Patient Opinion is your favourite band. Is NHS England the big record company? (Updated)

The Guardian this morning reports that NHS England will be setting up a “TripAdvisor”-style site to capture people’s feedback.

This has a number of implications in lots of different directions, but the one I wanted to briefly comment on is what this says about how markets arise in public services and are then distorted.

In social care, there were 44 care comparison sites at the last count. This “market response” presumably arose because there was a gap in the market: people weren’t getting the information they needed to make judgments about where is/isn’t a good care provider.

In the context of the NHS, and though not exactly equivalent to a comparison site, Patient Opinion has been doing a tremendous job over the last 7 years or so of enabling people to share their experiences of NHS services, aggregating that feedback and supporting NHS organisations to use this information to improve services.

Patient Opinion is a bit like* that really good band only you and a few people know about (a “few” being a relative term, here).

Patient Opinion needed to be created (and was done so very well indeed) because there was a gap in the market. It was an innovator at a time when no one else, including the NHS, was doing feedback particularly well.

Since today’s Guardian effectively says that NHS England is going to replicate Patient Opinion, it could be argued that Patient Opinion’s job is done. When the NHS adopts your idea, you’ve gone mainstream. It’s like EMI signing (or taking over) the band you love, and now all of your other friends and the general public will be listening to the band only you and your friends knew about.

But is this right? Is the presence of government here – in the form of the bizarrely-centralised-though-not-really-centralised NHS – a constructive or distorting market force?

I posed this question to myself when looking at social care comparison sites:

Is it appropriate to think that social care information / comparison sites should be centrally-led, guided more by a visible hand from government rather than by an invisible hand? Or is it ok for information about social care to be provided through the continued emergence of a demand-driven market, reflecting what we see in the film streaming and price comparison businesses around us?

@pubstrat has highlighted the same question using many other examples, such as MyPolice, fishing licenses and Patient Opinion itself, using the metaphor of government as elephant and others as small(er) creatures. He concludes:

I don’t, on the whole, think that government is obliged to leave the field completely clear for others where its own services and information are concerned. But I do think that the asymmetry of power and voice obliges it to take great care where it places its [elephant] feet.

In this case, my initial answer (with explanatory brackets for tortured simile purposes) is that there has to be joint work between NHS England (EMI) and Patient Opinion (your favourite band) to make the most of both unique characteristics they could bring to the question of feedback (your band’s music). NHS England brings scale, significant credibility and brand; Patient Opinion brings the platform, the independence and the learning/innovation of the last 7 years.

If both can work together, then the good music of feedback can be taken to the masses whilst maintaining its integrity. If not, we might end up with another Robbie Williams.

I really hope NHS England / EMI takes the opportunity to work with Patient Opinion.

*I generally don’t like argument by analogy, but make an exception here. Please don’t get too hung up on the band / record company thing.

Update (2 December): Paul Hodgkin of Patient Opinion has written an excellent post here on the topic, and @georgejulian has brought her characteristic “no bullshit” approach to the issue here. Both posts well worth reading.


The crowdfunding market

Last week I blogged it’s no surprise there are 44 social care comparison sites, because:

  1. Social care is a significant “industry”
  2. Social care is a confusing “industry”
  3. There’s something to be made (be it money, referrals or reputation) from helping people navigate their way through all the complexities of social care

The main question I posed myself was whether social care comparison sites should be led by the visible hand of government or by the invisible hand of the market.

Here’s a fascinating development from Nesta in another growth area: crowdsourcing. They have created CrowdingIn, which supports people to help find the crowdsourcing platform most suited to their financial need.

In the sense of comparison sites, Nesta’s offering is of course only one (compared to the 44 in social care). My point here, though, is this: crowdsourcing has grown exceptionally quickly, with 34 different platforms people can access to crowdsource their funding, such that Nesta’s idea of a comparison site for crowdsourcing sites seems a very reasonable thing to offer.

To me it’s remarkable that so many businesses can exist so quickly on the back of a relatively recent phenomenon to the extent that a site of the second order (first order: crowdsourcing sites; second order: comparison of crowdsourcing sites) needs to exist.

