Of the top people in the Department of Health in a new Nuffield Trust study, only one person is labelled a "straightforward" career civil servant. The others amass tremendous experience - as doctors, from business, as NHS managers - but Whitehall warriors they are not.
That one is now their leader. Last month, veteran Hugh Taylor, fortholder in the interregnum after the precipitate departure of Nigel Crisp, stepped up from acting to become the DH permanent secretary - bringing to the team both 10 years in the department itself and, since he joined the Home Office in 1972, time spent in private office, executive delivery (at the prison service) and at the Cabinet Office during its oddly fruitful period when John Major was in power.
Taylor says the Nuffield study is somewhat behind the curve. The DH has for a while been aware of the need to reblend its expertise, but he does hold his hand up to "a sense of not playing our part fully within Whitehall". He intends to change that, adding that you can't make a sharp distinction between policy and management, citing the credibility in policy of a Bill McCarthy (director of strategy) and his frontline and strategic health authority jobs. But there was a deficit to be filled, and that's happening; Taylor doesn't seem overly concerned with the forthcoming capability review of health.
Worldly
If you called Taylor "worldly", that might suggest calloused cynicism about power and politics - in a year when, who knows, an incoming prime minister might revolutionise the status of the NHS and dispense with the incumbent secretary of state. He's anything but cynical and talks animatedly about doing a job that matters, because health matters. Preferred, so rumour says, to Bill Moyes of Monitor and the Audit Commission's Andy McKeon, he brings to the party what he calls "subject expertise embedded in experience of how government works".
Party seems an appropriate word when Taylor surprisingly uses the word fun to describe what he does. It's a peculiar rave. On his watch, he knows, the DH has to go on rebalancing its relationship to the NHS; it must become a more "strategic" relationship. At the same time, the NHS itself withdraws, bureaucratically speaking, to allow more expression of local needs, and does less targeting.
All that will be happening within a fiscal context bounded by the coming spending review, growing demand for adult social care and a sense that we are bumping along the ceiling of public acquiescence in the tax rates required to pay for a free-at-the-point-of-use service. (Not that any other jurisdiction in the advanced world doesn't have health management and financial issues.) Whoever is in No 10 or the secretary of state's office, health management is going to be about sweating resources and productivity. That includes the department itself, which will shrink further along with Whitehall at large at the same time as it strives to get cleverer and better trained - a process that will have to go on long after Taylor, who is 57, has retired.
No heroic figures
Party may also be the word to capture the plural nature of leadership in health. No "single heroic figures", Taylor says firmly. He works in a troika with David Nicholson, the NHS chief executive, and Sir Liam Donaldson, the chief medical officer. Collaborating with the former is going to be critical, but all the signs the division of labour will be cordially managed.
As for joining the NHS and departmental top jobs in one, as with Crisp, Taylor simultaneously pays tribute to his predecessor's ability and characterises the episode as an experiment that came about as a direct response to the emergency focus of ministers on delivery.
And that sense of political reality does mark him. "Whatever we do is coloured by the political direction we get; I make no apology for that." But since the Crisp appointment, the wind has shifted. There's much more attention being paid to the wider determinants of health and wellbeing, which is why Taylor, knowing his way round Whitehall, says with some assurance that he will be talking extensively to his neighbours in communities and local government and education, mapping areas of overlap.
Taylor isn't a grand mandarin. He's cast more in the O'Donnell mould, a technocrat who understands (his phrase) that Weberian bureaucracy won't serve the modern state. He waits, like the rest of us, to see what the Brown regime will bring to health. It's fair to say that with Taylor the administrative turmoil that accompanied the Crisp years and (over-rapid) downsizing will end. There's pain ahead but at least it will be administered by a specialist in the arts of government, and assuaged if, as Taylor intends, the DH is steered back into Whitehall's mainstream.
· This article appears in the new edition of the Guardian's Public magazine.
