More rules, equals less change. Discuss.

Are we too hard on ourselves as a nation? We are very keen on our rules in this country – and yet businesses claim they are over-regulated and this is stifling growth. However many people argue that places such as  Hong Kong grew precisely because there were rules and deals done there were properly governed. Even in trivial places we want rules – the #popleveson Tweets this weekend have been funny and clever, but still in amongst the comedy gold were people complaining that most people hadn’t understood the rules of the game…..

All of this can be dismissed as ‘just the British way’ but it does have a more serious side in stifling innovation and a willingness to change. The reaction to the Queens Speech this weekend is interesting. The press are critical of the government for not making rules to make growth happen, and yet business want less regulation. Less regulation brings with it occasional failure and sometimes a bit of uncertainty. But one thing you can be sure of is that market forces prevail.

The challenge for us all, as citizens is to recognise that sometimes good stuff happens and sometimes bad stuff happens. However over-regulation and profound risk aversion to prevent the bad stuff limits the opportunity for the good stuff, which feels like lose-lose? Do we need to loosen up a little…..?

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Is the fax machine killing innovation in the health service?

When a piece of technology works does an organisation relax and design systems around it, rather than customers?

In the medical profession Doctors still write letters to each other as a means of referring patients, getting blood results around, etc. These letters are now often sent by fax. This is because it is perceived to be more secure than sending by e-mail. It is also cripplingly slow and inefficient when doctors have digital data in their surgeries which at the press of a button could be sent both to the patient and colleagues.

All of this is done to protect the security of my data. But on balance I value speed of treatment over a belt and braces approach to my data security. Others may take a different view so why doesn’t the health system offer a choice. If you want to opt in to e-communications then you simply tell your GP and they start sending stuff by e-mail . If you are concerned about your data then carry on with letters and faxes.

Given the embededness of the letter/fax combo in the NHS and the understandable reluctance to build any more big national IT systems I am wondering how exactly will the system change, or will we be using faxes forever? One way is to change the rules and invite people to consent to e-mail and enable customers to decide whether speed trumps the perceived security of their data.

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Why isn’t the NHS performing well enough out of hours?

Having spent more time in hospitals over the last few weeks than me or my family would have liked, I was very struck by Seth Godins latest great blog post http://sethgodin.typepad.com/seths_blog/2012/04/the-end-of-the-diva-paradox.html , talking about the ‘death of the diva paradox’.

My dad’s recent ‘simple’ hip replacement wasn’t quite so simple so I got to see the workings of an NHS General Hospital up close and personal over three weekends.

The nursing team on the ward were great – the polar opposite of some of the recent stories about hospital experiences. A nursing and ancillary team working together giving genuine care.

The picture with Doctors was mixed. It took most of one Saturday for a doctor to even ring the ward and authorise a procedure (which the nurse carried out) and most of the next for someone to actually come and see my Dad. All the time this was happening my Dad got sicker and his condition deteritoated in front of our eyes. His expected 3-5 day stay was actually 3 weeks.

Is this a people problem or a system problem? I guess a bit of both. However you cut it it seems wrong that the hospital was providing a 9-5 / Monday – Friday comprehensive Doctor service and a skeleton staff for the rest of the time. How many other businesses would run at 25% utilisation rate? So I think system design is wrong. The Police service learnt this lesson years ago. As a PC I knew that often the most senior officer on duty at night was a single Inspector for the county. Now system has changed and they have Chief Inspectors and Superintendents – recognising that some things need experienced decision-makers on the ground. They may not be experts in a particular field but they can coach more junior people and are more likely to be able to get something done when other experts are needed.

