Health service managers are comfortable with - or at least resigned to - the paradox of rising public expectation and plunging public regard.
Politicians could have used the election platform to educate the public about the vital role of managers. HSJ has yet to find a high profile example of that taking place.
In HSJ’s webchat, Jon Restell reached the sad conclusion that the public just don’t like managers being part of the NHS
The irony, of course, is that by the NHS Confederation conference in June, the new health secretary - assuming we have one by then - will be asking for your help and praising your efforts.
One subject he or she will have to tackle in that speech is pay - for NHS staff and for managers.
They will no doubt talk of the need for belt-tightening and the importance of showing an example. But the spending squeeze will not be the only motivation for this plea, it is also likely to reflect the view that NHS managers are overpaid.
Analysis by the Hay Group suggests middle managers’ remuneration is broadly competitive with that of their counterparts in the private sector. For senior managers - chief executives, directors and those who report to them - the private sector has a clear lead.
Many senior managers will happily accept this shortfall as the price to be paid for working in a public service.
What is dangerous is allowing the impression of overpaid managers to take hold, precisely at a time when high quality management is needed more than ever.
The call from every political party is for clinicians to take a greater role in managing the service. But what were the three reasons given by senior clinicians for their reluctance to take on managerial jobs? You’ve guessed it: job insecurity, damage to their reputation and poor pay.
In a time of constrained resources, the need to link reward to performance grows ever stronger.
Senior private sector managers accept this. Health services the world over have long understood that tying remuneration to agreed objectives is among the most effective ways to improve the performance of doctors. Whatever you may think of the role they play, it is hard to deny the cause and effect of clinical excellence awards or the GP contract.
Of course, the barriers to introducing effective performance related pay - the resistance of some managers apart - are significant.
There is the question of what performance would be rewarded and how success would be measured.
The actions of the incompetent and self serving remuneration committees of the banking sector also effectively mean that there is very little difference in the public imagination between “bonus” and “bung”.
The Liberal Democrats have hammered the very idea of bonuses being given to NHS executives.
But what is the alternative? In HSJ’s webchat, Mr Restell reached the sad conclusion that: “The public just don’t like managers being part of the NHS. Evidence and argument will not address that dislike because it is so entrenched.”
He calls instead for an improved “conversation” between managers and staff. On that he is right. But his claim on “evidence and argument” is a counsel of despair. If managers cannot press their case on that front, they will always be the whipping boys of the media and politicians.
Demonstrating the difference managers make and putting their money where their mouth is by linking reward to that difference would begin to shift the focus away from the infantile dialogue of the deaf we have witnessed in the last few weeks.