The Conservative opposition is so unlikely to land a hit on health during the election campaign that it has taken to producing only what looks like a policy. Lynn Eaton reports

The gloves are not off yet.

Officially. But the rivals are in the ring, plotting their best moves in the pre-election fisticuffs. The posters are being slapped up, the soundbites are taking shape, and those carefully worded manifestos are no doubt in draft stage, waiting the final goahead.

So it was that shadow health secretary Liam Fox flexed his muscles last week with a shopping list of what the Conservatives would do for the NHS (see box below).

Dr Fox was doing what all good politicians do at this stage in the proceedings: flying a few kites.

The same thing happened in the lead-up to the last election, when the then shadow health secretary, Chris Smith, formulated, more or less on the hoof, the guiding principles for the health reforms now being implemented.

But the consensus is that the Conservatives' health policies are hardly going to be a vote-winning issue - if they are an issue at all.

'They can't win the next election, ' says Dr Jennifer Dixon, director of the healthcare policy programme at the King's Fund. 'So what is the point of developing anything with any good ideas in it?'

She argues that the Conservatives are merely trying to produce what looks like a policy, but their aim will be to bring other issues to the fore.

Take a look at the Conservative website (www. conservative. com) and you will see the campaign issues are lowering taxation; keeping the pound; increasing policing; and saving the countryside.

There is no mention of the NHS.

Dr Fox struggled to get a headline from the shadow cabinet's plans to abolish what he described as the 'absurd' waiting-list initiative. Instead, he said, patients would be given a guarantee by their consultant of how long they would have to wait for their treatment.

But the media pack failed to take the bite. The Sun was one of the few papers to run with the headline: 'Tories to axe NHS targets'.

The rest took a different spin, concentrating on his plans to scrap taxation on private healthcare schemes, at a cost of£500m - the one thing that distinguished it from existing government policy, according to Dr Dixon.

In a sign of the pre-election times, health secretary Alan Milburn's response came through the Labour Party, not the Department of Health.

The£500m on tax perks for private health insurance was equivalent to this year's pay rise for nurses, and the British Medical Association recently dismissed such a policy as 'regressive', he pointed out.

If the proposals themselves initially failed to stir up much controversy, by Sunday, the Observer had unearthed a 'Secret Tory plan to axe NHS-for-all'. But Conservative Central Office was pretty sniffy about the views attributed to 'William Hague's top health adviser', Dr Michael Goldsmith, which suggested the NHS would be downgraded to become a 'core service' serving only those earning£35,000 or less.

The description of Dr Goldsmith as a 'top health adviser' provoked particular consternation. 'He is not. He is very peripheral, ' a spokesperson said.

A storm in a tea-cup then? But the fact that proposals dreamt up by a 'peripheral' player have captured the imagination more than Dr Fox's own policies must be ringing alarm bells.

Perhaps the Conservatives' best chance is to keep health off the election agenda altogether. 'They have just got to look concerned - and do nothing, ' says Dr Dixon.

See politics, page 23.

Conservative shopping list for a healthy NHS Abolish the waiting-list initiative and instead give a patients'guarantee - decided by consultant, of maximum waiting times.

Spend the same on the NHS as proposed by Labour, but 'differently and better', with particular emphasis on improving the quality of treatment.

Create a properly independent appointments body and ensure that the health secretary cannot interfere in its workings.

Phase out health authorities, to 'reduce costs and bureaucracy'.

'Provide a breathing space'by not allowing primary care trusts to move to care trust status for a minimum of four years.

Re-establish 'matron's values'on hospital wards.

No charges for access to NHS care.

Develop a much bigger independent sector, to supplement the work of the NHS.

Introduce a single regulatory body for NHS and private facilities.