Chair, Mid Staffordshire Foundation Trust public inquiry (2010 ranking: 76)

Robert Francis QC is the highest climber in this year’s HSJ100, up 73 places. The rise is a testament to the impact his report on the failure of the regulatory and supervisory system around Mid Staffordshire is expected to have in 2012.

In chairing the inquiry, Mr Francis has demonstrated an unswerving patient focus, a dry wit and a highly tuned bullshit detector that has won him the trust and respect of all sides.

A practising barrister since 1973, he is a specialist in medical issues including clinical negligence. A decade ago he appeared as a barrister to the Bristol inquiry and it has been noted that many of the same issues still abound, particularly around NHS data quality. He will be determined his own recommendations do not gather dust.

The fact that his report is still not imminent (those close to it will only say it will be next year and not early doors at that) leaves it looming ominously over the NHS landscape - and a few careers.

Add to that health minister Lord Howe’s recent commitment to bring forward another health bill if Mr Francis’s recommendations demand it and the stakes are high. Although, it must be said, the possibility of the prime minister sanctioning another health related bill in this parliament are very slim.

During the inquiry he has shown particular interest in the impracticality of the so-called “nuclear option” of shutting down failing services and seemed perplexed by the lack of performance management of struggling foundation trusts.

Those hoping for a pause in the shuffling of NHS deckchairs may take comfort that the contribution of the 2006 reorganisation to the failure of the system to pick up Mid Staffordshire’s problems sooner has not been lost on Mr Francis. More likely is a recommendation for the statutory regulation of healthcare assistants and NHS managers, both of which the government is not keen on.

More attention to “soft intelligence” and a louder patient voice are sure to form key tenets of the report. That may fit nicely with the government’s “no decision about me without me” rhetoric, but Mr Francis has been round the block enough times with the Bristol and Royal Liverpool Children’s inquiries and will want to make sure the NHS actually listens this time.