4 min read

The Maynard Doctrine: Now for some real reform, Mr Lansley

Health economist Professor Alan Maynard greatly increases his chances of a knighthood with calls for the NHS Information Centre to be funded adequately to deliver the data to drive real improvement in NHS productivity and quality; less ‘leadership’ guff and more analytics; and more in-house NHS bureaucracy to replace management consultancies.

Feeble old Parliament has now nearly done with 'gasbagging' the NHS reform bill amidst a media frenzy which has largely ignored how to improve NHS productivity.

Consequently, the focus now is how this cumbersome set of poorly-related proposals will be implemented by Nicholson’s nannies in the NCB and by hard-working managers and clinicians.


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There is now a nice opportunity for the Secretary of State Andrew Lansley (hereinafter SOSAL, the man with the pathetic alcohol policy!) to do something useful - but what?

The data day
Firstly SOSAL has rightly emphasised the need for better use of data. Amen! We all say! Hospital episode statistics (HES) have been collected and neglected by the NHS for 15 years at a cost of millions each year.

However SOSAL and his champagne-quaffing chums in the Coalition government have introduced blindly a set of austerity cuts. Of particular concern is the budget of the NHS Information Centre (the IC).

If the NHS is to follow SOSAL’s lead and use data systematically rather than “sticking their finger in the dike and praying”, they will need prompt and helpful assistance from the IC in downloading data and ensuring the accuracy, pertinence and timeliness of analysis.

As patient-reported outcomes data (PROMs) data continues to be released by the IC, it will show variations in treatment thresholds for hips, knees and hernias, as well as variations on improvements in physical and psychological functioning before and after expensive elective procedures.

As PROMs are expanded to cardiac surgery, heart failure asthma, stroke and acute myocardial infarctions (heart attacks), the IC will accumulate a goldmine of data to complement Hospital Episode Statistics:. we will be able to compare Mr Arrogant, a local orthopaedic surgeon, with his local peers and national norms both in terms of activity and mortality (HES) and in terms of improved quality of life after hip / knee replacements (PROMs).

What fun will be had!

Resourcing the data
Local NHS managers in CCGs and Trusts will want rapid access to HES and PROMs data downloads However, SOSAL has failed to provide the IC with adequate funds to exploit this potential.

Come on old lad! You will be accused of hypocrisy and stupidity (shame! shock! horror!) unless you give them the staffing and resources to implement a data usage revolution in the NHS.

So ’tis time for a radical reform: a consistent approach to a fundamental reform process which can ‘confuse’ the NHS with data to improve productivity. This can only be achieved if the IC is funded properly!

Less ‘leadership’ guff; more analytics
Another vital reform is SOSAL’s attitude to NHS managers. OK! The Tory twits he has to work with (and perhaps he too, in his cups?) think that NHS managers are a waste of space.

Careful with this line of argument, dearie! The NHS management trainee scheme creams some excellent talent. Their training has too large an element of guff (i.e. descriptive waffle and opinion) and inadequate training in the use of evidence and data, and fails to ensure their career development efficiently. These aspects of that programme need reform.

Existing NHS managers vary in quality, just as their private sector counterparts do. They, too, need better focused support and development with less emphasis on ‘leadership’ guff and more on analytics.

How well tuned in is your local management team to the Cochrane Collaboration (www.cochrane.org)? How often do they use NHS-CRD? Would they be able to define the strengths and weaknesses of randomised controlled trails (RCTs)? How closely are they tuned into NICE and the research activities of DH-NIHR?

I have deliberately not defined some abbreviations and assume all are familiar with them? Pigs may fly!

NHS reform will not fly until such aspects of the health service are integrated into routine NHS management activity. SOSAL’s funding and advocacy of such activity needs fine-tuning and incentivising. How?

Faith in management consultants
An essential first step is the further development of in-house NHS skills and expertise. A nasty habit of all SOS and senior civil servants in the Department of Stealth is when confronted by a policy challenge their response is to call up a consultancy firm.

The first NHS redisorganisation nearly 40 years ago, led by a SOS by the name of Sir Keith Joseph, led to the production of 1972’s “Grey Book” (Management Arrangements For The Reorganised National Health Service), a guide for managers, produced by McKinseys. Since then, management consultancy firms, like cancers, are everywhere and growing.

The remarkable thing about consultancy firms is the lack of peer review of their reports. These are always expensive, and rarely published. McKinseys, KPMG and their mates harvest tens of millions from the DH and the NHS annually. Why can’t much of this work be done in-house, by DH and the NHS?

Answer: the belief that consultancy firms do a better job. As with the Private Finance Initiative (PFI), there is no evidence to support this contention - and some evidence to support the contention that this work is a nice gravy train providing obvious answers at high cost

The cost of consultancies is rarely revealed. Due to lack of evaluation of their work and of peer review, their benefits can be obscure. Of course these firms offer nice ‘hospitality’ benefits to their funders, as often set forth in Private Eye: a day at the rugby or a night at the opera are nice little pressies when contracts are let!

So SOSAL the lessons are obvious. Invest in your civil servants and managers, as they could do much of the consultancy analysis in-house at a lower cost - even if the NHS administrative “burden” was increased somewhat, and your right-wing colleagues consequently die of shock at the idea! Some (perhaps the PM) might even welcome such ‘liberal-economic cleansing’.

Time, then, SOSAL old chap, to get focused on the essentials. The chaos you are inflicting on the NHS will the ill-considered NHS Bill is accepted by us as inevitable. If any aspect of that hotch-potch of changes is to succeed in improving NHS productivity, the issues raised here have to be dealt with efficiently and promptly.

Can we expect you to do that?

Here’s hoping.