Civil servant or health service manager? Northern and Yorkshire's new regional director, Peter Garland, talks to Seamus Ward about his role in an increasingly centralised NHS

Peter Garland says he does not think of himself as a typical civil servant. But when he sees me eyeing his grey suit he immediately bursts into laughter at the absurdity of this statement.

Sitting in his office at NHS Executive headquarters in Leeds, the next director of the Northern and Yorkshire regional office looks every bit the civil servant.

It is not surprising. Mr Garland has been working for governments since the 1970s, first in social services and latterly at the NHS Executive, where he is deputy director of finance and performance.

And though he is originally from Bristol, he speaks with the measured tones of someone who has spent 20 years in Whitehall.

When the laughter has died down, he explains himself. 'I probably have the reputation as being more outspoken and less risk-averse than some of my colleagues,' he says.

'One of the nice things about working in the Executive is that it doesn't feel quite such an old-fashioned civil service environment as some government departments may still do.

'The combination of people from more traditional civil service backgrounds and people from the NHS is very productive.'

He is certainly highly regarded. NHS chief executive Sir Alan Langlands says: 'Peter's incisive approach is exactly what's needed at regional level to ensure improvements in health and momentum for the NHS modernisation programme. He will be a key player on the NHS Executive board.'

The 52-year-old's CV is impressive. He led the Department of Health's work on the comprehensive spending review last year, following years of public spending negotiations with the Treasury.

Before that, he worked on developing fundholding. With so much experience of policy, he could be seen as an ideal regional director, which after all is a civil service post. But many feel that these positions should be filled by men and women with knowledge of the sharp end of service delivery.

Mr Garland does not believe his lack of direct experience to be an issue.

'On the Executive board we have a mix of people from different backgrounds. Those from trust or health authority backgrounds have a lot to contribute in terms of their personal experience of operational issues.

'Someone with my background has something to contribute in an understanding of the way these policies work. We will complement each other on the board.

'The diversity will make sure there is a strong team overall. I don't think it really matters where you come from. The critical thing is whether you can do the job. That determines your credibility.'

He sees his current job as a sort of mediator between ministers and HAs and trusts. 'It is one of the best jobs in the Executive, not least because it looks in these two directions,' he says.

'The Executive is such an exciting place to work. More than almost any other government department we are working at getting the mix of serving politicians with getting close to the operational issues in the organisation we run.

'That's not to say we do this perfectly, but if you compare how we do it now with 10 years ago there has been a huge improvement in the way we relate to the service.

'I hope this has come about without losing anything in terms of ministerial confidence.'

It is very important for the Executive, including the regional offices, to fulfil these two roles. 'I don't think you can divorce them. The health service is such a sensitive organisation in political terms that you can't run it without the confidence of ministers, without being able to work closely with them.

'Looking in the two directions is very much what the regional offices are about. It is an integral part of the Executive's work.'

He is sure of the regions' future - the service is so vast and devolved it would be difficult to run without a management tier at regional level, he says.

And he adds: 'There is a huge role for the regions, but in part it depends on what happens to regional government. Regions have a key role in relation to this government's wish to see a more integrated approach to delivering services, to make joined-up government a reality.'

His main job will be implementing the government's reforms. 'I am going to a regional office with a good reputation. It has done a good job and Liam Donaldson will be a hard act to follow.

'The biggest problem is the size of the agenda, which is what most people in the NHS would say to you.

'There is no doubt that we are facing a period of major change - primary care groups, clinical governance, a whole new agenda in performance around the assessment framework.

'It will be a long-run programme and will take 10 years to play out. The key thing is to make a good start.'

He feels the culture will also change. 'Regional offices are operating in a different climate than the one that existed a few years ago. The government has a much more centralised approach.

'One of the tricks will be

reconciling national standards and frameworks with local planning and operation, such as PCGs and Health Improvement Programmes.

'There will also be external review - the Commission for Health Improvement and the National Institute for Clinical Excellence. Part of my job will be to reconcile these three themes.'

Mr Garland already lives in Northern and Yorkshire region, in Ilkley, West Yorkshire, with his wife, Janet, and three daughters. He claims to have no time for hobbies, being too busy 'ferrying my daughters around'.

And though he will be sad to leave Quarry House, there is one aspect of his current job that he will not miss - travelling to and from London two or three times a week. A day trip to the capital is no joke. 'I have to get up at 5.30am, take the 7am train to London and arrive back home at 10pm,' he says.

He is hoping to use the time saved to get out and meet people in HAs and trusts. 'I hope travelling around the Northern and Yorkshire region will be less onerous than the twice-weekly run to Richmond House.'See comment, page 15.