comment : But how long will these harmonies resonate in the months ahead?

Getting the 'mood music' right is vitally important for modernising the health service, as NHS Confederation chief executive Stephen Thornton remarked at his organisation's annual conference last week in Manchester. It means, he argued, creating a climate in which managers can thrive, so setting the tone in which others' attitudes are decided.

The mood music in Manchester repeatedly struck the right chord. Prime minister Tony Blair, in a videotaped message, promised decentralisation, no avalanche of new initiatives and recognition for managers' contribution to reforming the service.

US management guru Paul Plsek set out a subversive theory for justifying the overthrow of central diktat, explaining that the NHS would never 'do as it was told' if beset by minutely prescriptive targets, but only after it was liberated to follow a mere handful of 'simple rules' . Even health secretary Alan Milburn, progenitor of controlfreakery, swore he was still intent on his pre-election promise to 'shift the balance of power' to the front line. And conductor Benjamin Zander - literally with the help of music - inspired delegates to consider a world of possibilities.

But for how long will these harmonies continue to resonate in the months ahead? The odd discordant note did break through even in Manchester. Concern about the impending damage traffic lights could wreak was palpable (see below). Discussion about care trusts was conspicuous by its absence, and NHS chief executive Nigel Crisp bluntly blocked questions about them at his press conference. Mr Crisp's uncertain grasp of the limits of franchising may have bruised his standing with Mr Milburn - it certainly suggests woolly thinking about a high-profile policy with deep symbolic significance.

Paradoxes remain, and to be fair, Mr Crisp for one fully acknowledged them.

Managers' attitudes may be a major factor affecting all other health professionals' attitudes, for example, but many managers are struggling to cope with the job insecurity brought about by yet more restructuring. It may well be a world of possibilities, but the dilemmas of those at the sharp end cannot always be dismissed as - in Mr Blair's phrase - the complaints of a 'coalition of eternal pessimists'.