Chief executives have been told that health secretary Alan Milburn has decided on a radical shake-up at the very top of the NHS. He is to appoint just one person to fill the shoes of both departing NHS chief executive Sir Alan Langlands and Department of Health permanent secretary Chris Kelly.

Mr Kelly has no other job lined up. A DoH spokesperson said he 'will be looking for other senior civil service posts'.

Mr Milburn said the new role would combine the leadership of the NHS with public health and social care, taking forward the national plan for the NHS due to be unveiled this summer.

Sir Alan leaves in a month's time. His deputy, Neil McKay, will act as chief executive until a replacement is found.

Managers saw some advantages, but worried about a 'civil service takeover' and more ministerial control of the NHS (see right).The news has triggered speculation on who will get the job (see left), which will be advertised this weekend and in next week's HSJ .