Professor Sir Mike Richards, speaking at the 2014 NCRI conference
At last year’s NCRI Cancer Research Conference, England’s Chief Inspector of Hospitals, and former National Cancer Director, Professor Sir Mike Richards was awarded a ‘Lifetime Achievement’ award for his work over three decades in helping to transform the UK’s cancer services.
Here, he shares his thoughts on the change he’s seen over his long and distinguished career.
‘What would I want for myself?’
Improving the way we care for cancer patients has been a passion of mine for decades. But I always try to take a step back and ask: if I were a cancer patient what care would I want to receive?
Well first, I would like to avoid getting cancer at all – taking action to stay healthy, and stack the odds in my favour to prevent cancer occurring. So I would want to know that everything is being done, across the board, to create an environment that helps us all stay as healthy as we can.
But if my doctor does suspect I have cancer, I would then want to be diagnosed promptly and accurately, and assessed by a team of experts. I would want access to the best possible treatments, without delay, so that I have the best chances of survival. And I would want to have a good quality of life after treatment.
Throughout this time I would want to be treated with compassion, dignity and respect. And, overall, I would want to know that my chances of survival are as good here in the UK as they are elsewhere.
This is what I would want.
But how can we ensure that all cancer patients receive what they want at each step along the way? And that – ultimately – our survival really does compete with the best countries?
It takes a multitude of factors to work together – political will, leadership, planning, standards, staff, infrastructure, communication, evaluation, funding.
So… how far have we come?
The dark 80s
The 80s were a time where there was little open discussion about cancer – often mentioned in whispered tones – the ‘Big C’.
Some patients were not even being told they had cancer (the leukaemia ward where I worked was euphemistically called the ‘anaemia’ ward) – the patient ‘voice’ was only just starting to be heard.
And cancer was not a high profile issue for doctors and certainly not a political priority.
But it was the start of a change. We saw the introduction of the NHS national breast screening programme and in the late 80s, cancer was mentioned for the first time in an election manifesto.
The 90s: the awakening
It was in the 90s that we started to see a real wakeup call that tackling cancer should be a priority. A number of reports set out improvements that should be made, like the influential Calman Hine report in 1995.
But it was evidence from the EUROCARE project showing that, shockingly, cancer survival in all four UK countries was below the European average (and the subsequent noises in the media), which provided the impetus needed to drive change.
The patient voice was becoming a substantial one. And with increasing pressure from charities and patients themselves, in 1999 the then-Prime Minister Tony Blair, declared cancer ‘a top priority’. This signal of political support to improve things for people with cancer was a big turning point.
I was appointed as the National Cancer Director and led the development of our first ever NHS Cancer Plan, which set aside dedicated targets, infrastructure, and staffing and equipment requirements needed to improve cancer outcomes.
The age of enlightenment
I call the 2000s the ‘age of enlightenment’ for cancer services in the NHS because the factors I mentioned above – political will, leadership, funding etc – all came together.
Not only was cancer a top political priority, but the patient and charity voice grew stronger. We had two updates to the cancer plan – both paving the way for a greater focus on cancer: a position often envied by others in the NHS.
Multidisciplinary teams were established – helping patients get the best treatment for their cancer – as were Cancer Networks which coordinated cancer services along the patient pathway.
Communication about cancer was increased, with initiatives like the Be Clear on Cancer campaigns running to raise public awareness of the signs and symptoms of cancer.
Spend on cancer (and the NHS as a whole) increased, as did staff working in cancer services.
We also increased our ability to measure performance against other countries through things like the International Cancer Benchmarking Partnership – which unfortunately confirmed in 2010 that the UK still lags behind in terms of survival.
Struggles in recent times
But then the spotlight on cancer started to fade, when in 2012 the NHS was put through the biggest structural reforms in its history, and there was a move away from focus on individual diseases to a more ‘generic’ approach.
Since then I believe we have seen a loss of momentum on cancer, and we are starting to see negative effects on performance, such as cancer waiting time standards now being missed.
This is extremely worrying. But the new independent Task Force recently announced by NHS England, to be chaired by Cancer Research UK’s chief executive, Harpal Kumar, will, I hope, bring some much needed focus to the challenges posed by recent pressures on the NHS. I will be proud to be a member of this Task Force. We have much to do.
So where next for cancer?
Compared to some of our neighbours, the UK woke up late to the problem of cancer. But at least it woke up – and I’m proud of the progress we’ve made over the last few decades. The real proof of the pudding has been in the country’s cancer survival, which has improved substantially.
But while good progress has been made, our cancer outcomes are still not up there with the best countries, and so it is vital that cancer remains a priority.
Firstly, there needs to be a focus on the big issues – prevention, early diagnosis, treatment, recovery. It is encouraging that all of these are priorities in the recent NHS Five Year Forward View, which also recognises the importance of research to provide the evidence needed to improve services.
As mentioned above, the Forward View also ushers in a new ‘generic’ approach to healthcare, rather than one divided up by disease type. Given the shared challenges underpinning many chronic diseases – e.g. shared lifestyle risk factors, the need for early diagnosis, and the importance of quality, as well as quantity, of life – this is sensible.
So, secondly, we need to make the best of this generic approach. Cancer is an important component of all that NHS England is trying to achieve – the case for cancer must be made alongside other major killers.
Thirdly, I see a great opportunity for making the new focus on quality and safety – for example, the project I am leading on with the Care Quality Commission – work for cancer.
While my time as the national lead for cancer has come to an end, I will keep a close eye on progress, and still be involved through the new Task Force.
Cancer is not an issue that will go away. All of us need to ensure beating it remains a priority.
- Support Cancer Research UK’s Cross Cancer Out campaign to keep cancer on the political agenda