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The 2020 Public Services Trust Blog

Friday, June 4, 2010

Four obstacles in the face of the final frontier

By Charlotte Alldritt

The sheer breadth and complexity of information and technology policy became all too clear at 2020PST’s roundtable yesterday morning.  Leading officials and activists met to discuss the next stage of open government and online self-services.  This brought us into the territory of – amongst other things – the Coalition’s ‘new politics’ of transparency and accountability; cost efficiencies and cuts; social and digital inequalities and the prospect for more personalised, responsive, citizen-focussed public services. 

 Many, many important points were raised, but four in particular stood out for me:

  •  Culture in government, Whitehall and public services - lack of awareness/understanding of the power of online ‘self services’ to deliver high quality for less is the primary barrier.  There is often a presumption that many public services can only be provided face-to-face and alternatives are ‘too cheap’ to deliver quality outcomes and too risky to implement.  Similar arguments apply with regards to open data.  Determined leadership is vital, but the business case for online service delivery and open government needs to be made.  Only then can we expect to see ingrained cultural attitudes and practices begin to change.
  • Provider capture and vested interests – often there are strong incentives acting against the diversion of citizens to lower cost channels.  While models of funding which ‘follow the user’ can help to support choice and competition in public service delivery (in theory generating cost savings and increased quality), they encourage default face-to-face interaction when alternative channels might be more appropriate and cost efficient.
  • Scale – the issue of scale often brings to mind the age-old debates of local vs central procurement of IT systems, software and shared services (for example) and delivery/administration (e.g. housing benefit).  But it also demands we consider the level at which we are trying to engage users and achieve certain outcomes.  For instance, are we trying to enable communities – whether for a locality or other common cause – to work together more effectively via social networking?  Or transform national public service institutions and systems?  Do we need to employ different tactics and strategy to achieve both of these aims? 
  • Public voice – how can the public voice demanding online access to information and services be rallied to push government and providers?  How do we ensure (and reassure the public) that it is as easy and secure to log on to public services as it is to access internet banking? 

Much is already happening in response to many of these four points.  The progress of and the Coalition’s commitment to publishing  data online is a good start.  But the withdrawal of funding Professor Nigel Shadbolt and Sir Tim Berners-Lee’s web science institute is a major blow.  More than ever – at a time of cuts and cost savings – technology should not be thought about as an expensive ‘bolt-on’ in the hope of making bad services slightly better.  Not least because in practice this (by lack of coherent integration and design) often makes matters worse.  Instead, it’s about using existing and emerging (typically low-cost) communication technologies to enable citizens to work with public services in a way which enables better outcomes at lower cost. 

But I’m at risk of sounding too tech-evangelical.  What is needed is to build the evidence base and let the argument speak largely (and loudly) for itself.

Monday, May 17, 2010

A vision for 2020 information and technology: Part 3 – healthcare

By Charlotte Alldritt

The year is 2020. Over the past decade, simple online technologies have transformed the way we access data and information, hold public services to account and engage with government. Transparency is the watchword of the day. The ultimate prize? Renewed political legitimacy and public services finally fit for purpose. In the third and final installment in this series, I look at how technology and information can transform healthcare through online ’self-services’ and open data.

Sally – 55, living in South East England, understands that technology represents at once a challenge and an opportunity. Ten years ago, the increasing cost of more effective treatments would have prevented Sally’s local PCT being able to prescribe the drug she needs to combat her cancer. Forunately, a switch to online service delivery through an extended, more comprehensive NHS Direct has enabled money to be diverted to frontline treatment.

A presumption of online ’self-service’ for primary care and follow up treatment means that patients can access detailed online health information supported by remote multi-channel consultations with a range of healthcare professionals (via 24/7 telephone, videophone, email, text and instant messaging) with a range of healthcare professionals.

There are also outreach services available via high traffic forums (e.g. Family Planning Association, Mumsnet and Bebo) to encourage user-led discussion forums and support networks. These are particularly useful for helping people to access information and advice from trained professionals in a readily accessible, anonymous way. Sally finds this particularly helpful when talking about more sensitive issues pertaining to her illness.

By sharing her unique health identification number, authorised clinicians can have access to relevant sections of Sally’s medical records. This tailors the service provided so that individuals receive the highest quality care.This information is automatically uploaded onto Sally’s ‘My NHS’, a with a customised and customisable homepage acting as a single portal access to her NHS health and social care records.

MyNHS also features:

  • a list of her relevant health professionals with links to openly published performance data
  • details of medication/prescriptions
  • useful reference information and learning resources
  • links to her GP practice website and reviews, and
  • a record of all of her upcoming appointments.


Sally’s daughter, Helen, is 27 and has registered with the national ‘virtual GP practice’ designed for patients who choose to engage primarily through telephone and digital channels. This means that Helen can access healthcare in any part of the country as and when she moves or travels with work. While this arrangement wouldn’t suit her mother, Sally, Helen finds it a convenient way of speaking to a GP on the rare occasion she has a health concern that needs face to face consultation/treatment.

Prior to her visit, Helen looks up comparative data on local GP practices and doctors on a single, government established website.  This website is a hub for information from across the market in healthcare informatics involving private and third sector organisations, as well as public sector agencies/providers.  This comparative website means that Helen can make an informed decision which clinician she chooses to consult.  She can then book her appointment online and all parties involved (the locum GP, MyNHS, and NHS Direct) receive information (including test results and next steps) automatically through the end-to-end, network of local IT systems.   

Sally and Helen find the online ’self-services’ and open performance data a convenient way of accessing a rich supply of healthcare information, diagnostic tools and – in some cases – prescriptions (e.g. repeat prescriptions).  Occassionally things go wrong, but there are clear procedures in place which allow patients to give their feedback, for this to be incorporated in the appropriate performance dataset, and for clinicians and/or managers to be held to account.  For example, Helen had a bad experience with her maternity ward as a first time mother.  She posted her dissatisfaction on the hospital ward’s website and received a response from the ward sister through her MyNHS account as to how they had since rectified the situation.  This reassured Helen and Sally that they weren’t battling ‘The System’, but that their views counted, and quality and patient experience were truly at the heart of the NHS.


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