The sense of frustration among health service managers revealed by our survey this week is palpable (see news, page 4; news focus, pages 13-14). Frustration at the time and effort being invested in the constant organisational revolution and the hunt for red tape. Frustration at the high priority given to NHS Direct - a project over which clearly no body of managers in either primary or acute care feels any sense of ownership. And above all, frustration at the inadequate human and financial resources managers have to deliver the government's programme and ministers' failure so far to invest in the skills they will need to do it.

It is not a happy picture, and not one that health secretary Frank Dobson will want to hear about as he puts the final touches to his conference speech today. Not the happy picture of a modern health service delivering miracles he would want to present.

And there is, of course, a danger that ministers will simply react with a shrug of the shoulders - by writing it off as the carping of a group hostile to the government and its bid to drag the health service into the 21st century. A certain concern for that clearly underlies the cautious reaction of Stuart Marples, whose members in the Institute of Health Services Management and Association of Managers in General Practice formed the basis of the survey. But Mr Dobson and his colleagues would be wrong to believe that managers do not want his reforms to succeed. All the evidence - and today's survey results are no exception - shows they are committed to the programme of modernisation and are working hard to try to make it a reality.

The fact is, they despair of their ability to do that with the material resources at their command. It would, of course, be too much to expect that Mr Dobson will stand up today and put that right. But if Mr Dobson wants to put the NHS on a truly sound footing for the new century, he will have to change the chancellor's views on public spending - truly a task to rank alongside the turning of the NHS supertanker.

For Mr Brown has gone beyond prudence to parsimony in his attitude to funding public services, and his argument in Bournemouth this week that he did not wish to repeat the mistakes made by Nigel Lawson in the late 1980s barely stands examination.

Managers will be looking to Mr Dobson to take their concerns seriously, and to start arguing for more even than the first comprehensive spending review delivered. The second comprehensive spending review round now beginning offers the opportunity for the health secretary to do that. It would be unprecedented were he still to be in the job by the time the money from that process comes through - but if he succeeds it would be a truly great legacy to leave his successors.