Health service managers believe they have neither the resources nor the training to deliver the government's agenda on schedule - and they don't expect to get them.
A survey of more than 200 managers across the NHS - ranging from GP practice staff to health authority and acute trust chief executives - found that three out of four did not expect to get what they needed to make the government's programme work.
And despite broad agreement with what managers saw as ministers' overall priorities, they wanted to see more time and effort put into solving staff shortages and less into shaking up acute care and searching for management savings.
The survey, carried out by HSJ with the Institute of Health Services Management and Association of Managers in General Practice, is published on the eve of the launch of the Institute of Healthcare Management, formed from a merger of the two groups.
The survey shows discontent and some fear for their own future among managers at all levels, but will be a particular cause for concern as six out of 10 of those surveyed are in senior posts and a similar proportion have been in the NHS more than 15 years.
IHM director Stuart Marples, who will launch the new organisation this evening at a primary care conference in Southport, said the findings should be taken by IHM as the basis for constructive discussion rather than as an attack on the government.
'It seems to me to indicate some confusion in the service over the relative merits of the different initiatives,' he said.
'But that seems to be about clarity over what takes top priority and about issues of timing.'
Mr Marples felt there was a need to ensure that managers' leaders liaised more closely with government and were able to make a constructive contribution to discussion about how the NHS could deliver ministers' agenda.
'It must be for us to demonstrate a credible voice, which means having something to say and being respected when we say it - and of course the government demonstrating its commitment to the management community as well.'
The survey shows that managers do not believe the government has confidence in them - just 10 per cent thought it did. Of the 61 per cent who said it did not, most wanted to see more money targeted at management and less public criticism.
Asked what they needed to deliver the government's main initiatives, respondents opted, in order of priority, for improved funding and resources, better training, more staff and revised timetables.
But only 7 per cent thought they would get what they wanted, and 74 per cent said they would not.
Even so, most felt fairly or very secure in their job, with fewer than one in 10 'very uncertain' about their position.
And even among those who were uncertain or very uncertain, almost half still expected to be working in the NHS in five years' time.
Mr Marples said helping its members to cope with uncertainty and 'making them employable' would be key tasks for the IHM.
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comment, page 19.
Key findings: what the HSJ survey discovered
43 per cent say waiting lists are a high personal priority;
76 per cent say waiting lists are a high government priority;
77 per cent say staff shortages are a high personal priority;
23 per cent say staff shortages are a high government priority;
7 per cent say expanding NHS Direct is a high personal priority;
63 per cent say expanding NHS Direct is a high government priority.