In the eight months since the 2021 HSJ100 was published, more than half the top 20 has changed.
That is testament to power and influence quickly being rearranged around what were at that point a very new health and social care secretary and NHS England chief executive.
The top two, Sajid Javid then Amanda Pritchard, remain unchanged from October. Ms Pritchard – working in a close triumvirate with Julian Kelly (3) and Sir David Sloman (4) – knows how to get things done, and has already shown she can extract victories from negotiations with government.
But this will be a febrile period of political jockeying and, as a serious Cabinet minister who still has leadership ambitions, Mr Javid will be unable to sit on his hands as the NHS battles high-profile quality, performance and funding problems. He has set a challenging narrative for the NHS – exemplified in the recent Messenger review launch – and now has enhanced legal powers of direction over NHSE too.
Ms Pritchard’s top team has changed shape quickly since she took the top job last August: Sir David brought in as chief operating officer with an extensive brief, Sir Jim Mackey (6) in as elective lead, Chris Hopson (8) as strategy chief, and Amanda Doyle (12) to lead primary and community services. The role of some regional directors has been enhanced, particularly Richard Barker (19), who is now covering the North West as well as the North East and Yorkshire; and Bola Owolabi (14) has been promoted. Strategy and primary care director Ian Dodge and chief people officer Prerana Issar are departing. Further changes are likely as the ripples spread.
Ongoing mergers with Health Education England and NHS Digital mean workforce and tech are up in the air – but judges felt NHSE’s grand plans for a new national data platform, following on from Ming Tang’s (20) innovations in the pandemic, warranted her surprise inclusion in the 20.
Moving on from covid
Under Mr Javid at the Department of Health and Social Care, director general Matthew Style (10) – who moved from NHSE last year – is ubiquitous in big decisions about the NHS. And Adam Memon, as the health secretary’s smart and trusted policy brain, ranks unusually highly on the list (17) for a special political adviser in the department.
The chancellor and prime minister are excluded from consideration, but the influence of the Treasury and Number 10 is still clearly felt. Their power is reduced by the political tumult undermining them, but the former department is keeping a tight hold on the purse strings, and the latter extending its tentacles further into delivery.
But their influence is fragmented across numerous ministers and advisers across policy and delivery, whose roles have not been stable. The most active in NHS matters is said to be Ninjeri Pandit – who previously ran the NHSE chief executive’s office under both Ms Pritchard and Simon Stevens, and is now Number 10 delivery lead for health and social care.
The list shows hope for moving on from the covid era with Sir Chris Whitty and Dame Jenny Harries leaving the top 20, but this also augurs a foolish if inevitable receding of public health influence.
ICS bosses crash in
Outside voices – those with no current role in officialdom – take more places in the 20, and higher ones, than usual (Jeremy Hunt, Matthew Taylor, Wes Streeting, Professor Helen Stokes-Lampard). That’s a sign of the fragility of NHS politics and policy today, and an opportunity to hear ideas from outside. With Chris Hopson’s imminent move to NHSE, and his likely successor Saffron Cordery taking part in judging, NHS Providers is not represented in the list but Ms Cordery is a clear contender for coming years.
Given the likelihood of industrial strife over the next 12 months, it’s surprising that union leaders don’t feature in the top 20 – impeded by ongoing turnover and travails at the Royal College of Nursing and British Medical Association.
Integrated care system leaders, still a month out from taking on their legal form, finally crash into the 80 with six entries (Sam Allen, Penny Dash, Adam Doyle, Claire Fuller, Marie Gabriel, Rob Webster), up from just one last year. That’s still short of trust leaders (10) but, despite the struggles of some ICSs to recruit leaders and the messy world they’re being born into, this may be the first sign they will in fact wield serious influence.
Last year there were three people in the top 20 known to be from a minority ethnic background, and 14 in the whole 80. This year the respective figures are four and 14 – barely progress.
However, nearly half of our 20 HSJ100 “wildcards” – nominated and selected because they should be listened to at the top, and might be in future – are known to have a minority ethnic background. Is that a sign of promise (these figures are skilled, ambitious, have fans in the service, and could well go on to be influential at the top)? Or does it simply highlight again that very deserving leaders from diverse backgrounds are still finding it higher to reach more senior levels?
On gender, 31 of the 80 are female – up from 26 last year. There’s worse news in the top 20, where the number of women is down from eight to six; and in the top 10 from three to just one.