The UK government plans to scrap the £12bn National Health Service IT scheme, commissioned by the Blair-Brown administration, and which was supposed to join up the provision of health care, linking patient records, family doctors, hospital consultants, nurses, pharmacists, managers and all the rest. The announcement comes as no surprise – from its outset, the scheme (originally and over-optimistically predicted to come in at around £2bn) always looked like a mess. Ask a consultant what a patient record should look like, for example, and you will get back a hundred pages of dense text, which will change every week as new conditions, treatments and equipment springs up, unintelligible to anyone but a specialist.
It was another example of top-down, centralist thinking. A Stalinist approach, one might even say. But the trouble with such approaches is that far too much information has to be collected, collated and processed at the centre. It is an impossible job.
The last government should have read their Hayek. Most complex human structures – language, to take just one – do not arise out of central planning but are built up through the millions of one-to-one personal interactions. We try to make ourselves understood to others, and from that grows up the words and the rules of grammar that we all use because it actually works. We don’t plan it – we don’t even realised we’re doing it – but it works.
When the budget hit £12bn – there were fears that it could reach £20bn – I commented that there was a much better way of getting a joined-up, computerised NHS. There are around 1.2 million people working in the NHS in total, so for the same price tag, £1,000 a head, we could buy them all a web-enabled laptop. Within months, rather than the predicted decade, they would all be talking to each other and working up protocols to move information about just like language – or the market – does. Sit back and watch it grow. Indeed, for £1,000 a head, we could have bought them all two laptops – one to use, and one with all our patient records on it to forget and (as seemed to be in vogue with civil servants at the time) to leave in the train.