The Maynard Doctrine: The Empress has no clothes
Health economist Professor Alan Maynard calls Mayday on Number 10's health and care policy position
Hans Christian Anderson’s tale of the Emperor being tricked by two weavers into selling a magic set of clothes that did not exist led to their victim being “naked as the day that he was born”, and subject to universal ridicule.
After six months in office, Prime Minister May appears to have no clothes and is subject to increasing ridicule. Admittedly, her agenda is broad and dominated by bewilderment about how to manage Brexit.
However, this is compounded by control freakery involving The Empress’ insistence on scrutiny of all policy departments. System constipation is the inevitable result of a lack of delegation.
These problems are epitomised by health and social care where the ridiculous British Red Cross recently declared a “humanitarian crisis”. Aleppo and Ebola fall into that category - an NHS beds crisis does not.
The Empress’s response to the political turmoil associated with trolley waits in A&E, lengthening waiting times and blocked beds due to inadequate social care has been to appoint a special adviser to Number 10, a former medic from Boston Consulting. What should this lucky lad do now?
The Empress’s line is that the NHS is adequately funded for the period to 2020, having been given £10 billion of additional funding and increased council tax funding for social care.
This line is continually emphasised by the Secretary of State for Health, Jeremy Hunt even though the £10 billion is really £4.5 billion and the council tax increase is meagre and advantages Tory shires rather than the deprived industrial north.
How can the Empress’s new adviser better manage the bare-faced lies and hysteria around NHS funding when the ideologues in the Conservative party insist on driving down public expenditure to achieve a small state?
In addition to The Empress and The Jeremy adhering to their mischevious funding assertions, they are also wed to the 24/7 weekend staffing model.
Nick Black, a Professor recently knighted in the New Year’s honours, has declared in a recent article in the Journal of the American Medical Association that there is no evidence of a weekend mortality effect.
Unfortunately, the policy was in the Conservatives' 2015 election manifesto. The Government have fought to implement the 24/7 policy with a contentious reform of the junior doctors’ contract, and delayed radical changes to consultant terms and conditions.
Can this policy be 'lost' without the media noticing? May’s new adviser will find the 24/7 weekend issue difficult to lose in the long grass.
The Empress has spoken about mental health funding, promising for instance adequate local institutional care for children by 2021. This is as pathetic as the missing £1 billion of additional funding for mental health promised by the previous Prime Minister.
Mental illness inflicts misery on millions, and the service remains under-funded. The new adviser will have to educate The Empress, but this looks quite difficult given the cult of austerity reigning in Whitehall village.
The usual 'Yes, Minister' approach to such difficulties is diversionary initiatives about quality and safety. Jeremy Hunt loves such tactics, which involve reforming existing agencies and inventing new ones.
The popular press like to consider safety and quality in terms of individual cause celebre which 'demonstrate' that the NHS is collapsing. (This of course ignores the hundreds of thousands of patients treated monthly with care and success.)
But hey! Individual patient errors sell newspapers, and give Jeremy occasion to pontificate and invent a new agency or two - without regard to opportunity cost and evidence of success.
Jeremy’s latest wheeze is to hire the former boss of the Air Accident Investigation agency, and set him lose with an appropriate bureaucracy so that fewer patients are damaged by healthcare. Noble intentions!
But why will this new agency succeed where the Care Quality Commission and others have failed? Healthcare, like all aspects of life, involves errors; perhaps ten per cent and more in the case of public and private health care organisations worldwide.
Of course we wish to avoid errors, but why duplicate efforts and fail to evidence significant old and new investments? The issue for The Empress’s new adviser to decide is whether such activity, which keeps Jeremy in the media, worthy or worthless?
Conclusions
The Empress is naïve and stubborn about routine health and social care issues. She exhibits inertia and indifference to a health and care system remarkable in its resilience, but brought to its knees by six years of wilful neglect.
She and Jeremy Hunt have united select committees, the professions and local government in opposition to inadequate funding and inefficient policy choices.
Whether the still, small voice of an additional adviser in No 10 can alter this seems unlikely amidst the swirling torrents of Brexit and other spending departments wanting
the means to reverse crumbling infrastructure and the systematic undermining of basic public services.
Good luck, nonetheless! Anything that clothes the naked Empress with greater understanding in the black hole that is Number 10 Downing Street policymaking is to be welcomed.