In his first speech since announcing his resignation, NHS chief executive Sir Alan Langlands emphasised the pressures on health service managers, increasingly in the harsh glare of the media spotlight. Paul Stephenson reports

Sir Alan Langlands says he knew he had done the right thing in leaving the NHS when an elderly woman living in his village said she had never seen him in daylight.

Tracked down by the press, in the frenzy of 'NHS boss resigns over crisis' headlines that greeted his departure, that was the only comment she could make.

Having made his decision, he was in relaxed mood for his first public speech since the announcement of his resignation.

Speaking last week to the Public Management and Policy Association on managing the new NHS, he even seemed to hold out the prospect of a return at some future date, pointing out that 'the last time I left the NHS it was only for 15 months'.

A public servant to the last, he didn't blow the whistle on the way the health service is run. But he laid out what he sees as the current and future pressures on the NHS as well as some interesting insights into problem areas.

Technology and the advance of science were the main areas that Sir Alan believed would create pressures over the next few years. He said that although he believed the National Institute for Clinical Excellence would be able to sort out what should be used, it 'won't sort out affordability'.

One of his passions while working in the NHS had been 'strengthening the scientific basis' of the service. He said it was the chance to carry on with this sort of work that had appealed about moving to Dundee University.

The other main pressure points for the NHS described by Sir Alan were politicians and the media: both would continue to have a major influence on way the organisation works, he believed.

Sir Alan said he thought the proliferation of the media, combined with the more limited role of government in running industry and services, would leave the press and broadcasters little to attack when they wanted to have a go at Labour.

Where previously, the government had been responsible for running huge areas of the economy through the nationalised industries, privatisation had significantly changed things.

'We have reached a point where the government runs very little. So there is not much to complain about except the Dome and the NHS, 'he said.

On political involvement, Sir Alan said he thought it was 'not unreasonable to expect politicians to increase their interest in us'.

He also said the impact of Europewide healthcare planning and systems was more likely to be seen in the near future, and that this was likely to come as a shock to people in the NHS.

Sir Alan was keen to put over the message that the government was constantly banging home: the NHS was only a small part of improving health.

He said this meant 'many policy decisions are being made by the chancellor, and the NHS is increasingly only a bit player' in improving public health.

Sir Alan also described his worries about a fall in support for the health service. Although he acknowledged the great backing the health service had, Sir Alan said he was concerned that younger people were less keen than older generations.

'My suspicion would be that thirtysomethings with young children are not terribly supportive of the NHS.'

Sir Alan was at pains to stress the pressures that all staff were under as a result of relentless change in the service, and said people told him two things about their work: 'I am run off my feet and I don't control my destiny.'

Answering questions from the floor, he added that although he thought doctors, nurses and healthcare workers were on board when it came to modernisation, the 'professional leaders do sometimes need to catch up'.

In reviewing the various 'modernisations' over his years in the NHS, he also claimed that the 1997 Primary Care Act - which introduced salaried GP pilots - had been the 'most enlightening piece of legislation in many years'.

Referring specifically to senior managers, Sir Alan acknowledged that there have been problems: 'We haven't been good at looking after chief executives.' But he also stressed that, as he has said in the past, they were not paid to get bogged down in all the changes going on.

He said he knew he had 'upset health service managers by saying you don't get paid£100,000 to get confused', but the best executives prioritised what they were doing and didn't chase after every last thing.

During his speech Sir Alan revealed that he had made more appearances in front of the Commons public accounts committee than anyone else 'in modern history'. At least that pleasure will no longer keep him out after dark.

Sir Alan's guide: the top five pressures on the NHS

The collective versus the individual


The media

Political involvement

The burden of disease