'Would an NHS constitution require primary legislation? How would an arm's-length board be accountable? Tricky'

Buried away in the mountain of briefing papers and speeches which greeted Labour conference delegates when they arrived in Manchester at the weekend was one inelegant paragraph that startled me when it should not have done.

No, not one of the endless discussions of when exactly Tony Blair is going to resign and which Blairite, if any, is going to challenge Gordon Brown for the top job.

Too soon to say. My hunch is still none of them, though I was intrigued to see former health minister John Hutton revealing (news to me) how his father had walked out on the family when he was small and his mother had to raise five children alone, at times on benefit.

Such experiences mark people, making mild Mr Hutton tougher than he sounds. That sort of talk indicated lurking ambition. But the paragraph which startled me was: 'With Labour, since 1997 spending on the NHS has more than doubled. By 2008 total UK health spending will be 9.4 per cent of national income, well above the current EU average of 8 per cent.'

That big an increase, eh? And easy to forget. It is, of course, Labour's pride, but also its terror. New research finds that some voters judge the NHS by their view of Mr Blair's unpopular regime, not the other way around.

And, as Patricia Hewitt noted in her important speech to the Institute for Public Policy Research think tank (she used to be its deputy director), NHS productivity growth has not matched spending.

Hence this week's headlines about new ways to run the NHS at arm's length from Whitehall under a sort of 'NHS constitution' which would reassure patients - and, just as important, staff -of the service's enduring aims and values at a time of great change in the ways healthcare is delivered.

Some reports have tried to present it as a running Brown-Blair-Hewitt faultline, with the PM and health secretary being cool towards the chancellor's idea of a health board setting policy and leaving managers to manage. Labour hates the idea of putting doctors in charge.

One model cited is the BBC board of governors. But much as I love the Beeb, it is not a byword for cost-saving or efficiency and the board and top management made a serious hash of its battle with government over the Iraqi 'sexed up' intelligence affair.

The Bank of England model, its independent power to set interest rates that was Mr Brown's great coup in 1997, seems a better one. He cited it on Sunday TV as proof of his desire to decentralise power, possibly even to create a written constitution not just for the NHS, but the whole country.

Easier said than done and ministers were mocked, by Simon Jenkins in the Sunday Times, for 'their obsession with imposing permanent revolution' - plans, targets etc - on NHS managers and head teachers.

Would an NHS constitution require primary legislation, for instance? And how would an arm's-length board, let alone local trusts, be accountable to parliament and public? Tricky. But ministers are actively engaged in such discussions and, so far as I can tell, not fighting over them.

Liam Byrne and his successor as health minister, Andy Burnham, have been among the young pro-unity group of 'Blairites for Brown' promoting these ideas with the connivance of both camps.

Ms Hewitt's IPPR speech, setting out what must change in healthcare, but anchoring it in enduring 'values', was part of that ongoing process - proof that Labour is still dynamic and (Lib Dems and Tories add) capable of pinching its rivals' ideas.

Not much sign of peace in Manchester over the NHS Logistics privatisation strike. Unison and its union allies have been pushing hard and Mr Blair faced the prospect that, for the first time, his own national executive would vote against him.

I am writing before the debate and therefore do not know whether a fudge was achieved, along the lines of agreement on greater staff involvement, not in policy-making which will still drive the NHS towards a mixed market economy.

Insiders tell me that ordinary delegates, as distinct from unions also involved in offstage haggling, are not bothered by public/private distinctions or re-structuring, provided it works. Minister Rosie Winterton reminded one heated secret session: 'If these reforms save lives, it's our duty to do it' - no matter what political pain.

Michael White is assistant editor (politics) of The Guardian.