The Maynard Doctrine: A leak from Lynton on policy and strategy

Health economist Professor Alan Maynard has received a wholly-authentic leak from a well-known political strategist to a well-known Jeremy. We publish it here in blatant defiance of the Data Protection Act.

NHS Downing Street briefing

Top secret: for your eyes only

Dear Jeremy,

Dave asked me to brief you on what he would like done with the National Health Service. As ever, and certainly until after we are re-elected in 2015 with a majority, the party line is that we are the heroic defenders of the NHS.

Once “Jeffrey” (Ozzy) Osborne has carried us across over the election hurdle, and with an EU-US trade agreement in place, we can hire some lovely Yankee capitalists to do what blundering NHS managers have failed to do. Several Cabinet members are counting on this happening as they wish to augment their meagre six-figure pensions and millionaire trust funds with nicely lucrative directorships.

The wages of failure is Northern Ireland
So what must you ensure 'twixt now and 2015 to avoid being appointed Secretary of State for Northern Ireland?

You must accelerate the firestorm of “policy initiatives” that you have already with further bold “innovations” to divert wastrels such as Polly Toynbee and other leftie nutcases who think (correctly) that we want to wreck the NHS and privatise the supply of healthcare.

Developing current diversions:
1) Beating up doctors to publish their results: as part of our desire to empower patients, it is essential that their choices are informed by mortality and complications data; and patient-reported outcomes measurement too, if your officials can get their fingers out.

This has two purposes. Firstly, to give hysteria fodder to the Daily Mail and other media outlets and help us show that the NHS is dangerous (we will ignore that all hospitals internationally are like ours and much more dangerous than bungee-jumping). Secondly, it puts the docs on the back foot, shows they are incapable of managing themselves, and makes them targets worthy of a policy of pay cuts.

We must not admit that Sir Bruce Keogh’s efforts to make his fellow docs performance-manage themselves is a good idea. However, if his efforts are successful, make sure we own them and he is given a peerage. (By the by, even Dave is doubtful that these data will actually alter many patients choices - but it is damned good PR showing our brave leader as a caring and engaged politician).

2) GPs. Do not admit their workload has increased, as this will engender sympathy for them: that would never do. Press on with the transparency and accountability e.g. just what do these perishers do and why is there so much variation in their referrals and use of blood tests and x-rays?

Assure them we see their corner shop organisations disappearing into commercial chains, as has happened in dentistry. We want them salaried employees asap and properly performance-managed! Stop dilly-dallying!

3) Ambulance services: think of some new ways to beat them up: blame them for failing targets e.g. overuse of ambulances and poor use of patient transport (which is much cheaper in terms of PbR tariffs). Give CCGs the power to fine them mightily if they miss performance targets.

4) Hospitals: keep them on the run by threatening them with more privatisation, closure and mergers. Mind those idiot academics with regard to the latter. For twenty years, they have been going on about how there is no evidence that hospital mergers reduce costs or improve quality (e.g. a Nuffield Trust publication in the 1990s by Goddard and Ferguson; and Gaynor, Propper et al, Journal of Health Economics, 2012). Do not get confused by such facts, or Belfast will call!

5) Encourage the daft think-tanks to be even dafter. The think-tank Reform’s notion of removing NHS budget ring-fencing was quite a good wheeze (see the recent BMJ piece). They and other tankers wanting crumbs from the Whitehall table should wheel out “impecunious” (over-paid) academics and other sycophants to advocate user charges as the only way of saving the NHS.

That despicable fellow Maynard at York has prattled on about the un-wisdom of this. Get the Tankers to tear him to shreds, as he is a perpetual pain in the arse! If things get bad, let’s get one of the Tankers to run “let’s emulate Australia private insurance policy”. The Howard government introduced lots of subsidies for private health insurance in Australia, and by the time Labour was returned to power, it was so embedded they could not remove it. Those damned academics have been very critical of this, so beware (Hall and Maynard, BMJ 2005)! They said it transferred resources to the more affluent. Splendid! Just what we want; screw the poor (as they never turn out to vote for us anyway).

So onwards, Jeremy, as commuting to Belfast is not much fun. Create havoc and change with a hurricane of non-evidenced wheezes.

Do NOT admit we are creating such wheezes to feed the media jackals and divert our MPs from mischief e.g. Euro-mania.

Do NOT admit we haven’t a clue how to save £20 billion and improve productivity. As ever, the maxim is don’t be confused by facts, don’t think critically and keep opponents confused and our right-wing colleagues smiling!

Good luck!

Your best pal,


Lynton 'The Oz' Crosby
(Prime Minister’s adviser for re-election in 2015)

P.S. - If the worst comes to the worst, and you are not suited even for Northern Ireland, we have assurances RM will keep you cosy!