I was on the phone to my Mum yesterday and we basically both ended up bitching about the NHS, particularly when we compare it to the South African medical landscape (which, to be fair, we paid for, but still found to be higher quality for less than 11% of our earnings).

What occurred to me when we were having this conversation, is that a lot of the NHS’s problems (e.g. treatment taking a long time, high cost, etc) come about as a result of emergent behaviours because of the rules put in place. For instance, the fact that every practice has been tasked with “keeping costs down” means that for anything expensive, GPs would rather refer someone to a hospital than treat them locally. That way, the eventual cost for the treatment lies in another cost centre.

Another obvious example is the ubiquitous treatment of budget allocation by most government departments — i.e. the “use it or lose it” principle. Because there is no generic, effective measure by which the GOOD use of a department’s budget has been used, the only real metric is whether it was used up/whether they ran out. This is what results in the emergent behaviour of the “last quarter scramble”, when departments will buy all sorts of shit, just to finish using their budget.

So what’s my point? My point is, that instead of employing all these management consultants who fail to build anything useful, the government/NHS should be employing some game designers/theorists. The important thing is not what the rules are, but what emergent behaviour they will result in.

DISCLAIMER: First, I am not a game designer. My knowledge of game theory is not extensive, but when I was doing AI-related research, I got enough of a taste to at least vaguely know what I’m on about. Second, I’m not a part of the NHS — and I apologise if I get some things wrong. My point is not to speak harshly about the PEOPLE in the NHS, but to question the structure/rules.