The appointment of the current secretary of the British Medical Association, Dr Mac Armstrong, to the post of Scotland's chief medical officer has raised eyebrows in the service north of the border.
The 55-year-old Scot replaces Sir David Carter, who was appointed in November 1996 by the previous administration and is staying on as acting chief executive of the NHS in Scotland until a successor to the ousted Geoff Scaife is found.
The selection of Dr Armstrong is being viewed as a shrewd political move as it means that the Scottish Executive now has a senior health service insider on its side. The BMA, a thorn in the side of the Executive, is delighted to have one of its own so well placed. As one NHS insider, who does not want to be named, puts it: 'They were dancing on the tables of the Edinburgh office of the BMA when they heard the news. '
Dr Armstrong denies that he is a poacher turned gamekeeper, but it is hard not to view his transformation in that light. He has described his role at the BMA as more diplomatic than confrontational and has been viewed as a safe pair of hands over the last seven years, guiding the association through the Bristol heart babies tragedy and the Harold Shipman murders.
Dr Armstrong believes that as CMO he will have two roles: a technical and a professional advisory role and a professional audit and monitoring role.
His job may not be easy. He will join a health department that has been severely criticised for its handling of last year's winter crisis, while severe financial problems are facing some trusts, most notably Tayside University Hospitals. He will have to continue implementing the services review which his predecessor Sir David started, and deal with a mistrustful health committee which feels undervalued. Dr Armstrong also faces the launch of Scotland's own NHS plan, due at the end of November.
For Donald McNeil, development officer with the Institute of Healthcare Management in Scotland, the appointment is a welcome one. 'I have been speaking to a lot of the managers in Scotland and they feel that he will appreciate their contribution and will be someone who understands the needs of the service from the inside. Many of them remember him from his time as a national general medical services committee negotiator and as deputy chair of the Scottish BMA council.
'His appointment is totally consistent with the move towards a primary care-driven agenda. . . the last four CMOs have all come from the acute sector, so this is the right move as far as we are concerned. I also believe that. . . his appointment is a conciliatory one to bring some calm to the situation with the BMA in Scotland. I am also sure there will be another agenda, although we haven't quite identified what that is yet. '
Although Dr Armstrong has worked in London for the last seven years he has commuted every weekend to his home village of Connel, near Oban, where he used to work as a GP and where his wife still works.
He sees the fact that he has not practised for the last seven years as an 'advantage' as it means he comes to his new role 'with less baggage'.
His appointment has also been welcomed by a senior union leader. Jim Devine, Unison's head of health in Scotland, said: 'I think that this is a very interesting appointment.
'This is one of three crucial changes which are being made at the top of the NHS over the next few weeks, and who is appointed will indicate precisely the seriousness of the intent of the Executive and whether they promise real change or not. '
The two senior posts still empty are those of chief executive and head of human resources, where there is a battle to appoint individuals from within the civil service rather than from the NHS. Interestingly, Dr Armstrong will take up his appointment on a full-time indefinite contract with the civil service, a break from the recent practice of appointing CMOs on secondment from other agencies or public bodies. This could indicate a longer-term view of the role.
When Dr Armstong was appointed BMA secretary in 1993 a friend told HSJ: 'He is not devious or Machiavellian and that is one reason why civil servants and ministers like to deal with him. '
But it remains to be seen whether those are the precise characteristics which might stand him in good stead in his new role.
The Executive has not been short of a spot of backstabbing and infighting over the last year or so. With three senior posts falling vacant at once, the office is crying out for stability.