As we prepare our list of the most influential people in health in 2010, Alastair McLellan and Darius McQuaid look back at who has wielded most power in the NHS during the last four years

An ex-communist, the former spokesman for the retail industry and a management consultant were the most influential people in the NHS during the past four years.

There is only one NHS trust chief executive in the top 30, Imperial College Healthcare Trust’s Steve Smith

The analysis is derived from the results of the first four HSJ50 polls, which identify the most powerful people in health each year. By aggregating the results from 2006-09, it is possible to determine whose longevity has meant they have exercised the most influence in this period.

Top of the poll, by a long way, is NHS chief executive and former member of the hard left Sir David Nicholson. He was placed third, first, second and first in the four polls.

Second comes the now retired executive chair of Monitor, Bill Moyes, who used to run the British Retail Federation.

In third place is Mark Britnell, who now works for consultants KPMG, but is best known for devising the world class commissioning programme. The 44 year old could well improve on his ranking.

HSJ has conducted the analysis to mark the fifth anniversary of the HSJ50, which is now being extended to cover the 100 most influential people in health.

The renamed HSJ100, which is sponsored by Ernst & Young and Harvey Nash, will be revealed later this year. As usual it will exclude the prime minister and the chancellor.

Our analysis reveals that 105 people were included in the four lists, but only 10 appeared every year (see right). Politicians were the most significantly affected by this trend, the three health secretaries during this period being placed 15th, 23rd and, in the case of Patricia Hewitt, 39th. But even aggregated, their score would have still found them in second place to Sir David.

The two most influential politicians were Lord Ara Darzi, who topped the poll in 2008, and the man who is now picking apart much of his vision, health secretary Andrew Lansley.

The fourth person to top the HSJ50, along with the NHS chief executive and Lord Darzi, is Paul Corrigan. He took first place in 2006, while he was health adviser to Tony Blair, and is placed 31st overall.

Management strength

The list demonstrates the dominance of management during this period in NHS history. Half of the top 10 have a management background and the top 30 contains four of the 10 strategic health authority chief executives.

Local NHS management is less well represented.

There is only one NHS trust chief executive in the top 30, Imperial College Healthcare Trust’s Steve Smith, although Sir Robert Naylor from University College London Hospitals Foundation Trust was placed 41st. Only two primary care trust and one mental health trust chief executives have ever been listed in the HSJ50.

Medics are heavily represented, demonstrating their growing influence sparked by Lord Darzi’s 2008 NHS review.

However, the highest placed GP was the Department of Health’s national clinical director of primary care Dr David Colin-Thomé, who was ranked 43rd.

The aggregated score of the two British Medical Association chairs - James Johnson and Hamish Meldrum - would have placed them 13th overall.

Only two nurses have ever been listed in the HSJ50, with Royal College of Nursing chief executive Peter Carter securing 33rd place.

Outside of the DH, the most influential organisation appears to be the National Institute for Health and Clinical Excellence, which is clearly benefiting from its stable leadership. NICE chair Sir Michael Rawlins and chief executive Andrew Dillon have each appeared in three HSJ50s, with both appearing in the last two polls.

The top 30 is heavily dominated by men, with only six women appearing, and none in the top 10.

The public profile and sensitivity of health is demonstrated by the presence of two journalists in the top 30, the Financial Times’s Nick Timmins and Daily Mail editor in chief Paul Dacre.

The top 30 most influential: 2006-09

  1. Sir David Nicholson, NHS chief executive*
  2. Bill Moyes, executive chair, Monitor*
  3. Mark Britnell, NHS commissioning director general*
  4. Andrew Lansley, shadow health secretary*
  5. Lord Darzi, health minister
  6. Mike Farrar, chief executive, NHS North West*
  7. Professor Sir Bruce Keogh, NHS medical director
  8. Sir Liam Donaldson, DH chief medical officer*
  9. David Flory, NHS finance director general
  10. David Behan, NHS social care director general
  11. Professor Mike Richards, DH national cancer director*
  12. Andrew Dillon, chief executive, NICE
  13. Professor Sir Michael Rawlins, chair, NICE
  14. Sir Ian Carruthers, chief executive, NHS South West
  15. Alan Johnson, health secretary
  16. Niall Dickson, chief executive, Kings Fund*
  17. Cynthia Bower, chief executive, Care Quality Commission
  18. Nicholas Timmins, public policy editor, Financial Times*
  19. Dame Carol Black, DH, national director for health and work*
  20. Anna Walker, chief executive, Healthcare Commission
  21. Jeremy Heywood, permanent secretary, Number 10
  22. Dr Hamish Meldrum, chair, British Medical Association
  23. Andy Burnham, health secretary
  24. Steve Smith, chief executive, Imperial College Healthcare Trust
  25. Professor Dame Sally Davies, DH director general of research and development
  26. Ruth Carnall, chief executive, NHS London
  27. Gill Morgan, chief executive, NHS Confederation
  28. Hugh Taylor, DH permanent secretary
  29. Andy McKeon, managing director for health, Audit Commission,
  30. Paul Dacre, editor, Daily Mail

* in the HSJ 50 every year