National cancer director Appointed: November 1999

My achievements

Progress on cancer undoubtedly started from 1995 onwards with the publication of the Calman-Hine report. By 1999, however, concerns were being expressed that the pace of change was too slow. In response, the prime minister convened a cancer summit at 10 Downing Street in May 1999, which I attended.

Soon after, the prime minister and the then secretary of state for health, Alan Milburn, asked me to lead the development of the first ever comprehensive strategy to tackle cancer in this country—encompassing prevention, screening, diagnosis, treatment, care, and research. The NHS Cancer Plan was published in September 2000. Since then my task has been to oversee its implementation.

The role of the national cancer director (cancer "tsar") has been incredibly hard work (and I can still remember being a junior doctor), but exciting and challenging. I miss my clinical work, but I use my clinical knowledge every day. A large part of the role is to be an interpreter—between, for example, politicians, civil servants, doctors and nurses, NHS managers, charities, patients’ groups, and industry.

Two things have made this task bearable and indeed enjoyable. Firstly, I have received enormous support and goodwill from all directions. There is a very strong will to make the NHS better. Secondly, we really are now making good progress across all aspects of the Cancer Plan.

Most importantly, death rates from cancer are falling, particularly for lung cancer and breast cancer. The fall in lung cancer deaths is due largely to a fall in smoking rates among adults over the past two decades. The improvement in breast cancer is due to a combination of screening, better treatment services, and new treatments.

Over the past three years, smoking cessation services have been established across the country, tobacco advertising has been banned, and awareness of the importance of eating fruit and vegetables has been raised through the "5 a day" programme. Screening programmes are being extended and waiting times are being reduced. Unprecedented numbers of new scanners and radiotherapy machines are being installed. Hospitals and primary care services are working much more closely together across cancer networks to ensure that care is better coordinated. Far more patients are being cared for by specialist teams. Extra financial resources have been put into cancer and palliative care services. Major new research initiatives are beginning to yield dividends—accrual of patients into clinical trials has doubled within a three year period.

I meet with many health professionals and patients every week, and they tell me that cancer services are improving, but they also remind me how hard it is at the frontline and how much more remains to be done. I am confident that by working together we can make further major strides forward in the coming years.

What others say

Dr Jane Maher, chief medical officer at MacMillan Cancer Relief and consultant at Mount Vernon Hospital, Middlesex: Oncologists on the ground universally welcome Mike Richards’ cancer plan, and one of the key improvements that we can all see has been the development of multidisciplinary teams in areas other than breast cancer.

Mike has been robust in fighting for adequate resources, but it has been clear that getting "badged" money (funding specifically for cancer) through the system to where it is needed has been very challenging, and it has sometimes been hard to keep up the morale of the cancer network teams. There has also been some frustration at the time taken to deliver the supportive and palliative care guidelines and scepticism among GPs, who have seen the cancer plan as overly biased towards the acute sector.

You cannot please all the people all the time, and Mike has done as good a job as anyone could to tread the line between "being us" and "being them."

Joanne Rule, chief executive of CancerBACUP: Cancer services need strong leadership. But whether a national cancer director contributes significantly to progress depends very much on the person. Mike Richards is exceptional.

The entire cancer community respects him—not just because of his clinical track record, although clinical leadership matters. His commitment to user involvement is wholehearted. He has brought patients’ groups to the top table and is a champion for accessible and high quality information. He cuts through the nonsense, saying if the NHS can distribute syringes, why can’t it distribute booklets.

He is passionately committed to the national cancer plan. Under his leadership, cancer networks have started to make a real difference and survival rates are improving. When faced with evidence of a genuine problem, he says: "That’s something we didn’t anticipate—let’s do something about it."

I sense that he was pivotal in achieving the exceptional tracking exercise after CancerBACUP highlighted a shortfall in spending in the cancer plan’s first year. He is now investigating worrying geographical variations in cancer drugs approved by the National Institute for Clinical Excellence (NICE). He clearly genuinely wants to uncover the reasons for this and ensure that lessons are learned.

Of course, we are not uncritical. We believe that continuing ringfenced investment in cancer networks would make the most difference, and we’ll continue to push for this.

But what marks Mike out as a leader is his ability to get to the heart of a problem and decide what to do. He’s the kind of leader that cancer services need.

Professor Stephen Spiro, consultant physician, department of thoracic medicine, University College London Hospitals NHS Trust: I believe that Professor Mike Richards has been highly prominent in promoting better care for cancer patients. He is available to attend national meetings, he is supportive, and he has provided an extremely important conduit for getting messages through to government.

In my own specialty of lung cancer, he has been sensitive to the problems of an inadequate number of medical and clinical oncologists and has been a principal driver for increasing the number of clinical oncologists. He has highlighted lung cancer as an oncological field that has lacked support. He has been responsible for getting more linear accelerators into radiotherapy units and also for a programme of replacing many of the current elderly linear accelerator machines. He has encouraged the creation of a national database for lung cancer under the aegis of the Royal College of Physicians.

He has been pivotal in encouraging recruitment to clinical trials, aiming to achieve the national standard of 10% of patients with cancer entering trials. The number in lung cancer has increased sharply.

There is a huge advantage in having a sympathetic, hardworking individual who is prepared to listen and take points forward through the machinations of government, and I do believe that Mike Richards has done this extremely well and has been a force for improvement in the field of cancer medicine.