Our weekly guide to healthcare's most influential people

Name: David Nicholson

Job: Trent regional director

Style: 'Tenacious and determined'.And as HR project director for the Shifting the Balance shakeup, It is just as well.One of the four 'toughies' heading the new health and social care regions - he's got the entire Midlands.'The image of the common man belies an incisive intellect and insight, ' says a colleague.NHS managers lurking anywhere between Southend Pier and the Welsh border, be warned: 'no matter how well you think You have prepared, It is his ability to ask the really challenging question you haven't thought about.'

He says he's keen to 'energise and support the front line - being bureaucratic will not do it'.Said to be approachable and a good listener.A passionate fan of Nottingham Forest FC.

Background: A history and politics graduate who joined the national training scheme with Yorkshire regional health authority in 1978.His first general management post was as hospital administrator at Northowram Hospital, Calderdale, moving in 1983 to become a unit administrator in Barnsley.

In 1985, he became general manager of Doncaster HA's community development unit, then moved into the acute sector as general manager of Doncaster Royal Infirmary in 1985.Became chief executive for Doncaster Royal Infirmary and Montagu trust in 1991.Trent region snapped him up as performance director in 1997.He was made regional director last year.

Future prospects: Though his mega-region role is already lined up, there are testing times ahead.

Will the Shifting the Balance rejig go smoothly with minimal loss of experienced NHS staff? He will not be the only one with his fingers crossed.