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The Maynard Doctrine: The season to be jolly? Postman Pat delivers Christmas thumbscrews for the NHS

The Christmas message of “goodwill” in the 2009—10 Operating Framework for the NHS is that the hospitals in particular are to be screwed until their pips squeak!  

This is a product of a mind-blowing discovery in the Department of Health: there is evidence that hospitals are inefficient! Comrade Darzi, a junior laddie in the Great Leader’s entourage, rediscovered what had been known for many decades - i.e. there are large, unexplained and wasteful variations in clinical practice, and that (perish the thought!) the patient outcomes of many of the billions spent on the NHS are largely unknown.

Comrade Darzi’s boss, Comrade Postman Pat, like the good protector of the proletariat that he is, immediately believed his laddie’s conclusion. After all, Darzi is not only a good comrade , he is also a learned quack.  So after pouring billions into the NHS for an unknown effect on population health, Comrade Pat has decided to engineer the beating-up of the hospitals in particular.

Strictly Come CQUIN
The first Christmas present for NHS hospitals is a meagre uplift in the PbR tariff. Hospitals are given an uplift of 1.7%, plus an additional 0.5% if they achieve quality targets. The quality targets are to be invented by PCTs as part of CQUIN i.e. Commissioning for Quality and Innovation.

You can now hear the scratching of many heads in PCTs around England, as comrades activate their all-too-long dormant grey cells and invent all sorts of nasty wheezes that hospitals will have to perform if they are to get their additional 0.5% uplift in tariffs.

Comrade Commissar Nicholson has announced that  2009-10 is to be the “Year Of Measurement”, in the good Maoist manner in which he operates. It will be followed by the “Great Stumble Forward”, as the NHS reflects on the recent seven years of plenty and prepares for the impending seven years of want in which all salaries will be reduced by the high levels of taxation needed to bail out overpaid bankers and other scoundrels who have ripped off the proletariat

It’s A Wonderful Life – predictions for 2009
This Christmas bounty is to be complemented by (as yet secret) policy announcements in the forthcoming Year Of Measurement.

Yet we can exclusively reveal the secret plans for 2009, foolishly left in a DH photocopier while Richmond House-ites rushed out for their Christmas Lunch of langue a la joue.

Firstly, medical schools are to close, as the NHS can no longer afford to employ doctors. Primary care will be based on one practitioner per 10,000 patients (compared to 1,750 now). GPs will be replaced by unemployed graduates, who will be given poorly-paid jobs provided they can pass a simple spelling test and can write legibly but are deemed unfit for journalism. It is anticipated that relatively few graduates will pass these tests; and if this is the case standards will be “adjusted” to reflect merit where applicants are party members.

In hospitals, unemployed science graduates will be dressed up (bare below the elbows, of course) to do diagnostic tests and escort unaffordable consultants from their workplaces. They will be paid a low salary, funded from the sequestration of all the pension rights of hospitals consultants. It is anticipated that these funds will also be sufficient to give all NHS nurses a fortnight’s holiday in Cuba.

This “Great Stumble Forward” may give rise to concerns about patient safety and access to care. Access targets will be achieved by extrapolating  forward the trends of the last five years, with no attention being paid to current reported data.

This evidence-based approach will be supported by policies that ensure that any complaining patients are offered a free passage to Zimbabwe. Any journalists or academics who question the innovative and forward-thinking policies of Comrades Pat and Nicholson will be offered accommodation in the Congo war zones.

These policies of redundancy and wage cuts will of course enthuse the workers, and ensure that the NHS will be revolutionised. Any public questioning that emerges will be countered by the recognition that we are all skint; and only the powerless should suffer the consequences of  the totally inadequate “light touch” regulatory policies adopted by successive governments.

Happy Christmas, and may you be healthy and stimulated by 2009 - the Year Of Measurement.