Two years into the ten year NHS plan there is evidence to show that changes are making a difference, but very real problems remain. Investment alone will not deliver results, a culture change is also required. This is the verdict of the NHS Modernization Board in its Annual Report. The Board is a 30-member advisory panel of health and social care professionals, including frontline staff and patient representatives, who provide independent advice to Ministers on the way forward for the NHS.The Board recognizes the crucial part that morale plays in improving health services and is dismayed that the high level of trust patients place in their doctors is not matched by the trust and esteem of the organisations in which they work. Unless the NHS demonstrates that doctors are seen as essential partners in the implementation of policy, at every level of service, morale will continue to wane. There is a need to ensure the NHS with 1.3 million staff, is seen as an attractive place to work and there is a recognition of the scale of the challenge to improve morale among hard-pressed staff. Commenting on the report the NHS Confederation said: “Better patient care can only be delivered if clinicians are fully involved in the improvement agenda.”

Morale is also adversely affected by constant negative reporting by the media. The report calls for the press to show greater responsibility and ensure that its comments and judgements are properly informed and well considered, balancing shortcomings in the actions of a few by ungrudging acknowledgement of the quality and commitment of the majority.

Changing the ways staff work and how services are organized is essential to delivering real improvements, but change fatigue has been a constant risk. The report notes that concerns are starting to abate because more frontline staff now feel there is a genuine opportunity not only to improve care for their patients but also to have more rewarding careers.

Ways in which the relationship between management and medicine can be improved are to be explored by the BMA, the royal colleges and the NHS Confederation.