The ebullient director of policy and communications for the NHS Confederation is loved by journalists for his pithy opinions but he also commands influence by being honest about the NHS’s failings and he is no apologist for managers - he wrote recently that the quality of middle management is variable.

His was an early voice forecasting a massive gap between health service demands and resources after 2011 and proposing solutions. Civil servants see him as a “sense check” for policies and he has been a constant in times of change at the confederation.