Improving the morale of staff is not the first aim of Lord Darzi's review of the future of the NHS, health secretary Alan Johnson has admitted - but 'buy-in' by employees will be essential to its success.

Conceding that morale is low and that last month's£52m pay deal was 'modest', Mr Johnson argued that the review by junior health minister Lord Darzi could make a difference.

He told a fringe meeting: 'Our primary objective is not the morale of the workforce, our primary objective has to be patient care. I just happen to think the morale of the workforce is very important in delivering that excellent care.'

Low morale had an impact on patients, he said, and dialogue was now needed with health professionals to make improvements.

He said: 'This really is trying to get a genuine engagement from this vast array - all these royal societies, the trade unions - into a buy-in for where the vision is for the NHS of the 21st century. That is what the next stage review is about.

'If we do it successfully I think we can genuinely lift morale.'

In his speech to the Work Foundation's event, 'Is the health of the nation built on the morale of NHS staff?', Mr Johnson said a 'difficult year' on pay had affected morale.

He also conceded that government policy had had an impact. 'There is a feeling that change has been done to them rather than with them,' he said. Staff also thought change had been ideologically driven, rather than in the best interests of patients, he said.

Dr Jonathan Fielden, chairman of the British Medical Association's consultants committee, said: 'Morale in the service is still in many places low. There are a few beacons of light where morale is being improved.'

Mike Jackson, senior national officer for health at Unison, said the initial pay deal had been 'unacceptable' and should not happen again.

Raids on training budgets in times of financial crisis had also damaged morale, said Mr Jackson. 'I think there are now some good signs. I think the new government is beginning to listen to some of the things people have been saying. Certainly we welcome its decision to announce a halt on further organisational structural change.'

NHS Employers director Steve Barnett said training was central to improving morale along with flexible hours, good working environments and 'fair and affordable' pay awards. 'We can't pretend that the last 12 months haven't been tough and I think there have been some real challenges for employers and their workers,' he said.

He added: 'Morale may be an issue but motivation remains high.'