Published: 10/02/2005, Volume II5, No. 5942 Page 10

For anyone working at the coalface of our public services, taking time out to attend a high-minded conference must come as the equivalent of respite care. Not a demanding patient or pupil in sight.

No incessant phones, just the soothing - yet challenging - speeches from the platform. Shall we break for coffee now?

Last week I attended one such event, entitled Balancing Choice and Risk, which was organised by my own newspaper. This took place at a time when the new mumps epidemic, bogus NHS dentists, and a suspiciously timed assault on cancer care by pro-privatising medics on Dr Liam Fox's Christmas card list were assailing health ministers.

You always learn something on these occasions, do not you? But it comes in a highly intellectualised package, which can seem remote from the rough and tumble of the hospital ward. Thus David Miliband, the high-flying Blairite Cabinet Office minister and very idealistic 39-year-old, elegantly made the case for devolved management and for both 'choice and voice'.

He said the key drivers of change were: strategy, resources and accountability from the top; diversity of supply and innovation from the professionals; and choice and voice from the public. Their greater involvement is the 'biggest untapped resource' in the reform process, Mr Miliband ventured.

You may raise a weary eyebrow, but Mr Miliband always has something interesting to say.

Those who argue that the free market is made up of millions of individual decisions but the public sector is driven by just 'a few decisions at the top' are fundamentally wrong, he told his audience in civilised St Albans.

However, he said: 'There is no substitute for getting the basics right. It is pointless trying to involve the citizen if they cannot get an appointment with their GP.' Gateshead - where Labour's spring conference will meet this weekend in the spectacular new Sage concert hall - has only been able to reinvent itself as a cultural centre because its dustbin collection is already brilliant. Only three bins out of 10,000 have gone missing, he claimed, tempting the gods.

During the sessions, I heard the senior managers in the hall mix keenness with scepticism. Patients are happy to discuss the curtains on the ward, said one delegate, but when it comes to clinical decisions 'they do not want to know'.

On the subject of professionalising public management in the choice era, we also heard from cabinet secretary Sir Andrew Turnbull - Whitehall's No. 1 man. Sir Andrew insisted his job nowadays is less Mafia consiglieri and more like a chief executive working in partnership - yes, partnership - with managers in health and local government. He does, however, want to unsettle their 'comfort zone'.

No more of the Whitehall knows best stuff, then.

'We looked at what we wanted to drop - risk aversion, over-reliance on outdated processes and written outputs, an excessively departmentbased focus, and an overtly hierarchical approach, ' he explained.

Out it went and in came: 'Innovation, customer orientation, knowledge-based strategy making, rigorous prioritisation, effective performance management, output focus and risk management.' Wow! What a pitch! And all this before the first coffee break.

But Sir Andrew did provide a nugget of insight. Prioritising healthcare might mean offering customers the choices they want.

For example, there are three groups who want to see a doctor: those who have chronic condition; those who need a 'limited and predictable range' of basic services; and those who need advice.

The Turnbull answer? GP; specialist clinics; and nurse practitioners or NHS Direct.

Sir Andrew admitted there is a perception gap. When ministers say there are more GPs or nurses, voters prefer to believe the frontline British Medical Association or Unison when they say there are not.

Mr Miliband had an interesting point on the media. Newspapers, he said, are worse than politicians in 'slavishly following' public opinion.

Get the public behind a local reform and a hostile media will buckle. It can be done, he said.

Do you think he has told John Reid?

Michael White is political editor of The Guardian.