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.

And so what will happen is very uncertain.

The NHS: safe with whom?
At present, Messrs Lansley. Lamb and Burnham assure us that the NHS is safe in their respective hands. This appears unlikely. The NHS is safe in nobody’s hands!

The Conservatives say they will protect “front-line services”. This is nicely ambiguous.

The inference is that angels (nurses) and gods (doctors) will be preserved in post - when what is needed is radical restructuring of services and roles.

Can we get hospital nurses away from nursing stations and spending more time caring for patients? The advocates of Toyota’s ‘lean’ methodology say that only 25 per cent of nursing time is spent with patients.

If the nurses could be leant upon to be ‘lean’ (and more methodical), that could be raised to over 40 per cent.

But what are they doing the rest of the time? And could administrative and other routine tasks be done by cheaper, less skilled staff? Sixty per cent of a lean nurse’s time is megabucks to organisations struggling to survive the coming storm.

The Cons …
One of the saddest aspects of the election campaign has been Cameron’s announcement that they will fund very marginally effective cancer drugs, despite NICE indicating they are not efficient. This example of selling-out to the “drug dealers” will give the Tories some votes. However, it potentially undermines health technology appraisal techniques built up over the last decade.

Cameron’s choice thus increases expenditure and gives few health gains. This does not augur well for the future.

… The Lib …
If we get Lamb what will the Liberal Democrats offer the NHS? Their evidence-free magic potion, or “something” in Yes Minister terms, is “local democracy”. Clearly, the population is deeply awed by and engaged in local government, with election turnouts often less than thirty per cent!

Government is awed by local democracy too, as witnessed by the need to regulate education at the national level given local failures to provide the young with the basic three R’s.

Elected PCTs will, in the best Sooty tradition of magic wand-waving, provide efficient commissioning and the productivity prayed for by the Department of Stealth.

And pigs might fly. Volcanic ash permitting.

… and The Labour
If we get Burnham again, we presumably continue with existing policies with knobs on. But Burnham will need some wheezes to keep in the headlines. They will no doubt continue to be based on rhetoric and the fluctuations in mood and preference at Number Ten Downing Street.

’Never waste a good crisis’
A crisis is an opportunity to be radical. The emerging crisis in Whitehall and the country is a major opportunity for radical reform.

Rather than civil servants inventing diversions and daily media sensations for their political masters, let’s hope they have been analysing options that offer real change.

How to kill and butcher a sacred cow
The politicians will need to slaughter many sacred cows. Their use of advice (aka lobbying) by the Royal Colleges will have to be dealt with robustly.

For instance: advocacy of concentration of facilities so as to increase volumes of activity to get (in some cases) lower patient mortality will have to be questioned as regard to cost and the effect on access and utilisation of disadvantaged groups.

Decisions should be based on evidence of efficiency and distributional access effects, rather than on mere clinical considerations.

The drug industry will need to be dealt with vigorously. They have had billions to invest in R&D as a result of favourable pricing in the UK.

Yet where are the new products? Their magic porridge pot has ceased to produce! Perhaps it is time to break up the industry and separate R&D from marketing, with new incentives which reward invention?

Furthermore, when interventions exist that industry seeks to restrict, as in the case of cheaper non-patented drugs as an alternative to Lucentis, government should respond swiftly rather than like a drunken snail!

Policy choices at the centre might usefully be discussed with (dare one say it?) academics. The Department’s drive for increased productivity confuses the production of widgets and the production of outcomes.

Use the academics
Instead of stuffing committees and advisory groups with managers of varying sorts, might not a sprinkling of academics offer some value added?

How better to apply the results of university research (funded in recent years by government) than by getting the academics to inform even better Whitehall discussions? Time to abandon age-old silos?

There is so much more that is needed, as discussed in previous offerings to this website. Hopefully, the crisis will be an opportunity for long-awaited change.

But are the politicians - let alone their advisers - capable of the intellectual and personal challenges that this involves?

If the answer is no, the barmy army of ignoramuses like Karol Sikora will engulf the NHS! Why do the media give such an advocate of faith-based policymaking so much publicity?