So was it all worth it? For three short days the health service's 50th birthday extravaganza at Earl's Court commanded the presence of the great and good, as well as some high-ranking international guests and plenty of media attention. But in the process it almost bankrupted the NHS Confederation. Initial ambitions had focused on attracting 4,000 paying delegates, and final estimates were nearer 2,500.

The organisers failed to get the active participation of the other main health professions: this remained predominantly a conference for managers rather than for the NHS as a whole. Consequently the scale of the event had had to be hastily reduced. The experience proved painful for the confederation, as its leaders confessed at their annual general meeting. Its partner in organising the conference, the Institute of Health Services Management, also had to face hard questions about its future during its AGM. Last week may have marked a watershed for both bodies. Delegates must have wondered whether their annual conferences can ever be the same again. Will they be forever doomed to appear as a pale anti-climax?

For it will not be possible to host the prime minister every year. In fact, Tony Blair is the first prime minister in living memory to address an NHS managers' conference. But let us hope we do not have to wait another 50 years for the honour to be repeated. If the NHS means as much to Mr Blair and his government as he claimed in his speech, addressing face to face the people who lead it ought to be a priority at least twice between elections - once to expound on plans for the service and once to pronounce on progress. From what Mr Blair said, the NHS is so central to the government's concept of the good society that its managers should expect to be kept abreast of thinking inside Downing Street as much as that inside Richmond House.

Mr Blair came dangling a large birthday present which he took away again still wrapped up. The service must wait for the spending review before finding out whether the gift is as generous as the packaging suggests. When that time comes it will be poked and prodded in a demanding manner more akin to a four-year-old recipient than one in middle age. Mr Blair himself upped the stakes last week. 'I think you will see we have kept our side of the bargain,' he pledged. 'You will see the NHS will get the resources it needs. I give you that commitment.'

This is a far cry from the careful attempts to manage expectations which characterised New Labour's early days in office. It was a long way too from the equivocal support which Conservative ministers lent the service from conference platforms - however reassuring their spending record may appear with hindsight. Gone are the flirtations with alternative funding methods, so long the staple of health management annual conferences. Health secretary Frank Dobson dismissed such schemes as 'the far blue yonder'. Although the official conference theme was 'all our tomorrows', and much effort went into staging elaborate 'futures' scenarios, Mr Dobson's put- down rendered it rather redundant. Delegates might want to discuss all that, he said, but the government - like the people - was committed to the system we have. Events, of course, may in the long term force a change of emphasis.

Even more unthinkable two years ago would have been NHS chief executive Sir Alan Langlands identifying himself with Nye Bevan and threatening to resign if the government introduced charges for treatment. Bevan's name was warmly invoked at intervals throughout the conference, a startling example of political rehabilitation after several decades of being an official non-person. As for Sir Alan, no one seriously expects to see him depart in a huff when the chancellor makes his big speech. He was doing his bosses a favour by ending in a vivid and memorable way the rumours inadvertently set in train by Mr Dobson a year ago. We have come full circle.