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The Maynard Doctrine

The Maynard Doctrine: Cutting costs in the NHS

Professor Alan Maynard welcomes greater attention to costs and quality, but warns that doing the right thing brings a fresh set of dilemmas along with it.

The NHS budget is set to stabilise. Indeed with a Darzi-enhanced NICE and the impact of ageing on NHS demand, the real rate of growth of NHS budgets over the next five years may be negative.

The Maynard Doctrine: The new NHS virus - how to incentivise quality

Professor Alan Maynard considers the costs and benefits of new incentives for quality

After splurging billions of additional spending on the NHS, even the politicians have now begun to question the value for money of their generosity.

The Maynard Doctrine: Time to deal efficiently with poor doctors and redundant senior managers?

Professor Alan Maynard discusses the need for efficient systems to address poorly-performing consultants and redundant managers.

The Department of Health management team are increasing their carbon footprint by touring the country and encouraging SHAs and PCTs to lead the revolution outlined in the Darzi report.

Whilst greater attention to outcome measurement and the reduction of unacceptable clinical practice variations is most welcome albeit very late, some fundamental issues are being ignored - in particular, job tenure of clinicians and senior managers.

The Maynard Doctrine: Suckling the NHS ‘piglets’ - the case of the drug dealers

The NHS is like a large sow with many teats, from which provider piglets draw succour. One of the most robust piglets in the sty is the pharmaceutical industry.

Take, for instance, the current debate about 'co-payments' for cancer patients. With NICE declining some products of marginal cost-effectiveness, industry is encouraging its compatriots in the medical profession and elsewhere to demand that where patients buy treatments declined by NICE, the administration of the drugs should be provided by the NHS.

The Maynard Doctrine: time to "screw" the NHS?

Alan Maynard is professor of health economics, University of York

Monday 1 September 2008

Time to "screw" the NHS?

The Blair-Brown axis has increased the funding of the NHS in an unprecedented manner, with an additional £50 billion and total expenditure now of £105 billion. Soon we will be spending ten per cent of gross domestic product (GDP) on the NHS. What are we getting for our money?

The Maynard Doctrine: the challenges of healthcare reform in the USA

The US healthcare system is fragmented and expensive, costing twice as much per capita as the NHS and consuming nearly 16 per cent of a much larger national income.

If you are elderly or disabled, you can get a reasonable package of healthcare benefits from Medicare, which is federally funded. If you have fought for US armed forces, you are eligible for benefits from the Veterans Administration which is also federally funded and an efficient mini-NHS.

The Maynard Doctrine: Darzi and nursing - time to tackle this time bomb?

The Darzi report rightly extols the virtue of outcome measurement, and reiterates yet again the problem of clinical practice variations. However its focus is primarily clinical, where clinical is defined as doctors getting involved in systematic comparative review of practice and subsequently getting their act together.

The largest workforce in the NHS is nursing. Nursing costs typically make up thirty-five per cent of hospitals expenditure and with growing employment in primary care, nurses are also an increasing cost there.

The Maynard Doctrine: the trouble with incentives

Alan Maynard is professor of health economics, University of York

Monday 21 July 2008

The trouble with incentives is that they work, but they may produce changes in behaviour that are at once welcome and perverse.

Take, for instance, the fines announced in December 2007 for NHS trusts that fail to hit their C.Difficile targets. These fines are potentially large, up to £3.5 million for unsuccessful trusts. Faced by such fines, managers are striving very hard to improve the performance of their hospitals - just as Ministers hoped they would.

The Maynard Doctrine: is competition 'The Answer'?

Alan Maynard is professor of health economics, University of York

Monday 7 July 2008

During the Wilson government in the mid-1970s, clinical practice variations were identified as a major problem. They remain so today, with the Darzi report, High-Quality Healthcare For All, demanding change because similar patients with similar needs get very different treatment.

The Maynard Doctrine: whither foundation trusts?

by Alan Maynard, professor of health economics, University of York

Ninety-nine NHS organisations now have Foundation Trust (FT) status. Most of them are acute trusts, but an increasing number are in mental health and related services. The objective of the FT initiative was to achieve greater efficiency by giving greater autonomy to hospitals within a rigorous framework of financial regulation in particular.

Has this objective been achieved?

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