THE departure at the end of the month of David Croisdale-Appleby, chairman of Buckinghamshire Hospitals NHS Trust, means both people responsible for putting through controversial changes at Wycombe and Stoke Mandeville hospitals are quitting.

Ruth Harrison, the trust's chief executive has already left. And Nick Relph, chief executive of Thames Valley Strategic Health Authority, which had the final responsibility for agreeing the changes, is also no longer in post after failing to get the top job when Thames Valley merged with Hampshire to form the South Central Strategic Health Authority.

Moving of women's and children's services from High Wycombe to Stoke Mandeville one of the most controversial decisions is set to take place at the end of the year.

Wycombe MP Paul Goodman said: "Our local hospital is effectively left without a chairman and a chief executive at a time when it needs committed leadership. I've been MP for Wycombe for about five years not a long time. No chairman or chief executive of a local NHS body has lasted even that long.

"Local NHS leadership needs continuity and commitment, and we're not getting it."

And Mike Appleyard, chairman of the Bucks health scrutiny committee, said the departures left a "gaping hole" at the top.

The trust has also lost its director of nursing Maureen Davies.

Changes at Wycombe and Stoke Mandeville were the most controversial issues in the document, Shaping Health Services, put out three years ago by all six NHS trusts in the county and looking at all aspects of NHS care. From the start Mr Goodman opposed the changes in so far as they affected Wycombe Hospital, both locally and in the House of Commons.

He said this week: "I believe that the changes at Wycombe Hospital during David's period were generally for the worse, but I wish him well in the future. I also note that the report on clostridium difficile at Stoke Mandeville is shortly to be published."

Professor Croisdale-Appleby said he decided some time ago to stand down after his four-year term was up though had been asked to stay on by the chairman of the NHS Appointments Commission. He became chairman when Wycombe, Amersham and Stoke Mandeville hospitals merged to form Buckinghamshire Hospitals NHS Trust He said: "I felt I had achieved the major tasks I set out to do. At the time I took up my role, the former trusts were both zero star-rated and had built up substantial financial deficits, with the possibility of hospital closures being discussed.

"Now, with the new hospital at Stoke Mandeville completed and open, financial breakeven achieved for the past two years, new advanced clinical units in operation and plans in preparation for the future of Wycombe Hospital, I feel that the future of our hospitals in Bucks is now secure."

He also has signed documents which could mean that by 2008 the trust could become a Foundation Hospital Trust.

"This will mean our hospitals will be directly governed and directed by the people of Buckinghamshire," he said.

The Department of Health has put Alan Bedford, from its recovery and support unit, in as chief executive for four months while a permanent chief is found. Asked about Shaping Health Services Mr Bedford said he knew that many local people had been concerned.

"My understanding is to say that it is impossible to do everything in one small hospital and we have to make best sense of it. I am here for four months and have to make progress."