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.

Professor Alan Maynard fully supports the decision to reduce the tariff premiums paid to childrens’ and other specialist hospitals, but wonders why most people in the media haven’t noticed.

Carefully study of Hansard is always fun. Having MPs insult Ministers and Ministers reciprocating is great entertainment. On November 2nd, the exchanges were particularly entertaining and very informative.

The socialist heart of Andrew Lansley

Profesoor Alan Maynard wonders what the changes to NICE’s remit mean for rationing.

Just what do the Con-‘em Coalition plan to do with NICE and the market for pharmaceuticals?

Firstly we have Cameron’s “Cancer Drugs Fund”. This was a bag of NHS swag used to buy votes in the election by pleasing both cancer patient groups and the merchants of inefficient and highly expensive cancer drugs to which NICE had said no.

Professor Alan Maynard describes how the ‘two divisions’ running hospitals must collaborate for the NHS to survive austerity

The Con-‘em Coalition is to provide between 0.3 (Institute of Fiscal Studies) and 0.4 (Department of Health) per cent annual growth in NHS funding over the next four years. The IFS note that this is the tightest settlement since 1951-56.

So we now know what the Coalition means by “protecting” the NHS: sweet parsimony for all is assured!

Professor Alan Maynard sees covert entrepreneurialism emerging and wonders about the opportunity costs of Mr Lansley’s liberation

Despite the efforts of the Department of Health and strategic health authorities, it is possible that the Lansley reforms will create a nice element of chaos in the NHS. Out of chaos comes opportunity for swift local deals to rationalise capacity and work practices.

Professor Alan Maynard casts a sceptical eye over the BMA’s unfavourable response to the ‘Equity And Excellence – Liberating The NHS’ White Paper

You have to love the British Medical Association. They are just so predictable.

Professor Alan Maynard considers the chaos, confusion and celerity surrounding the development and assurance of GP commissioning consortia.

As yet there is little enlightenment about how entry into GP consortia status will be achieved and what the powers will be given to the gatekeeper. This after one bland White Paper; a fistful of consultation documents; and much punditry from academe and think-tanks

In all healthcare systems, politicians continually strive for the Holy Grail of system improvement. This goal breaks down into three elusive targets: macro-economic expenditure control, equity and efficiency.

The upheaval inherent in the current NHS reforms may undermine expenditure control. This is well evidenced by NHS chief executive Sir David Nicholson continually telling managers that financial balance is an imperative and failure in this domain will lead to their dismissal.

Professor Alan Maynard scours the horizon for plausible post-2015 scenarios for the NHS

The Con-Dem coalition government is made of competing factions, driven by different ideologies. As in other governments, political and economic events lead to particular factions getting their hands on policy reform.

The current dominant political faction appears to have adopted some poorly-designed reforms that beg more questions than they answer. They may regret their choices.