But why is the NHS system so inefficient – is it a people problem? Is this because some senior doctors are acting, in Seth Godin’s words, like ‘Divas’ and NHS management can’t shift them to new work patterns? A harsh assessment? – probably, but somehow there needs to be a recognition that people in hospitals are sick 24/7 and it is unacceptable to leave the vulnerable just sitting there whilst nurses endlessly page the handful of overworked junior doctors on duty and don’t get a response. Inexperienced people make slower, and less effective decisions. In these situations experience counts. That experience needs to be available at the bedside (even if it is delivered via smartphone video conference)

Couple of ideas spring to mind. Should there be a couple of consultants on duty in the hospital all of the time? Even if they are not specialists in a particular field they can offer a steadying hand for the less experienced doctors, and are also more likely to be able to judge when the right moment is to wake up Mr Blogs for a consult.

I wonder what would happen if each hospital published its “time taken for a doctor to respond to their pager” metric alongside mortality, etc. It would be a great proxy metric for “does the system work out of hours” which lets face it, is the thing you should worry about for 75% of your stay in hospital.

The transparent act of publishing this measure would inevitably lead to focus on this area. This might not be wholly the right prescription but something needs to happen, because I have seen a lot of good people in the NHS being thwarted by a poor system that is wasteful and dangerous, and it is almost certainly happening in a hospital near you right now.

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What is a public service?

Having looked at the new GOV.UK website, which pulls together various UK government departments in one place, I decided to compare it to what the Americans are doing. The British site looks great and, certainly on first look, seems well laid out and works smoothly with access to the right range of central government departments – or so I thought.

The American version of the same sort of thing (USA.GOV) is quite different. Whilst it does the links to departments/states it also offers access to other things that blend public and private services. The thing that is really interesting is the prominence it gives to what to these British eyes seems unconventional. From the first page one of the tabs is Get services, second menu item is Find Cheapest gas prices and the next one down is Shop government auctions. The gas prices one provides links to a range of local websites that have crowd sourced the latest petrol prices in every state. The Shop government auctions link is even better with opportunities to buy all sorts of weird and wonderful things from aircraft to filing cabinets.

I guess many would argue that saving them money on running their car or on buying government surplus is a public service, albeit in some cases delivered via a private site. It set me thinking that we need to think really broadly about what is a truly public service as opposed to just a publicly paid for service.

Some people baulk at the way organisations such as the BBC and the Ordinance Survey operates, making money from their assets. As a result councils and Whitehall departments tend to keep their heads down a little when it comes to making money and leveraging the value of their real estate, be that physical or virtual. When we as a council auctioned off some car parking spaces on E Bay recently we were mocked in the local paper. Our use of E Bay for some premium allotments will doubtless raise a similar outcry over the next few months.

But in difficult times properly pub-vate (or pri-blic…) services must be the way to make ends meet for many conventional public service providers. If that adds value to citizens through lower taxes and better services then isn’t that a win-win?

Anyway I am off  now to work out how I get together a $10,000 deposit to bid on a mildly hail damaged military spec Lear jet currently stranded in Tiblisi….God bless America!

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Is Google a public service?

I was struck this morning by the slightly odd coverage on BBC News about Google’s changes to its privacy policy. The discussion took on a vehemence and moral indignation out of all proportion to what was actually happening. If a business with multiple product lines decides it wants to rationalise its policies in order to improve interoperability between those products and at the same time increase its attractiveness to advertisers (who provide its income) then what is the problem?

I accept that if I consume a ‘free’ service it needs to be paid for in some way. I know that I am fed advertising, and with the new policy it looks like that will be better targeted. If someone wants to try and link my recent searches then good luck. Knowing I have a penchant for inflatable roof racks, white shirts, running kit and large wheeled mountain bikes is hardly “dangerous” as was being suggested on the BBC by a so called expert this morning.

Whilst Google may be fairly ubiquitous (and Chrome is due to overtake IE as the browser of choice shortly)  ‘other search engines are available’. The real danger is that a dogged determination not to join things up in the private sector, where the consumer has the choice to simply go somewhere else will prevent the sort of thinking in the public sector we need to engage in.

The tenor of the debate today was of the sort normally reserved for discussions on monopoly public services. In the public mind is Google now a public service, (a right)?

