Rather unexpectedly, I had to visit NHS Improvement in London today. I was very grumpy! However, one of the joys of train journeys is the uninterrupted reading and thinking time. When else do you get two hours to read? I reflected on the financial pressures of the NHS and, with some sadness, how the prevention challenges of 5 Year Forward View (5yfv) are being squeezed out by the immediate pressures on acute care – despite our recognition of their ‘force multiplier’ effect on health. This thought was, however, balanced by the recognition of how our improved understanding of diseases, and the production and availability of clear guidelines, make our lives much easier and help us to deliver good care.