Survival of the fittest is a principle which has passed the test of time. It is therefore a mystery to me why, when it comes to information technology, the NHS Executive bureaucracy fights against it when the dire consequences of doing so are clear to see.
I am not complaining about size.
The NHS is big, and big can sometimes be wonderful in the world of IT. People forget that before IBM started selling PCs there were dozens of different machines and they were all incompatible with each other. That meant that your choice of machine was dictated by the program you wanted to run, and that one computer could not run all the best programs.
IBM, a company that at the time was larger than all of its major competitors combined, entered the market with a decent computer and a huge corporate customer base - and it created a standard overnight. Now every machine has to be PC compatible, which has had enormous benefits for all of us.
But size is not everything. The PC was not IBM's first attempt at desktop computing. A number of earlier products were simply not good enough and sank without trace (anyone got an IBM 5110 compatible?
- I think not). Size alone was insufficient to create a standard in the commercial world. The problem was that IBM, a private company, found that it was too large and bureaucratic to succeed in desktop computing.
Smaller, leaner companies such as Apple and Commodore were running it ragged. IBM's machines were becoming obsolete halfway through the design stage because its processes were too ponderous. So it formed a separate independent organisation to create the IBM PC and cut its idea-to-production time by more than 80 per cent. Only by doing this was IBM able to respond to customer demands in this lightening-fast environment - and the results were spectacular.
Unfortunately for IBM, when the blue giant tried to redefine the PC standard with the PS/2, it failed - mainly because there was insufficient reason to make the change and nobody cared what IBM wanted.
Despite its size and then near 50 per cent market share, IBM was unable to control the natural forces of evolution. In a commercial world, its misjudgement resulted in a massive reduction in its market share.
The NHS is big (nearly as big as IBM in revenue terms).However, its bureaucratic nature means that the organisation behaves very differently from independent groups of users in the commercial world. The NHS Executive is able to set guidelines and enforce strategies without regard to the views of the people they are going to impact on. The link between strategy and viability is often purely theoretical. Innovation is rarely based on widespread momentum at grassroots level in the way that it is in the private sector.
The NHS Executive must realise that having the power to impose strategies or technologies does not make them work any better. A dog is a dog whether it is in the private or public sector. The difference is that through a process of natural evolution, the mass of users in the private sector naturally select workable solutions. These become industry standards, and unsuccessful solutions usually fall by the wayside.
On the other hand, in a centrally controlled bureaucracy such as the NHS, where those setting the agenda are at a great distance from those who have to implement and work with it, centrally imposed schemes tend to lumber on and on, consuming vast resources, irrespective of whether or not they are found to be useful, successful or even offer value for money. In many cases, such as with the version three Read codes, projects are only withdrawn when it can be proven conclusively that the scheme is completely unworkable. In this environment, the fittest only gets a look in when all else has failed - and even then only if it is politically acceptable to move to a better alternative.
Darwin's theories rely on there being viable options to select from in the first place. It must be obvious that many individuals and organisations beavering away at an individual level on practical projects will produce a wider range of options than a single, centralised core project. But those opt ions must be considered as par t of the central decision-making process if they are to be of any value. For example, I wonder how much assessment was done of intranet interfaces in use before the Executive proposed its own design standards.
Judging by the limitations and suitability of the proposals in comparison with what is generally available, I would guess very little.
A few years ago, the Scottish Office came up with a scheme for identifying and propagating good practice in IT projects called 'find and foster'. I do not know whether the scheme was ever implemented, but the idea was excellent. Allow IT projects to evolve naturally and locally, see which ones work best and share the information with others in an open and honest manner. Make it easy for others to adopt the technology without actually imposing it.
This method of working has so many benefits. Ideas taken from the ground up are more likely to work, local initiatives are much faster to get off the ground. And, most important, user involvement in the selection process generates the type of ownership that is essential for success.
After a series of IT disasters, the Commons public accounts committee asked NHS chief executive Sir Alan Langlands: 'If you saw someone walk into a brick wall and pick themselves up and walk into a brick wall again, would the thought perhaps cross your mind that they might be drunk or of unsound mind?' Looking at Read/Snomed, the South West procurement recommendations, the national e-mail directory, NHSnet and the proposals for intranet standards, one is tempted to conclude - 'Here we go again'.