The deal is sealed; the new hospital will be built with private money. Robert Naylor, now in the hotseat, tells Tash Shifrin what's next at UCLH

It seems a bit cheeky, really. You wait for someone else to negotiate the country's biggest private finance initiative deal. It turns out to be the most controversial one, too.

You wait for someone else to take the trust through the rows, the strikes, the demonstrations, the bad press, to put back the beds that were going to be lost, and to sign it all off.

Then you pop down to London and slide into the chief exec's seat, just in time to see your new baby splashed all over the Sunday papers as the best in Britain. Makes you feel all warm inside, doesn't it?

Robert Naylor, new chief executive of University College London Hospitals trust, admits that it is a nice position to be in.

But he excuses himself, saying: 'I went through all the muck and bullets in Birmingham. '

And he adds, frankly, that he wouldn't have left his job heading Birmingham Heartlands and Solihull trust - where he started as general manager of 'an old run-down, isolated hospital' - to take up the UCLH post, had the£422m deal to build a new single-site hospital not been agreed.

Now, he says: 'I can afford to be really bullish about things because I start from this excellent position. '

Bullish means kicking off with a major restructuring of the trust's management, boosting the status of clinicians as he goes: 'It is exactly what I did in Birmingham. '

The idea is to get the new hospital built, bringing together services from across UCLH's current six sites, implement the modernisation agenda, and 'keep the organisation going in the meantime'.

He says: 'I am going to compress the structure down and squeeze it out at the bottom, so I can devolve authority to all the clinical directorates. '

The key plank will be four medical directors, each with a seat on the trust board, who will continue clinical work part-time.

They will be 'effectively four deputy chief executives', with 'full autonomy and responsibility for the quarter of the trust they are responsible for' - surgery, medicine, clinical services and the specialist hospitals. Under them will be 20 clinical directorates. Staff in the 'functional directorates' - such as finance, human resources and nursing - will be 'realigned to the new clinical directorates', although the directors of those functions will still report to the chief executive. But the clinical directorates, with their clinician leaders, will be the powerhouse.

Apparently the trust's medical committee gave the plan 'an ovation', at the first of a series of presentations.

But Mr Naylor is a man who says things like: 'Our consultants are pre-selected from a very early age to be the intellectual cream of society. '

And, he is keen to reassure health service managers, there are 'still very powerful administrative roles in the structure', too.

Ian Hamilton, chief executive of St George's Healthcare trust, south-west London, has not seen the UCLH plan. But he confirms that 'many acute trusts are reviewing their internal management structures, with a view to staff having greater ownership of delivering the modernisation of the NHS'.

His own trust has completed a management review which is going out to consultation with staff and primary care groups and trusts. It will 'improve' and 'strengthen' the current clinical directorates.

'Clinical teams are very much playing their part in delivering the modernisation of the NHS, ' says Mr Hamilton.

Or as Mr Naylor puts it: 'If it doesn't happen at the patient interface, it doesn't matter. '

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