Good management should be invisible, but good managers should be highly visible, argues Harry Cayton

A couple of years ago I visited a large teaching hospital for the day. I told them I didn't want to meet doctors or therapists or nurses. I wanted to see the stuff the public don't see, the people who make the hospital work rather than the people who provide the medicine and the care.

So I met people with endlessly ringing telephones who find beds for admissions, people coding activity so the hospital and everyone else could be paid, people managing patients' records - still mountains of paper - people managing IT systems for diagnostics, people ordering supplies of medicines and gloves and surgical instruments and dressings, and people delivering and distributing all these things throughout several buildings, people taking the waste (much of it hazardous) away again, people managing laundry and cleaning and people providing food and drink for more than 1,000 patients and staff.

These are the people forgotten by those who claim the NHS spends too much on management. But we couldn't do without them.

Good management is invisible. And it ought to be. The purpose of good management is to make things run smoothly.

If everything is working well, people using the health service should find only efficiency, courtesy, safety. Indeed, good management enables those very things; if the clinical staff are backed up by good management it is easier for them to be courteous and safe and efficient.

So patients should not be aware of management if it is working well - which is perhaps why so many think it is unnecessary.

It puzzles me then, when it is obvious that clinicians and managers are both inextricably part of the success of healthcare, that in the NHS I sometimes observe such mistrust between them.

In that hospital I visited, in a windowless room the size of a cupboard, a cheerful woman was managing the waiting lists for nine consultants on three sites.

Actually she was responsible for nine, but only managing eight. 'Dr X', she told me, 'manages his own list and refuses to be part of the system. It's difficult, sometimes they don't even tell me when they are going on holiday.'

The lack of corporate commitment in the NHS still shocks me because it has nothing to do with good care for patients or the wise use of resources. When things go wrong, no-one seems more ready to attack the NHS in public than some of the people who work in it.

While good management should be invisible, good managers should not. Good managers are out and about, finding out what is happening, walking the wards, checking their systems are indeed delivering for patient care, listening to what their clinical colleagues are telling them, creating the team work and respect and shared responsibility and communication that any successful organisation needs.

Good managers look outwards, too. They look to patients and the public, to the way their health organisation is part of the local economy and environment and the communities they serve.

Non-executive directors, governors in foundation trusts, and public involvement arrangements have a key role in this; they help to keep management and clinicians thinking about what matters: improving the health and well-being of the people who use the NHS.

Patients shouldn't need to know about management in the NHS, but they should be glad that it is there.

Harry Cayton is national director for patients and the public at the Department of Health.