David Cameron understands how crucial an NHS-friendly image is to Tory success. He may have ducked a Clause 4 moment but, in a first for a Conservative leader in opposition, he has actively championed a Tory commitment to maintaining NHS expenditure and the principle of universal access free at the point of need.

Beyond that Tory policy detail remains sketchy. Some elements are clearly stealing Labour’s clothes, with other rhetoric highlighting the key role of greater competition. Yet beyond pre-election PR, what are core Tory views about a health service built on socialist principles, which has delivered consistent progress on key standards and remains cost-effective? A few new clues are emerging.

In the summer Tory MEP Daniel Hamman provoked a Tory wobble after he denounced the NHS as a “mistake” that “made people iller” on Fox News. He was dismissed as “eccentric” by Cameron.

Now, a new right-of-centre vision claims that ending free treatment for minor or “lifestyle” illnesses, including fertility treatment and painkillers, could save the NHS £20 billion a year. The report is called ‘Responsibility in healthcare: changing the culture‘ by think-tank 2020health. The work is led by Tory “A-list” parliamentary hopeful, Julia Manning. It warns

“Cuts alone will not yield this level of savings so it is increasingly obvious that there needs to be reform of common health behaviours.”

This is described as promoting personal accountability for health, to combat “disease-mongering”. The report states that “examples of this include varicose veins, acne, short stature, IVF, cosmetic surgery and moderate increases in blood pressure or cholesterol.” It advocates fining drunks and drug addicts who present to A&E.

An official Tory line on the report’s ideas is awaited but it follows the Conservatives draft manifesto chapter on health committing to fine people who fail to turn up for NHS dental appointments.

Many commentators claim Cameron lacks a big idea – but evidently many Tories are rallying to his theme of the small state. Their ideas to shrink NHS coverage are starting to emerge.