Mr Cameron yesterday expressed admiration for US presidential candidate John McCain who turned around his fortunes in the race for the Republican nomination by holding one town hall meeting after another, engaging with the public face to face. It is a time-consuming and exhausting way to campaign but it produces results for politicians unafraid to talk about real issues with real people.

The Conservative leader demonstrated that ability at the Yorkshire Post's "60 against one" event. Faced with a wide range of questions on a host of policy areas he spoke confidently and did not merely fall back on well-rehearsed glib answers.

More than that, there were emerging signs of the platform the Conservatives will take into the next election. It will be one that acceptsa Tory government will not have the room to spend heavily or offer tax cuts but, nevertheless, promises new thinking on major issues.

Nowhere was this approach clearer than Mr Cameron's interest in the idea of striking a deal with voters that if they save up for their first year of residential care in old age, the state will pick up the rest of the bill.

Care of the elderly is an issue that affects almost every family at some point. Politicians studiously avoid discussing it, because the solutions invariably involve the public paying more, either to providers directly or through their taxes.

It would be tough to persuade people already not saving enough for
their old age that they should set aside money for residential care. However, many would find the idea preferable to obliging elderly people to sell the family home and it forces the Conservatives' opponents to offer a better alternative.

That willingness to adopt a politically difficult position and challenge others to do better was also on show in Mr Cameron's temptation to allow patients to co-fund their treatment where the NHS will not pay the whole cost. Agreeing to such a move would involve ditching a core principle of the NHS, that ability to pay makes no difference to the treatment received. But it would also recognise
that growing patient demands, accompanied by the increasing number of expensive treatments made possible by scientific advances, is placing
the NHS in a position that is unsustainable in the long term.

Mr Cameron must be careful though. He has worked hard to rid the Tories of their image as the "nasty party", concerned only with the interests of Middle England. His proposals on care, NHS treatment and also on transport, where he warned new roads may have to be paid for by congestion charging, would place new financial obligations on families, some finding them more of a burden than others.

They may be tough answers to tough problems but he must be wary of allowing his political opponents to characterise the Conservatives as the party of privilege. Equally, his positions on Britain's future in Europe and the way money is distributed to different parts of the UK may be infused with realism and honesty but he should not casually dismiss the serious concerns held by many voters in these areas.

The reaction of the "60 against one" audience suggested, at the very least, he had offered them food for thought. The forthcoming local elections will reveal whether he is impressing the public at large.