'Nothing would be worse for Beckham, Venice and the NHS to hear people say that they were once great but that was a long time ago'. Our new online-only columnist brings us the first of his regular diary piece charting life after NHS management

I recently returned from a family holiday in Venice. At first glance there may not be much in common between this most romantic city and the English NHS, but what connects them at the moment is a lack of vision for their future sustainability.

Vision is important because it provides meaning and motivation for people, whether those living in major cities looking for a role on the world stage or working in public services searching to secure their future against rapidly changing demographics, technology and consumer expectations.

At this point I would normally say strategic visioning is more challenging for public services but I think Venice may have the edge on complexity given its rapidly declining resident population, high dependency on tourism and the impact of global warming on the city's water level.

Recent predictions indicate that there may be no Venetians living in the city beyond 2024 and - heaven forbid - it may become something akin to an American theme park. Although there have been numerous proposals to secure a sustainable future for the city, most recently as an IT centre, political agreement cannot be reached on the preferred way forward. Sound familiar?

The most common mistake politicians and organisational leaders make when envisioning is looking backwards to secure the future. Venice will not find a sustainable future solely from reflecting on the picture postcard look of its city; and the NHS will not secure its future by looking back to a mythical bygone age of government-managed services provided from state-run, largely Victorian buildings operating without incentives to offer value for money to taxpayers.

The suggested charter for the NHS may help but if it is like most government documents then it is unlikely to be exciting and passionate. Now is the time for strong and unified political leadership if the world's most romantic city and the UK's most treasured institution are to be transformed into sustainable futures, and not be allowed to lapse into parodies of themselves.

Brand brilliance

An exciting feature of my holiday was the film festival and who should arrive but one of the world's most instantly recognisable couples, the Beckhams. David and Victoria and the Goodwin family chose to arrive at the same hotel at the same time, albeit in separate water taxis, and for a brief moment I thought the flashes of the paparazzi were HSJ. I hasten to add we were only dining at the hotel - staying in the same places as the Beckhams is somewhat out of my league.

This got me thinking about the shelf life of brands because brand management will become a developing skill for most NHS providers. David Beckham and the NHS are strong international brands but both are facing decline and the consequential need to reinvent themselves. Beckham is now in the autumn of his playing career while the NHS is at a crossroads in terms of policy direction.

Governments across the world are quickly realising that healthcare is too complex, costly and politically risky to be directly managed by modern politicians, most of whom have had no direct practical experience of leadership or management outside politics.

The UK has been slow to catch on to this and it should be no surprise that we no longer lead Europe and other parts of the world in healthcare design. However, if brand NHS can be successfully reinvented at the interface between publicly funded commissioning and regulated provision cut loose from government control then we may do so again. Nothing would be worse for Beckham, Venice and the NHS to hear people say that they were once great but that was a long time ago. Reinvention is the way to prevent that.

But given the furore that surrounded the departure of the Beckhams' water taxi from the hotel later in the evening - they even brought the hotel's terrace restaurant four floors up to a standstill as we diners, seemingly as one, laid down our cutlery to rubberneck over the balcony - I think there is plenty more mileage left in the Beckham brand.