Contracting for Quality in the NHS: 20th Annual Lecture Publication

The key to effective and lasting quality improvement is better, not more, regulation.
Professor Alan Maynard, University of York, delivered the 20th OHE Annual Lecture five months after release of the Francis Report, a public inquiry into serious failures in patient care at the Mid Staffordshire NHS Foundation Trust.

OHE’s Annual Lecture, given by Professor Alan Maynard in July 2013, is now available as a publication and can be downloaded from this website.

Professor Alan Maynard, University of York, delivered the 20th OHE Annual Lecture five months after release of the Francis Report, a public inquiry into serious failures in patient care at the Mid Staffordshire NHS Foundation Trust. This three-volume, 1,794-page report made 290 recommendations for more regulation. "Sadly", Professor Maynard notes, "[Francis’s] proposals were not evidenced, not prioritised and not costed".

As with many earlier inquiries into alleged deficiencies in care in the NHS, the Francis Report’s remedies emphasise additional regulation, an approach with which Professor Maynard disagrees. UK responses to perceived problems in health care quality, he notes, have produced continuous structural “re-disorganisation” over the past 40 years. These rarely have been evidence based; the disruptions created often were more profound than any improvement.

The alternative to "more regulation (as advocated by lawyers and public inquiries) is better regulation", according to Professor Maynard. Better regulation, in turn, is based on evidence and economic analysis. Outcomes measurement is at the core of the economic approach to reforming health care proposed by Professor Maynard. Understanding outcomes, in turn, allows the adoption of effective incentives for change, both financial and non-financial.

A crucial issue is variation in clinical practice, long of concern in the UK and elsewhere, as Professor Maynard explains. "Contracting for quality and patient protection in the NHS, and all other health care systems", he concludes, "requires scepticism about medical practice and rigorous performance review of clinicians by clinicians. . . . Reputation should be the engine of quality improvement that is led by clinicians, rather than repetitive political reorganisations and increases in legalistic regulation".

Download Maynard, A., 2014. Contracting for quality in the NHS: putting the Francis Report in perspective. Annual lecture series. London: Office of Health Economics.

Professor Maynard’s slide presentation for the lecture also is available by clicking here.