NHS England chief executive Simon Stevens has praised the work NHS staff have done to “keep the show on the road” and improve efficiency in the face of financial constraints.

In his speech to the annual leadership summit at the King’s Fund last week he saluted the “enormous and successful effort” of staff “doing what we’ve always done” more efficiently.

But he warned that there was a need for transformative change and the service should not “[do] something more efficiently that perhaps shouldn’t be done at all”.

Mr Stevens praised NHS management and said spending int his area and administration was lower than nearly all comparable countries.

He said “managing health services is never going to be easy and our work is often misunderstood” but that “NHS patients need top quality managers working on their behalf – now more than ever”.

He said: “To those armchair naysayers who assert that good management is a luxury the NHS can do without, let’s remind them that the evidence is now clear.

“Quality of care, staff fulfilment, and wise stewardship of resources all go up when great health care managers get to work.

“And by the way, as someone who has spent the past decade working in health care around the world, I can tell you that in England our spending on health care management and administration is now far leaner than just about any other major industrialised country.”

He also promised further action to increase the representation of black and minority-ethnic groups at senior levels in the service.

The current situation was unacceptable, Mr Stevens said, citing recent research by Middlesex University research fellow Roger Kline on the “snowy white peaks” of NHS senior leadership.

Mr Stevens, who took up the top job at NHS England in March, said in some cases BME representation had gone backwards.

NHS England’s NHS Equality and Diversity Council is due to report on 29 July on next steps. Mr Stevens told delegates the monitoring of equalities at NHS organisations might become more explicit.

Although some commentators believe NHS England will take a purely commissioning role, the former UnitedHealth executive said the body would be committed to “playing its part in system leadership”.

On the business of commissioning itself, Mr Stevens said, while taking into account funding, the service would need to “give weight to community’s own ideas about access and specialisation”.

On NHS leadership more generally he said the service wanted people “who respect our history but are not a hostage to it. [People who can] create unconventional partnerships and challenge clothes-less emperors”.