His appointment may not have captured the public imagination in quite the same way as the England football manager debate, but Nigel Crisp, too, will be judged by results. Ann McGauran and Laura Donnelly report

The top job vacancy obsessed the nation. The public stayed glued to the television and speculation ran rife among the tabloid pundits.

That was over the thorny question of who should replace Kevin Keegan. The issue of who might fill the boots vacated by Sir Alan Langlands occupied far fewer column inches last week.

The announcement that former London regional director Nigel Crisp was to take on the double job of head of the NHS and permanent secretary at the Department of Health received far more muted coverage.

Could this have had something to do with his non-appearance at his very own launch? Mr Crisp was 90 minutes late for his first session, with the press due to the over-running of the first full meeting of the modernisation board, followed by his briefing from health secretary Alan Milburn's special advisers.

The hacks went home, which was a bit unfortunate, given Mr Crisp's comments on Radio Four's Today programme earlier that day about wanting to raise his profile by talking more to the media.

But he apologised personally and swiftly, and the selection of one of their own appears to have delighted managers. Until his appearance the next day the one apparent thing about him was his 'invisibility'- a quality noted by an HSJ source who worked with Mr Crisp. 'You needed a bureaucrat to take through the merger and he is a very able bureaucrat, ' says another. 'I'm certainly glad they appointed an insider rather than someone from Burger King or a hotel chain.'

He thinks Mr Crisp has appointed 'managers who have reputation as hatchet men' as chief executives in London, but does not dodge the nasty stuff himself. 'If there is flak to take he will take it. He doesn't hide away and is prepared to go into the studio and say his piece.'

Mr Crisp says he will be concentrating on delivering the NHS plan, emergency care and staffing.The success of the plan hinges on recruitment, he says.He wants a 'radical, patient-centred outlook', and while 'delighted' by the joint responsibility for health and social care, he admits to also being daunted by the enormous job.

Challenged on what he thought were his key successes in London, he mentions a 'very substantial' reduction in surgical waiting lists, a health strategy shared with the mayor and the London boroughs, and the development of cancer networks.

Speaking exclusively to HSJ about what he would do differently from Sir Alan, he says: 'If I could be half as good as Alan then I would be doing well.'

He adds: 'I think I'll get the opportunity he did not get to reach out to social care and work to make sure we are all really focusing on the NHS plan.'

Things must work differently in Whitehall, because despite being due to take over at the start of next month, the subject of salary is still to be resolved. 'It hasn't been sorted out entirely yet, 'he says. One feels Terry Venables might have tackled that particular issue in advance.

The standard of health service management is 'usually high', says Mr Crisp. The areas that need more attention are 'sharing good practice, working across boundaries and being a bit more bold about how we do things'. He sees some tremendous managers 'and I know that a lot of them need a great deal of courage and determination to make things happen'. Morale in the health service will go up, he hopes.

'I get around the NHS a lot, and I think morale is patchy.'

His predecessor, Sir Alan, told HSJ that he 'could not be more pleased' about the choice. He sees Mr Crisp as 'committed to the purpose and values of the NHS'. He is 'very able', and 'equally at home with policy and implementation'.

But maybe there's a flip side to this emphasis on strategy. One source says: 'You wouldn't call him a man-manager. I suppose you could call him the John Major of the NHS. He's nice and harmless, but not a lot of spark and drive.

'In a way he was almost invisible during his career - working up the ranks without actually doing anything that anyone particularly remembers; working away behind the scenes to make sure things went smoothly.

'He isn't passionate. Maybe he's the best of a bad bunch.'

President of the Royal College of Physicians Professor Sir George Alberti disagrees. Professor Alberti sat on his selection panel and has worked alongside him in the past: he says Mr Crisp is the best of 'a range' of candidates, both external and internal.

He adds: 'It was not a question of taking him because no-one else would do it. I think people have underestimated Nigel. He's not just a safe pair of hands. He's a superb strategic thinker and that's come through already in London.'

The NHS Confederation calls him 'highly respected and experienced', with 'a real track record of achievement'. Chief executive Stephen Thornton says his 'understanding of the issues and networks into the service will stand him in good stead as he leads the process of modernisation'.

Deputy chief executive of the Institute of Healthcare Management Suzanne Tyler praises the appointment as 'a sensible decision and it's not a political one'.

NHS Alliance chair Dr Mike Dixon says Mr Crisp has to recognise primary care's disappointment over its lack of representation on the modernisation board and its failure to get its own modernisation taskforce.

'I don't think he's had a profile outside London, but I've heard good things about him, 'he adds.

John Cooper, chief executive of Hammersmith Hospitals trust, suggests charisma is not a necessary part of the job. 'Neither of the two previous occupants were naturally charismatic people. The job of being charismatic belongs to ministers, and they don't normally want someone to compete with them for the limelight.'

His brilliant career

The 48-year-old former Uppingham schoolboy and Cambridge graduate spent five years as a community worker in Liverpool before a management stint with sweet manufacturer Trebor.

He then went into the voluntary sector in Cambridgeshire, and then to a learning disabilities unit in Berkshire. After that he became chief executive of the Heatherwood and Wrexham Park Hospitals trust, Berkshire, leaving to become the first chief executive of the Oxford Radcliffe Hospital trust in 1993.In 1997 he became South Thames regional director, and in January 1999 was director for the new London regional office, which brought together North and South Thames regions.

What the papers say

'Nigel who? Funny you should ask.He is the new chief executive of the NHS.'

Daily Telegraph, City Comment,13 October 'One of the quietest and most unassuming NHS managers . . . Nigel Crisp is described as 'thoughtful, quiet and introverted' without any grand vision for the future. This is a far cry from the charismatic expert in 'change management' for which Alan Milburn, the health secretary, had said that he was looking. . . Mr Crisp is described as a 'natural civil servant' rather than having party political leanings'' The Times,12 October 'In some respects a southern version of the quiet, undemonstrative and soft-spoken determination that characterised Sir Alan Langlands. . . colleagues in the London region say he was able to think strategically and radically, and build unlikely alliances. . . but thought was combined with hands-on management that included personally visiting almost every London A&E department during last winter's pressure. . .

'Less tested is his skill on public platforms and whether he can provide the high-profile leadership of change that Mr Milburn has said he wants - and which many in the NHS doubt that the health secretary can or will provide room for.'

Financial Times,12 October