Labour’s first post-war prime minister, Clement Attlee, proposed to mark the creation of the National Health Service with a wireless broadcast. He would hail it as a triumph for the whole nation, probably because he recalled that the groundwork had been done by Conservative and Labour politicians toiling together in the wartime coalition.

Aneurin Bevan, the minister of health, was incensed, however. He persuaded his leader that since the Tories had voted against the second and third readings of the parliamentary bill, Labour should make health a partisan issue.

Ever since that day in 1948, the Tories have been on the back foot. Although the party had more years in office than Labour and has therefore nursed the NHS during more than half its existence, the public distrusts its intentions. Even though Margaret Thatcher during her whirlwind of public sector reform left the basis of health funding well alone, the Tories are still suspected of wanting to privatise the service. According to an opinion poll this month 34% trust Labour with the NHS, and only 20% the Conservatives.

How electors perceive the motives of political parties affects how they vote. In the past, Labour was suspect on law and order. Leftwingers criticised the police. In 1985 Bernie Grant, then a local councillor, said they had got a good hiding in the Broadwater Farm riot, during which a constable was murdered. Just as damagingly for Labour, its support for the CND made people believe the party was lacking in patriotism. A Conservative election poster showed a British soldier with his hands up, with the caption “Labour’s defence policy”. Opinion polls confirmed that voters did not trust Labour on those key issues.

The new Labour project worked to counter those damaging impressions. It dumped unilateral nuclear disarmament. Renegades who insulted the police were squashed. The leadership lost no opportunity to appear alongside police officers or to visit our troops. Blair promised to be tough on crime and tough on the causes of crime.

Had Labour during its time in opposition announced that it intended to reorganise the police or the armed forces, the public would have been suspicious of its motives and that would have undone its efforts to overcome negative images. In any case, Labour wanted to reduce the “salience” of the issues on which it was weak and shift the debate to better ground such as health.

The problem of trust that the Conservatives have on health today is like the one Labour used to have with police and defence. But the Tories are not trying to make the issue less salient. On the contrary, they are being, as Sir Humphrey said whenever he wanted to terrify the minister, “very brave”.

Far from reassuring a suspicious public that not much would change if it came to office, the party is proposing a revolution. It has not prepared the way with a public relations project: Tory leaders have not spent years protesting their devotion to the NHS, constantly being photographed with doctors and nurses. Labour cannot believe its luck.

We must distinguish between what the Tories should do if they were elected to government and the different question of what they should say now if they want to be voted in. I apologise if that sounds cynical.

The Conservatives’ health policies in themselves are good. When Bevan played the partisan card more than half a century ago, he made the NHS into a political football. That is the main reason why our service works worse than those of most other countries. Bevan’s creation has been such a political winner for the Labour party since 1948 that it cannot contemplate modernising the service.

While Blair has forced his party to accept privatisation in energy and a mixed economy in public transport, it clings to centralised control in health. Our system is unique and uniquely bad. In most other European countries, even the most social democratic ones, tax is just one of a number of ways by which people contribute to the cost of health. Patients receive their services from private as well as public sector suppliers.

The Tory plan is in the mainstream of policy thinking on how to improve public services. Indeed, it is probably what Blair (who is in general a pragmatic moderniser) would like to do himself, had he not already faced fierce opposition from his neanderthal backbenchers.

They could not bear the idea that foundation hospitals, which remain fully owned by the state, should be allowed even a modicum of independence. It is sad that a dogmatic Labour party has the prime minister tightly bound, condemning Britain to maintain a 1940s model of healthcare.

Explore Health News

• Swine flu

Times Recommends

• A vicar’s wife: ‘There is no one to fight for us’
• Every little helps at the supermarket
• Ugg or Fitflop? The battle of the boots