Professor Alan Maynard OBE celebrates his ascension into the pantheon of the British Empire with a typically pro-Establishment disquisition on the need for NICE to get nastier in the recessionary climate for 2009.

The NHS faces a profound financial “squeeze” due to the global recession and the British Government’s attempts to mitigate the products of lax regulation of the financial sector.

At the same time as the funding capacity of the NHS is being challenged, there are two significant sources of increased demand for care: the elderly, and technological change.

The Christmas message of “goodwill” in the 2009—10 Operating Framework for the NHS is that the hospitals in particular are to be screwed until their pips squeak!

Professor Alan Maynard on the need to address clinical revalidation and manage poor performance

A decade after the problems with Shipman in Manchester and Yorkshire, Wisheart at Bristol, Neale at Northallerton and Ledward in Kent, we still have no comprehensive system of revalidating doctors. The practices of these four doctors killed and injured scores of patients. Expensive and expensive public inquiries identified systematic failures in governance processes, and made strong recommendations to change the way in which doctors were licensed to practice.

Professor Alan Maynard welcomes greater attention to costs and quality, but warns that doing the right thing brings a fresh set of dilemmas along with it.

The NHS budget is set to stabilise. Indeed with a Darzi-enhanced NICE and the impact of ageing on NHS demand, the real rate of growth of NHS budgets over the next five years may be negative.

Professor Alan Maynard considers the costs and benefits of new incentives for quality

After splurging billions of additional spending on the NHS, even the politicians have now begun to question the value for money of their generosity.

Professor Alan Maynard discusses the need for efficient systems to address poorly-performing consultants and redundant managers.

The Department of Health management team are increasing their carbon footprint by touring the country and encouraging SHAs and PCTs to lead the revolution outlined in the Darzi report.

Whilst greater attention to outcome measurement and the reduction of unacceptable clinical practice variations is most welcome albeit very late, some fundamental issues are being ignored - in particular, job tenure of clinicians and senior managers.

The NHS is like a large sow with many teats, from which provider piglets draw succour. One of the most robust piglets in the sty is the pharmaceutical industry.

Take, for instance, the current debate about 'co-payments' for cancer patients. With NICE declining some products of marginal cost-effectiveness, industry is encouraging its compatriots in the medical profession and elsewhere to demand that where patients buy treatments declined by NICE, the administration of the drugs should be provided by the NHS.

Alan Maynard is professor of health economics, University of York

Monday 1 September 2008

Time to "screw" the NHS?

The Blair-Brown axis has increased the funding of the NHS in an unprecedented manner, with an additional £50 billion and total expenditure now of £105 billion. Soon we will be spending ten per cent of gross domestic product (GDP) on the NHS. What are we getting for our money?

The US healthcare system is fragmented and expensive, costing twice as much per capita as the NHS and consuming nearly 16 per cent of a much larger national income.

If you are elderly or disabled, you can get a reasonable package of healthcare benefits from Medicare, which is federally funded. If you have fought for US armed forces, you are eligible for benefits from the Veterans Administration which is also federally funded and an efficient mini-NHS.

The Darzi report rightly extols the virtue of outcome measurement, and reiterates yet again the problem of clinical practice variations. However its focus is primarily clinical, where clinical is defined as doctors getting involved in systematic comparative review of practice and subsequently getting their act together.

The largest workforce in the NHS is nursing. Nursing costs typically make up thirty-five per cent of hospitals expenditure and with growing employment in primary care, nurses are also an increasing cost there.