Sir Bruce Keogh, NHS medical director and Department of Health interim director general of informatics

Quick off the mark following the next stage review, the NHS medical director proved he had a firm grip on the quality drive. By publishing mortality rates on the web in July, allowing patients to compare trusts on a set of procedures, Sir Bruce broke a major taboo.

This proved that patients could be given access to outcome measures without the world crumbling and that Sir Bruce was serious about doing so.

Urbane, quietly spoken but determined, his clear message was “the days of discussing whether or not we should publish outcomes are over”, as one HSJ50 judge put it.

The service has overwhelmingly listened and heard, though reservations will be raised about some particularly blunt measures. Spreading a culture of openness on quality will take much more of the same and Sir Bruce’s next moves will be key to implementing Lord Darzi’s work.

The nitty-gritty will involve managing the proliferation of outcomes, with an extensive list expected imminently, while working patient reported measures and patient experience into the mix.

Challenges include outcomes for surgical teams, relating them to pay and ensuring the moves improve care.