Lord Darzi, parliamentary under-secretary of state for health

Lord Darzi climbs one place to the top of the power rankings after the success to date of his blueprint published in June for the next stage of NHS reform.

Arguably the strongest evidence of its success is that the public is not talking about it. Even before the financial crisis, the new mantra of quality and safety first - clinicians in control and outcomes not processes - meant the health service tumbled down the list of voters’ complaints. Conservative plans to make 2008 the year they became the party of the NHS are now in tatters.

On paper just a junior minister, Lord Darzi has not been content simply to write his report then leave the Department of Health to work out how to implement it. Instead he is centrally involved in driving it forward, the public face of this being his autumn regional tour with NHS chief executive David Nicholson (2) to elicit support.

Personable, engaging, passionate and refreshingly modest considering the welter of titles and initials that dangle off both ends of his name, he has been a convincing advocate of the new policy.

But challenges remain. Some have questioned his grasp of primary care policy, a criticism given weight by the ham-fisted way the government has gone about deciding where polyclinics should be built.

And while the government claims to have “engaged” many hundreds of clinicians, scepticism continues among medics in particular about the government’s intentions. Many doctors insist on seeing Lord Darzi simply as a politician, not an internationally renowned surgeon.

But as well as fulfilling his ministerial duties, he maintains a daunting schedule of surgical work and research, ensuring he will remain a significant figure in healthcare long after the trappings of office have gone.