It is not uncommon for the NHS to be accused of having a poor track record on communications, internally or in relation to the outside world. An impression persists of decisions being taken at the centre and passed along the line to be implemented. Whether the topic is waiting-time targets (when the goals are set by the political masters of the NHS at Holyrood) or the closure of hospitals or units (when health boards encounter flak from communities affected by planned centralisation) it can appear to staff and members of the public that consultation is something to be consigned to the periphery when it should, in fact, be central to the decision-making process.

It is not uncommon for the NHS to be accused of having a poor track record on communications, internally or in relation to the outside world. An impression persists of decisions being taken at the centre and passed along the line to be implemented. Whether the topic is waiting-time targets (when the goals are set by the political masters of the NHS at Holyrood) or the closure of hospitals or units (when health boards encounter flak from communities affected by planned centralisation) it can appear to staff and members of the public that consultation is something to be consigned to the periphery when it should, in fact, be central to the decision-making process.

A genuinely consultative process is important not just because it is likely to lead to the correct decisions being taken. It also means that NHS staff (and, indeed, the public) are more likely to be persuaded that change is necessary, so long as concerns raised are heeded and reflected in the plan finally adopted. Not managing change in the right way can create a "them and us" culture in the NHS which is counter-productive in a service where everyone needs to pull together for the benefit of patients.

It is therefore of concern to learn that an in-depth survey of NHS staff has identified just such a culture in their working lives. According to the survey, the results of which are revealed by The Herald today, staff encountered aggression from managers, worked in a poor physical environment and found that a failure to fill vacancies and an emphasis on meeting targets means they could not do a professional job in the contracted working week. Although the survey was on a limited scale, involving nursing, allied health professionals (for example, physiotherapists and dieticians) and administrative and clerical staff in community care in the Hamilton area of NHS Lanarkshire Health Board, the findings are none the less disturbing.

They are the result of local management deciding to delve deeper and invite feedback from staff focus groups after a general survey identified issues to confront. They might not have liked what they heard but no-one could accuse members of this local management team of not seeking out the views of staff. The findings perhaps go some way towards explaining NHS workforce figures, published last month, which showed the incidence of staff sickness in the NHS rising when the target (yes, another target) is significantly to cut it.

Working in the NHS is a stressful job, especially for those in the front line. Fortunately, patients and their families do not see that side of the NHS, or the low morale identified in this survey. In the vast majority of cases they experience the NHS at its best. The findings suggest that, by addressing staff concerns, the health service could be a much better place for its employees.