Mark Britnell is on a journey to transform healthcare commissioning. So it’s a surprise when, early into a breathless narrative, he retrieves a miniature hospital, rather than say a polyclinic, from a corner of his Richmond House office.

Before joining the Department of Health, Britnell was chief executive of a foundation trust, and the model in his hands is a glimpse of what he was working there to deliver—Birmingham’s first new hospital for nearly a century, due to open in 2010. He says that the hospital, which is privately financed and being built to replace the Queen Elizabeth and Selly Oak hospitals, will have “vastly superior facilities” and more beds.

“It’s a year ahead of schedule and absolutely on budget. As you can see from the design it’s both iconic and spectacular. It’s stunning.” So in two years’ time Britnell will have left an indelible mark on a city’s skyline, although that might still be too soon to judge his effect in his role as the NHS’s director general of commissioning and system management. He is 15 months into this latest job, which, put simply, is to develop commissioning and fashion “the missing link of healthcare reform for the last 20 years.”