It is funny noticing what really matters to people when the world is crashing down around them. I spent last Saturday at a Fabian Society conference, when Peter Mandelson's world lay in ruins and, rather more literally, so did a sizeable chunk of western India.

Closer to our own agenda, the newspapers were full of the latest baby organ scandal and the decision of the Scottish Parliament to press ahead with free personal, as well as long-term, nursing care for elderly people.

Yet, apart from the care issue, none of this impinged much on high-minded Fabian discussion about how to put the world to rights. I recall only one reference to Alder Hey, and that came from John Denham, Alan Milburn's deputy. He used it to illustrate the point that the NHS does not yet have 'a patientcentred culture'. Indeed.

I chaired Minister Denham's Fabian health workshop, where he sparred with Anna Coote, public health director of the King's Fund. I was there on behalf of The Guardian, but I explained that I have also been an HSJ columnist since Miss Nightingale's day.

'HSJ called me the most boring minister in the government, ' interjected nice Mr Denham.

'Not me, guv, ' I loyally replied. 'It must have been the sub-editors. '

As I say, Mr Denham and Ms Coote clashed mainly over her attack (endorsed by several speakers from the floor) on 'target tyranny', whereby the high hopes for more preventive medicine which were clear in the green paper, Our Healthier Nation, disappeared in favour of targeting key illnesses by the time the white paper, Saving Lives, was published.

'You can save lives without improving health, ' said Ms Coote, citing the example of a patient given drugs to treat high cholesterol problems without addressing the underlying cause of the high cholesterol. Minister Denham was unmoved.

The argument was the same as it had been with school league-tables, which had started out in pretty crude form and been refined with 'value added' - ie acknowledgement that some schools/hospitals have more difficult caseloads/pupils to deal with than others. 'It is better to use the information we have got than nothing at all, ' he said.

To rub home his point he described a trip to the Bury/Rochdale area to inspect a health action zone (HAZs were 'not a success', Ms Coote had said). Can we measure improvements? Mr Denham asked regional officials.

'Very difficult, minister, ' they replied. So Mr Denham asked parents. 'Improvements? Oh yes, this used to be a hard-to-let estate, now It is got a waiting list and the primary school is over-subscribed, ' they replied.

Not a bad yarn, but the bit I will remember was when Denham recalled how a Times columnist had mocked the boss for talking as if all NHS modernisation means is 'good management'. In their enthusiasm for policy-making rather than its implementation the gentlemen at The Times are like the Victorian upper classes, explained Minister Denham: 'Superior people who recognised that tradesmen are necessary but wouldn't want their daughter to marry one. '

He went on to say that, just as Labour should now be relaxed enough about the role of markets to say 'this is not a matter for a market solution' (eg the NHS), so public service managers should become confident innovators.

What the NHS needs is 'a tremendous investment in leadership and management which it hasn't had for years' - not just traditional management, but new forms that involve (for example) clinicians as managers. I hope that cheers you up, if you're a manager, just as Ms Coote's hope to make doctors 'help patients become co-producers of their own health' may terrify some medics.

As he finished, Mr Denham confided: 'What I worry about when I wake up every morning is how to make the system work better. ' 'Why haven't you asked him how much of the NHS budget will be trousered by PFI hospital schemes, ' I asked the audience, just to be helpful.

'None, ' he beamed.