Alan Maynard – Alas No More

Tony Culyer writes on the contribution to health economics of Alan Maynard, the pioneering health economist, who died on February 2nd 2018.

If you wanted to know what people thought of Alan Maynard, the pioneering health economist, and why they thought it, you could not do better than to pick up a little yellow paperback book called Maynard Matters – Critical Thinking on Health Policy which will tell you nearly all you need to know about him and why he mattered.

He will be chiefly remembered as an uncompromising rubber of other people’s noses (especially those belonging to doctors, politicians and health service managers) in the ineluctable truths of economics. His economics was not over-sophisticated and he never blinded innocent mind with maths or weighty abstractions. Simple mainstream economic points, well-made, empirically bolstered, forcefully (often ironically) expressed and insightfully applied to serious problems – these are the hallmarks of classic Maynard the window-breaker (not my phrase but Virginia Bottomley’s – consult the yellow paperback). He could coin a phrase. My favourite is “NHS redisorganisation”, a very handy neologism for all students of health care in the UK. These talents made him a brilliant teacher. I can’t imagine anyone sleeping through an Alan Maynard lecture.

But. (There’s a good one-word sentence for you.) Look at that yellow paperback. The first half of it tells you what others thought of him. The second tells you what he thought – about regional inequalities in the NHS, putting the economics in evidence informed medicine where Cochrane and Sackett had stopped short, resisting the narrowing perspective of “health economics” as it tended to become identified with “cost-effectiveness analysis”, addiction and policies for behaviour change, manpower (as was once said) planning and role substitution in the clinical professions, misdirected training in public health management skills, redirecting policy focus from inputs to outputs, the need for rational rationing, competition and choice in the NHS, avoiding misplaced market idolatry, NHS disorganisation and redisorganisation, fallacious international comparisons of healthcare systems, general practice fund-holding, and sensible regulation of pharmaceuticals.

Nearly all of his writing across this wide portfolio of topics appeared in accessible places – most notably the Health Service Journal – that were not exclusively where economists write for economists. This was his greatest gift: to be able to summarise large literatures in approachable language with eagle-eyed targeting and dollops of irony to discomfort the complacent. It wasn’t his only gift. He also made notable contributions to the material summarised. He founded the Centre for Health Economics at York and nurtured it into an internationally dominant position. He directed the first UK Masters programme in health economics at York, which can convincingly claim still to be the world leader. He taught countless students and won and undertook dozens (possibly hundreds) of research grants. He was an indefatigable lecturer throughout the UK and abroad. He was a generous helper and supporter of other university centres of health economics expertise (notably Aberdeen, from which he had an honorary doctorate). He was a committed Chair of York Hospital for twelve years and of the Vale of York NHS Commissioning Group for four until his health began to fail. He received an OBE for his service to the NHS.

In these days, when academic merit is increasingly being reckoned in terms of “impact”, he surely stands alone as an outstanding health economist who really did make a difference.

Read the full obituary here.

Alan Maynard gave the 2013 OHE Annual Lecture on Contracting for Quality in the NHS.