Ara Darzi stood down as a health minister in July but his influence is still central to the NHS and his push for quality is being carried forward.

That is why he is still so high in the HSJ50 as his reforms become more embedded and debate over the importance of quality recedes. Many of his ideas are evident in the Health Bill, still passing through Parliament.

But Lord Darzi has always been realistic about the NHS: he said the most important day for his review was not when it was published but the collapse of Lehman Brothers a few weeks later. The interplay between the twin towers of quality/safety and finance will be crucial in the years to come, and how much of the quality agenda survives the financial pressures will determine his lasting legacy.

Lord Darzi was not content just to write a blueprint for reform; he insisted it had to work bottom-up. While engaging clinicians is a marathon not a sprint, he at least fired the starting pistol. He insisted that clinicians should be in the driving seat for reform and that their support and involvement in drawing up service changes was vital. He has travelled the country to promote the reforms. He has remained in the wider health service debate, writing in The Washington Post recently to defend the NHS against its American critics.

When he quit, it was obvious he wanted to get back to spending more time with patients: he had continued to operate two days a week and had left political meetings if his expertise was needed in the operating theatre. But in the end the concentration and thrill of a complex keyhole surgery case - apparently carried out to the strains of Pink Floyd - were more attractive than yet more departmental meetings.