Published: 16/12/2004, Volume II4, No. 5936 Page 11

On Sunday night I rang Andrew Lansley, the diligent Conservative health spokesman, to find out how he feels about last week's HSJ report that his shadow Cabinet colleague, Oliver Letwin, plans to sack 30,000 NHS 'bureaucrats' if he becomes chancellor next spring.

But when 48-year-old Mr Lansley's mother-in-law told me that her daughter Sally had that very day given birth to their second baby, I beat a tactful retreat.

There is persistent rumour of tension between Mr Lansley and Tory co-chair Dr Liam Fox over health policy and between Dr Fox and Lynton Crosby, the Australian elections guru - remember that name - brought in by Michael Howard to repeat his four wins for Oz premier John Howard.

I have not yet got to the bottom of it. What I can confidently report is that the health secretary himself, John Reid, and his predecessor, Alan Milburn, Labour's campaign coordinator, are both thrilled with the prospect of fighting an election on Tory figures floated in HSJ:

18,900 managers cut at primary care trusts, 7,600 in arms-length bodies, 2,000 at strategic health authorities and 1,000 at Department of Health HQ.

It is not that voters love management as they love nurses.

You know that. But they do know managers are necessary It is a bit like economists. When the economy is doing fine - as it is, broadly speaking - they can be safely ignored as boring. The NHS has a way to go to reach that happy state. The Conservative election 'narrative' (we must all have one nowadays) is that City troubleshooter David James has identified£35bn worth of 'waste' in government that he can cut.

That frees up extra money for the NHS and for what we learned this week would definitely be£10bn worth of tax cuts. Mr Letwin firmed up previously vague promises under pressure: people like tax cuts, he keeps being told by internet pollsters.

Yet it would be a foolish MP who denied there is any NHS waste. Only last week Professor Nick Bosanquet of Imperial College London predicted that by 2010 the NHS will be costing 11 per cent of GDP - around£110bn - and£20bn more than needed when, claims Professor Bosanquet, the job could be done for 9 per cent.

Nor is NHS management a failure-free zone. Monday's Guardian highlighted 'red tape' complaints over foundation hospital status (see Media Watch, below).

The ever-cheerful Mail whipped up what read like a phoney 'tick the box and die' storm over hospital living wills procedures ahead of the midweek Commons vote on euthanasia fears about the Mental Capacity Bill.

In the process the paper assailed the redoubtable Baroness Warnock, Britain's heavyweight medical ethics champ, who dared to say she does not want to be kept alive at 80. I would pay good money to see her in the ring with Mail editor Paul Dacre.

She'd thrash the hooligan.

But does any of this provide real traction for the Tories? For instance, Professor Bosanquet also says reform of working practices succeeds (for instance, in accident and emergency) where funding alone fails. Surely the Letwin-Lansleys should focus on better value, not on our old chum 'savage cuts', which makes voters jumpy.

We learned what Labour will do to the Opposition come election day during the Queen's Speech debate.

Mr Reid acknowledged the need to tackle waste: we are doing it, he told MPs. But he also mocked the notion that a 1.3 million-strong NHS does not need 3-4 per cent senior management, far lower than the private sector incidentally.

The figure he bandied about with greatest zeal is the one we can expect to hear more of between now and May 5 (though I now hear the election may be on June 16), namely that better cancer and coronary heart disease recovery rates mean that '125,000 people are walking the streets of this country who would not have been doing so only 10 years ago.' You can quibble about long-term trends or complain that Labour wasted five years before embracing publicprivate partnership in healthcare. But it is a powerful statistic, especially if you know (as I do) one of the 125,000. Labour strategists believe they can win well if voters focus on policy but will do worse in a negative campaign about Blairism or Blunkettry.

That is where 0z's Mr Crosby fits in.

Michael White is political editor of The Guardian.