Nigel Crisp began his NHS career in 'what was then called a mental handicap unit' in East Berkshire. It provided one of the lowest points in his career. He suggests that one of his earliest decisions - to sack a charge nurse accused of ill-treating patients - was one of his hardest.

'Matters like this can split an organisation, and within this one were some very difficult issues.'

High points in his career at London regional office included the development of a strong relationship between the NHS and the Greater London Assembly, and work on the West London Partnership in Paddington Basin.

Further back in his career, Mr Crisp is proud of the part he played in the creation of a breast unit when he was chief executive of Oxford Radcliffe Hospital trust, between 1993 and 1997, and of work on the trust's trauma facility.

Interviewed on the day that South East region launched its review of cardiac services at the trust, Mr Crisp is quick to point out: 'That report is about the Radcliffe after I left.'

But he admits: 'The sort of issues you have there remind you how difficult it is to manage these things - there are a lot of pressures in the system and a lot of very powerful people.'