ALAN Maynard has always been an outspoken chairman of York Hospital. Nothing has changed now he is about to step down. But his parting shot, in the form of an exclusive, hard-hitting interview with The Press, is unlikely to make comfortable reading for doctors.

As the hospital’s part-time chairman, one thing Prof Maynard has always enjoyed doing is wandering around the wards and corridors incognito.

“You get a feel for the place, and what is going on,” he says.

“I think a lot of management is about going around hearing what people have to say. Not necessarily believing all of it, but triangulating from it. You know, if X says this, and Y says that, something might be going on.”

And what 65-year-old Prof Maynard is left with, after 12 years of doing this, is a sense of injustice about the way people who work for the NHS are valued.

You have doctors earning huge sums of money. Following a massive 25 per cent hike in their salaries a few years ago, he says, the average GP is now earning about £108,000 a year, the average consultant about £120,000.

“Nurses have done reasonably well, doctors have done exceedingly well. And yet you have ancillary workers on salaries that are honestly close to the national minimum wage. The pay gap is too big in the NHS, as it is in society generally. The minimum wage today is about £5.80 an hour. There are a lot of people living off really limited incomes, and we in the NHS are a major employer of them.”

You can’t run a health service without doctors, he accepts. “But it cannot work without cleaners, without porters, either.”

Too much of the money that Labour poured into the health service went on boosting doctors’ salaries, he believes. “And we got very little for that. I’d want the BMA (British Medical Association, which represents doctors’ interests) as my union!”

If anything, Prof Maynard says, consultants are actually less busy now than they were before. “Data over the last ten years shows that the activity levels of the average consultant have declined. They are doing less, and we’re paying them more. I say to them ‘we’re paying you more, and you’re doing less’ and they say ‘the quality is higher’. To which I say ‘where are your outcome measures, sunshine?’”

That is another of Prof Maynard’s bugbears – the fact that we don’t really measure how busy doctors are, how good they are at their job, or what happens to patients after they have been treated. Okay, there are plenty of targets that hospitals and health trusts have to meet now.

But they all tend to be to do with waiting times – how long you have to wait to see a cancer specialist, or to get your hip replaced, or before you can see a nurse or doctor in A&E.

These are all worthwhile targets, and they really have helped reduce the amount of time patients wait for treatment, he says.

“They have transformed care. Ten years ago, people were waiting in pain for six to 12 months and beyond for a hip replacement. Now they are guaranteed to have it within 18 weeks. There are still challenges. The A&E target is four hours, and if you are waiting there with a bleeding grandchild, four hours is a long time. But it is much quicker than it used to be.”

But targets only measure how long we wait to be treated. The NHS is still very bad at measuring what Prof Maynard calls “outcomes” – whether a patient lived, died, or felt better after treatment.

Doctors were doing this as far back as the mid-1840s when, under the terms of the 1845 Lunacy Act, they were required to keep records of whether patients who had been treated died or recovered, were relieved or unrelieved. “Doctors who failed to record this were fined £2 – that’s £10,000 in today’s money,” Prof Maynard says. But that kind of record-keeping ended when the NHS was launched in 1949. Things are, at last, beginning to change. Since April last year, hospitals have started keeping data on the outcome of operations such as hip and knee replacements, and hernia and varicose vein surgery.

That involves patients filling in a questionnaire before treatment, saying how they feel: and then filling in another questionnaire three to six months later saying how they feel after treatment. “We would expect that at least 80 per cent of people would be feeling much better. They should be able to kick the family cat over the fence,” Prof Maynard said.

These patient reported outcome measures, or PROMS, as they are known in health service jargon, are a real move in the right direction, Prof Maynard says.

The first results are expected to be made public in April this year. But they should be just the beginning. He sits on a number of influential national bodies, and advises the House of Commons health select committee.

“And the intention of Government is to extend the use of outcome data to the whole of medical surgery within three years.”

It won’t necessarily be easy to evaluate such data. And many health professionals are pretty twitchy about it, Prof Maynard admits. The data might, for example, reveal that there are certain doctors who are less good at performing certain operations than others. Managers will then have the job of deciding what to do about it.

But as a health economist – he is Professor of Health Economy at York University in his day job – Prof Maynard is all for it.

If patient choice is to mean anything, he says, patients need to know how good the doctor they are choosing to treat them really is. Better use of outcome data may also help hospitals cut out the unacceptable variations that exist in the quality of treatment. And it might even mean expensive but ineffective forms of treatment can be ditched altogether in favour of something that works better.

In the current economic climate, that would be no bad thing.

On nurses

There has been a trend towards nurses being treated more and more as professionals – to the extent that, by 2013, all new nurses will need degrees.

Nothing wrong with that, Prof Maynard says. Many experienced nurse practitioners can do much that a GP can do – in fact, he believes some GPs could be replaced by nurse practitioners, which would save the NHS a lot of money. Nevertheless, there is also a need for some nurses who are less highly-trained, Prof Maynard says. Otherwise, we may end up with a situation where nurses are all so highly-trained none of them want to do … well, the basic caring and nursing. “When I’m old and dying, who is going to wash my bottom?” he asks. “A graduate?”

On standing down

Professor Maynard steps down as chairman of York Hospital at the end of March, after 12 years in the post. But he has been involved with the hospital since 1983 – first as a non- executive director and then, since 1997, as chairman.

“So I will miss it enormously. It is the people. We have a great team, and it is a really vibrant, supportive, friendly environment.”

He won’t mope around the place once he has stepped down, however, he says. That is the last thing his successor, Alan Rose, will need. “You really don’t want the ghost of Maynard haunting you!”

He will keep busy once he steps down, however. He still has his day job as Professor of Health Economics at the University of York. And he will continue his work with national bodies such a the House of Commons select committee on health.

Praise from top

Paying tribute to Prof Maynard, Patrick Crowley, chief executive of York Hospitals NHS Foundation Trust, said: “I have known Alan for 18 years and have yet to meet anyone with greater enthusiasm for healthcare and its development. As chair of our Foundation Trust, he can be challenging and occasionally controversial, but those who know him recognise this is always well-motivated and driven by the interests of the hospital and our community, the needs of our staff and above all else the benefits we can provide to all our patients.”

Mixed reaction to issue of NHS wage levels

THE union which represents many low-paid health workers has praised Prof Maynard for his comments, but the British Medical Association (BMA) denied consultants were doing less work than before.

Dave Prentis, general secretary of Unison, said ancillary staff were generally paid between £6.79 and £8.38 an hour.

“Professor Maynard has hit the nail on the head when he says the pay gap between staff at the top and the bottom is too wide,” Mr Prentis said.

“Our NHS would collapse without the low-paid army of cleaners, cooks, porters and care assistants. They, too, should get a decent wage for the very tough jobs they do.

A BMA spokesman said: “We’d agree entirely that the NHS could not function without porters and cleaners and they deserve more recognition.

“However, this is a distorted picture of doctors’ pay. Medical professionals have been at the forefront of major improvements to the NHS, with waiting times and mortality rates falling sharply. GPs are employed on contracts which link their income to real improvements in the health of their patients.

York GP Dr David Fair, of Jorvik Medical Practice, said: “I can see where Professor Maynard is coming from, but as an economist, he will have some respect for market forces.

“Even though some GPs may be on salaries significantly above the national average, there is still a shortage of people prepared to invest training and effort from school and university to go into the profession. One of the incentives for them to do this will be salary.”