Published: 06/10/2005 Volume 115 No. 5976 Page 10

In a pub at the Conservative conference in Blackpool this week, I did a BBC2 charity quiz with Andrew Lansley, the shadow health spokesman.

Modesty prevents me saying whether the hacks' team beat the politicians, though I can confirm that the Dog and Partridge's inhouse trio were the overall winners.

Who won at the conference?

Whatever the week's final crop of headlines it is too early to tell. We will - at last - know who inherits Michael Howard's bed of nails on 6 December.

What we do know is that Mr Lansley's attempt to fly a leadership kite failed to take off this summer.

His conference speech on Tuesday was one of relatively few front bench contributions focused on his health brief, not on the candidates' 'beauty contest'.

More speculatively, many MPs (and me) are surprised to find Mr Lansley's predecessor, Dr Liam Fox, in a stronger position in the leadership race than we expected: the choice for Thatcherite Tories who do not trust David Davis and fear the Europhiliac Ken Clarke.

I do not have a clear view yet as to who will - or should - win the Tory leadership. But I am clear in my own mind that it should not be Dr Fox, who lacks both the character and intellect for a task which is becoming increasingly urgent: challenging the Blair government.

In Brighton last week ministers were privately despairing at not having a properly organised opposition to consult on bills and policy. It is true.

Politics is like a see-saw: it needs someone on either end to make it work.

In fairness to Mr Lansley, he used Tuesday's speech to do his job: talk about the NHS he cares for and how it might be improved if he remains health spokesman under the new leader.

Most of his ideas are now familiar to insiders. He wants the independent sector to have the legal right to supply NHS services in competition with in-service bidders, he wants fully independent regulation of healthcare, and to replace patients' forums with a truly independent patient voice.

That and the usual pieties about more staff, less bureaucracy, fewer targets, more empowerment. At one point he said the NHS must never abandon the principle that it 'cares for everyone' and contrasted the brilliant achievements of US healthcare with its failure to protect millions of Americans - as Hurricane Katrina showed the world.

'The NHS has never really been given the chance to live up to its founding principles, ' Mr Lansley told delegates.

'It must be given the chance now, not in the context of a nationalised monopoly service, but as the world's largest national health insurance system.' In other words he is pushing reform in the opposite direction to that voted for by Labour's conference, towards more private provision, free at the point of use.

Yet Mr Lansley also repeated last month's repudiation of the 'patient passport' manifesto commitment he inherited from Dr Fox, the one whereby the NHS would pay up to half the cost of an operation outside the NHS. As everyone expected, Labour whacked it.

David Cameron, whose leadership hopes seem to be fading, also rejected passports. All candidates know that public service reform - Labour's flawed goal - is vital, but must be inclusive - 'for the many, not the few' as Ken Clarke put it in a Blairite passage of his conference pamphlet.

As he said himself in Blackpool, the former health secretary remains the only big beast on the field of battle. Voters seem to warm to him, despite everything. But is Klever Ken too backward-looking, too nostalgic, I sometimes wonder?

His pamphlet cited four priorities: economic stability and growth (which Brownism undermines), domestic and global security (no wars), a healthier spin-free democracy, and better public services 'on a human scale'.

But how, Ken? It mostly sounds familiar: fewer targets, devolved and localised power, new methods.

'Just because they are public services does not mean they have to be provided by the public sector. The voluntary and private sectors and religious bodies all have a distinctive and invaluable contribution to make, ' he writes. As does Mr Lansley? And Patricia Hewitt? .

Michael White is political editor of The Guardian.