The launch of GOV.UK yesterday was a great step forward with a drive for government information in one place. I would like to see the same principle adopted for customer records so that when I tell DVLA that I have moved they automatically update my tax records, voter registration, council tax, etc. We should be applauding the principle of seeking to offer better service by leveraging the value of data – and if you don’t feel like clapping then go and use someone else’s free service……

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Can changing our tolerance of failure enable lower cost better service?

I use GiffGaff as my mobile phone company http://giffgaff.com/index/offer (don’t worry this isn’t an advert), partly because they are a little cheaper and more flexible than others but mainly because I like the business model.

The model is unusual because they don’t advertise in the conventional sense. They ask you to ‘like’ them on Facebook. You also get free airtime if you order a (free) SIM for someone else. Giffgaff to Giffgaff calls are free. There are lots of references to being in the “GG community”.   You can pay as you go, or buy a one month contract. No contract is over one month long, so if you have bought too much you buy less next month, and if you don’t like the service you go somewhere else.

Customer support is minimal with most questions being answered by members of the community, who receive a few points for questions answered. These points add up and can be converted into free airtime or a charitable donation. I recently bought an iPhone and the “how to set up an iPhone PDF” on the website had been written by a customer. Perhaps the most interesting thing I had from them recently was a link to a website with a range of T shirts advertising GiffGaff, again generated by a third party.

Reading the small print on the website they describe themselves as being “an independent company within the Telefonica Family”. They could be genuinely different or it is all very clever marketing.

The question for public services though is how do we replicate this level of passion for our brand and release similar levels of power in our community? I wonder what it would be like to crowd source our policy stuff, rather than use our current stilted processes. Can we get our community to spontaneously create communications materials? The list of things that could be done in a more collaborative way is endless.

Probably the main block to this collaborative model is our desire for ‘assurance’ and perceived blanket intolerance of ‘failure’. We, as consumers, have an increasing inability to distinguish between things that matter and things that don’t (how many times have you been thanked for waiting for a few seconds in a shop recently?). You wouldn’t have children’s safeguarding work being delivered by a collaborative model, but production of a fact sheet about how to get your children into primary school by a group of parents would be fine. This does mean that sometimes there will be failures. Is that OK  if the payback was more resource being freed up to deliver more services?

I’ll know we have got there when someone walks down Maidenhead High Street wearing a T shirt proclaiming “RBWM is great”….(and we didn’t make it)!

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How can we better use our buying power to grow our economy

I was visiting my parents over the Christmas holidays and drove past a Kia Cee’d police car. Nothing outrageous there you say. The Cee’d is apparently a fine car, but so is the Vauxhall Astra. The difference is that the Astra is built in a large, repeatedly threatened with closure, factory about 10 miles up the road from where my parents live.

The Cee’d on the other hand is built in a Czech plant owned by a Korean company. I understand why public bodies follow EU procurement rules and buy stuff based on most ‘economically advantageous’ tender as they are the rules. However is now not the time to have a bit of a rethink about what economically advantageous actually means at a system wide level.

Buying imported police cars doesn’t really tick any environmental boxes, neither does it re-invest tax pounds in the local / UK economy. The procurement purists will tell me how UK companies benefit in Europe so what goes around comes around. However you never see Gendarmes in Vauxhalls; others seem to play the game with a better grasp of the local impact of decisions.

Maybe we play the procurement game too straight here. I am not advocating chaos, but I am suggesting we add criteria in our procurement thinking which takes some account of how we can use our tax take more effectively to grow our economy. How about asking suppliers to tell us how much of the money we will pay them is being spent in the UK, then within, say, 20 miles of where the goods or services are to be used? If the price is within 10% of the cheapest then we reserve the right to go local. This will immediately incentivise a wash back into the supply chain, and would lead to growth in the SME sector locally.

However ultimately this is about recognising that building our economy is hand to hand combat, and of course taking some risks – every decision must count and add value to the local growth agenda, because if we don’t, we have to deal with the very real system wide social consequences of more job losses.

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