Lord Victor Adebowale opens NHS ConfedExpo 2026

Good morning.

It is an honour to open this conference. 

I want to begin by welcoming Doctor Penny Dash.

We will hear from her shortly and I will then be in conversation with her. Penny - thank you for being here. 

Before I begin, one thing. The speech I’m about to give is mine. It is not the NHS Alliance’s policy position. It is not Sir Ciarán Devane’s agenda - Ciarán, our new chief executive, will set out his own thinking later today, and I would encourage you all to be in the room when he does. 

What I want to do in the next ten minutes is something different. I want to name what I think this moment asks of us. Not as institutions. As leaders. 

Last month, the NHS Alliance published its first major report, Targets and Trade-offs. If you have not read it, please do.

It is the most honest piece of work this organisation has produced this year, and much of what I am about to argue is downstream of what 235 trust, ICB and general practice leaders told us in that survey. 

This speech is, in many ways, the membership talking to itself through me. 

I want to argue one thing this morning, in three parts. 

The thing I want to argue is this: leadership is the treatment. 

Not adjacent to the treatment. Not a soft skill that supports it. The treatment. 

The thing that determines whether the NHS recovers, whether it closes the gaps it has tolerated for half a century, and whether the people who work in it can still believe in it ten years from now - that thing is leadership. Yours. Mine. Ours. 

Three terrains. Change. Patients. And the workforce. 

Theme one - Leadership and change 

First, change.

Last year was extraordinary. Through industrial action, through restructuring, through a financial settlement no one in this room would have designed - A&E waits came down. Elective lists came down. Ambulance response times came down. 

The NHS ended the year in financial balance without extra central funding. 

Public dissatisfaction fell by the biggest margin in a quarter of a century. 

That was not policy. That was leadership. Yours. I want to thank you for it, plainly. 

And now I want to push, because that is the chair’s job too. 

We have spent a generation in this service confusing change with restructuring. Every few years a new architecture, a new acronym, a new set of boundaries on a map. And every few years, the same gap between what we promised and what people actually experienced when they tried to get care.

Restructuring is not change. Restructuring is what organisations do when they cannot bring themselves to do the harder work, which is leadership. 

Earlier this year I spoke at the Ambulance Leaders Forum. The ambulance service has, against every reasonable expectation, improved its performance against some of the hardest targets in the system. 

Not by reorganising itself. Not by waiting for the architecture to change. By leading. 

By a generation of chief executives and operational directors deciding, together, that they would be clear about what they were trying to do and would hold each other to it.

That is leadership as a clinical intervention. Stop waiting for permission. The permission is not coming. The structure will change again. The Secretary of State will change again. The plan will be rewritten again. Leadership is the treatment. 

And the treatment cannot wait for the next reorganisation. 

Theme two - Patients and the inverse care law 

In 1971, a Welsh GP called Julian Tudor Hart wrote a short paper in  The Lancet. He called it the inverse care law. He observed, with the kind of plain clarity the medical profession used to value, that the availability of good medical care tends to vary inversely with the need of the population served.

The people who need care the most get it the last, and the least. Fifty-five years on, that sentence still describes us. And the evidence is no longer in dispute. Dr Jennifer Dixon and the Health Foundation, in analysis published this spring, tell us something we should not be able to hear without flinching.

In the most deprived areas of England, healthy life expectancy for men is now under 50 years. 

In the least deprived areas, it is over 69. 

That is a 20-year gap in healthy life inside one country. Inside one health service. Inside one room of leaders who all believe in equity. 

The Health Foundation also estimates that the number of working-age people living with major illness will rise by 700,000 by 2040 - and that 80 per cent of that increase will be concentrated in the most deprived areas. 

Eighty per cent.

That is not a forecast about inequality. That is a forecast about which communities the next decade of NHS demand will come from. 

Dr Dixon described the dashboard as flashing red. I would say something sharper. 

The dashboard has been flashing red for 50 years. We have grown comfortable with the colour.

Now, some of you will be tempted to say - fairly - that the NHS drives only 20 per cent of the determinants of health. That the rest is housing, income, employment, education. That this is a public health argument, not an NHS one. 

That it is, in the language some have used about my own positions: ‘campaigning.’

The NHS may control 20 per cent of the drivers. It is responsible for 100 per cent of the response. 

The Health Foundation’s data describes who walks through our doors. 

What we do once they arrive - whether they are seen, whether they are believed, whether their condition is diagnosed early or late, whether the service has organised itself around their need or around its own convenience - that is entirely a leadership question.

And it is entirely ours. 

We are the destination of every failure further upstream. The question is whether we lead into that reality or pretend it belongs to someone else. 

I visited NHS Blood and Transplant earlier this year. It is an organisation that cannot do its work - cannot save the lives it exists to save - without the active engagement of the communities it serves. 

And so it has placed community engagement at the front, the centre and the core of its future strategy. Not as outreach. Not as a workstream. As the strategy. 

Because the people whose donations save lives, and the people whose lives need saving, are in many cases the communities the rest of the system has been least good at reaching. 

That is what closing the inverse care gap actually looks like inside an NHS organisation. It is leadership. 

Bravery is a clinical intervention. Not a personality trait. Not a quality some leaders happen to have. 

Something the service needs in measurable quantities, every week, in every board, in every commissioning conversation, in every workforce decision.

Leadership is the treatment. And in this terrain, more than any other, the treatment is overdue. 

Theme three - Workforce Third.

We will spend the next year talking about money. The real resource question in the NHS is not money. It is people. We will not get the funding settlement we want. 

The question that actually determines whether this service survives the next decade is whether the people who work in it choose to stay, choose to lead, and choose to bring others in behind them. 

Your own NHS Alliance, in the report it published last month, said something the system has been reluctant to say out loud. 

The choices the NHS is being asked to make in 2026/27 are not choices between good options. 

They are trade-offs between staff morale, patient services and the long-term shift to community care that everyone in this room - and the government’s own ten-year plan - says we need. 

Sixty-four per cent of you told us you expect to cut services this year. Ninety-three per cent of you named declining staff morale as your top concern. 

More than half of you are expecting to make cuts to clinical and non-clinical staff. 

That is your testimony, gathered into one document, made public a week ago. That is the system telling itself the truth. 

Leadership is what we do with that truth. 

The workforce is the resource. Not a cost line. Not a planning input. The resource. 

Every other resource in the NHS - buildings, technology, data, money - only becomes care because a person turns it into care. 

What are you doing this quarter - not this strategy cycle, this quarter - to make your organisation a place where the best people want to stay and the people you are not yet attracting want to come? 

If the answer is ‘we have a plan,’ the plan is not the answer. The behaviour is the answer. Leadership is the treatment. 

So here is what I am asking you to do. Go back to your organisations and ask one question. Not ‘how do we improve our service.’ 

Ask: who has our current service been failing, and what would it look like if we organised around them?

That is the question that closes the 20-year gap. 

That is the question that honours what this conference has been for. 

And before you leave this building this week, have the one brave conversation you have been avoiding. You know what it is. You know who it is with. Bravery is a clinical intervention. Take the dose. 

This is the last time I will open this conference as chair of the NHS Alliance, and before that the NHS Confederation. 

Six Secretaries of State, a pandemic, an election, a ten-year plan, and a merger by renewal. 

None of that is the achievement. 

The achievement is what this membership chooses to do next. 

Leadership is the treatment. 

Thank you.