Alan Maynard, emeritus professor of health economics at the University of York, who has died aged 73, was crucial in the development of his discipline into an international profession. He also had a real impact on policy, not just in the UK.
He was, for example, an originator of the idea that better value for money and better outcomes might be achieved if family doctors were given budgets with which to buy their patients’ care. He was an early and public advocate of the principle that, before the NHS paid for them, drug companies should have to show that their new products were not just clinically effective but cost-effective. That idea resulted in the creation in 1999 of Nice, the National Institute for Health and Care Excellence, a model that other countries have adopted and adapted.
Few would have predicted such an impact for the slightly scrawny kid growing up in postwar Bebington in Cheshire, the son of Edward Maynard, a shoe buyer, and his wife, Hilda (nee McCausland). “He hated school and didn’t really learn to read properly until he was nine,” according to Elizabeth Shanahan, whom Maynard met as a teenager and married in 1968, in one of the few conventional acts of his life. “The world was in revolt,” Liz recalled, “but we got married with lots of bridesmaids and Pyrex casseroles.”
He had scraped into the local grammar school, only to be told bluntly that he would never get to university. But two A-levels took him to Newcastle, initially to do accountancy – “something he also hated” – before a switch to economics took him to the subject that, Liz said, quite simply made him. A second degree at York led to an assistant lectureship at Exeter University alongside Tony Culyer, an equally influential economist.
Back in the 1960s, few economists believed health was a subject fit for their high-minded attention. But Culyer and Maynard, along with Alan Williams, who recruited the pair to York – Maynard became lecturer in economics there in 1971 – are now seen as the founding fathers of health economics in the UK.
Once at York, Maynard created an MSc in the subject and then, in 1983 (the year in which he was appointed professor), established the Centre for Health Economics, which in turn produced “the York diaspora”. More than 750 of its graduates now work in governments, universities, pharmaceutical companies, health services and think tanks around the world. He was an inspirational teacher not just of economists but of medical students, who would find themselves facing questions such as “Is killing people wrong?” Lectures and supervisions were laced with irony, humour and challenge, but also kindness and compassion.
Maynard authored or co-authored more than 500 academic papers, was founding editor in 1992 of what is now the leading journal Health Economics, and in 2015 was awarded the Graham prize – the closest health services research gets to a Nobel prize. However, his role as a great communicator and intellectual agent provocateur was at least as important as his academic work. He wrote countless, often irreverent, media columns, and engaged endlessly with journalists, because, to paraphrase his guide on how to get research translated into action, “you have to find your allies anywhere and everywhere”.
He spent a good chunk of his life hurling squibs of wit and doses of wisdom at the great, the good, and the misguided in the world of healthcare. Politicians were criticised for faith-based rather than evidence-based policy, and for failing to evaluate what they did. The august medical royal colleges were accused of taking taxpayer funded grants but failing to protect patients. The stricture that the NHS has been subject to repeated “re-disorganisation” is almost certainly Maynard’s. And he knew all about that, because, unlike many academics, he was “covered in coal dust” – he was the chair or a director of his local NHS organisations for more than 20 years.
His willingness to throw a match into any passing box of fireworks won him adoring fans. But it also made him enemies. To some he seemed just flippant, a trouble-maker. And he could overdo it. But behind the barbs was almost always a kernel of truth that even those who were wounded could come in time to recognise. Many who mattered most always recognised his value – the Department of Health, the Commons health select committee, the World Bank and the World Health Organisation were just some of those who called in his wisdom as well as his wit.
For behind the irreverence, the alliance building and the provocation was a serious intent – a profound moral belief that it was everyone’s duty to get the best value out of healthcare expenditure. The incentives and vested interests that stood in the way of that had to be challenged. Better incentives had to be found. The success of healthcare had to be measured by its outcomes, not its inputs – and that included the then revolutionary idea that patients themselves, not the just the clinicians, should be asked systematically whether their operation had in fact proved a success. For all that and more, modern healthcare owes him much. Maynard’s manoeuvres were masterful. And indeed a success.
He is survived by Liz and their children, Justin, John, Jane and Samantha, and his older sister, Jean.
• Alan Keith Maynard, health economist, born 15 December 1944; died 2 February 2018
