This year’s HSJ50, the ranking of the 50 most powerful people in NHS management policy and practice in England, reveals dramatic changes in who is wielding power.

This was drawn up by an expert panel in association with our partners, recruitment consultancy Harvey Nash, and management consultancy Ernst & Young.

This is the third year we have published the HSJ50 and no fewer than 20 of this year’s most powerful people are new entries. The list is controversial and we do not expect everyone to agree with the judges’ decisions. See below for the judges’ names and details of how they came to those decisions.

We decided to restrict the HSJ50 to England because we did not believe it would be valid to make comparisons between, for example, politicians in different parts of the UK.

As well as managers, politicians and government advisers, the rankings include clinicians, senior civil servants, strategic health authority chief executives, key players in the royal colleges, trade unionists, journalists, policy experts and regulators.

The ministerial team has made a stronger showing than last year, although only three of them made it, while public controversy over access to drugs has sent the leadership of the National Institute for Health and Clinical Excellence flying up the rankings.

The NHS senior management team is still a dominant force, while social care director general David Behan has, as we predicted last year, gained places. The Audit Commission continues its approach of growing influence by stealth, in contrast to the misjudged grandstanding of bygone years. The departing Healthcare Commission slips down, but the Care Quality Commission is still only in the power foothills - that will change rapidly in the new year.

Acute sector managers make a stronger showing, but it is still a struggle to find primary care big hitters.

Finally, the prospects of a change in political power are reflected in shadow health secretary Andrew Lansley jumping up the list for the second year running.

HSJ would be delighted to publish your views on the HSJ50. Email hsjfeedback@emap.com

Judging

The judging was carried out by a panel of experts from across the health policy and management field, who excluded themselves from consideration.

The prime minister, chancellor and leader of the opposition were also excluded. Those on the list had to be influential in constructing or delivering healthcare policy.

The judges created a long list of over 80 names, which involved culling a number of names from HSJ50 2007 and adding many whose influence had grown since last year. There followed a long and lively debate on the final rankings, punctuated by discussions on the nature of power and influence. The most difficult discussions were around judging the influence of opposition politicians and the national role of regional health chiefs.

While not everyone agreed on every ranking, a consensus was achieved for the final list. The results were closely guarded until they were revealed this week.

List of judges

Lord Warner, former health minister; Richard Vize, editor, HSJ; Alpesh Patel, partner, Ernst & Young; John Appleby, chief economist, King’s Fund; Rebecca Evans, news editor, HSJ; Stephen Ramsden, chief executive, Luton and Dunstable Hospital foundation trust and director of the National Patient Safety Campaign, with Mr Patel, Matt Tee, chief executive, NHS Direct, and Professor Kieran Walsh, professor of health policy and management, Manchester Business School; Frank McKenna, director of NHS and healthcare at Harvey Nash, and Sir John Oldham, GP and head, Quest; Emma Dent, features editor, HSJ.

HSJ50 at a glance

1 Lord Darzi

2 David Nicholson

3 Alan Johnson MP

4 Mark Britnell

5 Mike Richards

6 Sir Bruce Keogh

7 Sir Michael Rawlins

8 Andrew Lansley

9 Bill Moyes

10 David Behan

11 Steve Smith

12 Ben Bradshaw MP

13 Sally Davies

14 Sir Graeme Catto

15 Andy McKeon

16 David Flory

17 Andrew Dillon

18 Chris Brinsmead

19 Hamish Meldrum

20 Don Berwick

21 Bob Ricketts

22 Dame Carol Black

23 Dominic Hardy

24 Cynthia Bower

25 David Fillingham

26 Nick Timmins

27 Steve Bundred

28 Paul Dacre

29 Mike Farrar

30 Anna Walker

31 Neil Hunt

32 Sir Liam Donaldson

33 Sir Robert Naylor

34 Baroness Young

35 Niall Dickson

36 Stephen Thornton

37 Jeremy Heywood

38 Martin Roland

39 Malcolm Lowe-Lauri

40 Steve Field

41 Kevin Barron MP

42 Greg Beales

43 Peter Carter

44 Alwen Williams

45 Sian Thomas

46 Lord Carter

47 Hugh Taylor

48 Sir George Alberti

49 Gordon Hextall

50 Helen Bevan

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