Another roller-coaster week as ministers and MPs engage in close combat over the Human Fertilisation and Embryology Bill with one hand, while battling to maintain momentum on NHS reform with the other.

I write before the final outcome is known, though I have heard little to change my view that the bill is more right than wrong and the "Frankenstein science" lobby, which campaigned not always scrupulously, more wrong than right (again).

The wider outlook was not all darkness. On the day the Department of Health got poor marks for performance in the government's latest internal "capability" review, the King's Fund think tank detected the first rise in NHS productivity for a decade in 2006-07.

All right, so most of it came via A&E costs and falling staff numbers (8,500 in total: how long ago the Hewitt cost drive feels!). And the good news was offset by speculation that the 18-week wait target for 2008 may be missed, albeit narrowly.

None of which depressed the upbeat tone NHS chief executive David Nicholson doggedly injected into his annual report for 2007-08, a tone for which embattled Labour MPs were duly grateful. He gave managers a pat on the back for what they have achieved on the "journey" towards a better NHS, coupled with stern exhortation about the responsibility to deliver an NHS "truly responsive to what our patients and local communities want and need". Ah, "want and need" - not necessarily the same thing.

But what struck me for the first time in reading Mr Nicholson's report was his boast (the right word, I think) that the NHS now has much better capacity to respond to what he called "in-year pressures", or short-term crises.

He also cited the soon-to-be-completed deep cleaning of hospitals and appointment of 5,000 new matrons. He could have mentioned winter flu, not a crisis the Daily Beast has been able to report recently.

But before everyone could breathe a sigh of relief along came Civitas, one of the smaller right wing (but non-party) think tanks, to pour cold water on it. Civitas, which promotes "intermediate" institutions between the state and the individual, reported 9,000 patients still waiting a year, 62,000 waiting six months, "mediocre" cancer standards, stubborn rates of MRSA, etc.

As with the National Audit Office's latest report that the NHS's mega IT programme is running on budget (IT czar Richard Granger drove some hard bargains) but two years late, it's the old "half full or half empty?" question.

When I checked with Mark Todd, an independent-minded Labour MP and IT specialist, he said he was "encouraged". "It's not over-budget - though we should be careful not to drive contractors away - and we're getting there, admittedly slower than expected. The gains are starting to come through."

Two other aspects of the week are worth noting. One is that Gordon Brown's draft Queen's Speech included a reference to inserting a patient satisfaction criterion into payment by results as well as promising that NHS constitution.

Asking around I don't think MPs and health ministers have yet thought either of these through. The constitution was Andy Burnham's idea during his brief stay at the DH, although Andrew Lansley has his own Tory blueprint. I suspect it won't come to much. As for the payment by results change, that apparently was very much Number 10's idea, Gordon Brown pressing on value for money.

Value for money was also the dominant theme of the new PCT procurement/tendering guidelines that emerged mid-week. Managers are warned there will be more bidding from private and voluntary sector operators - a point David Nicholson's report underlines - and that requirements of efficiency and transparency, reinforced by new EU competition rules, are creating a more contract-based NHS.

Health ministers are up for that, although NHS managers will run higher risks of litigation by disappointed bidders if rules are not followed. Civitas, which is EU-hostile, won't like pressure from Brussels. Yet in proclaiming the NHS "the sick man of Europe" it seems happy to accept EU health statistics. Odd that.