The Tories plan an NHS offensive - but they're heavily outgunned

The Conservatives are gathering in Harrogate for their spring conference with a fresh spring in their stride. The sun is almost shining and an opinion poll has been published showing a narrowing of Labour's lead. As Downing Street is in a panic when Labour is 40 points ahead, there will be much introspective gloom at No 10, in contrast to the almost heady excitement in the northern spa town. The Conservatives are not used to being only nine points behind in the polls.

As an ambiguous bonus, Lady Thatcher has retired from the political fray. The loud proclamation of her silence has stolen the thunder of another Conservative conference and there will be genuine sympathy for her. Still, the latest party leader, the most devoted disciple of the lot, must be hugely relieved that he has the chance to claim some political space of his own without the Lady breathing down his neck.

The National Health Service has become the unlikely chosen political battleground for Iain Duncan Smith. Like the BBC, this was an institution that Lady Thatcher despised, but did not dare to challenge. Reforms to the NHS were introduced, dropped and then reintroduced in a different guise, but always against a broader context that the NHS itself was not under threat. It was "safe" in her government's hands. John Major always used to raise the treatment of his dodgy leg as an example of his unswerving commitment to the health service. William Hague flirted with the idea of more radical reform, but these ideas disappeared along with his baseball cap long before the last general election.

Today in Harrogate Mr Duncan Smith will raise questions about the future of the NHS as an institution, suggesting that additional spending does not guarantee better healthcare and pointing to systems in other countries that work more effectively. Fundamental reforms of the NHS will become a symbol of the Conservatives' claim that they can run the public services better than the Government can.

Yet the apparently confident denunciations of the current NHS disguise considerable unease and doubts within the Conservative Party about what its alternative policy should be. As Gordon Brown pointed out in his substantial and meaty speech last week, no party has rushed forward with a fully worked-out alternative to an NHS paid for out of general taxation, although all the other options are well known. Indeed, no party has even come forward with an alternative policy that has not been fully worked out.

Mr Brown went about demolishing the other options with a brutal precision not normally associated with New Labour speeches. This was a speech that avoided waffle about hard choices and traditional values in a modern setting or modern values in a traditional setting. The arguments against other forms of finance included one that tackled head on the notion that the NHS is an outdated product of the Forties. The standard of treatment and technology now are such that – unlike in 1948 – some illnesses or injuries could cost up to £100,000 to cure. The need for what Mr Brown described as "comprehensive insurance cover of healthcare" was therefore stronger than ever.

This rare clarity over a government policy would not have come about in a hurry. Indeed, the starting point, probably in the Treasury, certainly in Downing Street, would have been an enthusiasm for other forms of funding. Look at the appetite for all sorts of convoluted funding plans in other fields. Mr Blair's unequivocal support for an NHS funded out of general taxation, first outlined in an interview with this newspaper last November, would have followed an intensive scrutiny of other options, especially as on the surface they appear to be more New Labour: social insurance, private insurance, charging – or a combination of all three. Even the ardent Blairites in Downing Street, terrified of higher taxes, concluded that the other options were less practical and more costly.

Compare the Government's clarity and confidence on the NHS with the continuing obfuscation over the euro, constitutional reform and fox-hunting. On the NHS it knows more or less what it wants to do and how it plans to do it.

The Conservatives, therefore, are taking a huge risk by confronting them over this issue. Even on the surface they cannot entirely hide their own doubts about what they are doing. So far there has been no attempt to present an alternative policy or to offer the outlines of an alternative. Indeed their Health spokesman, Liam Fox, acknowledged in his speech yesterday that voters felt an affinity towards the NHS that had to be taken into account as the Conservatives formulate their package.

Privately, senior members of the Shadow Cabinet are even more wary of taking too radical a route. One told me that, although they will vote against the Budget next month, he expected that by the time of the election they will not pledge to reverse any tax rises to pay for the NHS. Another suggested that the policy will differ from the Government's only at the margins. He thought that the Conservatives would encourage GPs to charge for additional services such as sports clinics on a Saturday. He did not envisage an additional range of charges.

The political mood is changing. In 1997 the greatest control freak was not an individual waving an intimidating wand in Downing Street. It was the novelty of power that made ministers and MPs stay rigidly on-message. Novelty is a wasting asset. No minister was going to risk the sack after waiting 18 years for a whiff of power. Now that five draining years have passed, some of them are contemplating their personal convictions again. The back benches are teeming with sacked ministers or MPs who realise that they will never become ministers. Most of all it is Mr Blair's approach to Iraq and his relationship with President Bush that makes them restive. I have not met a single Labour MP over recent days – including many who are loyal on other matters – who do not have their doubts about the Prime Minister's approach to the US and Iraq.

As disillusionment with the Government spreads, interest turns to the Conservatives. There has been more media attention as they gather in Harrogate than for any of William Hague's various speeches. Nor has the focus been entirely on the noisy silence of Lady Thatcher. Yet the flattering attention is a double-edged sword. With greater interest comes greater scrutiny. On the NHS it appears that the Conservatives are either planning to present themselves as being more radical than they really are – or to be genuinely radical. Either way, on one of the biggest issues of the day, the Government has got the ammunition to win.