• Sir Mike Richards says capital budgets meant for diagnostic scanners have been raided for “propping up” revenue side
  • Also says Lansley reforms had “stalled” progress in cancer outcomes
  • Calls on ICS to “take responsibility” for driving up improvements in early diagnosis

Repeated raids on NHS capital budgets have left hospitals with “woefully poor” diagnostic equipment, according to the previous national cancer director.

Sir Mike Richards, the former director of cancer services in England, said: “What has happened in the past is that capital budgets have been raided, so when a CT scanner, MRI scanner or LINAC [radiotherapy machines] ought to be replaced they are not and [the unspent capital] is propping up the revenue side…

“We have woefully poor diagnostics in hospitals and if you look at comparisons with other [Organisation for Economic Cooperation and Development] countries, we are right down the bottom of the league table both on MRI and CT scanners.

“In other countries, GPs have the ability to investigate, refer and diagnose quickly [and] we have to somehow overcome that blockage.”

Speaking at HSJ’s inaugural cancer forum, he said the upcoming spending review, due in the autumn, may ease the problem, “but we have got to make sure capital goes into these areas”.

Earlier this week, HSJ reported that Barts Health Trust had to cancel hundreds of MRI scans after ageing equipment stopped working because of “historic underinvestment” in its machinery.

Sir Mike, who is also a former chief inspector of hospitals for the Care Quality Commission, is currently leading a review of screening services in England. Among other things, he will “assess diagnostic capacity for cancer”.

He also said the Lansley reforms had “stalled” progress in cancer outcomes and that the Health and Social Care Act 2012 meant the NHS “lost ground” in improving patient cancer care. He again reiterated concerns he has raised in the past that the UK has not “narrowed the survival gap” with other OECD countries.


Sir Mike also called for integrated care systems to take on accountability for driving improvements in early diagnosis.

The long-term plan said it wants the proportion of cancers diagnosed at stages one and two to rise “from around half to three-quarters of cancer” patients by 2028.

Sir Mike said: “To get the improvement we want, it is all too easy for people to say it’s somebody else’s problem but I think it is the ICS supported by the cancer alliances that ought to take responsibility for that.”

It is not yet clear how ICS and alliances will work together to commission for cancer outcomes or against what standards they will be held.

David Fitzgerald, NHS England’s national cancer programme director, said at the event: “[Clinical commissioning group] planning guidance makes it absolutely clear that [sustainability and transformation partnerships] and ICS should be coming together through their cancer alliances to plan for cancer across their local system.”

He also said the alliances “can play a really healthy role in balancing supply and demand”.