Will the NHS respond to Dr Sykes’s treatment?

Corporate titan turned London healthcare chief Sir Richard Sykes faces his toughest challenge yet, says Judi Bevan — but he’s full of praise for the handling of swine flu

Sir Richard Sykes darts across the hallway of the Athenaeum club to greet me. Lightly tanned, thin as a whippet, the former head of GlaxoSmithKline and Imperial College cuts a dash in pinstripes and a tie the colour of crushed raspberries.

Sykes is to ‘change czars’ what Roger Federer is to tennis. In both his former roles he radically changed the institutions he headed. Through the takeover of Wellcome, followed by merger with SmithKline Beecham, he transformed middleweight Glaxo into GlaxoSmithKline, the third largest pharmaceutical group in the world. As rector of Imperial, he dramatically improved standards and secured financial independence by floating Imperial Innovations. No wonder his old colleague, surgeon turned health minister Lord (Ara) Darzi, was so supportive when Sykes applied to be chairman of the newly created Strategic Health Authority for London. ‘He is a superb leader who did wonders at Imperial,’ enthuses Darzi — who, after two years as a minister, has resigned to return to pioneering surgery.

There are some, however, who believe Sykes’s new job may turn out to be the ultimate hospital pass. Sykes himself is under no illusions. ‘It’s a huge challenge. Unlike running a company, the health service is very difficult because it’s a tangled web of many vested interests,’ he says in his still broad Yorkshire accent, while ordering a spartan lunch of asparagus and fish. Lack of clarity particularly irks Sykes, who has an enviable focus — and likes to have his way. ‘He’s very quick on the uptake,’ says Lazard’s Nicholas Jones, who advised Glaxo on its 1995 bid for Wellcome. ‘But there are no shades of grey. Once he has made up his mind about something, he’s very hard to shift.’

Sykes has, it seems, made up his mind that healthcare in London needs a drastic shake-up along the lines of Darzi’s 2008 report on the NHS, High Quality Care for All. ‘The big problem is that instead of running a health service, we’re running a sickness service. I agree with the direction of travel [in Darzi’s report] but getting to the destination will be tricky. I can see the top of the mountain. What I can’t see are all the crevasses and bear traps in between.’ Speaking of which, he has nothing but praise for the way the NHS is handling swine flu. ‘I think they’re doing extremely well. They have a clear process which they have been preparing for years and they have stuck to it. It’s always difficult to get the right messages across because people panic. But Liam Donaldson [the chief medical officer] is the right person to be in charge because he really understands infectious diseases.’

That’s high praise, because infectious diseases are Sykes’s passion. He grew up near Huddersfield, where his father was a carpenter. Although good at science he displayed no great academic ability and left school at 17 to work in the pathology labs at Huddersfield Royal Infirmary. From there he went on to take a microbiology degree at London University and a doctorate at Bristol. He joined Glaxo in 1972 but became part of the brain drain, moving to Squibb in the US in 1977. He returned to Glaxo nine years later, and swiftly rose to the top.

Now Sykes has two priorities for NHS London. The first is to take a layer of non-critical care out of hospitals and bring it into the community. ‘We have to increase access, increase quality and ensure more treatment is available outside hospitals. If we don’t, the NHS will be bust in ten years’ time.’

In this new world, controversial poly- clinics would be open 24 hours a day, manned by GPs, dentists and physiotherapists with access to full diagnostic facilities, so that only acute-care patients would go to hospital when necessary. From the patient’s point of view it sounds great — particularly to those with GPs like mine, who only open during office hours and close on Wednesday afternoons. The worry is there will not be enough polyclinics and — to Sykes’s evident irritation — that the GPs themselves will resist the change.

Secondly, Sykes and his team, led by chief executive Ruth Carnall, want more centres of excellence for dealing with strokes and severe trauma. ‘It’s pointless someone who has had a stroke going along to an A&E in a general hospital that doesn’t have a CAT scanner.’ Here again, Sykes is decidedly unsympathetic to those opposing him. When hospital trusts complain that this policy will take away their business, he says he tells them bluntly: ‘You’re trying to kill people. If you send people to ill-equipped hospitals, they will die.’

He was also shocked to find that all 31 Primary Care Trusts in London were both commissioners and providers of health services. By October, they will have to devolve the provider part — midwifery, home nursing, physiotherapy — and become pure commissioners. And he is highly critical of abuses of the health service, particularly in London. ‘Pregnant women with complications from overseas arrive at Heathrow, get on the Paddington Express and go straight to A&E at St Mary’s. Sometimes they’re there for months. It costs a fortune.’ One solution would be to insist everyone who goes into A&E must be registered with a GP first. When I point out that just one person has to die and there will be media uproar, he nods gloomily. ‘That’s why the NHS is a risk-averse system and progress is so difficult. If evolution was risk-averse, we wouldn’t be here.’

Like many businessmen brought in to sharpen up the public sector, Sykes clearly finds the prevailing NHS culture a struggle. But he is not giving up yet, despite Darzi’s resignation — which came as no surprise to him. ‘He has done his work, outlining the strat-egy. It’s for others to implement.’ Those others include Sykes himself, although he has a clutch of less challenging non-executive roles, including chairing the think tank Reform, to provide relief from his main task.

When he was at Glaxo I described him as a steely-eyed workaholic and dedicated messiah of science. More than a decade later, he has not changed — but I can’t help feeling that the NHS is his toughest challenge yet.