Chief executive, NHS London (2010 ranking: 47)

Dame Ruth ensured London was quickest to implement the NHS reforms, including PCT clustering and management cost reductions. She got her reward when the government took the hit for the iconic decision to close services at Chase Farm.

The health secretary’s original opposition to London’s plans cost the SHA so many board members it was only just quorate. But it appears Mr Lansley and Dame Ruth are now pretty much in concert on what needs to happen in the UK’s biggest and most challenged health economy.

Being spared the pain of SHA clustering has certainly helped maintain focus and London’s reformed stroke system is close to achieving international recognition. Dame Ruth would also like to improve cancer and mental health services, but knows reconfiguration is the big game in town.