David Nicholson

Despite swapping places with Lord Darzi at the top of the power rankings, the NHS chief executive has successfully consolidated his influence at the top of the health service.

Keeping as tight a grip on Lord Darzi as he does on his Nottingham Forest mug, Mr Nicholson has ensured the political and strategic parts of the Department of Health are joined at the top, if not in many other places.

His team is performing strongly, with NHS medical director Sir Bruce Keogh (6) driving the publication of outcomes data for clinical teams, commissioning director general Mark Britnell (4) pushing world-class commissioning with messianic zeal and finance director general David Flory (16) overseeing a system with so much surplus cash it is getting embarrassing.

Mr Nicholson can claim to have made considerable progress in achieving his aim of keeping politicians off managers’ and clinicians’ backs, although some believe the new lease of life Lord Darzi’s next stage review has given to strategic health authorities reflects Mr Nicholson’s instinctive reticence about relinquishing central control.

Surprisingly introverted and reflective for someone in such a prominent role, he depends on a close circle of advisers drawn from both inside and outside the DH’s Richmond House headquarters.

A strong platform speaker, he delivers a convincing narrative on where the health service is heading which lulls you into believing all the contradictions will be resolved.

Priorities for the coming year will include ensuring the reform programme is not knocked off course by financial turbulence and improving integration between health and social care.