The august British Medical Journal editorialised yesterday that home rule might be good for Scots, suggesting that health care could be better organised under a devolved parliament producing a national strategy to meet the needs of the population and the professionals who care for it. The suggestion would have found no favour among the dinosaurs at the truncated Scottish Conservative Party conference in Perth yesterday. Loyally and truly they stuck to the party line that devolution was utterly bad for Scots and the Union. It was a mantra hymned by a succession of speakers, in bravura terms by Michael Forsyth, the former Scottish Secretary. His was a barnstorming performance, invoking Thatcherism on a range of issues. It was a speech, and a line on devolution, which could have been delivered a year ago. It was as if nothing had changed. But everything had. Scottish party activists loved it,

but they seemed to miss the paradox. The message might have been constant, but it had cost them the General Election, and parliamentary representation at Westminster.

At least the reformers were not there to hear it, either from Mr Forsyth or their leader, William Hague. The dissidents, centred on Tory reform group chairman Arthur Bell and arguing for a separately-funded, separately-constituted party in Scotland with a more flexible approach to devolution reflecting the views of sympathisers among the wider Scottish public, had heeded the message to shut up or get out. They left early. The writing appears to be on the wall for Mr Bell, who now faces a challenge for the chairmanship which bodes ill for the Tories and devolution since, if it succeeds, will result in a stifling of debate by effectively bringing the group under establishment control. Scottish Tories decided not so much to grasp the thistle of party organisation and policy-making north of the Border as flutter suicidally around it. There is to be an ill-defined commission to look at structure

in Scotland involving what can most kindly be described as the same old (and older) faces.

And it has no deadline for producing a blueprint. Yet the referendums will soon be upon us, followed by the devolution bill. Rigorous ''no'' campaigns on both fronts are essential if we are not to sleep-walk into sloppy home rule. But it has to be attractive to devolution sceptics and opponents, challenging to supporters. It demands more than the same old arguments from the same old machinery. Both have failed, spectacularly. But that is to be the way forward. Or downwards, since vigorous opposition to the devolution referendums and beyond can surely hold little attraction to the 500,000 Scots who voted Tory at the election. A Scottish parliament would guarantee them representation at decision-making level. Yet they are being asked to stick with the old line which promises nothing in that direction, far less a machinery which can tap into their hopes and desires and produce candidates reflecting

the new Scottish identity. In the unreal world purity might be all; in the real world it is nothing.