Leading England’s largest trust and being at the centre of medical innovation secures Professor Steve Smith’s place as HSJ50’s highest placed acute chief executive.

His Imperial College Healthcare NHS Trust imported the academic health science centre concept to the UK in 2007. This year it was awarded “official” AHSC status and watched four other clusters follow in its footsteps.

Professor Smith is moving Imperial towards foundation status and, as one of the few “fixed point” trusts in London, it will be central to any restructuring of the capital’s hospital sector.

Internally, its service groups are now genuinely led by doctors who have taken on director roles while maintaining their practice.