Chris Lancelot: Could evolution also save the NHS?

Last week, I discussed how Darwinistic evolution applies not just to the natural world but to all autonomous units - biological or non-biological - competing for finite resources.

GP practices are an excellent example: provided there is no external interference from managers, good-quality practices will thrive while inefficient ones go to the wall.

But can we apply this logic to the whole NHS? At a time of financial cutbacks could we use evolutionary principles to reduce costs while maintaining quality?

The answer is undoubtedly, yes - but there is an important caveat. Evolution by natural selection only occurs when several conditions are met: there must be competition; this must be for finite resources and between autonomous entities; there must be no external interference or preferential treatment; and there can be no rescuing of failed entities.

In the NHS, primary care comes closest to satisfying these requirements, which is why general practice works so well. Similarly, in secondary care, a variety of providers creates the competition vital to Darwinistic evolution. The DoH's plan to introduce more providers will create competition which will drive standards up and costs down - but only if there is no external interference through preferential pricing or favouritism, which unfortunately is not the case.

However, primary and secondary care is where evolution in the NHS currently stops, because the remainder of the NHS - its core managerial structure - has no competition and therefore experiences no natural evolutionary pressures. Because there is only one PCT in any one area, only one SHA for each region, and only one DoH, then Darwinistic evolution cannot apply: and it is significant that these groups are the most wasteful and inefficient in the NHS.

If only these central structures could experience the refining effects of compet-ition, evolution would inevitably occur and the NHS would be free of its resource-sapping over-management, its quangos and its complex, non-evolved and totally unfit central IT system. What a thought!

But how can a monolithic organisation experience competition, other than from private practice? More next week.

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