Perhaps a cold winter or an epidemic will trigger a crisis that gives Labour cover and an excuse to raise more NHS taxes. Most voters care less about theory than remedies.

Before we turn to Ed Miliband’s Labour conference speech pledges on the NHS (he is speaking at 2.30pm today), let’s pause to acknowledge how much and how fast the wider world is changing.

Russia threatens again, China surges ahead, the faltering US is again bombing the Middle East, while David Cameron talks to old foe Iran, but Europe looks marginalised.

Much closer to home, the existential UK crisis over Scotland’s independence referendum is far from over.

‘The existential UK crisis over Scotland’s independence referendum is far from over’

Some of the disturbing features of surging Scots’ nationalist sentiment - I kept hearing fresh yes camp intimidation stories in Manchester - are stirring in England.

It all comes as Westminster politicians face the delicate task of delivering “devo max” to Holyrood without upsetting the UK - all this in a general election run up.

It’s not just a British problem. But it’s not good for sure footed macro-management of NHS England - NHS Scotland’s problems won’t miraculously evaporate either - at a time when there are even fewer easy options than usual, and the public temper is frayed.

Labour’s election ‘offer’

Talking up legitimate concerns about waiting times - by Labour, the Scottish National Party or the media - has a self-fulfilling aspect, doesn’t it? Reality is tough enough.

So in putting the NHS at the heart of Labour’s election “offer” (the fashionable but unsuitable word) is Miliband signalling a retreat to Labour’s “35 per cent” core strategy? I think so, though that is denied.

It’s as traditional a pitch as the Tories banging on about Europe or (years ago) the empire.

‘Labour’s evolving position on health is “interesting”’

Talking of which, stirring up immigration issues before 2010 hasn’t done David Cameron much good either. Making promises Theresa May couldn’t meet only helps Ukip.

So Labour’s evolving position on health is (dangerous word) “interesting”.

Health professionals at fringe meetings told Andy Burnham they definitely don’t want another reorganisation.

That’s hard to square with repeal of the Lansley Act and an ambitious integration of health and social care to make it as easy to get frail old folk out of hospital as it is to admit them.

Will it save money too? Maybe in the long term, Andy; short term it may just increase demand. “Invest now to save later” is an old tune.

‘Save the NHS’ rhetoric

Burnham and Ed Balls - keen in Manchester to show how financially responsible a chancellor he would be in 2015 (activists weren’t pleased) - have won the battle to tie a bit more cash to a lot more NHS reform and to stop Miliband from promising an extra 1p on National Insurance to pay for it.

This week’s offer (I write before seeing the details) instead targets big tobacco’s profits - always a popular pantomime villain - for a windfall tax. Also a hit on £2m homes which would be called “red brick Victorian semis”, not “mansions” anywhere but London.

‘Sceptical NHS watchers doubt if Miliband’s “save the NHS” rhetoric is matched by such modest tax proposals’

Sceptical NHS watchers in Manchester doubt if Miliband’s lofty “save the NHS” rhetoric is matched or undermined by such modest tax proposals, worth £2bn at most. They give the Tories a target and their richer donors a motive, without exciting stay away Labour types who voted yes in Scotland and may vote Ukip next May.

It reminded me of John Smith’s too clever shadow budget before the 1992 election which John Major won against the odds.

Is this where weary voters are? Labour activists hate private sector incursions into NHS provision. Most voters care less about theory than remedies.

Perhaps a cold winter or an epidemic will trigger a crisis that gives Labour (or Jeremy Hunt?) cover and an excuse to raise more NHS taxes.

But in the world turned upside down we now inhabit, I also heard senior Labour advisers in Manchester - men who have run many companies - salivate about the millions they could save in streamlining and centralising NHS procurement alone if only they could. Dream on.

Michael White writes about politics for The Guardian

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