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The Maynard Doctrine

The Maynard Doctrine: As the dust settles on the boomerang of reform …

As the dust settles from the White Paper where are we? Apart from the mere issues of detail to be provided in the ten (yes, ten!) consultations in the next few weeks - essential beach reading, with comments requested by October 5th - what is changing?

Goodbye old bureaucracy, hello new bureaucracy
There is a major assault on bureaucracy, with PCTs and SHAs to go. But hold on a minute: aren’t the proposed GP commissioners just PCTs run by GPs?

Moving from 152 PCTs to 500 GP commissioning consortia (GPCCs) is like going back in time to when we had 300 or so too many PCTs.

The Maynard Doctrine: The opposite of evidence – faith-based policymaking

Professor Alan Maynard looks for the evidence justifying proposed new changes. And looks. And looks …

“Christianity has not been tried and found wanting; it has been found difficult and not tried” GK Chesterton

Chesterton’s views on Christianity are replicated in healthcare by policy wonks who base their works on faith rather than evidence. The left declare all things “private” to be the devil’s work, whilst the right regard government as twice cursed!

The Maynard Doctrine: Musings on the contradictions appearing from the NHS policy fog

Publish Date/Time: 
06/24/2010 - 11:26

Professor Alan Maynard OBE looks at the emerging elements and wicked issues from the current policy fog

The English NHS is scheduled to have its most significant “redisorganisation” since the 1970s. As ever, it is well-intentioned but largely evidence-free.

Furthermore, the details of the changes are lacking - and HM Treasury is currently very worried about ensuring that GPs are accountable. The idea of GP accountability is a nice issue, as primary care has largely been a data-free black hole since 1911.

You say you want a revolution …

The Maynard Doctrine: Transparency and accountability in theory and practice in the NHS

Professor Alan Maynard OBE minds the gap between political rhetoric about openness, choice and outcomes and the practical reality of lacking comparative data – and the implications for NHS redisorganisation.

The political rhetoric is of openness in all the workings of the NHS.

The practice is of avoiding confusing consumers with facts.

Both New Labour and the new Government must know that their advocacy of patient choice is empty cant unless consumers are informed about the risks involved in using healthcare facilities.

The Maynard Doctrine: Evidence-based healthcare policy: please do it better!

Professor Alan Maynard OBE notes the lack of evidence for the 30-day unpaid emergency acute readmission policy, and politicians’ and policymakers’ poor use of evidence more broadly.

Politicians in all parties advocate the use of evidence in making difficult policy decisions.

The Maynard Doctrine: Confronting sacred cows: why are big hospitals more costly?

Professor Alan Maynard OBE reviews the validity of the idea that teaching hospitals have higher running costs

Traditionally, it has been argued that university teaching hospitals are more costly to operate. The primary argument to support this assertion is that they have a more complex case-mix.

Is this argument tenable, or is it a case of special interests defending their inefficiency?

Economics teaches us that larger units may have lower costs due to economies of scale and economies of scope. Why are these hospitals exceptions?

The Maynard Doctrine: £200 million National Cancer Drugs Fund - nice price for Big Pharma; nasty for NICE

Professor Alan Maynard reviews the reasoning behind government proposals for spending another £200 million on new cancer drugs not recommended by NICE health technology appraisal

The Conservative manifesto pledged an additional £200 million to fund cancer drugs, which the previous government and NICE had been reluctant to fund.

Is this a good idea?

The answer to this simple question is it all depends on what you are trying to achieve.

The Maynard Doctrine: So what now after the election?

Professor Alan Maynard OBE reviews the post-electoral options available to the next secretary of state for health

The votes are in, and the British electorate has proved unable to choose between the devil they know and the uncertainty of the deep blue Tory sea. Possible coalitions look potentially frail.

So what now?

Imagine no recession …

The Maynard Doctrine: How to turn a crisis into an opportunity

Professor Alan Maynard OBE emphasises the high value of avoiding business as usual after the election.

Business as usual involves the following thought processes amongst politicians and their admirable civil servants

Step One “We must do something”

Step Two “This is something”

Step Three “Therefore we must do this”

(The Politicians’ Syllogism, Yes Minister, volume 2 [1987])

Within the week, there may be a new Secretary of State for Health. Like all secretaries, the purpose of their work is to keep secrets.

The Maynard Doctrine: 'Our Mutual Friend' - another wannabe solution; but to which NHS problem?

Professor Alan Maynard OBE warns that faith in mutuals as commissioners is not supported by any actual evidence

The rule of thirds
Since 1997, we have had the Blairite rhetoric of the ‘Third Way’ (based partly on Etzioni), as refocused recently on the use of the ‘third sector’ of charitable and non-profit-making organisations as an alternative to NHS and commercial provision of health care.

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