Schools and hospitals still test the 'nasty party'

If there was one negative that David Cameron was desperate to remove in his drive to "decontaminate" the Conservative Party brand, it was on health policy. As the man who wrote the party's 2005 election manifesto, he was well-placed to judge its shortcomings.

His main target was the ill-fated "patients' passport" to give a taxpayers' subsidy to patients who opted for private treatment, which sent a powerful signal that the Tories cared about the few rather than the many, and allowed Labour to claim that the Tories wanted to privatise the NHS even though they did not. So it was dumped, in one of his first acts after becoming Tory leader. The decision was underpinned by a firm pledge to match Labour's spending on health, in order to neutralise Labour attacks over "Tory cuts".

The Tory leader has repeatedly vowed to make the National Health Service his top priority. One of his closest allies sums up the party's campaign strategy for the next election as "economy, crime, NHS". That the Tories can even aspire to put health, traditionally Labour's strongest issue, at the heart of the Tories' strategy is testament to how far the party has come.

As the NHS marks its 60th anniversary, the Tories are back in the game. Some senior figures even believe they can pull off a stunning away win on Labour's ground. Privately, most would settle for a draw. Some opinion polls have even put the Tories ahead on the issue, although they may reflect general discontent with Labour rather than positive support for Tory policy.

Mr Cameron has led from the front, and has been able to speak from the heart. He has probably spent more time in NHS hospitals than most politicians, because his son Ivan is severely disabled and suffers from epilepsy. So, despite Labour's sporadic attempts to portray him as a "Tory toff", he carries credibility when he describes the NHS as "one of the greatest gifts we enjoy as British citizens". The gaps between the parties on health have gradually narrowed. There are some differences, although they are not as great as both parties imply.

Last month the Tories won headlines by promising to sweep away Labour's centrally imposed targets on the grounds that they distort clinical priorities. The party also promised to reduce day-to-day interference by ministers by setting up an independent NHS board. This proposal has not won many friends among health professionals, even though they have warmed to the Tories after being wooed by Andrew Lansley, the shadow Health Secretary. He has been dubbed one of "the untouchables" as Mr Cameron has guaranteed him the health post in his first cabinet.

Under a Tory government, the focus would be on health "outcomes", but "a set of objectives" would still be agreed by the Health Secretary and the independent board. Experts, such as the independent King's Fund, say these objectives could feel like targets and still impinge on clinical freedom, arguing that the Tories need to provide "further detail" about how the board and the objectives would work.

Labour insists that targets are necessary, pointing to the prize that will be achieved this year of a maximum 18-week waiting time from GP appointment to operation. Labour points out that "good" targets – such as half of all GP practices offering extended hours within three years – would be scrapped by the Tories. Some natural allies think the Tories have been too opportunist on health – by opposing closures any government would have to make, and running "scare stories" about Labour's plans for small GP surgeries to be replaced by medical centres or polyclinics.

While the two main parties converge on health, the gap between them on education is widening. Although it might feature less as an election campaign issue than health, education would be one of the Tories' key legislative priorities in power. The flagship would be to allow groups of parents, educational charities, philanthropists, existing school federations, not-for-profit trusts and co-operatives to set up new independent schools in the state sector, and to give them the same public funding as existing state schools.

It is based on the system in Sweden, where hundreds of new schools have opened. The Tories say this has driven up standards and social mobility, because parents have the right to take children out of failing schools, with the per-pupil funding transferred to the new independent one. The Tories believe the revolution would force poor schools to improve – or die. Labour says it would entrench "educational apartheid".

The "Swedish schools" policy epitomises the Tories' wider approach to public sector reform generally. By extending "choice", they say they will be completing the unfinished business of Tony Blair's reform programme, claiming he was prevented from doing so by his party – and Gordon Brown. There is some common ground between the Tories, ultra-Blairites and the Liberal Democrats on a voucher-style approach to schools.

Some critics say the Tories are making the running on education but are in danger of echoing the Government rather than leading opinion on health. Andrew Haldenby, director of the pressure group Reform, said: "The party is leading the agenda more on education than on health. It has put forward innovative ideas such as new academies, and there is evidence of more new thinking which is yet to be launched. On health, they have to watch out – Alan Johnson's review of top-up payments [under which people pay towards the cost of their drugs] could make the party seem backward-looking."

Oliver Letwin, the Tories' policy chief, will answer questions from Independent readers in next Monday's newspaper. Send yours to: yourquestion@independent.co.uk

Key policy commitments

HEALTH:

* Match Labour's budgets for health and education until 2010-11.

* Set up independent NHS board to reduce politicalinterference.

* No further NHSreorganisations.

* Scrap Labour's top down "process targets".

* Extend practice-based commissioning to allow GPs to hold budgets; patients allowed to choose GPs.

* Trusts would commission but not provide services.

EDUCATION:

* Create an extra 220,000 school places by allowing parents, charities and philanthropists to open new schools.

* Give heads greater powers to expel pupils and teachers greater powers to search children.

Unanswered questions

* Would the creation of the NHS board reduce political interference because its objectives would still be agreed with the Health Secretary?

* Would a switch to outcomes from targets merely reinvent targets under another name?

* Would there be a rush of groups coming forward with proposals to set up their own schools – particularly as charities have little incentive to expand?

* Would a Tory government allow more grammar schools?

* Would existing schools suffer from the Tory plan to cut £4.5bn from Labour's programme to refurbish or rebuild every secondary school?

Face to watch: Michael Gove

A member of David Cameron's inner circle, he enjoys much more influence than his post of shadow Education Secretary suggests. A key moderniser and architect of Project Cameron, he advises the Tory leader on a range of policies and helps prepare him for Prime Minister's Questions. The former journalist, who still writes a column for The Times, became MP for Surrey Heath in 2005. He would be a senior figure in a Cameron cabinet and admirers see him as a possible future party leader. He chairs the Policy Exchange, a centre-right think-tank.

Tomorrow: Environment

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