The Healthcare Commission will leave a rich legacy, including the remarkable and powerful staff surveys that have given the people of the NHS a voice to which we should listen.

The most recent survey, published last month, is most encouraging. Job satisfaction is high: 75 per cent of staff are satisfied or very satisfied with the support they get from colleagues, 68 per cent with the amount of responsibility they are given and 64 per cent with the opportunity to use their skills. Seventy-eight per cent "always" know what their responsibilities are.

These results suggest that people in the NHS know their purpose and that they support each other. We should salute their resilience and commitment.

Hats off also to the team managers. Staff feel they receive a "high level of support from immediate managers". In a personal crisis 71 per cent said their manager is supportive, 71 per cent feel encouraged to work as a team and 67 per cent of managers can be counted on to help with a difficult task.

However, four areas of concern demand attention at all levels. First, feedback. Only 53 per cent of staff said their manager gives clear feedback on their work and only 32 per cent that they know how well they are doing their job. This suggests that even though 61 per cent had received an appraisal, there is much to do in increasing the quality and coverage of this process.

The second concern is violence and bullying. Twelve per cent of staff had experienced physical violence from patients and 23 per cent harassment, bullying and abuse. This raises questions about life at the front line and about our society. Thirteen per cent were harassed, bullied and abused by colleagues and 8 per cent by their manager. This is not acceptable.

The third concern is the relationship with senior managers. Only 23 per cent of staff agree or strongly agree that seniors try to involve them in important decisions, 22 per cent that communication with them is effective, 31 per cent that seniors encourage them to suggest ideas for improving services and 17 per cent that the different parts of the trust communicate effectively. Profoundly worrying, this suggests the time of senior managers being encouraged to face upwards to boards, strategic health authorities and the Department of Health must end as soon as possible.

The fourth concern, and for me by far the most worrying, is that only 46 per cent of staff believe the care of patients and service users is their trust's top priority. How on earth did we end up here? We need an urgent and unambiguous message from ministers, senior managers at the Department of Health and strategic health authorities and from boards that the care of patients is what we are here for, not for balancing books, world class commissioning or any other management initiative.

Given that the people of the NHS will believe what they see in practice as well as the words they hear, we need actions as well as messages. Patients first, last and always - that is our business and that is what we are for.