Steve Bundred has broken into the top 20 in his second year in the HSJ50. Considering he has been chief executive of the Audit Commission since 2003, this represents a distinct step change in his influence on the shape of healthcare.

The reason is largely his leadership on the public spending debate. Where Mr Bundred has trodden everyone else has followed.

He was the first to say the situation really was going to be much worse than everyone had been admitting and that large scale cuts would be needed in the public sector.

His article “Our public debt is hitting Armageddon levels” in The Times in February framed the present fiscal situation in the context of the 1970s and early 1990s, providing the cover for the Department of Health and others to admit the problem.

And in the day job, Mr Bundred still had time to oversee the publication of influential Audit Commission reports on payment by results, NHS boards, and the financial performance of NHS trusts and primary care trusts.