We now know why Tony Blair didn't let up on Monday, so soon after his heart scare. A breakthrough in Northern Ireland was close, and he was not going to let go of the levers at such a crucial point. The following morning, bang on cue, a new election date was set; the Sinn Fein president, Gerry Adams, got as close as he could to saying that the war was over; the IRA went further than it has done before in handing over its weapons; and the Prime Minister was airborne to complete the choreography. It all felt so optimistic, until events intervened. That is the Blair premiership in microcosm.
The drama in Ulster was - unless you belong to that rarefied breed of Unionist rejectionists - one of those occasions where Blair should be praised warmly for his efforts. Two steps forward in Belfast are usually followed by at least one step back, but without Blair's personal input, we almost certainly would not be where we are. The Northern Ireland Secretary, Paul Murphy, is one of the most able and unsung members of the cabinet. He has put in the legwork, talking to the various sides for months on end while the media's attention was elsewhere. But it is in the nature of this government that the big heave is made only when Blair is involved.
Those who saw the PM in the first 48 hours after his hospital admission reported a man as focused and fit as ever. You would not, one of his advisers told me, have noticed that anything had happened. Another pointed to the contrast between what the medical experts were saying ("temporary difficulty", "will have few consequences if any") and the political world's near-hysterical discussions of Blair's mortality and rehearsing of the runners and riders list for the succession.
Was the positive talk of Monday morning spin? Possibly, probably - actually, I have no idea, and nor does any other journalist. Yet there is no sign that the man will slow down, not just because people would draw the appropriate conclusions about his prospects, but because this government would not know how to function without Blair's hyperactive involvement in all its workings. It would grind to a halt.
It has ground to a halt several times before. I remember how, when Blair was embroiled in his first major military venture, the war in Kosovo in 1999, his advisers complained that nothing else was getting done because they couldn't grab his attention. When he was despatching troops to Sierra Leone in 2000, he took his eye off the ball at home and failed to see the anger of the fuel protesters. As soon as he engaged, the dispute was dealt with. For much of this year, in the run-up to and fighting of the war in Iraq, the domestic agenda was put on hold. Then, just when Blair was hoping to refocus, he spent weeks desperately trying to salvage his own reputation in the Hutton inquiry.
During all this, other government departments got on with day-to-day problems such as exam results, negotiations over doctors' contracts and the perennial crises afflicting the transport system. But without Blair, they could not get a single issue, in the words of one minister, "up in lights". They could not get the media interested. They could not get things moving.
The degree of confidence and autonomy varies from ministry to ministry, minister to minister. The department most in vogue at present is Health, partly because its head, John Reid, is fully signed up to Blair's "choice and diversity" agenda, partly because he is trusted to manage problems on his own. Blair involves himself, according to one minister, only when he needs to "deal with a blockage". The analogy of an emergency plumber might lack grandeur, but it explains some of the thinking. Another minister likens Blair's interests in particular issues to a lighthouse beam. It comes round once in a while, but when it shines on the department, it can have a deleterious effect, leading to a frantic bout of initiatives and policy papers being shuffled to and from No 10.
Underlying this way of working is a constitutional deceit. For all the squeals about the number of special advisers, Downing Street is a ludicrously small place. The policy unit, now merging with the strategy unit, contains not many more than a dozen people. The central co-ordinating function has traditionally belonged to the Cabinet Office, but the separation is both inefficient and artificial. The delivery unit, headed by Michael Barber at No 10, set up after the 2001 election to track and monitor the performance of the main public service departments such as Health, Education and Transport, comes under the Cabinet Office, although it reports to the PM.
Several times since 1997, Blair has toyed with the idea of creating a fully fledged Prime Minister's Office, along the lines of the German Chancellery, but each time he has resisted through fear of the media accusing him of presidentialism. Paradoxically, a much bigger central department might make central control less haphazard, with the departments themselves permanently represented at the heart of decision-making. There might be something to say for the intimacy of the current arrangements, with aides bumping into the boss several times a day in the corridor. But a more formalised department might take much of the power out of the hands of the kitchen cabinet of four or five people, the same cabal who on any given day in recent years would be seen at Blair's side, one minute in discussions over antisocial behaviour and the next minute involved in intricate discussions over Iraq.
The debacle of the war and the departure of Alastair Campbell have led to a rethink of sorts. Iraq marked an absolute low point when only Robin Cook and Clare Short, in their very different ways, murmured any discontent. Cabinet meetings now, I am told, have a consistently different feel. The first signs of change could be discerned in May and June, when ministers were given all the papers relating to the assessment of the economic tests on the euro. For once they were being allowed, if not decision-making powers, at least the right of consultation over decisions that went beyond their departmental remit.
Over the past few weeks, there have been vigorous discussions on identity cards - forcing Blair to tone down his enthusiasm for the project - and on pensions. "We're not getting issues dropping on us from the sky any more like foundation hospitals and tuition fees," says one cabinet member. It is early days. It is unclear how enthusiastic Blair really is for a free and frank exchange of views around the table, or how wide he will allow the parameters for such discussions to be set. It is unclear how far he wants his departments to go it alone, to take full responsibility for their actions, big and small, rather than referring back to him or his people in Downing Street. Blair's aides sometimes express frustration at the timidity of some ministers, claiming that the PM would actually like them to stand up for themselves more often. Would he really if it came to another Iraq?
Blair can change certain working practices. He started doing so before his medical drama. But neither the style nor the substance of his government can change fundamentally because he sees himself not just as the advocate of his government's policies, but as the architect of them, too. Blair dare not let up, fearing the vacuum that he would thereby create. One cabinet minister was talking to me about how the situation had changed for the better, how he was being allowed to run his show much more, when his other telephone rang. He had to go, he said hurriedly. "No 10 is on the line."