Little has changed, yet much has changed. The same five individuals occupy the top spots in the 2017 HSJ100 as did in the refreshed rankings produced after this summer’s general election, but their interactions will be very different. By Alastair McLellan

The HSJ100 is a ranking of those people who will exercise the greatest influence over the English NHS and health policy between now and November 2018. Established in 2005, the HSJ100 is judged by some of the most knowledgeable and experienced figures in healthcare leadership.

After the upheaval of the summer, the HSJ100 wears a more settled look – but appearances can be deceptive.

A stalemate

NHS England chief executive Simon Stevens and health secretary Jeremy Hunt are now in a Mexican standoff with the former publicly stating there is not enough money to deliver on all the services’ priorities and the latter insisting there is.

As my colleague James Illman has written, this will make the regular Monday meetings between the pair tense affairs and lift the NHS mandate from the obscurity it has languished in since the Lansley era legislation which gave it birth.

It is by no means certain that Mr Hunt will choose to engage with the debate about priorities. He may simply stonewall Mr Stevens daring him to up the ante. The NHS England chief executive’s trump card could be the government’s fear that a member of the public may launch a legal challenge over the waiting time guarantees enshrined in law.

It is by no means certain Jeremy Hunt will choose to engage with the debate about priorities. He may simply stonewall Simon Stevens daring him to up the ante

All of this will be going on, of course, during celebrations for the NHS’s 70th birthday.

It will be fascinating to see how the two men – both of whom are as close to unsackable as it is possible to get in their positions – handle this tension. Both like to be in control – and to be seen to be in control – but eventually an accommodation will have to be reached.

And there is a deal to be done. If Mr Hunt can find some more cash or give the nod to an easing of performance pressures, then Mr Stevens can take the message to the service and public as he did last spring.

David and Dalton 

Watching all this will be two other figures with key roles to play: Care Quality Commission chief executive Sir David Behan and newly appointed NHS Improvement chief executive Ian Dalton.

The CQC’s role will be crucial in determining the context in which the unacknowledged negotiation will take place. A fall in trusts rated outstanding or good would be a difficult message for the government to handle – but on the other hand if the CQC’s new analysis of trust efficiency showed significant savings to be made, then the NHS’s case for more cash would be weakened.

How Sir David chooses to handle those messages as and if they emerge will have huge impact.

Mr Dalton is an old school system manager of extensive experience and cool determination - he is not known as “commander” Dalton for nothing. Unlike Mr Stevens, he does not do politics. He will have walked into the job knowing that all his peers had turned it down and that most consider it effectively impossible. Another intriguing aspect of how the NHS will be led in 2018 is how he positions himself and his organisation.

Ian Dalton is an old school system manager of extensive experience and cool determination – he is not known as “commander” Dalton for nothing

After a promising start, relations between Mr Stevens and Mr Dalton’s predecessor Jim Mackey became increasingly strained – but the new NHSI chair, the energetic Baroness Harding, has expressed her wish for the two organisations to be more closely aligned.

Trust chiefs would applaud that and one of the most influential, Salford’s Sir David Dalton, has already urged the two organisations to be more radical in any integration plans.

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But anything which would place NHSI too firmly in the “NHS England camp” would worry the increasingly influential NHS Providers, as well as the many in government.

Of course, Mr Dalton, along with the “NHS’s crown prince” Matthew Swindells, now both present the government with alternative potential leaders of NHS England should Mr Stevens conclude that he has not been given the resources to deliver what he promised in the Five Year Forward view, and go.

Other key figures

Another important figure in the debates to come will be emergency care tsarina Dame Pauline Phillip who has jumped 12 places to become the first female non-politician to make the top ten of the HSJ100. Her analysis of how well trusts are running their emergency departments is the metric most feared by their chief executives.

Also up 12, is Dame Pauline’s equivalent in mental health, Claire Murdoch. She has been highly vocal in support of Mr Stevens’ demands for more cash – no doubt seeking to remind all that the prime minister made the sector a priority. MIND chief executive Paul Farmer, up 19 at 23, will also be a powerful voice.

National director of acute care Professor Keith Willett has often been pushed forward by NHS England to deliver tough messages on performance and his climb of 44 places underlines how much of a hot potato the area will be next year.

Another person who can expect to find herself in the spotlight throughout 2018 is social care chief inspector Andrea Sutcliffe (up 14 at 15), who has become increasingly vocal about the crisis strangling that sector.

A good outside bet for a future leader of the NHS might be DevoManc supremo Jon Rouse. In a healthcare economy of big beasts, he is getting decisions made and work done

At NHS Improvement, two women have risen significantly in prominence. Medical director Dr Kathy McLean (up 11 at 20) was closely linked with the top job until the last few weeks of the recruitment process and leads the efforts to get trusts out of special measures, while finance director Elisabeth O’Mahony (rising 61 to 27) will bear a much greater burden of responsibility following the departure of deputy chief executive Bob Alexander and Mr Mackey – both of whom, unlike Mr Dalton, had finance backgrounds.

A good outside bet for a future leader of the NHS might be DevoManc supremo Jon Rouse (up 23 at 16). In a healthcare economy of big beasts, he is getting decisions made, getting work underway and dreaming big dreams

Communicating health messages to a constantly misfiring number 10 must be no easy task – but Mrs May’s advisor James Kent has built a reputation for quiet low profile efficiency – playing an important role in translating the prime minister’s aspirations on mental health into action for example - and leaps into the top 30. 

Royal College of GPs chair Professor Helen Stokes-Lampard is another whose avoidance of grandstanding has helped build credibility and she rises 23 to 29.

In a good year for the women of the HSJ 100, final mention should be made of NHS England’s chief digital officer Juliet Bauer who entered the rankings at 100 last year and is now number 66.

The most notable absences from this year’s list are leaders of most of the Sustainability and Transformation Partnerships and/or accountable care systems. The care revolution appears to be taking a back seat while the service struggles with survival.

Stevens and Hunt in a Mexican standoff at the top of this year’s HSJ100