Lord Victor Adebowale, outgoing chair of the NHS Alliance, opened the organisation's annual conference in Manchester on Wednesday with a call for health service leaders to treat leadership itself as the primary instrument of NHS recovery, rather than waiting for policy change or organisational restructuring to drive improvement.

Lord Adebowale recognised that the NHS last year ended in financial balance without any government funding. Lord Adebowale also acknowledged that public dissatisfaction fell by its largest margin in over 25 years. A&E waiting times, elective backlogs and ambulance response times all improved over the same period. He attributed those results to the decisions of leaders on the ground rather than to structural change from above.

His central argument was that the NHS has repeatedly mistaken reorganisation for progress. New architectures, new boundaries and new acronyms have followed one another across successive governments, he said, while the gap between what the service promises and what patients experience has remained largely unchanged. He pointed to the ambulance service as an example of what he considers genuine improvement, describing a generation of chief executives and operational directors who improved performance by setting clear collective goals and holding each other to account, without waiting for organisational change to create the conditions for it.

On health inequality, Lord Adebowale drew on recent analysis from the Health Foundation to put numbers to a disparity he described as long-acknowledged but insufficiently acted upon. Healthy life expectancy for men in the most deprived areas of England now sits below 50 years, against more than 69 years in the least deprived areas. The same research projects that working-age people living with major illness will increase by 700,000 by 2040, with 80 per cent of that rise concentrated in the most deprived communities.

Lord Adebowale addressed what he described as a common response to such figures: that the NHS controls only around 20 per cent of the factors that determine health outcomes, with the remainder shaped by housing, income, employment and education. He accepted the statistic and rejected the implication. The NHS may not control those upstream factors, he said, but it receives every patient they produce, and what happens to those patients once they arrive is a question of how leadership has chosen to organise the service.

He cited NHS Blood and Transplant as an example of an organisation that had placed community engagement at the centre of its strategy rather than treating it as peripheral outreach work, arguing this was what closing the inequality gap looked like in practice.

The third part of his address focused on the workforce. Citing the NHS Alliance's recently published report, Targets and Trade-offs, which surveyed 235 senior leaders, Lord Adebowale said 64 per cent of respondents expected to cut services in 2026/27, 93 per cent identified declining staff morale as their primary concern, and more than half anticipated cuts to clinical and non-clinical staffing. He described the workforce not as a cost or a planning variable but as the resource on which everything else depends, arguing that every other asset in the NHS only becomes care because a person converts it into care.

He closed by asking leaders to return to their organisations and put a specific question to themselves: not how to improve their service, but who their current service has been failing and what it would look like to organise around those people instead.

Lord Adebowale has served as chair of the NHS Alliance and before that the NHS Confederation across six Secretaries of State. This was his final address in that role. The conference also heard from incoming NHS Alliance chief executive Sir Ciarán Devane, and Lord Adebowale was later in conversation with NHS England chair Dr Penny Dash.

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