As a career health service manager takes top slot this is an NHS tribute

Welcome, Nigel Crisp, to the post which has been heavily trailed for months as the biggest public sector management job in Europe. It is a tribute not only to you but to the calibre of NHS management in general that a career health service manager has been chosen for the role which combines being chief executive of Britain's largest employer with heading one of Whitehall's biggest spending departments.

If the jubilation seems a little muted, if it is hard to dispel a slight sense of anti-climax, that is because of ministers' widely reported infatuation with the notion that Sir Alan Langlands' successor should come preferably from outside the public sector, or at the very least from outside the health service. This is the perennial obsession of all ministers into whose gift it periodically falls to appoint the NHS chief executive. For offering the job to an outsider has great symbolic significance: it signals dissatisfaction with the status quo and a determination to keep the underlings - no matter how powerful in their own right - on their toes, sending a flutter through the dovecote. And it fulfils those most pressing of ministerial imperatives - marking a new beginning and being seen to be doing something.

But the idea is a folly wrapped in a miasma. Apart from the obvious salary disparity between this post and what captains of industry command, few, if any, private sector managers would come with the necessary skills to be able to function effectively in so visible a public office and in so political an environment. And few managers, if any - it has to be said - would be likely to acquire such skills quickly or soon grow comfortable with the constraints on them, judging by history. It has been tried and failed - in the 1980s. During this period, neither the NHS nor ministers could afford a lengthy period of acclimatisation for the chief executive to grasp the service's peculiar culture, so the search for an outsider was a wild goose chase right from the start. All ministers come to realise sooner or later that, like it or not, their best bet is someone who knows the machine inside out. Better to acknowledge that now than suffer anguished months until a hapless square peg resigned amid acrimony and political embarrassment.

None of which should detract from Mr Crisp's appointment. He is amply qualified for the job. He has won his spurs in the traditional way - by running a large acute hospital, in his case not once but twice. That is not all: he knows what it is like to run a Cinderella service, having managed a learning disabilities unit. He has been a community worker in Liverpool - no soft option. And he has spent a short interlude in the private sector with mint manufacturer Trebor.

Observers have noted his unassuming demeanour and complained of a lack of charisma. But that is to miss the point. It is the minister's role to supply the charismatic public face of the service, and macho management styles have long been discredited. If Mr Crisp comes across as approachable and a good listener, it augurs well for the NHS.

Will he be able to stand up to ministers in order to curb their zanier whims, a duty which has befallen all his predecessors from time to time? We will not know until a test arises. But Mr Crisp appears to have political nous in abundance: he did not merely survive as regional director of South Thames but went on to successfully manage the merger which formed London regional office, and he has avoided the eruption of any major scandals in the capital since. Ministers must be grateful for that achievement, though perhaps the clinching factor was the shrewd manner in which he positioned the regional office to work with the mayor and Greater London Authority. Securing his public health director's appointment as Ken Livingstone's advisor was a coup de grace.

Now Mr Crisp will have to navigate the health service - and social care - towards the NHS plan's exciting vision and around its many weaknesses and contradictions. He will also have to manage the public's ferocious and unrealistic expectations of rapid change in the NHS. We wish him luck.