Health Policy Insight
Healthcare management online analysis and intelligence
The home of UK health policy

Regular Columns

The Maynard Doctrine: Are policymakers and politicians stupid, ignorant, or both?

Health economist Professor Alan Maynard looks at NHS reform plans from 1974, and finds that all too little has changed.

An appraisal of the history of NHS reform since 1974 shows a naïve belief that altering organisational structures will improve the processes of healthcare and benefit patients in terms of their outcomes: i.e. improve their length and quality of life.

The links between structure, process and outcome are assumed, with reformers asserting unevaluated and un-evidenced conclusions from their repetitive and learning-light organisational reforms.

The Maynard Doctrine: The harsh reality of NHS reform: time to end the purchaser-provider split

Health economist Professor Alan Maynard suggests we need radical reform: end two decades of policy failure and let purchasers merge with providers

The Health and Social Care Act 2012 has created a plethora of new bureaucracies, whilst undermining collective memory about past decision-making by retiring and making redundant many effective managers.

The Maynard Doctrine: Cautionary policymaking tales

Publish Date/Time: 
03/05/2013 - 14:19

Health economist Professor Alan Maynard skewers the policy commissariat

“We know it’s stupid, but it is policy” said the Department of Health civil servant as the Secretary of State (SoS) left the room.

“But why don’t you tell Jeremy that it’s stupid?”

“Don’t worry we have but he just smiles, congratulates us on our insightful support and ignores us. It was, with varying degrees, ever thus!”

The Maynard Doctrine: Why are managers so dumb?

Health economist Professor Alan Maynard queries why healthcare managers appear unwilling or unable to learn from history and evidence.

Non-clinical managers and their medical colleagues appear to be dumb, as defined by their failure to learn from history and evidence. For this dumbness, they are highly paid and continue to manage the delivery of care characterised by variations in process, cost and outcomes that damages patients and taxpayers.


The Maynard Doctrine: The arrogant and the ignorant must be collaborative friends

Health economist Professor Alan Maynard explains why researchers ("the arrogant" *) and managers ("the ignorant" **) have to start to work together

The problem: ignorant managers and arrogant researchers
NHS managers offer us New Year messages advocating hospital closures to fund “care in the home”. Some of them vigorous advocate “telehealth” and “telecare”.

The Maynard Doctrine: What the NHS Mandate misses, or ‘Another Episode Of Nero Playing His Violin Whilst The NHS Burns?’

Health economist Professor Alan Maynard suggests that the NHS mandate may have missed out most of the critical issues

The Maynard Doctrine: The vultures coming home to roost

Health economist Professor Alan Maynard looks at NHS-saving savings, taking in decremental salary scales, reviewing pharmaceutical price naughtiness and the incredible shrinking tariff.

As the new Secretary of State snuggles into Richmond House, he is no doubt contemplating tanks on the forecourt of Richmond House and the SAS in the corridor to protect him from the gathering storm in the NHS.

Where to start?

Let us start with QIPP (quality, improvement, productivity and prevention). Has it worked?

The Maynard Doctrine: The Chronicles Of Nirvania, home of unicorns and zombies

Professor Alan Maynard looks at the oncoming financial storm facing the NHS, and explains why health policy Nirvania is home to unicorns and zombies.

Into the NHS storm with all hands on deck
The Department’s productivity challenge has translated into harvesting the low-hanging fruit: squeezing costs. How far can this continue before quality declines and rationing hits political sensitivities where they hurt?

The Maynard Doctrine: Is the world mad or sad? The return of the global budget must await.

Professor Alan Maynard considers whether system reform needs a psychiatrist or a grief counsellor - oh, and why global budgets must come back.

Any commentary on the current state of NHS policy must, as in so many domains of public policy, address the question of whether the world is mad or sad.

In the context of the NHS, I will address two areas of contention: the role of Monitor, and the recent draft document “Setting levels of ambition for the NHS Commissioning Board (latterly known as the national coal board)

The Maynard Doctrine: Managing NHS demand

Professor Alan Maynard on managing demand and perverse incentives, and the need for major change in primary care.

Compared to the cuts in local councils’ budgets, the NHS financial challenge could be viewed as modest. However, life is complicated by The Lansley’s re-disorganisation of the NHS which is reducing management capacity and destroying historical memory.

What is remarkable about the Nicholson challenge is its focus on the reduction of hospital care by mergers and closures and the need to develop “community care”.

Syndicate content