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'Stop wasting millions on constant reorganisations which change nothing for the patient,' urges one health service manager. 'Use more middle and senior NHS managers in the NHS Executive - not civil servants,' advises another.

The results of HSJ's survey with the Institute of Health Services Management and the Association of Managers in General Practice show widespread dissatisfaction with many aspects of the government's health agenda.

It reveals that managers have little attachment to high-profile policies such as NHS Direct, and believe too much priority is being given to attacking waiting lists, reconfiguring acute care and searching for management savings. In contrast, they say ministers place too little emphasis on addressing staff shortages, on mental health strategy and on tackling health inequalities.

And they have little faith that the resources and the training they need will be there to help them deliver the government's priorities within the proposed timetable.

At first sight, the findings look like bad news for ministers. But, argues IHSM director Stuart Marples, there are rays of light amid the gloom - and even some of the more alarming results are mitigated or explained by answers given elsewhere in the survey.

He points out that while members of the IHSM and AMGP - which merge this week to form the Institute of Healthcare Management - disagree with the government on specific priorities, most still believe its overall programme is right.

He also points out that while managers' priorities relate to 'operational problems' such as staff shortages, the government's relate to 'strategic issues' such as clinical governance.

'That's not really surprising given the number of modernisation issues,' he says. 'There may be confusion over priority and timing, but since there is general support for the government's priorities, it indicates a need for constructive dialogue.'

According to the managers surveyed, it also indicates a need for improved funding, better training and more staff - the top three demands of those who agreed with the government's priorities.

Further down the list, they wanted to see a change in the timetable. Options for either more or less central guidance were rated least important in delivering the programme.

But when asked whether they thought they would get what they had asked for, 74 per cent answered 'no' and just 7 per cent said 'yes'.

Asked how confident they were that they could deliver the government's priorities within the proposed timetable, not one declared themselves 'very confident', and only 12 per cent said they were confident. Forty- two per cent were not confident.

Only 10 per cent thought the government had confidence in them, while 61 per cent believed it did not, and 29 per cent did not know.

Those who did not think they would get what they asked for wanted more money to be targeted at management and less public criticism of their efforts.

Finally, managers were asked about their own sense of job security. The results showed that for every two who felt uncertain or very uncertain, three were secure or very secure in their job.

But while just 16 per cent of those who were uncertain about their position expected to be in the same job in two years' time, 47 per cent still expected to be in the NHS five years from now.

Broken down by the area of the NHS in which respondents work, the figures show that most of the findings hold true across all sectors and at all levels of seniority. But there were some differences.

Managers in general practice were even more concerned by the need to address staff shortages - with 88 per cent claiming it as a high personal priority - than those elsewhere in primary care (79 per cent) and in acute trusts (81 per cent).

Similarly, general practice managers gave higher priority to waiting lists and finding management savings, while primary care managers were more focused on repositioning primary care and ending racial and health inequalities.

Acute trust managers gave higher priority to clinical governance and only slightly higher priority to reconfiguring their own sector.

Overall, they were more likely to list the various initiatives as low priority - but 80 per cent of them regarded the overall programme as right for the NHS, against just 57 per cent in general practice and 50 per cent in primary care.

In no sector and at no level of seniority did expanding NHS Direct creep into double figures as a high priority for managers, while every group saw it as a high government priority.

Who, how and whereQuestionnaires were sent to 1,000 members of the IHSM and AMGP working in the NHS, targeted at a cross-section of managers across acute and primary care, general practice, in health authorities, mental health services and specialist organisations. The response rate was 21.1 per cent, allowing meaningful results to be drawn from a breakdown of the findings by work area, seniority and length of service in the NHS.

The full results of the survey appear on the HSJ website at