Managers in healthcare need to do more than ever to look after their staff. I don't have a problem with this; it's the right thing to be doing.

What worries me is that the managers themselves are being left behind, their welfare largely ignored. However, where other staff groups might demand that the centre does something - for example, in a new contract for GPs - we tend not to put our energies into doing something for ourselves. This needs to change. The first and perhaps the most important thing we could do to help ourselves is to accept that our well-being matters.

This is an issue with a steadily rising profile. Politicians, academics and think tanks are all taking seriously the question: why, if we've never had it so good, do we not seem that happy about it? Unsurprisingly, the issue is biting hardest in employment. Trade unions now talk about the quality of work and job satisfaction, as well as the traditional themes of pay and hours. Critically, employers are doing things aimed at their employees' workplace health and well-being. And the business case is not all negative - it's not all about avoiding legal claims from stressed employees.

If you want to mug up on the latest developments, read the Institute of Directors' guide, Wellbeing at Work: how to manage workplace wellness to boost your staff and business performance. This booklet has many useful indicators and lists. Of all of the lists, the one every manager should memorise is the six key areas identified by the Health and Safety Executive's stress-management standards as the primary sources of stress at work:

  • demands: workload, work patterns and work environment;

  • control: how much say someone has in the way they do their work;

  • support: encouragement, sponsorship and resources provided by managers and colleagues;

  • relationships: whether positive working is promoted to avoid conflict;

  • role: do people understand their role within the organisation?

  • change: how is organisational change managed and communicated?

You will probably be familiar with these standards and consider them when managing your staff. But do you see them applying to you in your own job? The chances are, on a practical level, that you don't and nor does your employer.

When you start to think about it, the invisibility of our welfare is quite striking. This is not necessarily because NHS organisations are overtly ill-disposed towards managers. In a recent NHS Employers seminar for trust chairs, a lawyer used by trusts made the point that executive directors are employees themselves and can make mistakes and require the same duty of care to their welfare as anyone else.

The essence of what he was saying was that senior managers are not a breed apart. Although the point did not meet any resistance, it was clearly a new idea for many in the room - they just hadn't seen their executives like that before.

Accepting that our well-being as managers matters isn't going to be easy. First, we're up against the kind of gut feeling I get when I hear Premiership footballers complaining about burn-out in seasons ever more tightly packed with fixtures: "Fifty thousand a week and that useless donkey wants eight hours' sleep as well."

But when I think about it, the footballers do have a case, whatever their earnings. In the same way, we all find it hard to overcome the gut feeling that as managers we get paid more for more responsibility, more pressure and more hours. Whether you really believe that or not, there must come a point when enough is enough.

Second, on top of the "you get what you're paid for" argument, there is also the cult of the invulnerable leader. Many managers, consciously or not, promote this notion themselves. This is dangerous not only because it is delusional but also because managers who then display signs of vulnerability are seen as failing.

Third, many managers are not comfortable dealing with the welfare issues of colleagues, particularly management colleagues. I once burned out. I reported my stress and anxiety to my then boss. I must have been desperate. In what turned out to be a very short meeting, he alternated between eyeing the door nervously and shuffling paper as, I guessed, he looked for his occupational health referral forms. Not the practical discussion about my job I was actually after. An experience no doubt recognised by lots of NHS managers.

Fourth, there is a powerful belief that patients and other staff must come first. This means managers nearly always come second, including in their own minds.

So it is possible to see why many healthcare organisations are blind to the well-being of their managers. But they should be looking hard at them. Last year's survey of middle managers by HSJ and the NHS Confederation found nearly a third of middle managers always or usually feel stressed or anxious at work. That's a lot of people struggling with more than the normal pressure of a job.

Managers in Partnership's survey evidence to the NHS pay review body found 74 per cent of middle managers said their workload had increased in the last year, with 59 per cent reporting a detrimental effect on their personal health and well-being and 64 per cent a detrimental effect on their family life. The answers to what have so far been only a handful of survey questions warrant further investigation at the very least.

They also warrant the acknowledgement that every worker's welfare matters. I have just read a foundation trust's stress management policy. It is very good. The chief executive has overall responsibility for the welfare of all staff and the director of workforce has specific responsibilities.

This policy could go from good to excellent if it stated that the chair is responsible for the welfare of the chief executive and the chief executive for that of the director of workforce.

Jon Restell is chief executive of Managers in Partnership