Health economist Professor Alan Maynard examines the ills of Big Pharma, and offers his own prescriptions for improvement.

Big Pharma is struggling, and with a continuing history of naughtiness involving greed and corruption, its critics are out for blood.

Health economist Professor Alan Maynard has received a wholly-authentic leak from a well-known political strategist to a well-known Jeremy. We publish it here in blatant defiance of the Data Protection Act.

Top secret: for your eyes only

Dear Jeremy,

Dave asked me to brief you on what he would like done with the National Health Service. As ever, and certainly until after we are re-elected in 2015 with a majority, the party line is that we are the heroic defenders of the NHS.

Health economist Professor Alan Maynard looks at NHS reform plans from 1974, and finds that all too little has changed.

An appraisal of the history of NHS reform since 1974 shows a naïve belief that altering organisational structures will improve the processes of healthcare and benefit patients in terms of their outcomes: i.e. improve their length and quality of life.

The links between structure, process and outcome are assumed, with reformers asserting unevaluated and un-evidenced conclusions from their repetitive and learning-light organisational reforms.

Health economist Professor Alan Maynard suggests we need radical reform: end two decades of policy failure and let purchasers merge with providers

The Health and Social Care Act 2012 has created a plethora of new bureaucracies, whilst undermining collective memory about past decision-making by retiring and making redundant many effective managers.

Health economist Professor Alan Maynard skewers the policy commissariat

“We know it’s stupid, but it is policy” said the Department of Health civil servant as the Secretary of State (SoS) left the room.

“But why don’t you tell Jeremy that it’s stupid?”

“Don’t worry we have but he just smiles, congratulates us on our insightful support and ignores us. It was, with varying degrees, ever thus!”

Health economist Professor Alan Maynard queries why healthcare managers appear unwilling or unable to learn from history and evidence.

Non-clinical managers and their medical colleagues appear to be dumb, as defined by their failure to learn from history and evidence. For this dumbness, they are highly paid and continue to manage the delivery of care characterised by variations in process, cost and outcomes that damages patients and taxpayers.

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Health economist Professor Alan Maynard explains why researchers ("the arrogant" *) and managers ("the ignorant" **) have to start to work together

The problem: ignorant managers and arrogant researchers
NHS managers offer us New Year messages advocating hospital closures to fund “care in the home”. Some of them vigorous advocate “telehealth” and “telecare”.

Health economist Professor Alan Maynard suggests that the NHS mandate may have missed out most of the critical issues

Health economist Professor Alan Maynard looks at NHS-saving savings, taking in decremental salary scales, reviewing pharmaceutical price naughtiness and the incredible shrinking tariff.

As the new Secretary of State snuggles into Richmond House, he is no doubt contemplating tanks on the forecourt of Richmond House and the SAS in the corridor to protect him from the gathering storm in the NHS.

Where to start?

Let us start with QIPP (quality, improvement, productivity and prevention). Has it worked?

Professor Alan Maynard looks at the oncoming financial storm facing the NHS, and explains why health policy Nirvania is home to unicorns and zombies.

Into the NHS storm with all hands on deck
The Department’s productivity challenge has translated into harvesting the low-hanging fruit: squeezing costs. How far can this continue before quality declines and rationing hits political sensitivities where they hurt?