Professor Alan Maynard OBE looks at the changes needed to make NICE’s rationing role more effective in an economically-challenged environment

The current economic and financial crisis will affect public expenditure for the next decade. Even if the Conservatives and the Labour parties seek to meet their pledges to maintain public funding of education and the NHS, it is doubtful whether they can maintain their promises, let alone increase the funding of these services as demand increases.

Professor Alan Maynard OBE wonders why the NHS fails to prepare for the worst, when facing dire economic circumstances

Where are the UK’s finances now?
The current economic situation is grim, and this must inform our planning to ensure that we protect as best we can both the volume and quality of healthcare delivered to the local population.

Here are two key issues to bear in mind:

Professor Alan Maynard OBE makes full disclosure of a document passed to him anonymously

The postmark on the brown envelope in which this document was sent to me is, unfortunately, too blurred for legibility, and the address printed on a label. There is, in short, no indication as to who sent this document or why.

Nevertheless in the zeitgeist spirit of freedom of information, its contents are as follows.

[DOUCUMENT BEGINS]
Private and Confidential

Memorandum: Plans for the Reform of the NHS in 2010

Professor Alan Maynard OBE challenges the Whitehall Village People to evaluate their initiatives around quality for cost-effectiveness

The Government has recognised that ‘it ain’t what you spend, it’s the way you have spent it’ that matters to patients. They are interested in whether healthcare makes you “better” or, as Hippocrates and Florence Nightingale both emphasised, does no harm!

Hospital healthcare harms one in ten

Professor Alan Maynard argues for equitable distribution of recessionary pain, warning that those in well-paid jobs, including doctors, will not be immune from attention

The rate of exchange of the UK pound for the euro and US dollar has declined by thirty per cent. This is increasing the cost of imports to the healthcare sector - and the cost of living, as imported staples such as tea, coffee and sugar increase in price.

Professor Alan Maynard OBE warns that although emotionally appealing, moves towards higher cost-per-QALY thresholds for spending on end-of-life and rarer conditions are inequitable and inefficient

Governments believe that they may lose votes (and know that they will get hammered by the Daily Mail) if they deny we all have a terminal sexually-transmitted disease called life, whose certain clinical outcome is that one day we will surely die. Nowhere is this clearer than when dealing with end-of-life treatments for cancer and other patients.

Professor Alan Maynard OBE suggests that Lord Darzi is a well-intentioned Marxist who does not really understand quality

“If a man is not a socialist at 18, he has no heart. If he is a socialist at 30, he has no head.”

This adage from Winston Churchill seems particularly pertinent to the former comrades who now rule us, as they track even further away form their Marxist and Trotskyite origins and become what the Chinese communist dictator Mao Tse-Tung used to describe as “capitalist running dogs”!

Professor Alan Maynard OBE appraises the cost-benefit possibilities – expected and otherwise – of computerisation in healthcare

We book our travel, hotels and holidays electronically. We access our bank accounts and shop electronically. And we are continually told that information technology is about to revolutionise the NHS.

So why is the revolution such a long time coming?

The first problem is the chaps and chapesses who get paid over £100,000 per year to work in the NHS. There are two overlapping types of such persons.

Professor Alan Maynard OBE looks at the role of doctors in management ... and finds that though it already exists, it isn't working properly

A fundamental part of the Darzi report is the role of doctors as managers in producing improved quality of patient care in the NHS. The notion is that if doctors are brought into management, resources will be used more efficiently.

Is this assertion a non-sequitur in need of resolution by Sooty and his magic wand? Or is the promised land about to arrive?

Professor Alan Maynard OBE surveys the impact of the recession on the NHS's chances of survival

The UK economy had two major strengths: its finance industry and North Sea oil. The latter is gradually running out; and the bankers should be run out of town for ruining the prosperity of our country.

Depending on whose forecast you read, the UK economy may shrink by three to five per cent this year. Some pessimists think that we may emulate the Japanese, and lose up to ten per cent of national income.