Chief executive, Royal College of Nursing (2010 ranking: 23)

The RCN’s decision to duck out of the strike on 30 November may have underestimated the professions’s fury over attempts to cut pension benefits and raise the retirement age. But under Peter Carter’s leadership, the union has belatedly announced it will take the unprecedented step of balloting for industrial action if government talks break down. The equally thorny issue of how the royal college engages with trusts over NHS pay costs could make the difference between QiPP targets being hit or not.

Dr Carter’s move up the rankings reflects not just his bolstered industrial might but the possibility of tangible policy triumphs. Having successfully joined the alliance piling pressure on the government to “pause” reform - he is in a good position to press for concessions.

What role will nurses play on clinical commissioning boards? Will healthcare assistants be regulated? given widespread support for the latter, taking credit for a win would be a boost to the former mental health chief executive - not least now his union has opened its doors to the expanding population of HCAs.