The advent of the coalition has, of course, brought about a major overhaul of the existing power and influence matrix within the NHS.
However, it’s not just the ministers and special advisers that have changed places in the rankings. With the government committed to less intervention from the centre and the dismantling of whole layers of the organisational architecture, pinpointing future influence was a complex task this year.
One notable change is the rise of journalists and media commentators, who figure more prominently in the list than in previous years. This reflects the media tightrope that will have to be walked in order to keep the public onside throughout a fundamental redrawing of the nation’s healthcare landscape. The power and influence that the public - and the patient - will exert is the hardest factor of all to predict.
The white paper identifies patient choice as the dynamic force for change within the NHS, driving the competitive market. But, evidence suggests that while competition between providers may lead to better outcomes, patient choice may not be sufficiently effective to drive change.
It is not clear that consumers select high quality providers when routine information is made available, although the public (and providers) do respond to the media.
Patient choice will need a voice but will also need to be supplemented with other key levers such as inspection and accreditation, financial incentives for providers and clinical commissioners, and appropriate powers for the regulators.
Choice is one weapon but not a magic bullet.
Steve Kirby, head of healthcare practice, Ernst & Young
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Can patient choice alone force the changes the service needs?