Richard Smith: can the internet transform public services?

Richard SmithSlowly but surely the internet is transforming industries—finance, travel, music, entertainment—but so far it has had little impact on public services. But can it transform public services and if so how and when? These were the questions that ran through a day of “cocreation” organized by Patient Opinion, an organisation founded by GP Paul Hodgkin that allows patients to share their stories of the NHS with the hope of improving services.

The long term vision of the social entrepreneurs at the day is that the internet can make all public services, including the NHS, police, and local government, more responsive, more bottom up than top down. Patients will not be seen simply as needy recipients of care but people who, through sharing their stories and experiences, can help others.

Denise Stevens, founder of Enabled by Design, described how she’s begun to make this vision a reality. She has multiple sclerosis and found that the living aids that she was given for her home were ugly and depressing and made her home feel like a hospital. Surely, she thought, it doesn’t have to be like this. She found mainstream products that looked a lot better and would serve her needs just as well as those supplied by the NHS, and then she wondered what she could do to make things better for others. The website she founded has her blog, loves and hates, product reviews, and an ideas factory. Other people can find their way to better products, but her longer term aim is to stimulate innovation and good design in an area that hasn’t had it for decades: aids now look very like those from the 1970s.

Tom Loosemore, the head of Channel Four’s Innovation for the Public Fund and formerly head of broadband at the BBC, is getting impatient with the speed of progress. After 10 years of thought he has reached the radical conclusion, unpopular with many, that governments should get out of websites. NHS Choices, for example, should be canned. The problems with government websites is that they are stuck firmly in the past, dampen innovation, are terrible value for money, and stop government truly “listening” because moderation of websites is in the end censorship.

Instead of building websites government should make data available for other organisations—whether for profit or not for profit—to build into websites with contractual requirements to keep the websites up to date and display the brand of whomever produces the data—perhaps the NHS. Similarly governments should pull out of transaction sites and let other organisations build them. This arrangement is common in the United States, and HM Revenue and Customs has begun to make it a reality here, allowing interaction of its system with other systems.

The result of such a development, Loosemore believes, would be an acceleration in innovation, more rapid achievement of the vision of the public becoming cocreators of public services, and dramatically improved value for money. A representative of NHS Choices was less keen but welcomed competition and the existence of Patient Opinion.

From his experience at the BBC, where he closed several community sites, Loosemore also believes that government — and the BBC – should listen not through its own websites but through tapping into the conversations about their services going on all over the web.

The values of Channel 4 written into the act that created it are that it must encourage innovation, inspire change, and “make trouble in the public interest.” These, he argued, are excellent values for those using the internet to improve public services. I agree.

Competing interest: RS is chairman of Patients Know Best, one of the sponsors of the meeting, and an organization that might benefit from governments getting out of websites (as might the BMJ Publishing Group).

  • How rejuvenating for this former clinician and recent patient to have all his past perceptions, even prejudices, vindicated by Richard Smith.

    However, I have, as ever, a small difficulty in embracing the predominance of one partner in any transaction, whether as a patient or the business organisation “knowing the best.” How could any one possibly know the best, even if they knew what was best.

    At the turn of the last century, William Osler declaimed : “listen to the patient, he is telling you the diagnosis.” True, very true in 1903 but things have moved on immeassurably since then.

    My own patients who regularly left the choice of their therapeutic options to me in 1970s {“ know what’s best”} began to bring list of questions in the 1990s,often gleaned from unreliable internet sites, and not infrquently claimed to know better than their GPs!

    I have no axe to grind as a superannuated consultant but any imbalance of power is transparently against the principle of the “golden mean ” propounded by Aristotle in his seminal treatise on ethics*.

    Strange, how we seem to fallen into the habit of emphasising extremes [for instance about weather, wealth, poverty or religion } instead of listening to Aristotle, who proclaimed that balance is the key to the good soul.

    We may not be be able to step in the same river twice, as Heraclitus told us, but to forget the golden mean in all human affairs is as wrong as the patronising arrogance of some of us.

    * Aristotle,’The Nichomechean Ethics.’ Penguin Classics,2004, 284-285