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A good summary thanks Sarah.

No professional group comes out of Francis well - doctor, nurse or manager. But NHS managers have allowed themselves to become associated in the minds of staff and pubic with an agenda that is not seen as being part of quality care delivery. Targets, budget management and reconfiguration are examples, despite the fact that most managers I work with are very definitely trying hard to continually improve patient care.

Secondly, we have somehow come to see a focus on whole system of care, rather than on individual patients, as a less worthy aim. For example, a doctor focuses on the patient in the clinic room, and is rarely criticised, while the manager organises the whole clinic, the booking, the car parking etc and is often criticised. Both are worthy roles, but there is an imbalance in how the two roles are perceived.

Respect for managers won't increase through regulation or formalised training, or a blacklist. We will have to earn it, through having, and being seen to have, the right values and motivations. And yes, having the courage to reject any pressures that drive us away from these too.