Langlands was chief executive of the NHS in England during a period of rapid change. His six years at the top, from 1994 to 2000, spanned the election of the new Labour government and included the Bristol inquiry, the rise of concern about healthcare-acquired infections and pressure for changes in working practices in the NHS. He also oversaw the setting up of bodies such as the National Institute for Health and Clinical Excellence and the Commission for Health Improvement, which drove improvement and consistency across the NHS.