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HSJ100: Politicians and medics surge to power in the new world order

We live in political times. That much is clear from the first HSJ100, the expanded version of the HSJ50 which, for the past four years, has plotted the most influential people in health.

In 2009 there were five political figures in the top 50, this year there are 10. For the first time the health secretary ranks number one and the entire ministerial team are among the top 50.

They - and the other five political figures - owe their rankings to the radical and controversial nature of the government’s reform process, whose future will be determined during what might become a fierce parliamentary battle during the first half of 2011.

The greater political emphasis is just one manifestation of the overriding theme of this year’s list: that of change. Of the top 50 influencers, 26 are new entries, including eight of the top 20.

GP commissioning is the government’s flagship policy and, as a result, there are nine GPs in the 100, including numbers 3, 8 and 11. Indeed, as a sign of the changing power relations within the health sector, 25 of the list have clinical backgrounds, 22 of them medical.

But the influence of the managerial community remains strong. Just under half of the 100 hold management positions at local and national level. This is just as well as the other main narrative of 2011 will be the success of NHS chief executive Sir David Nicholson’s “national management system” in overseeing the efficiency savings of “up to £20bn” that chancellor George Osborne has now made a government commitment.

Commissioning lead Dame Barbara Hakin (up 39 places) and new entries Ian Dalton (12), Sir Neil McKay (18) and Jim Easton (39) emerge alongside Sir David, David Flory and Mike Farrar as among the national management elite.

With so much action on the national stage, it is perhaps not surprising that there are only 12 NHS chief executives in the top 100, and just two in the top 50, compared with six last year.

Readers' comments (3)

  • Clive Peedell

    (Apologies in advance for the long post!)

    The HSJ is absolutely correct to put Oliver Letwin second on the list. His right wing ideology is all over the White Paper. In fact its unpopularity chimes with another of his famous policy ideas - the Poll Tax.
    He is also author of the book: "Privatising the World: A study of International Privatisation in theory and in practice" (Foreward by John Redwood!)

    The current reforms are based on an evolving form of neoliberalism, which has its roots in the work of Friedreich von Hayek and Milton Friedman, as well as think tanks like the Centre for Policy studies, IEA, ASI, and more recently Policy Exchange. Shirley Letwin helped set up the Centre for Policy Studies, where "thinking the unthinkable" was the order of the day (Alfred Sherman quote)

    This current, ever evolving, form of neoliberalism accepts the role of the state, but only as a promoter and protector of the market. Public services and public money are privatised with market forces penetrating all parts of the public sector. This is why we have the academy schools programme, Universities competing against one another, massive outsourcing of public sector jobs (e.g police back office jobs outsourced). We are also seeing public sector jobs being transferred to third sector organisations. The best example of this will be FTs becoming social enterprises, but a more recent example was the DH announcement of the transfer an estimated £900m of services and almost 25,000 NHS staff into the social enterprise sector.

    The transfer of FTs to SEs will take the cost of NHS hospitals off the public sector balance sheets.
    The reduction in public sector workers and their transfer to the private sector results is aimed at reducing Government spending and reducing the pensions burden. Poorer T+Cs for the workforce quells wage inflation, keeping general inflation down. When this is coupled with a lower taxation burden from less spending, this provides improved market conditions for the International Bond markets and investors, which can have increased confidence of being taxed less and not having their loans or assets inflated away. The fear of "capital flight" dictates our domestic policy, because the international bond markets demand low tax, low inflation economies i.e public sector and welfare state R.I.P. The power of the bond markets explains why New Labour abandonded social democracy in favour of a "social" market Third Way.

    When are we going to wake up to the fact that the NHS is dismantled and privatised?

    It is painfully ironic that the neoliberal doctrine that led to the global financial crisis is alive and well in the NHS under the stewardship of the right wingers Lansley and Letwin.
    Paul Mason, the economics editor of BBC Newsnight was therefore mistaken, when he wrote in his book, "Meltdown: End of the Age of Greed":
    "Basically neoliberalism is over: as an ideology, as an economic model. Get over it and move on. The task of working out what comes after it is urgent . Those who want to impose social justice and sustainability on globalised capitalism have a once-in-a-century chance".

    The radical, rushed and illogical (on health policy grounds) nature of the WP reforms all starts to make sense in the context of the Letwin/Lansley neoliberal ideology. Thatcher wouldn't have dared go this far - no wonder Cameron is getting twitched

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  • T

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  • As with earlier versions of the 'most influential' in seems that the UK = England.

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