The Big Society is easy to lampoon but I wonder….

When Thatcher was elected in 1979 privatisation did not figure for several years but gradually became a core policy. This happened partly because it raised handy billions but also because it acted as a clear policy principle: wherever possible people not the state should end up owning stuff.

Clearly there are echoes here for the Big Society. In times of recession the Big Society may – perhaps - be a way to reduce the bills by outsourcing services onto citizens. Dubious but possible.
More important though the idea of the Big Society may turn out to be the same kind of divining rod for this government as privatisation did for Thatcher. Faced with a policy dilemma both wings of the coalition may find it useful to ask ‘will this policy increase the power of the state or decrease it?’

It might seem counterintuitive for the politicians to give power away – but then it was counter-intuitive to many when Thatcher gave away the family silver in her privatisation fire sales.

But perhaps this credits politicians with more power and insight than they deserve. I think the real importance of the Big Society is not because it tells where Cameron will take us, but what he is following. He senses incoherently that the relationship between citizen and government has already changed and the Big Society is his way of trying to ride the change. He hopes that this will lead to a renewal of civic virtue – that people will flock to start schools, car pooling and recycling. Well that might or might not happen but what sure IS happening, and what is driving the change that Cameron transmutes into the Big Society, is people’s willingness to share their stories via social media. Without knowing it perhaps Patient Opinion is already part of the Big Society!

Connecting people up is what Patient Opinion is all about. Connecting the insight and wisdom of past patients to future patients. Sending your story to the ward, and then getting their response back to you and the local PCT.  That’s what we do.   

So it was great to read hear Nicholas Christakis talking about his latest work on social networks on the RSA down load service. Christakis is a medic at Harvard but also a sociologist who has spent the past 15 year studying social networks.

Turns out that all sorts of things can be seen ‘flowing’ through networks – including many sorts of behaviour. If I’m obese then it’s more likely that my friends will be obese. What’s more if my friend’s friend is obese then I’m more likely to be obese. And the same effect works for happiness, or drug use, or altruism. People who know each other face to face create similar patterns of behaviour in each other and this effect is detectable for up to 3 degrees of friendship – in other words in friends of friends of friends who of course have mostly never met each other. Which is weird but if nothing else shows how profoundly social humans are.

So what’s this got to do with Patient Opinion? Well we’re thinking of making some of our connections more visible to everyone. First we want to explore letting ‘friends and family’ follow a particularly story. These will be people who the author has invited to follow their story and who have clicked ‘Yes’ on the invitation. Every time there is a response to a story these people will be notified of it, just like the original author is. We would then display the number of Friend and Families that were following each story.

Second we're thinking of doing the same for organisations and other stakeholders. So if the PCT, the hospital and the local LINk are getting automatically notified of that particular story then you‘ll be able to see them just by clicking on the ‘Who’s tracking this story?’ button. That way it’s clear to everyone whether we’ve succeeded in getting any given story to just the right people who need to hear it.

But perhaps we should let anyone, any member of the public, follow any story. Surely that could be even more effective. But Christakis work on networks indicates that this isn’t so. It might be gratifying to know that 63 people (or 263) are following your story  but FaceBook ‘friends’ are not real friends (and do not exert Christaki’s's network effects on each other). So what we’re really interested in at Patient Opinion is how to leverage each author’s network of ‘real’ friends and families on behalf of their story. And from the hospital’s point of view knowing that the mini-network of highly involved people around each story see the hospital's great response and the changes that have been made means they are likely to become real ambassadors for the hospital. Even when if in the original story things didn’t go so well.

Hey, you think I'm going to let myself be outdone on video? No way!

So here's me speaking at Nick Marsh's excellent recent Service Design Thinks evening.

Ten times as long, but only twice as embarrassing (to me, anyway).

James Munro, Patient Opinion - Service Design Thinks 3 from Nick Marsh on Vimeo.

Where's Paul been the past few days? We had to turn to YouTube to find out.

Turns out he's been at the OxfordJam unconference all the time - and here he is, caught on camera:

One of the great things about building a platform like Patient Opinion is that people are always finding wonderful new of ways to use it that we have never thought of. Like the young couple using an addiction service who had a baby just 5 weeks old. They had had a few slip ups and used a bit of this and that other than their prescribed methadone. Terrified of having positive urines and loosing their beautiful new baby they could not ask their drug workers because then the cat might have been out of the bag. But at the same time they desperately wanted help.

The answer turned out to be sharing their story on Patient Opinion. They could see that the clinic was run by  PCAS who had a great record of responding to other requests on Patient Opinion, so they posted their story anonymously but publicly. That way they could get find out whether coming clean would end up with them loosing their baby. What is more everyone else can see the response too – which may be reassuring to other mums-to-be with an addiction problem. And one more vulnerable couple and baby helped to keep going, to not give up. 

Generic responses won’t do in these circumstances. Patients and service users need to know how this clinic, this medical director would handle the situation, not what NICE or the PCT recommends. And they will use the quality of the response to decide whether it’s to be trusted or yet more corporate speak.  Of course it’s not just substance misusers. If I had to have a coronary bypass graft, I’d want to know what the surgeon's mortality rate was and how many of these operations she did per year. But being British I’d be probably be too embarrassed to ask. But I would be happy to punt the question on Patient Opinion anonymously. And may be get an answer that helps everyone using that service.  

May be confidential conversations that can only be asked in public will turn out to be really common. And important.