Published: 01/09/2005, Volume II5, No. 5971 Page 21

Q: You have to expect cynicism working in the NHS, but there is a growing sense of disillusionment among my colleagues. I try to keep things positive with my staff, but it feels like a pointless struggle when my peers undermine the progress We are all trying to make by making 'ironic' comments about the current reorganisation. Their attitude is setting a bad example and encouraging others to take their eyes off the ball. What can I do?

A: It is not surprising that cynicism and disillusionment have been made worse by the latest reorganisation. Structural change is not an inspiring process.

In these circumstances cynicism is often a disguise for anxiety. And these are anxious times. Structural change is a real threat to personal futures and life chances, not to mention paying the mortgage. It is always worse when It is a downsizing reorganisation rather than an expansionist change. This time there is a real risk of loss of jobs and career opportunities.

In these circumstances you are going to need courage and focus. You will need to support others while having your own concerns about your future.

Not an easy combination.

The real answer is to concentrate on the main game. Delivery and service improvement matter deeply to patients, carers and communities. Even if that fundamental motivation is foundering, remind your cynical colleagues that their best defence is delivery. The real threat to personal futures is poor performance.

Continuing to do your best at a time of difficulty is the best hope of survival.

Sometimes it is possible to fight cynicism with cynicism. The lesson of structural change is that it rarely delivers the expected cost savings and that more jobs survive than you might expect. So remind your ironic colleagues of these realities. Try to persuade them to do their best and keep doing it. That is their best defence. They are their own greatest enemy and their own salvation.

Ken Jarrold is former chief executive at County Durham and Tees Valley strategic health authority. If you have a query you want Ken to help you with, e-mail in confidence to alexis.nolan@emap. com. If we publish your question, you will win a copy of HSJ's Leadership at Every Level toolkit (normal price£95).