Health service management is seen as overbearing, NHS deputy chief executive Neil McKay admitted.

He told delegates: 'Many people characterise our management systems as too top-down.' NHS management was seen as 'rigid and disempowering', he added.

While government was setting clear priorities for the NHS, local staff had to be given more power to decide how to meet targets: 'The 'what' will be fixed, but for the 'how' we need to create an organisation that allows as much as possible.'

A chief executive told Mr McKay that managers found it difficult to tell ministers and top civil servants what frontline staff had to say.

Elaine Way, chief executive of Foyle health and social services trust in Northern Ireland, made a plea for 'removing the fear from management'.

She said: 'When my back is against the wall I am faced with the reality that some of the things I wish to say would be unpopular with my political masters.' Employees felt services were suffering from a lack of resources.