The role of the NHS chief executive job is now better defined than it was in the past, said Mr Nicholson. The job was not about 'exhortation', he said, but about 'aligning the new system with organisations and people'.

The role of the NHS chief executive job is now better defined than it was in the past, said Mr Nicholson. The job was not about 'exhortation', he said, but about 'aligning the new system with organisations and people'.

He said that this was reflected in the markedly different role for strategic health authorities.

'When I was first appointed as a regional director, I was told by the NHS chief executive and the politicians: ?your job is to fix things and you will be judged by how much noise we hear from the system?, and that's what we did.

'We are setting up SHAs in such a way that their job is not to fix - their job is to create this new system. They are mechanisms of reform not a drag on the system, which very often the intermediate tier can be.'

He said that another priority fror the health service was to change the business processes which trusts used. Such reforms could help to combat the problem of deficits, he said, and work had already started on changes for next year.

'The present way we plan, organise and manage our services is almost designed to deliver a deficit,' he said. 'You have a bottom-up system which comes up with a number which is the deficit.'