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The Maynard Doctrine: a Conservative Party memo on modest proposals for NHS reform?

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.

Private and Confidential

Conservative Party – Shadow Cabinet Only

Memorandum: Plans for the Reform of the NHS in 2010

The funding situation
The budget deficit when we assume power in May 2010 will be greater than shown in the recent budget statement (March 2009). The expense of  financing government bonds and the cost of social security now that unemployment is headed to three million plus is creating an ever-worsening gap between government tax revenue income and expenditure.

NHS funding
The government has indicated ambiguously its intention to fund the NHS in a “flat cash” manner for the 2011-14 planning period. This is clearly unaffordable, and once in power as Chancellor, George Osborne will initiate further cuts across the public sector.
Furthermore, when elected next year, we will have an emergency budget and cut 2010-11 allocations in addition to the £2 billion already removed by the current government.

Our programme of reform
We will cut public sector wages by five per cent when elected (we understand that Labour, if re-elected, will do the same). We will exclude all those earning less than 125 per cent of the national minimum wage from these cuts.

All bonus, overtime and performance-related pay will be curbed by delegating the management of pay and conditions to local NHS employers. Cash limits and block grant funding of all NHS institutions will mean that local budgets will be very tight, and thus employers will de facto have to stop these payments if they are to remain in financial balance.

The current earmarked funding of clinical excellence awards will be paid to hospitals as an allocation that can be spent freely. We anticipate that doctors and managers will be agreed that these monies be spent on patient care, rather than augmenting already large salaries in this time of national hardship.

The national reform of pensions will affect the NHS. All new entrants to the NHS labour force will be denied access to the current public sector pension programme. Retirees benefiting from public sector pensions will pay an additional income tax levy of between one and three per cent, depending on their pension benefit level.

Even though ideologically we favour choice, this policy can no longer be afforded. To have choice, we have to have excess capacity - and this can no longer be tolerated in an efficient NHS.

We will sell this policy switch by arguing that costs have to be cut and that the remaining capacity will be guaranteed to be of the highest quality. We are preparing for discussions with Max Clifford Associates to help us market this image of safety and economy.

Given the incompetence of the Department of Health, we will as promised delegate management of the NHS to an autonomous agency staffed by businessmen and women who have voted for us in the election. NICE-approved truth drugs will be administered to all applicants for membership of this agency, to ensure that these people are really “one of us”.

We will save money by abolishing one in two medical and healthcare quangos. Monitor and the Care Quality Commission will be merged. The National Institute for Health and Clinical Excellence (NICE) will be abolished and the English NHS will henceforward use the technology appraisal data created by the Scottish Medicines Commission at a much lower cost.

The proliferation of workforce regulatory bodies will be culled to provide one agency. These savings and the withdrawal of subsidies (particularly tax subsidies) to the ineffective Royal Colleges will fund a unitary body headed by an experienced police person. This new organisation will deliver all decisions about fitness to practice of individual practitioners within three months of the initiation of review. Where necessary, coins can be tossed to ensure a speedy outcome.

These radical policy innovations will enable us to meet our promise to protect the NHS and ensure its future. Contingency plans have been drawn up to extend the scope and level of user charges and subsidise private insurance cover if economic circumstances (in particular the arrival of the International Monetary Fund) lead to a run on sterling and the need to reduce public expenditure further.

(N.B. For those interested in leaking this document, it seems that the price you will get from the Telegraph group may exceed that which will be offered by News International)