Tuesday, September 28, 2004

Our Approach

My contention is that the money is being wasted and that the project is doomed to failure because it is operating on the following assumptions:

1) A big problem cannot be solved except by a centralised, massively funded, standardised approach.

2) There is no need to study working practices on the ground before trying to improve them.

3) The "experts" know best. The more highly paid they are, the more they can be trusted to solve the problem.

This is in contrast to the following approach:

1) Start by assuming we don't know anything about how the NHS REALLY works.

2) Don't ask people what they want until you have studied what they actually DO in their working lives. If you ask them what they want, they will just tell you what they think would impress their peers, or tell you what you want to hear.

3) Having understood local working practices in depth, invent ways to use ICT to enhance working practices and free people up from burdensome bureaucracy. Do local pilot schemes to prove that things work.

4) As much as possible, leverage the hard-won wisdom of committed, local personnel on the spot. Where an existing solution is robust, enhance it in cooperation with its providers.

5) Having understood the local requirements in depth, define the specification for the central "spine" and the gateways into and out of it. Publish the specifications (like Internet RFCs), so that experts can provide feedback and local providers can develop their connections to and from the spine.

6) As much as possible, allow existing local providers to continue to provide the service. This is a public service, so it should support the economy of the community it serves.

If this approach had been taken from the start, there would be no need to try to "sell" the system retrospectively to the community of practitioners and patients, since they would have been involved in inventing it in the first place.

The above approach would leverage existing expertise, and the whole thing could be done successfully for less than 10% of the cost of the monster which is currently being created.

If anyone had tried to develop a system for car maintenance using the centralised approach, the road transportation system would never have been successfully developed. Likewise, the Internet would not exist if such an absurd approach had been attempted.

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