Gordon has to win back health for Labour

Not that Mr Brown has really been away. A visitor summoned to his Kirk-caldy home reports that he had an array of Prime Ministerial computer link-ups installed in a spare room and was happily surrounded by briefing papers, forward planning and grids. "He's really enjoying it," he reported. No, Mr Brown is not like other mortals in August.

He returns from the perfect political summer: an abiding lead over the Conservatives and high levels of voter satisfaction with his leadership, if more ominously for the real fight ahead, not with the Labour record as a whole.

That makes autumn a more difficult proposition. Unless there is a further serious upset to Mr Cameron, the likelihood has to be the wide poll lead (up to eight points) will undergo some correction. Clearly, Mr Cameron needs a reversal of fortune and a more consistent relationship with the electorate.

But Mr Brown now needs to establish a more settled pace, too. Unless he really intends to dash for a super-speedy election, he must start to tackle some of the underlying Labour malaise which the early burst of popularity has concealed.

One new battlefield looms wide open for a ruck and that is the health service. It is the single area preoccupying Mr Brown this summer. He knows that the closures of local A&E units are unpopular and likely to become more so. That is why the report on planning GP services was farmed out to Ari Darzi, the surgeon appointed by Mr Brown as a health minister.

Oddly, Professor Darzi's report does not claim that there would be anywhere near the 150 polyclinics in London which were finally announced by Gordon Brown. That ambitious target appears to have been added afterwards, at the behest of Mr Brown.

Therein lies the danger. As one Conservative strategist puts it: "We know what works for us, and talking about the NHS and stopping the cuts does." The narrative of health reforms to create a more modern and logically run service has shifted quickly into a row about where cuts will fall.

This has edged Mr Cameron into an unconventional position. A party full of thinkers who would like to tackle the NHS and its inefficiencies more robustly is treading softly on our dreams of preserving all the great gods of local hospitals, quality services, improvements in cancer cure rates (still down on European comparisons, according to a new report this week). Its leader adopts a tone towards "frontline" NHS staff of pure emollient treacle.

So Mr Cameron talks of "evolution not revolution", which is what health professionals want to hear and the public finds comforting.

It is, in essence, a trade-off of the old Tory reforming instinct on health for a less radical agenda, but one which Mr Cameron hopes will get a hearing.

Together with his health spokesman Andrew Lansley, he concluded that the Conservatives could not break Labour's lead on health unless they were first listened to by NHS professionals - who have an inordinate impact on the public's opinion of the service. As one health minister concedes: "Doctors and nurses meet more members of the public day to day then we ever do. They form the view of how we're doing."

I saw an interesting vignette of this the other day when, after a lengthy wait in the GP's for what should have been a timed appointment, a harassed doctor emerged and announced he had an emergency call and that he could not guarantee when any of us would be seen that morning.

Was I the only person wondering why a highly paid, fundholding GP in a modern surgery, which can plan its own schedules and staffing, had left himself in this position - and expected busy patients to bear the brunt of it? Of course, no one complained. We tend to take for granted what doctors tell us about their conditions or concerns.

Mr Brown is privately furious at the super-generous deal handed out to GPs without reliable provision for evening and weekend working. But he knows that post-Hewitt, confrontation will not work. So he uprooted the ever-pleasant Alan Johnson from education - where he preferred to stay - and deposited him in health to cheer up the troops. Mr Johnson, who usually thrives on being in the limelight, is diligently closing down the debate on health with a year-long "review" - to the exasperation of many who feel that the problems of the NHS have already been reviewed substantially.

Indeed, the freeze on further measures is a largely political move, while Labour works out its pitch on health at the next election.

That leaves the programme of hospital closures and the move to larger centres on the German "Polyclinic" model. Mr Brown's sudden expansion of the polyclinics from an unstated number in the Darzi report to 150 is mysterious and badly explained. Ministers have floundered in establishing how such a substantial number of large clinics can mean anything but the end of local GP services.

It is also questionable whether the target figure of births required for many existing smaller maternity units to remain open could be met - short of a vast increase in the number of babies. Not even Mr Brown has thought of setting a central target for this.

Now another report dramatising the risks of longer trips to hospitals has appeared. There are answers to these objections, of course, ranging from better paramedic training to increasing the number of defibrillators accessible to give emergency treatment to heart attack sufferers. But the Government also needs to reassure when it makes major changes to key services - and so far, very little of that has come across.

Mr Johnson could argue that the number of cases where the risk would be greater is so small as to be outweighed by the general good: or row back on the plans for particularly sensitive closures. The present silence is the least convincing solution.

It is not clear that the Conservative opposition is based on a 20/20 vision for the NHS, either. David Cameron is convinced that the real logic behind the polyclinics is that the EU working time directive is more easily complied with in such large units. The tendency of Conservatives to find a Brussels-based malaise at the bottom of most things is reasserting itself at quite a rate these days.

Mr Cameron also insists that he has not ruled out any health reforms of his own - but this is another example of the pick-and-mix message which confuses voters about the instincts of his party. A campaign based on fending off "Gordon's cuts" is essentially an election battle plan, rather than a plan for government - and Mr Lansley will have his work cut out to put across a broader intent in his public health review later this year which seriously attempts to redefine some priorities on health budgets.

But it is the Government that carries the can for high spending on health - and a disaffected mood inside the service spilling over into voters' attitudes. In his final period as Chancellor Brown was highly critical of the Blairites for "losing" health - the traditional Labour trump card. Now he has to find it again - or reap the consequences.