Finance director, DH (2010 ranking: 52)

DH expenditure has always worried Her Majesty’s Treasury. For one thing it’s huge, dwarfing schools, for example. For another, unlike many departments where the Treasury can keep an eye on spending, DH cash goes out the door to be spent by hundreds of NHS organisations, some of whom like to think they are autonomous. Two people give the Treasury some confidence in the management of the health budget; Sir David Nicholson, whom it perceives as having grip, and the DH’s veteran finance head, Richard Douglas.

In the eternal tension in Richmond House between those aligning themselves with the NHS and department, Mr Douglas has achieved the rare distinction of having the confidence of both. For the Treasury and civil service he is “one of us”, a career government finance man who understands arcane accounting rules and speaks Whitehall mandarin. For the increasingly autonomous NHS side Mr Douglas is someone who understands NHS finance and has credibility in their community as someone who will bat for them against the Treasury.

It should come as no surprise that Mr Douglas has risen so sharply up the HSJ100 this year. He came out of a very successful period as acting permanent secretary (many thought he should have gone for the full job) to be director general of policy, strategy and finance, he is the calm voice of experience as the department faces greater change than at almost any time in its history.

The DH budget is being squeezed to help support the commitment that NHS spending will rise in real terms. Meanwhile, the NHS is attempting to make historically challenging efficiency savings and many predict the number of organisations running deficits will rise. Cometh the hour, cometh the man. Step forward Richard Douglas.