Care and treatment in the NHS is better if senior positions such as nurse manager jobs stay close to the front line of services.

The NHS staff survey for 2009 was published earlier this week. The report showed that levels of staff satisfaction had a possible relationship to levels of care at trusts. Where the majority of front line staff recommend their workplace, the trust is more than twice as likely to get a rating of "excellent" from the Care Quality Commission.

Speaking to The Nursing Times, Royal College of Nursing Policy Howard Catton said that keeping nurses involved in service decisions and listening to their feedback was crucial in maintaining levels of satisfaction. He says that without engaging with front line staff, trusts management risked making ill-informed decisions about patient care.

"If people are not involved and don't feel their voice is being heard" said Dr Catton, "their belief becomes that those decisions are based on finance, without consideration about care."

Research published last year by the Department of Health suggested a link between staff satisfaction and patient experience; where nurses felt they had clear goals and a solid structure, patients felt that their treatment was better. Jeremy Dawson, author of the research and director of the Aston Business School Institute for Health Services Effectiveness said that good staff management practises were linked to improved treatment, such as lower death rates.

Mr Dawson said: "If staff feel they know what is expected of them, how they can improve and they have training, that can only lead to better working, which naturally will lead to improved patient care."