'Handy Andy Burnham urges respect for NICE's independent experts and insists that complementary medicines (another regular bugbear) must be a matter for 'local determination'.'

The cries of pain which routinely emanate from the NHS these days remind me of a busy day on the maternity ward, far noisier than accident and emergency in my admittedly limited experience, except when the customers start fighting on Saturday nights.

As I type leftish doctors are celebrating the British Medical Association's annual conference by telling Radio 4's Today that the private sector should be kept out of expanding healthcare provision, rightish ones that it should be brought into healthcare purchasing as well: in other words, we should all pay health insurance instead of health taxes.

Tory spokesman Stephen O'Brien's contribution to the BMA's jamboree is to declare that Labour has finally run out of excuses for not delivering a high-quality service.

'NHS professionals must be trusted to do their work without the turmoil of endless reforms, which are imposed centrally and are no way to manage our NHS,' he says. Whatever that may mean.

During Commons health questions the other day similar confusions and concerns were painfully evident as MPs on all sides complained about centrally imposed deficit targets.

Thus Oxfordshire Tory Tony Baldry reported that 5,000 people met the other Sunday to express concern over local cuts. That is a lot of people when a protest competes with sunshine and the World Cup.

Yet simultaneously MPs protested at the lack of centrally imposed rules on patient access to, say, anticholinesterase, the early-stage Alzheimer's drug. The National Institute for Health and Clinical Excellence is still examining it, but impatient MPs insist the delay is a 'false economy'.

Ministers have to hold the line on both without being rude. Handy Andy Burnham urges respect for NICE's independent experts and insists that complementary medicines (another regular bugbear) must be a matter for 'local determination'.

Health minister Caroline Flint admits that too many children are now obese. She blames food labelling and sedentary PlayStation games for this shocking situation. Labour ministers never blame the News of the World for creating panic over paedophilia, though it cannot help. The radio tells me the government plans to build more bikes lanes. We will see what the tabloids make of that. 'Pederasts pedal paths' perhaps?

As ever, health secretary Patricia Hewitt's problem is having to justify her insistence on Prussian discipline. I quote: 'We will return the NHS as a whole to financial balance by the end of March next year. Within that, we would like all overspending organisations to achieve a monthly balance between income and expenditure, again by [March 2007]. Some will not be able to do so, but overspending in one organisation will have to be matched by underspending in another'.

As local MPs are quick to protest, that translates as meaning that in Avon, Gloucestershire and Wiltshire strategic health authority, Gloucester is having to tackle its own modest deficits and contributing£6.5m to help sort out its new partners. Stroud's maternity unit is at risk. So much for birthing choice for all by 2009, murmurs Tory health spokesman Andrew Lansley.

In all this anguish I also spotted the normally clear-sighted Dr (PhD, economics) Vince Cable, the Lib Dems' gangling shadow chancellor. Yes, I know it sounds very grand, but at 63 he is almost twice the age of his Tory counterpart George Osborne (35). Dr Vince protested to Ms Hewitt that NHS management has doubled since 1997, while clinical staff are only 30 per cent up.

Surely the saintly Cable had not stooped to manager-bashing, I said to myself. But yes. If management and clinical staffing had increased at the same rate 'there would be 12,000 fewer and the NHS would save about£500m a year, a large part of its deficit', he told Ms Hewitt, who cunningly countered that management is now only 4 per cent of total NHS costs. It was 5 per cent in the old days.

I rang Dr Vince to check his thinking. It was modest. Doctors and managers in Twickenham keep telling their MP how much time is wasted collecting data for the boss class. Some of it is useful, but only some. If you stop smoking without using the NHS-approved course it doesn't count in Twickenham, he tells me. -

Michael White is assistant editor (politics) of The Guardian.