'The arrival of another world-class surgeon at Richmond House is a significant coup for NHS chief executive David Nicholson'

The imminent appointment of the first NHS medical director - who is revealed in this week's HSJ - will shed light on the complex relationship between the Department of Health and its precocious offspring, the NHS.

The arrival of another world-class surgeon at Richmond House, following on the heels of Gordon Brown's appointment of Lord Darzi as a junior minister, is a significant coup for NHS chief executive David Nicholson. Adding chief medical officer Sir Liam Donaldson into the equation, it means the departmental civil service, the ministerial team and the NHS management now each have a respected medic in their front rank - and it is worth noting they share a passionate commitment to patient safety.

The importance of the director post can be judged from the fact that the announcement has been delayed until Mr Gordon Brown - true to his centralising reputation - can rubber-stamp it.

The medical director will provide an NHS counterweight to Lord Darzi's immense influence, as well as provide a further boost for the imperative of effective clinical engagement.

It will also highlight the evolving role of the chief medical officer. Sir Liam is, in plain English, the government's top doctor. He will focus on advising the government and the voters on public health issues - taking the lead on sun cream, as one wag put it - while the NHS medical director will focus on healthcare improvement and delivery.

The NHS medical director's freedom of manoeuvre will be a strong indicator of the government's willingness to maximise the operational autonomy of the health service following last year's separation of NHS management from the DoH. By hiring such a big hitter, the NHS management team has ensured Lord Darzi will not be left unchallenged on clinical policy within the health service's ruling elite.