If it is this bad for staff, it is no wonder that patients complain

While relations with line managers were more positive, it was the corporate leadership that, in too many cases, was failing to get its message across or listen to the rest of the organisation.

Among a welter of damning data, less than a quarter of those who responded felt communications between senior managers and the rest was effective.

But even this was good news compared with the dire state of communications between trust departments.

The survey is littered with the wreckage of missed opportunities. Staff feel blocked from suggesting service improvements, excluded from important decisions, and do not believe the trust they work for is focused on the patient.

Little wonder that the experience of patients is so variable.

Communication with staff is the most basic skill managers have to master. But the pace of reform in the health service is exposing the communication cracks. This is not a reason to slow down, but it does mean redoubling efforts to engage staff.

A badly managed member of staff feels assailed from all sides. Tough national targets will be foisted on them with little explanation, private sector consultants and contractors - still viewed by many as the devil's spawn - will be questioning their working practices or threatening to take their work. Meanwhile, managers will be changing services without listening to those who really know how they work, and every day will be blighted by other departments letting them down.

It is no surprise the survey confirmed bullying - a word heard a great deal in the health service - remains a problem.

By contrast a well run trust, built on excellent communications, reveals itself to the visitor in minutes. Senior managers work as a team, know their respective roles, set clear goals and devolve decision making. Clinicians feel respected and empowered and everyone feels able to suggest ideas. Success is celebrated, staff feel positive about the future, failures and mistakes are used as opportunities for progress and the patient is at the centre.