Chief executive, NHS Midlands and East (2010 ranking: 18)

Sir Neil has led big acute trusts and NHS East of England but is now in charge of the largest SHA cluster, covering a 15 million population. One of his hardest tasks will be overseeing aspirant foundations in the region, comprising more than a third of the national total.

The success or failure of Circle Health’s franchise of Hinchingbrooke Health Care Trust, which he backed, will have repercussions for the rest of the NHS. Sir Neil will also have to deal with some of the fallout from the Mid Staffordshire Foundation Trust public inquiry.

His secondary role overseeing the human resources elements of transition is now likely to focus on the implications of developing commissioning support. His slip down the rankings reflects the transient nature of SHA clusters, although he will undoubtedly have a place in the new NHS if he wants it.