Chief Inspector of Hospitals: ‘People might believe in the NHS. But it doesn’t mean it’s perfect’

Professor Sir Mike Richards says there is a blindness among supporters of the NHS to its failings

Professor Sir Mike Richards says hospitals that work tend to have managers who are ‘well aligned’ with clinical staff (Micha Theiner)

When I mentioned to a senior doctor recently that I was interviewing Professor Sir Mike Richards, he made a surprising remark.

“You know, I don’t think there anyone alive in Britain today who has saved more lives than Mike,” he told me.

And he is, arguably, absolutely correct. In the 13 years that Richards was the NHS’s first National Cancer Director, he was responsible for an unprecedented overhaul in how the disease was treated.

He established cancer networks to share best practice, introduced waiting times standards for diagnosis and treatment, and set out plans to enhance facilities and improve screening.

And the results were dramatic – in 2010, five-year survival rates for five of the most common cancers had improved by up to 15 per cent, while a study earlier this year showed death rates from breast cancer had fallen by 41 per cent in the past two decades.

To put that in context: 130,000 people in Britain die from cancer annually, so Richards can claim some of the credit for saving or lengthening the lives of more than 10,000 people a year who would otherwise have died.

It was therefore perhaps not surprising that in the wake of the mid-Staffordshire scandal it was to the dry-humoured, softly spoken former oncology consultant that the Government turned to last year to become the NHS’s first Chief Inspector of Hospitals.

And while his current role is rather different from his previous one it still has the same basic aim: helping people to live longer.

“Let me make an analogy with my previous job when I was National Cancer Director,” he says.

“How did it take us so long to really believe that our survival rates were less good than Europe? Well, because we hadn’t measured it and we then hadn’t really looked into why that might be.

“There is such a belief in the NHS – which is a great thing – but it doesn’t mean that the NHS is perfect.

“Sometimes our loyalty to the NHS may blind us to the fact that the NHS is not doing quite as good a job as we would like it to do. My job is to show what the differences [in hospital care] are and identify how we can improve. I don’t think the previous [inspection] regimes have ever really done that.”

Under the new Care Quality Commission inspectorate, hospitals face assessments of all their core services: A&E, medical wards, surgical wards, critical care, maternity, out-patients and children’s services. Each hospital is inspected by a team of about 30 people – including doctors, nurses and managers from high performing hospitals who work alongside full time inspectors.

Each service is then rated, from outstanding to good to requiring improvement – or in the worst cases, inadequate. These inform the hospital’s overall rating.

It is an expensive and time-consuming process – but it is revealing a discrepancy of care across the NHS which has been hidden from public scrutiny for a very long time. While some hospitals face particular challenges such as geography or deprivation, Richards says those factors alone do not explain the discrepancies.

In one corner of his office he has a map of England with the colour-coded ratings of all the hospitals so far inspected. Pointing to it, he contrasts Homerton Hospital in East London with Wrexham Park in Slough.

“If you take Homerton, it’s a sea of green – it’s mostly good. There were a couple of areas where we said they needed to improve but equally, quite remarkably, their A&E was good throughout.

“Exhibit B [Wrexham Park] – that’s a slightly different picture. You don’t have to go into detail but there are three areas rated as inadequate. That is a hospital that is really struggling.

He pauses, then adds: “There is huge variation in the NHS and I would go further than that and say there is unacceptable variation in what is a nationalised health service. We have got to make sure that the Wrexham Parks of this country become more like the Homertons. What we are doing is revealing the difference. We are showing the range of quality. We are showing what can be done. Homerton is not an affluent part of this country. It’s got one of the most multicultural, deprived populations and they are providing a damn good service.

“But at Wrexham Park there is one line which was completely green, and that was the children’s services, so even within hospitals you can find individual services that are doing a good job despite everything else.”

He is clear about the overriding factors that make the difference between a good hospital and an inadequate one: good leadership and an interest in learning from best practice.

“There are those that are somewhat in denial about their current position. That’s not a healthy state to be in,” he says. “Some hospitals haven’t really looked outside – they haven’t looked at the rest of the world for what looks like decades. I have seen it myself in hospitals. They haven’t realised that the world has moved on.

“It’s not as if they are thousands of miles from civilisation. They can be quite close to other hospitals but they haven’t really looked to see what other people are doing. That’s where we need much greater learning across hospitals.

“I think that the ones who have said, ‘yes please, come and help us’ are the ones that have made the big change.”

But unlike the political classes you will not hear him attack hospital managers because he believes they are as vital as doctors to improving services.

“Hospitals are hundreds of millions of pounds worth of business,” he says. “They have anything up to 12,000 to 15,000 staff. They have hundreds of thousands of people coming through one door or another in the course of a year. This isn’t going to happen on its own.

“There is no doubt that an organisation needs good management and it needs good management that is well aligned with clinicians. This is about management and clinicians working together. Our joint business is doing our very best for patients so we need to work out how best to do that.

“In some of the trusts we’ve been into, we’ve seen a very much ‘them and us’ culture – where we see that, the trust is not working very well.”

In those cases, Richards says it is “not just about putting people on the naughty step” but about ensuring they get the help they need to turn it around.

Richards, who was appointed to the new role following the Mid-Staffordshire scandal, adds that it is unacceptable for there to be such variation in care in public health services. And he warned that the public should not be blinded by their faith in the service.

He rejects the argument that a lack of financial resources makes it impossible to give hospitals the help they need, pointing out that well-run hospitals are managing even with expensive PFI contracts.

“I don’t have to modify my comments and say, ‘Oh poor them, they don’t have enough money’. I just say that’s poor quality and that’s good quality.

“Patients want to know their hospital is of good quality. It is unacceptable for the population near Slough not to have a good hospital. It is unacceptable for the people of Medway not to have a good hospital. Those are just two examples.”

And as with his previous job Richards, who is now 63, hopes his legacy will be seen in the mortality statistics long after he has retired.

“We are not an improvement agency but we are very definitely an agent for improvement,” he says. “I would not be doing this job if I did not believe this was not going to lead to better healthcare as a result.”