Michael White on Darzi's plans

Look carefully and you can see ministers struggling to turn the tide. On Monday Gordon Brown went to the King's Fund to speak in support of Alan Johnson's six-month debate on the future of social care for the fast-expanding numbers of elderly.

For NHS professionals it is familiar stuff about personalised, home-based services which preserve independence and are socially fair while remaining affordable, as those in SNP Scotland look set not to be.

But the speech coincided with the second reading of the Human Fertilisation and Embryology Bill, a spot where scientific and theological passions clash, raising more media heat than light.

Both subjects had been targeted by rival partisans at health question time a few days earlier. Tory critics of abortion cite the rising number of repeat abortions to 59,687 in 2006 to suggest things are not right with the 1967 Abortion Act. Labour MPs cite the 88 per cent perinatal mortality rate among babies delivered below 24 weeks to suggest that cut-off time should be kept.

It was the same with social care. Tory MPs like the veteran ex-health minister Sir George Young complained of lack of funding. Current health minister Ivan Lewis (fresh from telling the Cabinet to do better again, cheeky fellow), reminded everyone just how much Labour has spent since 1997. Expert carers' training courses and much else are just round the corner.

But the gap between ministerial hope and reality was widest in the Department of Health's efforts to prepare the public for junior health minister Lord Darzi's plans for primary care reform.

Despite his Lordship's gentlest efforts it generated one headline "Hospital services face axe in NHS shake-up" in The Telegraph which must have spoiled his breakfast. The Financial Times's "NHS faces more instances of double running costs" was kinder, though not ideal. The word "cost" rarely is.

I tagged along with my Guardian colleague John ("NHS reforms rule out closure of hospitals before election") Carvel to listen to Lord Darzi, a man for whom respectful hospital doctors flatten themselves against walls rather than brush those charismatic surgeon's hands.

I am happy to report that powerful political office (on top of those hands) does not appear to have changed him; he remains modestly, persuasively soft-spoken as he presses home his much-repeated message that "all change" must benefit patients; be clinically driven; be locally driven; involve everyone; and must not see existing services withdrawn until new/better ones are in place. "You will see the difference first."

This last pledge goaded The Telegraph into a negative headline about the strategic health authority plans for primary care due to emerge in the coming month, the latest move in the drive to create a "self-improving NHS".

Lord Darzi believes a decade of top-down change and a doubled budget has shifted the NHS from adequate to good. But a£110bn business must be better than good. To go "from good to great" we must unlock the system.

We have heard it before, but not from a magic-handed surgeon who believes self-generated change is happening. That region with its own stroke agenda, those pressing for two-hour waits in accident and emergency and pushing for trauma centres represent self-generated change. He cites efforts in the North East to improve patient access despite huge investment in NHS Direct, in walk-in centres and out-of-hours care.

Patients still feel NHS gateways remain confusing.

Quiet confidence is infectious. If the British Medical Association's spokesman or shadow health secretary Andrew Lansley could have heard him they might have been enthused like me instead of being negative in their comments.

I was especially taken by Lord Darzi's view of London's NHS. Young, crowded, hyper-mobile, unequal, it also has too many powerful doctors, he seemed to suggest. In short, a bit backward. That's the spirit.