In a break with tradition, there was not a single pot shot at health service managers during the political conference season. Patrick Butler wonders if 'mature' debate is, indeed, the order of the day

The Tories' quaint invocation of the spirit of matron suggests that politicians' rhetorical habits die hard. So it was astonishing to record that, for what seems like the the first time in living memory, the reputation of NHS managers remained almost unbesmirched throughout the party conference season.

The failure of Westminster's finest to attempt even the most elusive of digs at a profession they had battered shamelessly for years can surely only mean one of two things: that it is far too early in the course of the reforms to find a scapegoat; or that, like Ann Widdecombe, they have vowed to pursue only 'mature' debate.

When she talked of mature debate, Ms Widdecombe meant 'facing the facts' of NHS rationing, the assumption that the NHS cannot 'do it all'. This echoed Liberal Democrat health spokesman Simon Hughes' promise a fortnight earlier to tackle rationing 'head on', on the grounds that his party was 'being honest with people'.

With the government seemingly in denial about rationing, despite Viagra, the two opposition parties clearly see the issue as an opportunity to make life uncomfortable for health secretary Frank Dobson. It will be interesting to see how they deploy their arguments in the coming months.

It is a moot point whether Mr Hughes does entirely support rationing or whether he is simply prepared for tactical reasons to raise the spectre of a non-comprehensive NHS to shock the public - and backbench MPs - into supporting higher taxes for health, nationally or locally.

In the same way one suspects that for Ms Widdecombe - who specifically ruled out support for higher taxes - rationing appeals not just as a boost for a flagging private healthcare industry but as an incentive to the kind of Tory voter who morally disapproves of certain so-called 'lifestyle' treatments on the NHS.

So far, Ms Widdecombe, a noted moralist, has declined to dabble publicly in the rationing nitty-gritty. It was left to a delegate speaker, nurse Ann Milton, to suggest some lifestyle treatments are important, and others - as such sex change operations - are not. Delegates voiced their approval with tumultuous applause.

The shadow health secretary's extraordinary stage performance got the headlines; but the real message was that she wants to drag Tory health policy rightwards.

Her vision, of a core NHS supplemented with private healthcare resources, is not too far removed from former NHS chief executive Sir Duncan Nichol's Healthcare 2000 report two years ago.

To gauge the rightwards drift, one should recall that after the Healthcare 2000 fiasco, her colleague, the then health secretary Stephen Dorrell swiftly brought out a white paper, A Service With Ambitions, which explicitly ruled out rationing and argued that the NHS was affordable.

Labour kept well away from the r-word. Like Mr Dorrell it officially believes, as The New NHS white paper puts it, that 'the arguments in favour of rationing are not convincing'. Many Labour supporters would agree.

Rationing is still, one delegate suggested, something that only left- over Tory health authority chairs practice. But what happens when all the Tories are sacked?

At the Institute for Public Policy Research fringe meeting Mr Dobson looked on stony-faced as Patients Association chair Claire Rayner - a Labour supporter and friend of the health secretary - declared that rationing was a 'hard fact' and ought to be properly debated.

Rationing aside, the conferences suggested the other area for mature debate is likely to be Primary Care Groups. The Liberal Democrats won't fight PCGs, but will argue for stronger accountability. The Tories gave every sign that they will fight them tooth and nail, deriding their 'collectivist' nature of PCGs.

Health minister Alan Milburn suggested Labour was prepared to concede little on PCGs. No way, he told the Chartered Society of Physiotherapists fringe meeting, would he allow PCGs to be just like the old Labour Party, run by committees of 50 people.

'PCGs have got to be organisations that work,' he declared.