By the time you read this, Labour's 2008 party conference in Manchester will be over and Gordon Brown will still be prime minister, despite whatever has happened or not in the interval.

Given the state of global financial markets at present, almost anything might have happened. Few of us expected US president George Bush, of all people, to dash around nationalising banks this September.

The bill for all that will feed through to NHS managers' budgets. Higher borrowing means a higher price for money that will be in shorter supply.

Sooner or later taxes too will rise. Chancellor Alistair Darling is saying he will avoid spending cuts provided there is "strict spending discipline". We shall see.

Yet the global financial crisis has given the prime minister a reprieve of sorts: flawed he may be (is), but voters know he is a highly experienced captain for a storm. When even bankers put their hands out for state aid, exponents of state power are strengthened, though not as much (I hope) as Labour left-wingers would like. Regulation, not romantic renationalisation, will be the new mood.

Balancing act

So it was the wrong month (says me) for Liberal Democrat leader Nick Clegg to promise in Bournemouth last week to shrink the state or for Vince Cable, his usually impressive Treasury spokesman, to threaten all£100,000-plus public servants with having to reapply for their jobs. No wonder HSJ's editorial ticked him off. David Cameron too must avoid being caught off balance.

Regardless of the quality of Mr Brown's conference speech (as I write he has not yet made it) this was always going to be one of those overrated tests for him. But being among the party faithful in Manchester is to be sharply reminded how difficult it would be to replace him and how little regarded some replacement "candidates" are outside media land.

One name touted, of course, is Alan Johnson's. On conference eve the health secretary seemed to tell The Times he is not interested, praising foreign secretary David Miliband instead. It was not quite like that. When I bumped into him at a union party, he explained it is more a 95 per cent view: he does not seek the leadership, but one never knows what will happen in life.

Health has not had much of the spotlight in Manchester, so I turned to the small print of the conference report from the national policy forum, which formulates policy away from the media gaze.

Perception and practice

There is much for Labour to be proud of in its health record: 38,000 more doctors, 80,000 more nurses, 3,600 psychotherapists in training, waiting lists down by 600,000 and waiting times slashed.

But inevitably the forum's picture presents a more upbeat view of the NHS than is evident from the average edition of HSJ, where the nitty-gritty proves harder to manage.

Of course, themes which tick Labour and union boxes are to the fore. Public health is presented as "an equality issue", in which special early interventions will be needed to ensure the poorest get their fair share. It is ambitious stuff and, as I heard ex-public health minister Tessa Jowell tell a fringe meeting "we are better at talking the new politics [localism, participation etc] than we are at doing it; public service reform unlocks the humanity of the public services. But we have to get the language right".

Spread thin

Or as David Miliband put it, "doing 30 per cent of a lot of things in politics is not as effective as doing 80 per cent of a smaller number of things". In other words, New Labour tried to do too much. NHS managers know that.

Also there in the forum's small print is the need to reassure staff about retaining a "central role for public provision and a directly employed workforce" as private, voluntary and localised services get a larger role in the choice era.

So central government will remain a strategic "guarantor, comparator, standard-setter and leading innovator" while commissioners will be required to "give full consideration to in-house options and public sector solutions".

In Manchester, ministers and unions have been haggling over transferred pension rights and security of employment. A fine balance in harder times.