Mark Britnell is the highest ranked horticulturist in this year’s HSJ50: he was on gardening leave when the list was drawn up, before starting a new job as European head of healthcare at KPMG.

His departure from the Department of Health, where he was director general for commissioning and system management, shocked many but may be prompted by a desire to see the world of the private sector after a lifelong career in the NHS.

Mr Britnell is expected to remain influential in or out of the NHS. His DH role saw him drive forward world class commissioning, set up the cooperation and competition panel and bring in private firms to help primary care trusts commission.

With chief executive of NHS South Central and chief executive of University Hospitals Birmingham Foundation Trust on his CV he has also spent a year in the Australian health system.

Still in his early 40s, could he be a future chief executive of an “NHS independent board”?