Pride, pressure and possibility – the state of the NHS


The Chief Executive of NHS England has laid out the challenges and opportunities facing the health service as it approaches its 70th anniversary.

Addressing our annual Teddy Chester lecture, Simon Stevens said while there was great pride in all the good things that the NHS was doing, one also had to recognise the pressures that frontline staff and services were under in the face of a growing and ageing population, and an ever-increasing range of new treatments.

And as he added: “All this is playing out against the backdrop of the most sustained constraint in public funding for the NHS that we have had since it was founded in 1948.”

However Stevens said alongside pride and pressure there was also the “possibility” of what health services could offer over the next five to 10 years.

For instance while cancer survival rates were at an all-time high, he said there was still too big an outcomes gap relative to what the service could be achieving in many parts of the country. Likewise there was a need to invest further in mental health and social care services, he added.



Stevens said a huge effort was underway to redesign the way different parts of the health service and social care system interacted in what he described as a “triple integration agenda”.

This meant better linking primary and secondary care, physical and mental health, and health and social care. “We have got to overcome some of the design features which were hard-wired into the NHS at the time it was founded,” he said.

Stevens added that we should also recognise the “evolutionary path” that the health service needed to take in different parts of the country. “It is ok for the NHS to evolve in different ways in different parts of the country,” he said.

We should also “back energy where we find it”. “In some places it could be vigorous local government which is capable of leadership roles, in others it might be groups of GPs coming together to drive scale in primary care, in other cases it could be a particular hospital that is the driver.”


Powerful voice

Stevens said the NHS did not exist in isolation from the rest of the country and that it had to be a powerful vocal advocate for health promotion.

“It is extraordinary that one in ten primary school children are obese, and one in five are obese by the time they leave primary school. That is storing up an enormous burden of preventable illness. The average five-year-old is drinking their own weight in sugar each year in this country.”

He said that the danger of not addressing these preventable illnesses was that treating them would consume an increasing share of government funding, leaving less to be spent on other parts of the service.

Meanwhile regards the devolution of health services across Greater Manchester, Stevens admitted that the Devo Manc construct was complex and that the “country’s eyes” were watching what happened in the city region.


*Teddy Chester was the first professor of social administration at the University of Manchester. He was a pioneer in management development, using evidence and research with policy makers and working with clinical leaders.




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