The Maynard Doctrine: Udder problems for the NHS

Professor Alan Maynard  ventures into the anthropomorphic, assessing the porcine nutrition issues arising from the latest NHS redisorganisation

The American economist Uwe Reinhardt has likened a healthcare system to a sow, with beneficiaries of her milk competing for suckling rights. In the NHS, the ‘milk’ level exceeds £100 billion. Accordingly, the ‘piglets’ are bodies such as the pharmaceutical industry, hospitals and general practitioners.

Each time there is a healthcare ‘reform’ (AKA redisorganisation), the sow changes her position and there is a furious scuffling as public and private pigs seek to improve or at least retain their sucking rights.

The sow, better known as the Department of Health, is inevitably concerned about the welfare of her piglets, particularly the noisy ones in the private sector. The sow loves her public sector offspring - but they are somewhat complacent and fat. Her natural concern for the brood leads to her occasionally ‘reforming’ or shifting her position, in order to hopefully improve the welfare of all.

The new farmer, Old Andy Lansley, has bought NHS Farm, and is determined to increase its productivity. He has decided to focus his changes in pig rearing on a little, much-loved but largely ignored and noisy little pig, called GPs. He has sent the PCT and SHA piglets to slaughter.

Farmer Lansley has swept up the little GP blighter into his arms; kicked the other surviving piglets off their teats; and settled the little fella back with the sow.

Suckling GP piglets
GP piglet is nearing maturity, and she is ready to suckle her own piglets on the £80 billion in her control. Inevitably there is a mad rush by the new crop of piglets for NHS goodies.

Old Lansley has issued instructions (better known as a consultation paper on regulating the new, “liberated” NHS Farm) about the rules for accessing the sow, but these are pretty half-baked and unlikely to control the behaviour of the public and private piglets.

Ther opportunity cost of red diesel
Sadly, each piglet fails to realise that their success in accessing a NHS teat, draws down goodies which are consequently unavailable to her brothers and sisters.

Old Lansley is vaguely aware of the concept of opportunity cost and is engulfed in squeals and commotion when individual piglets lose access to NHS milk.

When he took over the NHS farm in May, Old Lansley was determined to adopt a laissez faire approach to the piglets. However this policy is not as easy to retain as he thought. For instance: Little Vince piglet is concerned about getting nourishment to enhance his pharmaceuticals and is squealing loudly about threats to his growth from the NICE piglet.

Liam Piglet is sucking for public health, which is laudable but a bit of a luxury in a farm focused on production now rather than some day in the distant future. Nigel, the clever NHS hospital piglet, is sucking for this important source of care and employment and convinced that no-one can deny the importance of his role.

Charlie the private provider piglet is hoping that the scraps offered by Old Farmer Blair before his demise, will turn into a flood of nutritious milk now that a new millionaire aristocrat called Sheriff Dave is ruling the county.

The two “bruiser” piglets in this competition for goodies from the NHS sow are GP piglets and consultant piglets. The latter have tended to pride themselves on their intellectual superiority and their access to sow’s milk.

The GP piglet is now to become the new sow, and given power to put these upstarts in their place i.e. control access to her NHS teats.

Farmer Lansley, and his mate Sheriff Dave have assured the GP piglet that her feeding will be “ring-fenced”. However, GP piglet can already see that her trough is being affected by VAT and National Insurance increases and by transfers of NHS goodies to social care. Some £500 million went to this other greedy sow only last week!

Farmer Lansley is feeling increasingly harassed, in particular by the demand of Sheriff Dave for tranquillity in the countryside. Our Dave is very anxious that as Charlie is given greater accesses to the NHS sow, the other piglets are kept quiet and do not generate a cacophony which might disturb his tranquillity, affluence and Con-Dem security.

Dear old Farmer Lansley would like the piglets to compete on a level playing field - but the imponderable issue is the behaviour of GP piglet. She is a robust defender of the NHS is little Iona and will be very watchful of her piglets’ behaviours! She may not be as pliable as was her colleague GP piglet Steve.

And the moral of this story is …
The lessons to be learnt from this little piggy fairytale?

One piglet’s progress is another piglet’s disadvantage - and with the NHS flow of feed declining, some little piglets are facing potential malnutrition. Squealing and demands for “more” seem inevitable as the “crisis” down at Farmer Lansley’s farm is fuelled by the usual media stories of disaster and decline!