Senior NHS ranks have proved their value, how can they maintain it?

This could suggest one of two things. Either NHS managers really are the “bean counting bureaucrats” so despised by the tabloid press - and an organisation with more of them simply has a bigger army of pen-pushers to tick boxes for the regulators - or it could be that better management really does lead to higher quality services.

Managers should shout loud about the demonstrable value they add

Obviously managers prefer to believe the second explanation. And regulators argue that their assessment is more sophisticated than the alternative would suggest. The next step is to find additional ways to prove it.

With significant cuts in management costs required sooner rather than later, whichever party wins the general election, the figures are a valuable starting point to think about how best to make the required savings while continuing to improve quality of services.

Now is not the time to deny that savings must be made, but it is worth exploring how the extra value that high performing trusts seem to extract from their senior ranks can be maintained under any restructuring.

Managers should shout loud about the demonstrable value they add to services just as doctors celebrate their clinical achievements.

Effective talent must be nurtured. This may be through protecting training and development for staff, to ensure managers remain motivated as well as efficient. And it may be about learning to let go - if resources are tight and managers are stretched, better to delegate and show faith in the leaders of tomorrow than to try to fill the void by being all things to all people.

As for accountability, it’s not really all about box-ticking. Visible managers, taking responsibility for maintaining quality in financially challenging times, are vital too.