Laura Donnelly interviews the new chief executive of South Central SHA

The manager at Mark Britnell's local bar in Birmingham looks worried. I thought at first he was joking, but it seems not. He had heard about the promotion and he was delighted for him, but until now he hadn't realised it would take Mr Britnell and his associated business right out of the city. He wanders off distractedly, apparently calculating the loss of income associated with the end of its role as an overspill NHS meeting room.

After all, Mr Britnell has put his time in, supporting the city's economy. We meet an hour after he finally signs off University Hospital Birmingham foundation trust's private finance initiative, after eight years of work. Just in the nick of time, then: 'I had given my word that I would stay until I got the PFI.' He knew that it would come off, as he points out, by the time he accepted the strategic health authority role.

So closely associated is he not just with the city, but with the acute and foundation sector, that I wonder how he feels about 'crossing over' to a role in the intermediate tier.

Does he expect to change his views on automony and freedom, once he sees the sector from an alternative perspective? In short, will he become exactly the kind of performance manager he has spent a career trying to shrug off?

'Look, I didn't leave a very good trust to become a performance management monkey.

'I'm a great believer in autonomy, financial freedoms, foundations and so on. I hope I never listen to the siren voices, I hope I don't lose my nerve ? or have it beaten out of me,' he laughs.

Mr Britnell, famously the youngest ever chief executive of a teaching hospital when he got the top job at University Hospital Birmingham at 34, reckons his management style amounts to 'what you see is what you get'.

Which means? 'Driven, focused and fun.' (Also prone to speaking in very short sentences.)

Is that what everyone would say? What about any hypothetical enemies? 'Oh they would say I'm too confident by far.' Friends, he adds would describe him as 'inspirational' and 'motivational'.

His health service career began when, as a student Labour Party member, he was attracted by the NHS reforms under Thatcher. (Asked about this, his comment amounts to a raised eyebrow.)

The first graduate of the NHS Management Training Scheme to join the civil service fast track, Mr Britnell spent a year in the Department of Health's performance directorate. He then spent three years as a general manager for surgery at St Mary's Hospital in London, and three years at Central Middlesex Hospital trust as director of contracting and clinical activity as well as project manager for its pioneering ambulatory care and diagnostic centre.He arrived in Birmingham in 1998 as director of operations and deputy chief executive, landing the top job two years later. He has been there since.

'I'm no flippity gibbet,' he concludes.

What has he learned during his career? 'You are only as strong as your weakest link.' And 'yes', he had found that out the hard way. So has his style changed since he was a young pup, fresh out of Chester Law School?

'Well, I think I'm less personally driven than I used to be. At the beginning a lot was about what I could do individually. I still think it's very important that any one single person can make a difference, but there are so many factors outside your direct control.'

Working with over 20 parties to negotiate the PFI has given him plenty of experience of the complexities of the health system.

But he recognises that one change with the new job will be 'it's less about direct control ? and more about inspiration, influence and working in a wider sphere'. That said, he is optimistic that the business skills gained through running the three-star hospital and negotiating the new PFI will be transferable.

Does he see something deliberate in the way that most of the new SHA leaders have been wrenched away from familiar geographical territory? Is this a chance for managers to reinvent their styles, and shrug off old baggage?

'Yes, it was very clear to me that they wanted to move people around and create some fresh perspective and energy.'

Partly to avoid turning this into part of the job application for the vacancy at the top of the NHS, I don't ask any of the SHA chief executives for comments on any plans beyond their latest promotion.

But Mr Britnell has long been tipped for a role at the top of the NHS, if not this time, then next. Without me saying anything he leans forward: 'It's been put to me that it's good for me to get broader experience.'