Kennedy reaches for his sandbag in a fit of pique

The way to cope with such change - local and global - is neither to resist it ('futile') or just let it rip, but to manage it, he said. Yes, you've guessed: the third way.

'But it can't be managed unless there are rules of management, value judgements as to how and why we are managing in a particular way, 'Mr Blair suggested.

I kept thinking of all this as reports poured in from the British Medical Association conference ('Doctors demand urgent reform of GMC' and 'Young doctors coerced into life-or-death decisions'), from health authorities unearthing fresh scandal - that police investigation of a nurse - and from the Westminster Whitehall ghetto as they approach the launch of Alan Milburn's national plan for the NHS.

What a lot of pressure! Not least on Mr Blair, who is finally discovering how 'events, dear boy, events' (as Harold Macmillan put it) can wear down even a fit and motivated 47-year-old manager, especially one with a new baby. As HSJ's series on modernisation has underlined, the pressure is relentless. It will intensify on politicians and health professionals as election day looms.

Take Charles Kennedy's Liberal Democrats. They have a tricky course to plot between co-operating with this government and competing with it enough to steal disgruntled Labour votes next year. They illustrated it twice last week on health matters.

As you may have noticed, Mr Kennedy sandbagged Mr Blair at question time over health minister John Hutton's leaked letter, the one that admitted that health action zone funding 'is less than we had previously indicated'. A separate memo recommended 'we would not recommend a press release'.

Mr Blair was not ready for it. Was it 'a triumph of spin over substance?' Mr Kennedy asked. Absurd, replied the PM, who promised to look into the matter, but predicted that he would find that HAZ 'funding has gone up'.

It has not. Competitive Kennedy harvested a crop of front-page headlines, and the Tories crowed at Labour's 'lost moral authority' - much as the novelist Ken Follett would do at the weekend.

Yet 24 hours after Blair spoke, Kennedy's health spokesman, Nick Harvey, was offering the Commons the co-operative face of Lib Dem election strategy. In a bad-tempered Commons debate initiated by Dr Liam Fox (was it Labour's ex-NHS manager, Julia Drown, that I heard bellowing on Yesterday in Parliament? ), Mr Harvey spoke as if he and Minister Milburn often have a pint together (which they don't).

Not only did Mr Harvey reaffirm Lib Dem commitment to a tax-based NHS ('we believe it is sustainable'), he did what ministers should have done themselves:

unearthed an Australian experiment over the past year which saw that country's conservative government spend nearly£1bn in the shape of a rebate to anyone taking out private health insurance - only to produce an increased take-up of 0.9 per cent - 'the equivalent of going into the street, picking up a drain hatch and pouring money down it, ' the North Devon MP explained.

This sort of talk is doubly damaging to Dr Fox's efforts to take the NHS down a similar privately bolstered route, because when Margaret Thatcher forced her chancellor (it's all in their memoirs) to give tax relief to elderly people in 1988 the numbers here rose only modestly. It's what economists call 'dead weight': paying people to do what they 'd do anyway.

It is far from clear how Dr Fox will resolve this problem. Indeed, Labour GP Howard Stoate again quoted Nigel Lawson in warning that 'if we simply boost demand by tax concessions to the private sector without improving supply', the result will simply be higher prices.

None of which is to deny that ministers were not regaled in the debate with fresh horror stories about rising waiting times and pensioners using their savings to buy private care.

Mr Milburn is trying to answer Lord Lawson's supply side question by unleashing consumer power and tackling restrictive practices within the NHS. Peter Lilley called it the 'command and control' model, doomed to failure. But he had the grace to admit that the last Tory shake-up had got a lot wrong.