HSJ100 2012: Under 'Baron' Nicholson, a new health aristocracy takes shape
Behold the barons. Sir David Nicholson, who has now topped the HSJ100 for four of its seven years, divides the world of healthcare leaders between “barons” and “knights”.
Barons command armies, knights quest between castles doing good needs. Robert Francis is a knight, as is Sir Bruce Keogh.
‘Just one CCG chief has fought his way into the rankings. But there has been even less success for the army over the water - the private sector’
But it is the barons who will rule healthcare in 2013. Staring out from the keep of mighty Quarry House, Sir David will spy the lesser, but still impressive fortresses of Monitor (undergoing a huge expansion), the Care Quality Commission and the NHS Trust Development Authority. He may well ponder that the leaders of all these baronies share his first name and smile wryly as he remembers it means “beloved”.
After the great war of the Health Act, this is an NHS looking to build anew and the centre of power has shifted. The Department of Health still claims seven of the top 30 places but the commissioning board has nine and occupies, in total, a fifth of the HSJ100.
The reform war was fought in part to install the clinically qualified in places of power. There are more than last year but they still account for less than a third of the total. Just one clinical commissioning group chief has fought his way into the rankings. But there has been even less success for the army over the water - the private sector - for whom many claim the war was waged. Just two of their princes figure.
The list also continues to reflect the medieval power balance in being dominated by men. The women included are no damsels in need of rescuing but are massively outnumbered. Like the court of dark ages England, the corridors of power are also trodden almost exclusively by those with white skin.
Read on, and learn where true power lies in Baron Nicholson’s world.
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Readers' comments (17)
Anonymous | 6-Dec-2012 11:01 am
Im sorry- is that the same Mike Farrar on the list that negotiated the GP contract with its let out clause for out of hours (for £6k per year loss only, worth it !) and GP salaries that have seen such large increases for less work?
Can I make a plea he's not let anywhere near contracts or negotiation - oh dear isnt that what the NHS Commissioning Board....
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Anonymous | 6-Dec-2012 12:35 pm
I am perplexed at why Andrew Lansley's name does not appear at all. Surely the legacy of his actions as SS will continue to dominate health and health politics for several years to come? (Like the Ghost of Christmas past perhaps?)
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Blair Mcpherson | 6-Dec-2012 12:39 pm
The wealthy powerful Barons in their castles who control our lives, the privileged lives of the knights who fight to impress the fair ladies. I know who the peasants are in this description of a medieval style NHS but who is the court jester?
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Anonymous | 7-Dec-2012 8:34 am
As usual, list dominated by white men in grey suits. What does that say for health which employs a majority of women and BME staff? Loss of PCTs has worsened visibility of these groups. Come on... recognise the talent!
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Anonymous | 7-Dec-2012 5:12 pm
Talk of Baron's and Aristocracy makes one think that everyone else is a Serf. Not a very modern way of thinking about management in the 21st century although perhaps appropiate for NHS
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Andrew Craig | 7-Dec-2012 6:53 pm
Alastair I think the whole tone of this is unfortunate. Barons and aristos is most definitely NOT what the NHS needs now. Turf wars and power struggles have got us into much of the mire we currently see. We need leadership to get out of it, and that has to come from the front line, grass roots or whatever else you want to call it. The job of the "aristos" is not to get in the way.
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Anonymous | 8-Dec-2012 12:06 pm
So if David Nicholson is Baron Hard Up who is widow Twanky?
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Anonymous | 9-Dec-2012 12:51 pm
Andrew Marr show today had item on crisis of compassion in the NHS. Are the people on this list going to turn that round?
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Anonymous | 9-Dec-2012 1:22 pm
Where is Roy Lilley? Why isn't he on the list? People read his blogs, he is a sought after conference speaker, and he is an opinion former.
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Anonymous | 9-Dec-2012 6:42 pm
Great timing - Ali Parsa becomes an unperson, yesterday's man to quote a comment on the story about his departure, apparently jettisoned from any executive role at Circle after burning his shareholders' money, but still secures a place half way up your list!
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Kenneth Lownds | 10-Dec-2012 10:57 am
Alastair, The continuing collapse of the culture of caring in the NHS can certainly be ascribed to Nicholson and his cohort. Julie Bailey and the rest of us in Cure the NHS made Robert Francis Number 2. The only thing that any of the people on your list should be thinking about over the festive season is delivering healthcare of the highest standard with Zero Harm, Right First Time. Nicholson made his views of patients and loved ones crystal clear as the Healthcare Commission started its investigation into Mid Staffs, contempt. Since then neither he or anyone else has done a single meaningful thing at NHS level to improve the safety of patients or the standards of their care. And they won't and can't because they are from the Blair/Brown era of 'top down like it or lump it' NHS; the era of sham and charade regulation. Read Julie Bailey's book from 'Ward to Whitehall' over Xmas and then ask who ran the NHS in Staffordshire and then nationally in this period. Your New Year's resolution Alastair should be to focus your excellent magazine solely on the one goal of NHS delivery, healthcare of the highest standard delivered with Zero Harm, Right First Time. Cure the NHS - Stafford
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Camilla Bashaarat | 10-Dec-2012 11:39 am
Blair Macpherson and Anonymous 1:22 - isn't Roy Lilley our court jester?
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Kenneth Lownds | 10-Dec-2012 12:11 pm
Alastair, The continuing collapse of the culture of caring in the NHS can certainly be ascribed to Nicholson and his cohort. Julie Bailey and the rest of us in Cure the NHS made Robert Francis Number 2. The only thing that any of the people on your list should be thinking about over the festive season is delivering healthcare of the highest standard with Zero Harm, Right First Time. Nicholson made his views of patients and loved ones crystal clear as the Healthcare Commission started its investigation into Mid Staffs, contempt. Since then neither he or anyone else has done a single meaningful thing at NHS level to improve the safety of patients or the standards of their care. And they won't and can't because they are from the Blair/Brown era of 'top down like it or lump it' NHS; the era of sham and charade regulation. Read Julie Bailey's book from 'Ward to Whitehall' over Xmas and then ask who ran the NHS in Staffordshire and then nationally in this period. Your New Year's resolution Alastair should be to focus your excellent magazine solely on the one goal of NHS delivery, healthcare of the highest standard delivered with Zero Harm, Right First Time. Cure the NHS - Stafford
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Anonymous | 10-Dec-2012 4:41 pm
Like Feste in Twelfth Night or The Fool in King Lear, Roy Lilley should be on the list, even if he is the court jester he makes the has the ability through wit to undermine the main protagonists in this story and keep their feet on the ground. I would have him in the top 5.
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Christopher Foster-McBride | 10-Dec-2012 4:50 pm
I agree with Anon 8:34 the most striking thing about this list is that it is mainly white people......and most are men. This is worrying.
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Anonymous | 18-Dec-2012 9:49 am
I agree with anon 8.34. I was struck when reading the list of the 100 most influential people at the lack of women featuring in the list. As usual it is the male, pale and stale that dominate and not helped by the sexist language of "knight and baron" used to describe them.
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Anonymous | 24-Dec-2012 12:59 pm
So it must be me? 25 years in the NHS 11 of them as a CEO and i do not knopw who about 40% of these people are - never heard of them.
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