The seventh year of the HSJ100 in the wake of the passage of the Health Act reveals a landscape under transition as well as scrutiny.

The secretary of state remains in the top five but not in the form of Andrew Lansley, the architect of the system. Jeremy Hunt, his successor, will continue to, in part, explain but principally oversee the delivery of the reforms.

That task falls squarely to Sir David Nicholson who again is at the pinnacle of the HSJ100. His handpicked senior team at the NHS Commissioning Board feature across the list for good reason - they can effect significant change in the NHS and how care is delivered more broadly by a wider sphere of providers.

Those responsible for making the system work across government are increasingly represented in the list: David Bennett, steering Monitor through its shift to be an economic and market regulator; Ian Dalton, who as Nicholson’s right hand will forensically drive forward delivery of the NCB’s role and the rapid maturing of its internal processes; Bill McCarthy, leading the policy and strategic elements of transition; and David Flory and the Trust Development Authority, who will be forcefully shepherding provider organisations towards FT status - or the failure regime that Matthew Kershaw is implementing for the first time in south London.

And yet there is a pause in this year’s HSJ100 while the long anticipated Francis inquiry report is awaited. His forensic diagnosis and prognosis for the future of the standards of care, of harnessing the patient’s voice and of truly engaging clinicians and staff, remains an opportunity to bestow seismic change on the NHS that occurs once in a generation.

It will take time for NHS observers, patients and staff to calibrate the magnitude of what will flow from the inquiry but it is clear this is an unstoppable train

Frank McKenna, managing director of Healthcare at Harvey Nash plc