The Department of Health's document, Shifting the Balance of Power within the NHS, contained encouraging words about working differently, underpinned by a 'culture of mutual respect' across all levels in the service. The way in which chief executives are currently being treated appears not to be based on such respect.

The guidance on intervention strategies for trusts given zero stars in the performance ratings contains 'deliver or be shot' language: 'The chief executive will be removed and acting arrangements will be applied.'

But how their leaders are treated has a huge impact on staff morale and therefore on a trust's ability to deliver change.

And no recognition is given to the formidable structural difficulties faced by many of these trusts with delayed transfers and staff recruitment.

The appointment process for chief executives of the new strategic health authorities is now under way. The current health authorities are managed by some of the most outstanding NHS leaders of this generation.

Is it appropriate to subject such people to half-day senior management assessment and development exercises, an interview with NHS chief executive Nigel Crisp, an interview with a three-person panel, the preparation of an outline franchising plan and its presentation to a health authority appointment panel?

Not to mention the time being lost to NHS modernisation by such an energy-sapping process.

Nurturing trust is the single most important characteristic of high-quality management. Trust is demonstrated by a high level of mutual understanding, knowledge and confidence between the manager and those managed.

Delivering the NHS plan is a huge challenge. The government needs NHS leaders to be wholeheartedly alongside it. This will not be achieved without processes that place more trust in their capabilities.

Jenny Griffiths (former chief executive, West Surrey HA) Woking Surrey