Alan Maynard is professor of health economics, University of York

Monday 1 September 2008

Time to "screw" the NHS?

The Blair-Brown axis has increased the funding of the NHS in an unprecedented manner, with an additional £50 billion and total expenditure now of £105 billion. Soon we will be spending ten per cent of gross domestic product (GDP) on the NHS. What are we getting for our money?

The US healthcare system is fragmented and expensive, costing twice as much per capita as the NHS and consuming nearly 16 per cent of a much larger national income.

If you are elderly or disabled, you can get a reasonable package of healthcare benefits from Medicare, which is federally funded. If you have fought for US armed forces, you are eligible for benefits from the Veterans Administration which is also federally funded and an efficient mini-NHS.

The Darzi report rightly extols the virtue of outcome measurement, and reiterates yet again the problem of clinical practice variations. However its focus is primarily clinical, where clinical is defined as doctors getting involved in systematic comparative review of practice and subsequently getting their act together.

The largest workforce in the NHS is nursing. Nursing costs typically make up thirty-five per cent of hospitals expenditure and with growing employment in primary care, nurses are also an increasing cost there.

Alan Maynard is professor of health economics, University of York

Monday 21 July 2008

The trouble with incentives is that they work, but they may produce changes in behaviour that are at once welcome and perverse.

Take, for instance, the fines announced in December 2007 for NHS trusts that fail to hit their C.Difficile targets. These fines are potentially large, up to £3.5 million for unsuccessful trusts. Faced by such fines, managers are striving very hard to improve the performance of their hospitals - just as Ministers hoped they would.

Alan Maynard is professor of health economics, University of York

Monday 7 July 2008

During the Wilson government in the mid-1970s, clinical practice variations were identified as a major problem. They remain so today, with the Darzi report, High-Quality Healthcare For All, demanding change because similar patients with similar needs get very different treatment.