Richards: NHS must protect waiting times and access to treatment

Sir Mike Richards, one of the UK’s top medical leaders who has worked at the top level for more than a decade, is retiring at the end of this week.

He told HSJ in an exit interview: ”I would never support restricting access to evidence based care.”

Asked about concerns of national clinical leaders that clinical commissioning groups have introduced some restrictions on elective operations which they believe are not clinically justified, he said: “There are some patients who in the past may have had knee replacements who weren’t… likely to benefit from it, but where there is evidence for it I certainly want us to be able to deliver those treatments.”

He also warned that – with elective waiting lists and times growing – very long waits “mustn’t be allowed to happen again”.

Sir Mike added: “It is worth remembering about the 18 weeks, those that have been around long enough will remember, that why did they choose 18 weeks? Because it used to be 18 months, it is as simple as that. People used to wait 18 months for cardiac surgery.”

NHS England said in March that planned care was not one of the top priorities for the next two years, and that18 week elective waiting time target was, therefore, unlikely to be met. 

Revealing he will be becoming a trustee at Cancer Research UK after he leaves the regulator, Sir Mike – who led huge improvements in the 2000s as national clinical director for cancer – said that the NHS “ought to be able” to begin treatment for cancer patients within the mandated 62 days. The NHS has failed to meet the 62 day wait target for over three years.

In relation to financial constraints on the NHS, Sir Mike said it was “an amazing thing that we still have good and outstanding trusts despite the austerity”.

He said: “I am making it clear that of course we need more money, it is very tight [currently], but when we get it, we need to use it wisely. We need to use it in transformation, not just in doing the same.”

Sir Mike said the NHS was dealing with “really very difficult issues to do with flow” between hospitals and social care – and that the precariousness of the social care system has “not got any better” since the Care Quality Commission warned over it last year.

New regime

Sir Mike said that, despite the CQC’s plans to work more closely with providers under a revised inspection regime, it “will be able to maintain [its] independence”.

It should “never rely on” self assessment by providers, and that the main purpose of taking trusts’ own views was to indicate whether they have “got insight” into their own issues.

Of the CQC’s joint work with NHS Improvement to rate trusts’ “use of resources”, he said: “We have seen what happens when you focus only on the money, you don’t have to look much further than Mid Staffs. But we need to get the balance right because if someone is just spending their way out of trouble it is robbing Peter to pay Paul.”

In response to concerns over the CQC being conflicted by rating efficiency as well as quality, he insisted that even where a trust had financial problems, but is “being efficient with their use of resources and doing what they need to on quality, we will say so”.

Meanwhile, Sir Mike confirmed that the CQC was seeking a change to regulations to enable it to inspect and rate the “corporate headquarters” of independent sector providers – as it can with NHS providers – in addition only to separate sites.

c