Health economist nonpareil Professor Alan Maynard considers how we might do something really radical, like focusing on how to make commissioning more efficient. And he seeks your input.

’The current “pause” will be used to sell the proposals, with much sucking-up to the professions and other lobbies, but no real changes in policy.’

The Coalition is likely to plough on with its reforms of the NHS. The current “pause” will be used to sell the proposals, with much sucking-up to the professions and other lobbies, but no real changes in policy.

Professor Alan Maynard on the specious McKinsey Report, mushroom management and the whereabouts of £4 bilion a year over the next four years

Comrade-In-Chief Nicholson has decreed that the NHS has to re-cycle £20 billion over the next 4 financial years, following his absorption of McKinsey’s so-called report, with its several references to McKinsey data! President Lansley has concurred.

With neither of our bold leaders apparently capable of a critique of the McKinsey alchemy, NHS managers are busy seeking to meet the demands of these latter-day Stalinists.

Professor Alan Maynard on data use, incentives, PROMs, private sector HES and a 1974 Burlington.

The reformed NHS has some “nice” data gaps which need to be plugged quickly, if performance management and transparency are to be improved.

Without improvements in data collection and analysis, NHS managers will not be able to manage efficiently and the NHS Commissioning Board will not be able to commission efficiently and equitably.

Professor Alan Maynard explores whether the Coalition’s ideology is guiding health policy towards the introduction of more NHS user charges.

The Coalition’s attitude towards the NHS is a mixture of right-wing ideology and optimism that market-orientated reform will be the salvation of the service.

If the latter fails, the ideologues will inevitably pursue their goals by advocating changes to the funding of the NHS. This will be presented as the ardent efforts of concerned policy advocates seeking to “save” the NHS!

Professor Alan Maynard suggests that evidence for a primary care-led NHS is seriously lacking.

When an expensive system of healthcare such as the NHS is accused of having “failed”, there are two urgent needs: firstly, to define what is meant by this term and secondly, to present evidence of both “failure” and the evidence that proposed reforms will remedy the system’s deficiencies.

Sadly the current reforms fail either to define the failures or to offer an evidence base for reform.

The National Hospital Service reforms

Professor Alan Maynard points out the ludicrous state of NHS workforce planning.

The Department of Health usually has to hire some management consultancy to be told that the NHS is labour-intensive and the major cost pressure is the payment of wages and salaries.

Professor Alan Maynard wishes you all a Happy New Year, but is basically a realist, and so doesn’t propose to push it. Here he investigates competition and whether it works in healthcare.

Successive governments have become enthusiastic proponents of competition in healthcare in the USA and the UK. The nice issue is whether there is proof that such enthusiasm for and development of competition can be evidenced as having reduced the costs of providing good-quality care patients.

Professor Alan Maynard wonders whether the funding pressures facing the NHS are properly understood by policymakers, whose proposals promise to increase them.

Re-disorganising the NHS is a favourite pastime of all politicians, as witnessed by dozens of structural reforms over many decades. The common characteristic of these reforms has been unbounded political optimism, with very little beneficial effect in the processes of patient care and on users’ outcomes.

Professor Alan Maynard suggests that ‘tis the season for discussion

1) Do specialist hospitals need super-subsidy?
Specialist hospitals are supposed to benefit from economies of scale i.e. because they are big and specialised, surely their unit costs should be lower?

If these economies of scale exist, why are specialist hospitals such as Great Ormond Street Hospital, Alder Hey and the other hospitals in London and other cities given subsidies?

Professor Alan Maynard asks, not for the first time (nor undoubtedly for the last time), where is the evidence to suggest that the proposed NHS reforms are going to work?

The Coalition Government, full of sufficient revolutionary vigour to bring a warm glow to Chairman Mao, is seeking to transform the public sector with radical reforms. Many of these reforms are intellectually intriguing … and as such, require careful piloting and evaluation.