Whether Nesta counts as a visible hand or an invisible hand is a different question altogether. What’s fascinating in the context of crowdsourcing is that the need for the hand exists.

(On crowdsourcing itself, here’s a nice blogpost from Carrie at FutureGov.)

Film streaming services, the multitude of social care comparison sites and offering a challenge to myself

I found myself on the Underground earlier this week looking at a poster for a  service that streams films. This one is owned by Tesco, though goes under the name Blinkbox.

This is hardly a new service. By my very quick count there are at least 3 other major services that offer something similar: Lovefilm, Netflix and NowTV (and many more besides, no doubt).

It begs the question: why the need for another streaming service?

Well, Tesco has clearly done its homework and determined that:

  • There is a known market for their particular product
  • Their offer is likely to appeal to a particular segment of that market
  • They have a market position and known reputation (though not necessarily in streaming) which means they can exploit the market segment they’re targeting
  • There’s money to be had in doing so.

The same holds for, well, anything: think price comparison sites, toilet paper, cars, money lending companies etc.

What does this tell us about the multitude of comparison services for choosing social care?

Well, it tells us that a situation in which there are 44 sites [1] (at the last count) for comparing the quality of social care provision is a natural situation. It says that, in a world where there is a significant market for providers of social care (be it domiciliary care or residential care), it is perfectly natural for there to be a significant market for information to support people to navigate the huge range of social care providers. (The comparison with comparison websites –, etc. – is obvious.)

Of course, Adam Smith would tell you that none of this is new. Nor would Tony Blair. This issue is essentially one about the role of markets in public services and how people navigate those markets.

The interesting point, though, is where the invisible hand of government should be in all of this.

My natural inclination for an issue like information about the quality of social care is that the invisible hand should be visible: such a service, for an important issue that affects the quality of so many people’s lives, should be a centrally-led service. This was once the case when CQC had its star ratings, and a watered-down version of the same has been created by the Department of Health more recently. There are also quasi-centralised versions of social care comparison sites with things like SCIE’s Find Me Good Care (which I happen to think is excellent).

But there are other, more market-driven, invisible ways of doing this. Probably the most wholesome example of this would be Patient Opinion (an approach that is being extended by its social care equivalent, Care Opinion): a bottom-up, user-driven site in which people share their views and opinions on health for both health providers and other users to see. And there are other, less wholesome approaches where the business imperative is more explicit – the business just happens to be providing information about social care. Thus, the 44 sites highlighted.

These market-driven responses are typically pushed by people identifying a gap in the market and seeking to exploit it. I don’t think anyone could reasonably say that providing information about social care is an issue that is sorted, so the gaps in the market obviously exist.

Thus, the challenge to myself is this: is it appropriate to think that social care information / comparison sites should be centrally-led, guided more by a visible hand from government rather than by an invisible hand? Or is it ok for information about social care to be provided through the continued emergence of a demand-driven market, reflecting what we see in the film streaming  and price comparison businesses around us?

[1] There’s a full list of the 44 sites here.

“Voice” starting to rule the roost over “choice”

An excellent paragraph or two in a paper from the NHS Confederation, “Alive and clicking: information that benefits all“:

“In the lexicon of public policy there are two ways to improve public services: exit and voice. Exit enables people to choose a provider so they can leave services they do not like. In NHS terms, it is about choice, markets and the Any Qualified Provider policy. By contrast, voice is about getting involved and trying to change and improve services for yourself and your family. For NHS users, voice is about taking action such as complaining or becoming a member of a foundation trust or patient group, writing to the chief executive or even suing the organisation.

“Over the last 30 years, exit, markets and choice have largely ruled the roost while voice has been a whisper at the policy table. However, the costs of structuring markets are static or rising. Meanwhile, the costs of having a voice are falling like a stone.

“Successful providers will get much better at motivating and engaging their local populations, albeit through more people commenting about them, getting angry with them, making suggestions, and thanking their staff. Some of this will be on generic platforms like Facebook and blogs, and some will be on platforms dedicated to making feedback easy to use for busy staff like Patient Opinion and NHS Choices. These conversations will very likely play back into choice and the market because what consumers learn from their friends and other users of similar services is a powerful predictor of behaviour.”