The government must paint a coherent vision of the NHS's future and give more support to managers in implementing it, according to senior leaders leaving their posts this week.

The government must paint a coherent vision of the NHS's future and give more support to managers in implementing it, according to senior leaders leaving their posts this week.

Outgoing Greater Manchester strategic health authority chief executive Neil Goodwin said the government needed to paint a 'radical' vision that brings its reform programme together.

Speaking to HSJ as he prepared to leave his full-time NHS post after 36 years in the service, Mr Goodwin said each of the reforms had a vision, but an overall picture was now required. 'I think there are a number of visions flowing from the different policies. What is required is to bring those policies together and to create a single articulation of a bold and ambitious vision for the future NHS for this country.'

He added that this would be a vital tool for the new SHA chief executives. 'Vision is terribly important. When you have a national vision it allows you as a manager to create a local vision to build on, to create interpretations that are relevant for local staff so they can implement the necessary change and transformation.'

Outgoing joint chief executive of Trent and Norfolk, Suffolk and Cambridgeshire SHAs Alan Burns told HSJ something was needed to replace the NHS plan, which, although some of its themes persisted, was no longer a relevant document. 'I haven't even opened the NHS plan in three years,' said Mr Burns.

But outgoing South East London SHA chief executive Julie Dent said policy makers must 'hold their nerve' or 'end up with a mess'.

'We are in the middle of a 10-year plan and what needs to keep being reiterated is why we set out on the plan in the first place. The vision was right five years ago and that vision needs to be consistent.'

She added that if dramatic changes were made to the reform process halfway through, the NHS would end up 'in a mess'.

'My homily is about the pace of change. If you make a cake you get all the ingredients on the table and you decide to make a Victoria sandwich. In the middle it's always a muddle.

'If you decide you're still making a Victoria sandwich then you get on with the process and you end up with the cake. If you panic in the middle and start changing, it is likely you will get a mess,' she said.

Meanwhile, both Mr Burns and Mr Goodwin warned against policy makers putting all their eggs in the private sector basket in terms of finding new leaders.

Mr Goodwin said that while the NHS 'does not have a monopoly on leadership wisdom', research pointed to business experience and relevant networks as the key to success as a senior leader.

And he added that it sent a demoralising message to managers. 'The management community interprets [a search for a private sector leader] in the same way it interprets the restructuring of the NHS ? that government does not have faith in their ability and they are not to be trusted to deliver the government's agenda,' he said.

Mr Burns agreed. 'If you look back over the last 20 years across the civil service and across the health service, there have been many occasions when there has been talk of a new approach to the private sector. Tell me a place where it has come to fruition and been successful,' he said.