If Lord Darzi’s legacy on quality puts him at the number two slot, it is money and control over it which has propelled David Flory’s ascent to number three from 16th place last year.

Mr Flory - director general of finance, performance and operations, to give him his full title - is seen as a man to watch as the NHS has to cope with tighter budgets and drives for increased productivity. He admits to being “very private” and looks uncomfortable when he is put in a public arena - never more so than when he was caught up in the Rose Gibb court case. But behind the scenes he has tremendous influence and it is hard to get significant expenditure through without his support. His influence will be felt both by trusts and primary care trusts through the operating framework, with potential changes to the tariff and increased emphasis on quality. He is likely to be a tough operator in hard times - in the past, he has said that the NHS “needs to know what success looks like” and that things should not be “too cosy”.

He was the troubleshooter for financially challenged regions after the 2006-07 problems and has seen the NHS return to financial surplus in the past couple of years. He has an accounting background and worked in local government and consultancy before joining the NHS. Before his move to London, he worked at finance director and chief executive level in the North East, most recently as NHS North East chief executive.