Published: 07/10/2004, Volume II4, No. 5926 Page 25

Hopping between TV channels in my hotel room on a wet Monday morning in Bournemouth, I spotted a new ad for private health insurance. It showed a fat bloke in a gym and explained how you could earn points to help the premiums or the pay-outs (I couldn't quite understand) by doing healthy things like getting jabs and going to the gym.

Excellent? Well, yes, but There is a catch. You have to go to one of the two chains of gym tied to the insurance company. In any case, it is mostly people who are already healthy who do this stuff.

So it widens the health gap.

Not a happy omen for the first day of a very wet Tory conference, I thought. Then I thought: 'No, That is unfair to Andrew Lansley, ' the Tory health spokesman, who did his conference turn on Tuesday.

I like Mr Lansley. He is a decent chap, albeit lacking the cheerful, populist cunning of his old patron, Norman Tebbit, in whose ministerial private office he worked 20 years ago before catching the politics bug.

Before the conference opened, Mr Lansley sent me two thoughtful documents on policy: one about public health, the other about dentistry, the latter being 3,000 sensible words arguing the case for a capitation payment basis for adult dentistry to help boost prevention and curb the 'drill and fill' culture.

As for public health, a topic he aired in a speech in Taunton in February and again in the Tories' Right to choose statement in June, it is obviously not a policy field where personal choice is paramount - as the Victorians realised when Edwin Chadwick led the fight against cholera.

But Mr Lansley argues that it has been too low a Labour priority, led by a succession of junior ministers.When (and if ) he is secretary of state, he will lead on it.He will also establish a Public Health Commission - a bit like the National Audit Office - to monitor and prod.

Fine, although the long list of failing public health targets he cites, from obesity to sexually transmitted infections and smoking (why do Tony Blair and John Reid contradict each other on the ban in public places, Mr Lansley frets), have a long history and are rooted in Tory health failures.

Never mind.Mr Lansley wants to bring primary care trust public health functions, the infections role of the Food Standards Agency and local authority public health work under a single public health director. The National Institute for Clinical Excellence will also get a stronger public health remit.

He is a thoughtful man.More thoughtful, dare I say, than his predecessor, the bouncy Dr Liam Fox, who is said to harbour postHoward (and misplaced) leadership ambitions here in BoMo.

In his conference speech, Mr Lansley defended choice. He made his case to a subdued conference for diversity of provision, freeing hospitals from bureaucracy, increasing capacity through incentives, and, not least, better patient information.

In his vision, information means that patients can rate their hospital of choice - not confined to a mere five hospitals, as Labour choice plans propose - and their chance of surviving surgery or not getting MRSA.

There is a kicker in his thinking. Labour now pays lip service to choice, too, he admitted in Bournemouth. But even Mr Blair believes 'choice should follow an increase in capacity', which shows he understands health markets as little as he understands the London housing market because he bought a£3.6m new home on the wrong side of Hyde Park at the top of a market that is about to weaken.

I add that last bit about housing because I have more of Lord TebbIt is saloon bar populism in me than Mr Lansley does. But he did dig up the fact that chancellor Gordon Brown claimed in a speech to the Social Market Foundation last year that 'the consumer is not sovereign in health' because he/she lacks sufficient information to make informed choices.

As I wrote in HSJ at the time, that is a serious misjudgement, highly revealing of Mr Brown's thinking.

In Labour's internal turmoil since Mr Blair's heart/ job/home announcement, the Tories are not alone in thinking Mr Brown would make life easier for them. So does Number 10. Right or wrong?

It is your choice.

Michael White is one of more than 20 speakers at this year's HSJ Forum on 16 November, 'The NHS towards 2008'.