After a warm welcome earlier in the summer, the NHS constitution is now the subject of some sustained chuntering. This is wrong.
The constitution - especially its staff pledges - is a good thing and deserves continued support throughout the service. It is an unmissable chance to finally align managers as staff, as fully paid-up members of the healthcare team.
And it offers revolutionary possibilities for the lives of managers and the development of leadership skills and culture. Sounds too good to be true? Perhaps. But you can say one thing about the constitution: it has staggering ambitions for the people who work in our health service.
Let's quickly deal with the chunterage. Two moans are at the fore. First, that the constitution has failed to engage the public's interest. Second, that it is a charter for the Department of Health to crush localism and line manage the workforce agenda.
I have no idea why anyone thought the constitution was going to set the English public on fire, Obama-style. We don't need to retake the public for the NHS - public imagination was completely captured by the essence of this proposed constitution just over 60 years ago and has been solidly held ever since. A restatement of what it already thought it had was at best going to get from the public a response along the lines of "that's nice, dear, now what about car parking charges?".
The constitution has a different purpose. In part it is "legacy" law, designed to make it hard for any future ne'er-do-wells to ditch the founding principles of the NHS without at least alerting the public to what mischief is afoot. More immediately, it is about ensuring the values of the NHS do not get lost as new providers come in from the private and voluntary sectors.
The radical new element in the constitution is the suite of staff rights and pledges, which rank equally with patient pledges. It is in many ways remarkable. So the second gripe doing the rounds might be grounded in a valid concern about central control and bureaucratic strangulation. But people should not start knocking a very good idea. I don't see the rights and pledges as prescriptive and they are certainly not the enemy of localism. These ideas were carefully informed by the What Matters to Staff research, which was a seriously good piece of work.
Next, the shocking idea that managers are staff.
To inform our response to the constitution, Managers in Partnership surveyed healthcare managers over the summer. The headline result is that they remain highly committed to the health service. Most respondents are happy in their role, feel it is well defined and feel that they are fairly rewarded. And most intend to stay in the service. There is a long-hours culture - most work beyond their contracted hours, some well beyond - and only half feel their training and career development needs are fully and regularly assessed.
But managers see themselves as part of the healthcare team. The team is thriving. To do a good job managers say they need support from senior colleagues and from their team and in our survey most believed they were positively valued by their team and by their managers. Perhaps unsurprisingly feelings change markedly when it comes to being valued by the public and media. What is disturbing is that managers also feel the government has a negative attitude towards them.
Critically, managers place the quality of patient care as the most important thing in their work. They strongly believe in the need for a working environment free from discrimination, harassment and bullying, promoting dignity and respect for all and want a culture of openness, where staff can raise concerns about quality. They give high priority to treating patients with dignity and respect and believe we should engage staff and patients around service development.
The survey does suggest we fall down on delivery of much of this. But all in all it is clear managers have the same strong sense of vocation and commitment to the health service as other staff.
We can stop seeing managers as separate groups with separate and often antithetical values. We can start thinking of managers as staff.
And we should expect managers to be subject to the pledges in the constitution in the same way as everyone else. This should not be like Improving Working Lives, where many managers found themselves implementing benefits for their staff which the system considered irrelevant for managers themselves. Bad move, if you want something implemented with heart and soul.
Revolutionary possibilities arise from managers expecting and getting delivery on their rights and pledges. David Nicholson is investing much in leadership capacity at the top of the office. The constitution can help local chief executives drive development at the rougher end of the management trench, in a way that has never been undertaken seriously before. Middle managers are crying out for attention and development and if we are to deliver in the next five years we need to build their capacity quickly.
So let's plan for a future where the NHS is committed to providing managers with well designed and rewarding jobs that make a difference to patients, with personal development, appropriate training and management support to succeed. Opportunities to keep themselves healthy and safe, active engagement in decisions that affect them, a good working environment, conditions free from bullying, fair pay and contract. On it goes.
It is a good list. If the constitution is adopted in the boardroom - and in the management relationships between organisations, including the DH - as well as the ward, there will be a seismic shift in the management culture of the NHS. I am prepared to hold my breath.