Professor Alan Maynard OBE reviews the post-electoral options available to the next secretary of state for health

The votes are in, and the British electorate has proved unable to choose between the devil they know and the uncertainty of the deep blue Tory sea. Possible coalitions look potentially frail.

So what now?

Imagine no recession …

Professor Alan Maynard OBE emphasises the high value of avoiding business as usual after the election.

Business as usual involves the following thought processes amongst politicians and their admirable civil servants

Step One “We must do something”

Step Two “This is something”

Step Three “Therefore we must do this”

(The Politicians’ Syllogism, Yes Minister, volume 2 [1987])

Within the week, there may be a new Secretary of State for Health. Like all secretaries, the purpose of their work is to keep secrets.

Professor Alan Maynard OBE warns that faith in mutuals as commissioners is not supported by any actual evidence

The rule of thirds
Since 1997, we have had the Blairite rhetoric of the ‘Third Way’ (based partly on Etzioni), as refocused recently on the use of the ‘third sector’ of charitable and non-profit-making organisations as an alternative to NHS and commercial provision of health care.

Professor Alan Maynard OBE wonders whether the politicians vowing to protect NHS budgets are deceitful or stupid. He outlines the main options for the NHS to save some money.

Two of the main political parties have managed to keep the NHS off the election agenda by saying that they will protect and continue to grow its funding.

Is this downright deceit? Or merely the misguided hopes of optimists?

Safe hands holding the legacy of Tredegar bedpans

Professor Alan Maynard OBE suggests that reforms to improve and incentivise commissioning should be based on evidence. What is not going to help is a faith-based cut-and-paste from Holland.

There is universal concern over - if not condemnation of - the quality of ‘commissioning’ in healthcare.

Professor Alan Maynard OBE examines the determinants of lifetime health through the prism of the ‘Bard of Hull’ Philip Larkin’s best-known poem.

The ‘experts’ are predicting that many children born in 2010 will live for a hundred years and more provided the population is not cropped by Malthusian war, diseases and famine (and earthquakes and volcanic eruptions!).

Professor Alan Maynard OBE torches a Spaghetti Junction of bridges with the professions. The RCN in particular will be very fond of him for this …

There is a proliferation of professions in healthcare and as George Bernard Shaw emphasised, these institutions are “a conspiracy against the laity”.

Professor Alan Maynard OBE admires the Buddhist nature of NHS reform. The wheel turns and civilisations rise; the wheel turns, and civilisations fall …

Health policymakers continue to rediscover ancient and well-researched problems, and to repeat the redisorganisational mistakes of yesteryear.

In part, this is due to a failure to distinguish between organisational structures; processes of care (or outputs); and patient outcomes - i.e. the rather important question, ‘did we make the patient better’?

Professor Alan Maynard OBE casts a critical eye over the information divulged by the Health Select Committee. Medical unemployment; nurse substitution for GPs; and the delivery of real efficiency increases; and management consultancy spend all come under acerbic review.

Recently, the Select Committee on Health of the House of Commons published its annual report on Public Expenditure. This sets out DH responses to Select Committee written questions, and is a goldmine of extraordinary information.

Professor Alan Maynard OBE looks at the upward drivers on healthcare demand, and predicts some patterns of probable NHS behaviour in response

The fate of healthcare funding and the NHS is unclear. Despite the rhetoric of decades, there is little evidence that community care is cheaper or more efficient. With patient demand for care continuing to increase, community care may be no solution.

The usual explanations of increased patient demand are technology, an ageing society and patient expectations. Let’s review each of these.

Worthy innovation?