Richard Douglas, the new NHS finance director, will have to hit the ground running when he takes up his new job in May.
NHS finance faces difficult challenges in the coming months, despite ministers' claims that last year's historic £19bn increase over four years had ended the service's money troubles.
Managers are warning that ministers' demands on the service, laid out in last summer's NHS plan, far exceed the funds allocated to deliver them.
Mr Douglas, director of finance at National Savings, also has a tough act to follow. The incumbent NHS chief Colin Reeves, who leaves this week after nearly seven years at the NHS executive, is widely acclaimed to have done a good job in often difficult circumstances.
The NHS is on course to break even this year for the first time in many years. Mr Reeves successfully secured major resources for the NHS in last year's spending review. And the "biggest ever" hospital building programme is now well under way with funding provided through the private finance initiative (PFI).
Mr Douglas will have to try to emulate his predecessor's street credibility in the NHS. Mr Reeves managed to deliver ministers' policies, which are at times unpopular with the service, while retaining the respect of finance managers in trusts and health authorities.
Mr Douglas is an "outsider" - a career civil servant. Mr Reeves was, to NHS finance directors, "one of us". He was the first NHS finance director at the NHS executive to be appointed from within the health service, a fact seen as a major endorsement of the NHS finance function in general.
Nevertheless Mr Douglas's appointment appears to be a popular one among NHS finance professionals. He is no stranger to the health service, having served two stints at the Department of Health.
He was the NHS executive's head of financial planning and monitoring from 1990-92. Then following four years at the National Audit Office, he returned to the executive in 1996 as Mr Reeves' deputy director of finance and performance.
"It is good to see Richard back," said Mark Millar, chairman of the healthcare financial management association. "We know him in the service and he knows the system and the service. We look forward to an early meeting to discuss matters of mutual interest."
Other finance directors dismissed his lack of service credentials as irrelevant. "His appointment will be extremely well received in the finance profession," said Barry Elliott, director of finance at Barts & the London NHS trust.
"He was highly regarded as Colin's deputy, he knows his way around the department and he is comfortable with ministers."
Others say he has both good technical accounting abilities and the subtler skills needed to work with ministers and politicians.
The high profile finance job, which carries a salary of up to £120,000, will also mean periodic grillings from backbench MPs on the often hostile Commons select committees.
But Mr Douglas is already acquainted with such skirmishes. He accompanied Mr Reeves to give evidence to a health select committee investigation into PFI in 1998.
And last year he appeared before the Treasury select committee to give evidence in the committee's review of National Savings.
His key role, during his last period at the executive, in breaking the log jam in PFI - one of Labour's manifesto commitments - is certain to have impressed ministers and officials who are relying on the initiative to deliver the NHS plan's promise of 100 new hospital schemes between 2000 and 2010.
