Rocking the boat is not welcome in the modern, dependable NHS. Pointing out unintended or unfortunate consequences of government policy, far from being a duty on all managers, may prove career-limiting and will almost certainly lead to an immediate dressing-down.
Civil servants have, of course, always been bound by obligations of confidentiality and discretion. The 1990s have seen such restrictions extended to NHS managers. Those in regional offices have been gagged by their absorption into the civil service itself. Meanwhile, chief executives and other board directors have long since become accustomed to the danger of political lightning bolts striking any who mouth views which could embarrass a minister, the voltage usually being conducted either through the medium of their trust or health authority chair or the regional office.
It all began under the Conservatives, and some managers harboured fond hopes when Labour came to power of a new era of glasnost . Instead they are enduring a new era of Stalinism. Now not only are individual managers told to shut up and keep quiet, so are their professional organisations, part of whose very remit is to speak out on their behalf.
Last week's astonishing rebuke by NHS chief executive Sir Alan Langlands to the annual conference of the Healthcare Financial Management Association, and the shabby tale which has emerged of the pressure applied to the HFMA after its survey of NHS finances, mark a new low in the struggle for openness in the health service.
Sir Alan's record for fairness and integrity is impeccable, and it is hard to resist the suspicion that he was acting on strict ministerial injunction. He has, after all, previously encouraged professional organisations to speak up: witness his address to the then Institute of Health Services Management's annual conference in 1996, when managers' reticence about posing awkward questions to ministers seemed to have reached absurd heights. He made it plain then that it was fine by him for the IHSM to express views with which he might disagree, or point out inconvenient truths; that was part of its job.
Or take a letter he wrote to the British Medical Journal in 1995: 'I am appalled at the thought that there remain in the NHS people who feel that they work in a climate that prevents them from freely expressing their views. That is not the kind of organisation I wish to lead.'
Whether he knew it or not, Sir Alan then was merely reasserting a tradition which had been enshrined in the NHS by Aneurin Bevan, who told managers in 1946 they would be 'fully free to conduct agitation' and oppose the government 'at any time you care'. Today's health ministers should be ashamed at how far they have strayed from that assurance. And their shame should be deepened by the hypocrisy with which they ostensibly espouse whistle-blowing for clinical staff.
Freedom to speak out is indivisible; it cannot be a perk only for those whose message is politically safe.
The HFMA was right to publicise its concerns that the NHS is heading for a significant deficit. Its offence was to evade the Department of Health's news management process and raise questions about the government's stewardship of the service. It was not scare-mongering: informed sources suggest if anything it understated the problem, and it went public out of frustration that that was the only way to make ministers take any notice.
So ought HFMA members shoulder any blame for the parlous state of NHS finances? After the praise Alan Milburn, then health minister, lavished on them at their conference last year, thanking them for sorting out 'the mess' Labour had inherited, and after four years in which the accounts have been passed without qualification, no one could seriously argue that the problem was down to a feckless and incompetent finance function. It will be important to remember that, as the accounts for this financial year look likely to enjoy a rather less smooth passage past the auditors.
We can only hope that behind all the PR bluster and bravado, the HFMA's message has sunk home at Richmond House.