of midwives'- an unfortunate phrase - and the alarming link between understaffed, over-stressed maternity units and the incidence of unplanned Caesarean sections. But a more striking contribution had come earlier from a ward sister ('modern matron, as Mr Blair would say') who told the conference that hospitals should not do patients active harm.

The reality was that 100,000 people a year caught illnesses in hospital,5,000 died and even the best domestic staff - contract workers, I imagine - were not supermen. They could not keep hospitals clean on the resources they had, nor did the ward sister have the real responsibility she should have to enforce standards.

'My latest monitoring tool is to write my name in the dust, date it, then see how long it stays there, ' she explained. After that, Nick Harvey, the party health spokesman, was bound to be a bit of an anticlimax. As you may recall, he has got matey with Alan Milburn, who consequently escaped the kicking given to Gordon Brown and - this year's villain - Jack Straw.

So Mr Harvey duly backed the commitment to extra investment, but said investment wasn't enough, either in terms of cash or nonmoney issues. 'We must continue to seek out new ways to make healthcare more efficient and more equitable, ' by which he meant, among other things, a wider remit for the National Institute for Clinical Excellence and better treatment of those 'on the margins of our society - the poor, the elderly and the long-term sick'.

It was this last which got the conference going when Paul Burstow, spokesman for older people (he is 38), called for 'zero tolerance' of rationing on the grounds of age within the NHS - rationing whereby people over 65 or 70 were routinely denied screening or treatment on the grounds that they have had their share. Oddly enough that was the argument which the late Jeffrey Barnard, Soho philosopher, gambler and drunk, used to advance to justify his dissipated habits: at least I won't be a burden on the NHS, he used to say.

And he isn't, not any more, though he was. Mr Kennedy's own speech insisted that Lib Dems are needed to keep Labour up to the mark. Hadn't Mr Blair derided his own calls for more cash until he changed his mind? 'On health, nurses and doctors - more of them.

Prescription charges - abolish them. Eye and dental check-ups - free once again. That's why patients need the Liberal Democrats, 'he said.

Bingo! I like Mr Kennedy, and have a soft spot for the Lib Dems, who are not as daft as they were. But things looked grimmer closer to the ground where I chaired a Unison-sponsored fringe meeting. Both the union and the audience of councillors and officials were gloomy about over-centralisation, the private finance initiative and local public service agreements, much of it at the expense of staff terms and conditions.

There were also jitters about integrated care trusts for health and social services - with minimal involvement of elected councillors. I'm sure that thought will cheer some NHS managers - so much easier that way. But it stores up trouble for the future.