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The Maynard Doctrine

The Maynard Doctrine: Building NHS reforms on sand - whatever happened to evidence-based policymaking?

Professor Alan Maynard suggests that evidence for a primary care-led NHS is seriously lacking.

When an expensive system of healthcare such as the NHS is accused of having “failed”, there are two urgent needs: firstly, to define what is meant by this term and secondly, to present evidence of both “failure” and the evidence that proposed reforms will remedy the system’s deficiencies.

Sadly the current reforms fail either to define the failures or to offer an evidence base for reform.

The National Hospital Service reforms

The Maynard Doctrine: Who is managing the NHS workforce?

Professor Alan Maynard points out the ludicrous state of NHS workforce planning.

The Department of Health usually has to hire some management consultancy to be told that the NHS is labour-intensive and the major cost pressure is the payment of wages and salaries.

The Maynard Doctrine: Does competition work in healthcare?

Publish Date/Time: 
01/11/2011 - 02:19

Professor Alan Maynard wishes you all a Happy New Year, but is basically a realist, and so doesn’t propose to push it. Here he investigates competition and whether it works in healthcare.

Successive governments have become enthusiastic proponents of competition in healthcare in the USA and the UK. The nice issue is whether there is proof that such enthusiasm for and development of competition can be evidenced as having reduced the costs of providing good-quality care patients.

The Maynard Doctrine: It’s the money and the waiting times, stupid!

Professor Alan Maynard wonders whether the funding pressures facing the NHS are properly understood by policymakers, whose proposals promise to increase them.

Re-disorganising the NHS is a favourite pastime of all politicians, as witnessed by dozens of structural reforms over many decades. The common characteristic of these reforms has been unbounded political optimism, with very little beneficial effect in the processes of patient care and on users’ outcomes.

The Maynard Doctrine - Two Christmas debating issues

Professor Alan Maynard suggests that ‘tis the season for discussion

1) Do specialist hospitals need super-subsidy?
Specialist hospitals are supposed to benefit from economies of scale i.e. because they are big and specialised, surely their unit costs should be lower?

If these economies of scale exist, why are specialist hospitals such as Great Ormond Street Hospital, Alder Hey and the other hospitals in London and other cities given subsidies?

The Maynard Doctrine: Revolution and reform - where is the evidence base?

Professor Alan Maynard asks, not for the first time (nor undoubtedly for the last time), where is the evidence to suggest that the proposed NHS reforms are going to work?

The Coalition Government, full of sufficient revolutionary vigour to bring a warm glow to Chairman Mao, is seeking to transform the public sector with radical reforms. Many of these reforms are intellectually intriguing … and as such, require careful piloting and evaluation.

The Maynard Doctrine: Conservative Radicals with socialist hearts - whatever next?

Professor Alan Maynard fully supports the decision to reduce the tariff premiums paid to childrens’ and other specialist hospitals, but wonders why most people in the media haven’t noticed.

Carefully study of Hansard is always fun. Having MPs insult Ministers and Ministers reciprocating is great entertainment. On November 2nd, the exchanges were particularly entertaining and very informative.

The socialist heart of Andrew Lansley

The Maynard Doctrine: NICE troubles to have

Profesoor Alan Maynard wonders what the changes to NICE’s remit mean for rationing.

Just what do the Con-‘em Coalition plan to do with NICE and the market for pharmaceuticals?

Firstly we have Cameron’s “Cancer Drugs Fund”. This was a bag of NHS swag used to buy votes in the election by pleasing both cancer patient groups and the merchants of inefficient and highly expensive cancer drugs to which NICE had said no.

The Maynard Doctrine: The Con-‘em Coalition and the management of hospitals

Professor Alan Maynard describes how the ‘two divisions’ running hospitals must collaborate for the NHS to survive austerity

The Con-‘em Coalition is to provide between 0.3 (Institute of Fiscal Studies) and 0.4 (Department of Health) per cent annual growth in NHS funding over the next four years. The IFS note that this is the tightest settlement since 1951-56.

So we now know what the Coalition means by “protecting” the NHS: sweet parsimony for all is assured!

The Maynard Doctrine: Out of chaos comes what?

Professor Alan Maynard sees covert entrepreneurialism emerging and wonders about the opportunity costs of Mr Lansley’s liberation

Despite the efforts of the Department of Health and strategic health authorities, it is possible that the Lansley reforms will create a nice element of chaos in the NHS. Out of chaos comes opportunity for swift local deals to rationalise capacity and work practices.

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