The HSJ100 is now in its sixth year. Its job is to predict who will wield the greatest influence over health policy and the NHS in the coming 12 months – in this case to November 2012. The prime minister, his deputy and the chancellor are excluded.

The judges were instructed to make no value judgements about whether influence was exercised for good or ill. They were also asked to reflect the balance of power as it is, resisting the temptation to correct any perceived bias in gender, ethnicity or world view. The judges themselves were chosen for their knowledge of who is making the running on the changes buffeting the service.

The message from 2011’s HSJ100 is that – in this year of transition – government has taken a firm grip on the NHS. Twenty of the 30 most influential figures are politicians or mandarins. The influence of civil servants and top NHS managers is particularly noticeable, accounting for half of the top 30.

All of those figures – and their political “masters” – would express a desire to devolve power to healthcare leaders on the ground. But NHS chief executive Sir David Nicholson has stated that the transition to the new system is “the most dangerous time” for the NHS. That danger will be – apparently – mitigated by an iron “grip” exercised by the centre.

There is little sign of new system leaders emerging. The clinical commissioning group leads included in the 100 are largely there because of their roles on representative groups. Just 22 of the 100 have clinical backgrounds.

2012 will be a year of uncertainty and the judges were required to make some educated guesses as to who would fill the leading roles at the NHS Commissioning Board and elsewhere. Then there are the wild cards that could dramatically change the makeup of the HSJ100. The passage of reform, a ministerial reshuffle, financial and service failure and the Mid Staffs inquiry may all affect the standing of many.

But, with that caveat aside, we once more recommend the HSJ100 to readers as the best guide to where power lies in health policy and the NHS.

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